Repair of isolated axillary nerve lesions after infraclavicular brachial plexus injuries

Object The aim of this retrospective study was to evaluate the restoration of shoulder function by means of supra-scapular nerve neurotization in adult patients with proximal C-5 and C-6 lesions due to a severe brachial plexus traction injury (BPTI). The primary goal of brachial plexus reconstructive surgery was to restore the biceps muscle function and, secondarily, to reanimate shoulder function. Methods Suprascapular nerve neurotization was performed by grafting the C-5 nerve in 24 patients and by accessory or hypoglossal nerve transfer in 29 patients. Additional neurotization involving the axillary nerve could be performed in 18 patients. Postoperative needle electromyography studies of the supraspinatus, infraspinatus, and deltoid muscles showed signs of reinnervation in most patients; however, active glenohumeral shoulder function recovery was poor. In nine (17%) of 53 patients supraspinatus muscle strength was Medical Research Council (MRC) Grade 3 or 4 and in four (8%) infraspinatus muscle power was Grade 3 or 4. In 18 patients in whom deltoid muscle reinnervation was attempted, MRC Grade 3 or 4 function was demonstrated in two (11%). In the overall group, eight patients (15%) exhibited glenohumeral abduction with a mean of 44 ± 17° (standard deviation [SD]) (median 45°) and four patients (8%) exhibited glenohumeral exorotation with a mean of 48 ± 24° (SD) (median 53°). In only three patients (6%) were both functions regained. Conclusions The reanimation of shoulder function in patients with proximal C-5 and C-6 BPTIs following supra-scapular nerve neurotization is disappointingly low.

Download Full-text

Brachial plexus injury in the child

10.1093/med/9780199682874.003.0040 ◽

2021 ◽

pp. 266-268

Author(s):

Robert Bains ◽

Simon Kay

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Brachial Plexus ◽

Axillary Nerve ◽

High Birth Weight ◽

Root Avulsion ◽

Obstetric Brachial Plexus Palsy ◽

Previous Child ◽

Obstetric Brachial Plexus ◽

Ligamentous Attachment

Obstetric brachial plexus palsy (OBPP) was first described by the Scottish obstetrician William Smellie in 1779 who described, in a newborn, a case of unilateral arm paralysis which rapidly recovered. He attributed this palsy to compression of the axillary nerve against the humerus, probably wrongly in light of subsequent knowledge. The main risk factor for OBPP is high birth weight (>4000 g) and intrapartum shoulder dystocia causing traction on the brachial plexus. It has been demonstrated in cadaveric models that traction on the arm with the neck laterally flexed in the opposite direction causes rupture or avulsion of the brachial plexus. Upper roots are more likely to rupture due to strong ligamentous attachment to the spine whereas the lower roots are more likely to be avulsed. For unknown reasons, however, in the rare circumstance of small babies born breech, upper root avulsion is common. Other risk factors for OBPP include a previous child affected, prolonged labour, instrumented delivery, and multiparity, although each of these may be a surrogate for large birth weight.

Download Full-text

Nerves originating from brachial plexus in the porcupine (Hystrix cristata)

Veterinární Medicína ◽

10.17221/5685-vetmed ◽

2012 ◽

Vol 49 (No. 4) ◽

pp. 123-128 ◽

Cited By ~ 2

Author(s):

A. Aydin

Keyword(s):

Brachial Plexus ◽

Biceps Brachii ◽

Cranial Nerves ◽

Suprascapular Nerve ◽

Axillary Nerve ◽

Biceps Brachii Muscle ◽

Caudal Part ◽

Hystrix Cristata ◽

Dorsi Muscle ◽

Thoracodorsal Nerve

In this study, dissemination of forelimb’s nerves of the porcupine (Hystrix cristata) was investigated. Four porcupines (two males and two females) were used and nerves originating from brachial their plexus were dissected. Origin and dissemination of forelimb’s nerves orginated from brachial plexus constituted from cranial and caudal trunks were examined. Suprascapular nerve and the first branch of subscapular nerve orginated from cranial and caudal part of cranial trunk, respectively. Nerves orginated from caudal trunk, pectoral cranial nerves, constituted four branches spreading in pectoral muscles. Musculocutenoeus nerve gives a branche to brachial muscle and, after giving medial cutaneus antebrachii nerve was divided to two branches (digital dorsal commun I and II nerve). Axillary nerve gives a branche to subscapular muscle and ends as cranial cutaneous antebrachii. Radial nerve separated to branches as ramus profundus and ramus superficial which also was divided to digital dorsal commun III and IV nerve and lateral cutaneus antebrachial nerve. Thoracodorsal nerve spreaded to latismus dorsi muscle. Median nerve was divided to digital dorsal commun I, II, III and IV nerve. Ulnar nerve was divided to digital dorsal commun V and digital dorsal commun V nerve after giving caudal cutaneous antebrachi. An undefined nerve branche orginated from caudal trunk entered corachobrachial muscle and biceps brachii muscle. Lateral thoracic and caudal pectoral nerves orginated from caudal trunk. In the porcupine, branche which goes to corachobrachial muscle directly from caudal trunk of the brachial plexus and distrubutions of musculocutaneous, radial, ulnar and median nerves were different from rodantia and other mammals.

Download Full-text

Reconstruction of the spinal accessory nerve with selective fascicular nerve transfer of the upper trunk

Journal of Neurosurgery Spine ◽

10.3171/2018.12.spine18498 ◽

2019 ◽

Vol 31 (1) ◽

pp. 133-138 ◽

Cited By ~ 3

Author(s):

Johannes A. Mayer ◽

Laura A. Hruby ◽

Stefan Salminger ◽

Gerd Bodner ◽

Oskar C. Aszmann

Keyword(s):

Brachial Plexus ◽

Nerve Repair ◽

Nerve Transfer ◽

Axillary Nerve ◽

Spinal Accessory Nerve ◽

Accessory Nerve ◽

Nerve Function ◽

Analog Scale ◽

Spinal Accessory ◽

Active Range Of Motion

OBJECTIVESpinal accessory nerve palsy is frequently caused by iatrogenic damage during neck surgery in the posterior triangle of the neck. Due to late presentation, treatment regularly necessitates nerve grafts, which often results in a poor outcome of trapezius function due to long regeneration distances. Here, the authors report a distal nerve transfer using fascicles of the upper trunk related to axillary nerve function for reinnervation of the trapezius muscle.METHODSFive cases are presented in which accessory nerve lesions were reconstructed using selective fascicular nerve transfers from the upper trunk of the brachial plexus. Outcomes were assessed at 20 ± 6 months (mean ± SD) after surgery, and active range of motion and pain levels using the visual analog scale were documented.RESULTSAll 5 patients regained good to excellent trapezius function (3 patients had grade M5, 2 patients had grade M4). The mean active range of motion in shoulder abduction improved from 55° ± 18° before to 151° ± 37° after nerve reconstruction. In all patients, unrestricted shoulder arm movement was restored with loss of scapular winging when abducting the arm. Average pain levels decreased from 6.8 to 0.8 on the visual analog scale and subsided in 4 of 5 patients.CONCLUSIONSRestoration of spinal accessory nerve function with selective fascicle transfers related to axillary nerve function from the upper trunk of the brachial plexus is a good and intuitive option for patients who do not qualify for primary nerve repair or present with a spontaneous idiopathic palsy. This concept circumvents the problem of long regeneration distances with direct nerve repair and has the advantage of cognitive synergy to the target function of shoulder movement.

Download Full-text