scholarly journals Clinical Anatomy for the Innervated Pattern and Boundary of the Subdeltoid Bursa

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Chang Min Seo ◽  
Kyungyong Kim ◽  
Anna Jeon ◽  
Chang Sub Uhm ◽  
Je-Hun Lee ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Sensory Nerve ◽  
Axillary Nerve ◽  
Clinical Anatomy ◽  
Horizontal Line ◽  
Anterior Branch ◽  
Shoulder Region ◽  
Line Passing ◽  
Muscular Branch ◽  
Age Range

The aim of this study was to accurately identify the distribution of sensory nerve branches running to bursa with mesoscopic dissection and boundaries following the injection of gelatin into the bursa. Eighteen shoulders of 11 Korean soft cadavers (average age, 65 years; age range, 43 - 88 years) were dissected. The most prominent point of greater tubercle of the humerus (GT) was used as a reference point. The horizontal line passing through GT was used as the x-axis while the vertical line passing through the GT was used as the y-axis. Average distances of the anterior, posterior, superior, and inferior from the GT were 1.9±0.6, 2.4±1.3, 2.1±0.7, and 3.2±1.5 cm, respectively. In 15 cases of 18 shoulders, the anterior branch of the axillary nerve was distributed to the subdeltoid bursa that was running posteriorly. The muscular branch of the anterior and middle parts of the deltoid was distributed to the branch of nerve that was running into the subdeltoid bursa. A branch of the posterior cord of brachial plexus was distributed to the subdeltoid bursa that was running anteriorly in three cases. Most of the branches of the axillary nerve were distributed into the posterolateral area. The branches of the posterior cord of brachial plexus were distributed in the anterolateral area. These results might be useful for preventing residual pain on the anterior shoulder region following an injection for the relief of shoulder pain.

scholarly journals VARIATIONS OF ORIGIN AND DISTANCE OF AXILLARY NERVE: A DESCRIPTIVE STUDY

2018 ◽  
Vol 4 (4) ◽  
pp. 13-16
Author(s):  
Rakate Nilesh S ◽  
Gadekar Savita H ◽  
Gajbhiye Vivekanand M
Keyword(s):  
Brachial Plexus ◽  
Coracoid Process ◽  
Axillary Nerve ◽  
Common Trunk ◽  
Anterior Branch ◽  
Human Cadavers ◽  
Infraclavicular Brachial Plexus Block ◽  
The Mean ◽  
Plexus Block ◽  
Formalin Fixed

Background – Axillary nerve, one of the terminal branches of posterior cord of brachial plexus is more prone for injuries. Lack of proper anatomical knowledge and variations of axillary nerve leads to risk of nerve injuries. The present study describes the origin of axillary nerve, its distance of origin from tip of coracoids process. Method: Thirty brachial plexuses from fifteen formalin fixed human cadavers of both the sexes were studied by dissection method. Origin and branching pattern of axillary nerve and its distance of origin from the anteromedial aspect of tip of coracoid process & posterolateral aspect of acromion process was recorded. Results: Out of the 30 specimens studied, axillary nerve was originating from the posterior cord of brachial plexus in 90% of specimens, remaining 10% specimens showed a common trunk of origin of axillary nerve from posterior cord of brachial plexus. The mean distance of origin of axillary nerve from the anteromedial aspect of tip of coracoid process and posterolateral aspect of acromion process is 3.98cm & 6.30cm respectively. The axillary nerve terminated into anterior and posterior branch within quadrangular space in 29 specimens. In one specimen articular branch for shoulder joint was not directly arising from axillary nerve instead it is arising from anterior branch of axillary nerve. Conclusion: In studied population Axillary nerves display variations in the origin and distance of origin. Knowledge of this variation in axillary nerve is very important to clinicians, anaesthetists and orthopaedic surgeons during surgical exploration of neck, axilla and upper arm, shoulder dislocation, infraclavicular brachial plexus block and fracture of surgical neck of humerus.Keywords: Axillary nerve; Posterior cord; Coracoid process; Acromion process.

Prolonged brachial plexus neuropathy: a rare complication following protracted endometriosis surgery in Lloyd-Davies position

2021 ◽  
Vol 14 (11) ◽  
pp. e243408
Author(s):  
Anna Katrina Hay ◽  
Anna McDougall ◽  
Peter Hinstridge ◽  
Sanjeev Rajakuldendran ◽  
Wai Yoong
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Rare Complication ◽  
Patient Positioning ◽  
Sensory Innervation ◽  
Plexus Brachialis ◽  
Clinical Anatomy ◽  
Reduction Strategies ◽  
Risk Reduction Strategies ◽  
Endometriosis Surgery

Brachial plexus injury is a rare but potentially serious complication of laparoscopic surgery. Loss of motor and/or sensory innervation can have a significant impact on the patient’s quality of life following otherwise successful surgery. A 38-year-old underwent elective laparoscopic management of severe endometriosis during which she was placed in steep head-down tilt Lloyd-Davies position for a prolonged period. On awakening from anaesthesia, the patient had no sensation or movement of her dominant right arm. A total plexus brachialis injury was suspected. As advised by a neurologist, an MRI brachial plexus, nerve conduction study and electromyography were requested. She was managed conservatively and made a gradual recovery with a degree of residual musculocutaneous nerve neuropathy. The incidence of brachial plexus injury following laparoscopy is unknown but the brachial plexus is particularly susceptible to injury as a result of patient positioning and prolonged operative time. Patient positioning in relation to applied clinical anatomy is explored and risk reduction strategies described.

scholarly journals Ossification of the superior transverse ligament in a South African scapula: a factor to be considered in the diagnosis of suprascapular nerve entrapment

2016 ◽  
Vol 33 (03) ◽  
pp. 155-156
Author(s):  
O. Azu ◽  
D. Ofusori ◽  
E. Naidu ◽  
J. Naidu
Keyword(s):  
South African ◽  
Critical Factor ◽  
Suprascapular Nerve ◽  
Nerve Entrapment ◽  
Clinical Anatomy ◽  
Shape Variation ◽  
Suprascapular Notch ◽  
Suprascapular Nerve Entrapment ◽  
Shoulder Region ◽  
Superior Transverse Scapular Ligament

Abstract Introduction: Ossification of the superior transverse scapular ligament is one of the factors considered in the classification of the suprascapular notch based on shape. Variation in morphology of the superior transverse scapular ligament is always considered a critical factor in the diagnosis of suprascapular nerve entrapment syndrome. Case Report: This study reports the complete ossification of the superior transverse scapular ligament in a South African scapula and a note on its clinical anatomy. Conclusion: This anatomical knowledge is of extreme clinical relevance to surgeons in relation to various syndromes associated with the shoulder region in the South African population.

scholarly journals Evaluation of suprascapular nerve neurotization after nerve grafting or transfer in the treatment of brachial plexus traction lesions

2004 ◽  
Vol 16 (5) ◽  
pp. 1-13
Author(s):  
Martijn J. A. Malessy ◽  
Godard C. W. de Ruiter ◽  
Kees S. de Boer ◽  
Ralph T. W. M. Thomeer
Keyword(s):  
Brachial Plexus ◽  
Muscle Power ◽  
Nerve Transfer ◽  
Deltoid Muscle ◽  
Suprascapular Nerve ◽  
Shoulder Function ◽  
Axillary Nerve ◽  
Infraspinatus Muscle ◽  
Function Recovery ◽  
Grade 3

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.

Brachial plexus injury in the child

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.

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

2012 ◽  
Vol 49 (No. 4) ◽  
pp. 123-128 ◽  
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.

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

2019 ◽  
Vol 31 (1) ◽  
pp. 133-138 ◽  
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.

Repair of isolated axillary nerve lesions after infraclavicular brachial plexus injuries

Neurosurgery ◽  
1990 ◽  
pp. 403 ◽  
Author(s):  
A H Friedman ◽  
J A Nunley ◽  
J R Urbaniak ◽  
R D Goldner
Keyword(s):  
Brachial Plexus ◽  
Axillary Nerve ◽  
Nerve Lesions
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