Nerve injury following ultrasound-guided nerve root block with 2% lidocaine for shoulder manipulation: a case report

Shoulder manipulation under ultrasound (US)-guided C5 and C6 nerve root block is effective for treating refractory adhesive capsulitis (AC). We herein report the development of cervical nerve root injury following manipulation under anesthesia (MUA) in a patient with AC. A 47-year-old woman underwent shoulder manipulation under US-guided C5 and C6 root block with 2% lidocaine for the management of AC-induced shoulder pain. For the procedure, 3 mL of 2% lidocaine (total of 6 mL) was injected around each C5 and C6 nerve root under US guidance. Seven days after the procedure, the patient visited a university hospital because of severe neuropathic pain (numeric rating scale score of 9) in the right anterior arm, lateral arm, and forearm areas. Sensory deficits in the corresponding C5 and C6 dermatomes and motor weakness of the right shoulder abductor, elbow flexor, and wrist extensor were observed. Electrophysiologic studies demonstrated C5 and C6 nerve root injury. The patient was diagnosed with right C5 and C6 nerve root injury following MUA, and lidocaine toxicity or ischemia was the suspected cause. Clinicians should be mindful of the possibility of this complication.

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Accidental Strangulation with Cervical Nerve Root Injury Caused by the Entrapment of Clothing in a Soybean Milling Machine

Case Reports in Emergency Medicine ◽

10.1155/2019/4706278 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Kazuhiko Omori ◽

Ikuto Takeuchi ◽

Youichi Yanagawa

Keyword(s):

Nerve Root ◽

Electrical Machine ◽

Milling Machine ◽

Cervical Nerve Root ◽

Cervical Nerve ◽

Pattern Of Injury ◽

Nerve Root Injury ◽

Root Injury ◽

Creatine Phosphokinase Level ◽

The Right

The clothing of a forty-five-year-old man became entrapped by the mixing rotator while he was operating a soybean milling machine. His clothing was wound around the rotator, and tightened around his neck and chest, causing strangulation and a loss of consciousness. He was rescued by his coworkers and transported to our hospital by helicopter. Upon arrival, he regained consciousness. A physiological examination revealed multiple petechiae on his face and strangulation marks with subcutaneous hemorrhage on his neck and upper trunk. In addition, he had motor weakness of the right upper extremity and bilateral paresthesia from C5 to Th1. All radiological studies were negative. He was admitted for observation. After the patient’s creatine phosphokinase level peaked and his focal neurological signs improved, he was discharged on foot on the 6th hospital day. Accidental ligature strangulation with cervical nerve root injury, in which an article of clothing is caught in an electrical machine and strangles the wearer, is very rare. This case is presented for its rarity and the unique pattern of injury.

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Anatomy of the L5 nerve root in the pelvis for safe sacral screw placement: a cadaveric study

Journal of Neurosurgery Spine ◽

10.3171/2021.8.spine21962 ◽

2021 ◽

pp. 1-6

Author(s):

Shota Tamagawa ◽

Takatoshi Okuda ◽

Hidetoshi Nojiri ◽

Tatsuya Sato ◽

Rei Momomura ◽

...

Keyword(s):

Nerve Root ◽

Sagittal Plane ◽

Pedicle Screws ◽

Cadaveric Study ◽

Nerve Roots ◽

Nerve Root Injury ◽

Inflection Points ◽

Root Injury ◽

The Right ◽

Intervertebral Foramina

OBJECTIVE Previous reports have focused on the complications of L5 nerve root injury caused by anterolateral misplacement of the S1 pedicle screws. Anatomical knowledge of the L5 nerve root in the pelvis is essential for safe and effective placement of the sacral screw. This cadaveric study aimed to investigate the course of the L5 nerve root in the pelvis and to clarify a safe zone for inserting the sacral screw. METHODS Fifty-four L5 nerve roots located bilaterally in 27 formalin-fixed cadavers were studied. The ventral rami of the L5 nerve roots were dissected along their courses from the intervertebral foramina to the lesser pelvis. The running angles of the L5 nerve roots from the centerline were measured in the coronal plane. In addition, the distances from the ala of the sacrum to the L5 nerve roots were measured in the sagittal plane. RESULTS The authors found that the running angles of the L5 nerve roots changed at the most anterior surface of the ala of the sacrum. The angles of the bilateral L5 nerve roots from the right and left L5 intervertebral foramina to their inflection points were 13.77° ± 5.01° and 14.65° ± 4.71°, respectively. The angles of the bilateral L5 nerve roots from the right and left inflection points to the lesser pelvis were 19.66° ± 6.40° and 20.58° ± 5.78°, respectively. There were no significant differences between the angles measured in the right and left nerve roots. The majority of the L5 nerves coursed outward after changing their angles at the inflection point. The distances from the ala of the sacrum to the L5 nerve roots in the sagittal plane were less than 1 mm in all cases, which indicated that the L5 nerve roots were positioned close to the ala of the sacrum and had poor mobility. CONCLUSIONS All of the L5 nerve roots coursed outward after exiting the intervertebral foramina and never inward. To prevent iatrogenic L5 nerve root injury, surgeons should insert the S1 pedicle screw medially with an angle > 0° toward the inside of the S1 anterior foramina and the sacral alar screw laterally with an angle > 30°.

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Application of ultrasound-guided C5 nerve root block using polydeoxyribonucleotide in traumatic C5 nerve root injury caused by fracture of the articular process of the cervical spine

Medicine ◽

10.1097/md.0000000000008728 ◽

2017 ◽

Vol 96 (46) ◽

pp. e8728 ◽

Cited By ~ 6

Author(s):

Donghwi Park

Keyword(s):

Cervical Spine ◽

Nerve Root ◽

Ultrasound Guided ◽

Nerve Root Block ◽

Nerve Root Injury ◽

Articular Process ◽

Root Injury

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Rating Spinal Nerve Extremity Impairment Using the Sixth Edition

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2009.julaug01 ◽

2009 ◽

Vol 14 (4) ◽

pp. 1-6

Author(s):

Christopher R. Brigham

Keyword(s):

Nerve Root ◽

Spinal Nerve ◽

Upper Extremities ◽

Motor Deficits ◽

Nerve Injuries ◽

Sixth Edition ◽

Federal Employee ◽

Nerve Root Injury ◽

Root Injury ◽

Rating Process

Abstract The AMAGuides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, does not provide a separate mechanism for rating spinal nerve injuries as extremity impairment; radiculopathy was reflected in the spinal rating process in Chapter 17, The Spine and Pelvis. Certain jurisdictions, such as the Federal Employee Compensation Act (FECA), rate nerve root injury as impairment involving the extremities rather than as part of the spine. This article presents an approach to rate spinal nerve impairments consistent with the AMA Guides, Sixth Edition, methodology. This approach should be used only when a jurisdiction requires ratings for extremities and precludes rating for the spine. A table in this article compares sensory and motor deficits according to the AMA Guides, Sixth and Fifth Editions; evaluators should be aware of changes between editions in methodology used to assign the final impairment. The authors present two tables regarding spinal nerve impairment: one for the upper extremities and one for the lower extremities. Both tables were developed using the methodology defined in the sixth edition. Using these tables and the process defined in the AMA Guides, Sixth Edition, evaluators can rate spinal nerve impairments for jurisdictions that do not permit rating for the spine and require rating for radiculopathy as an extremity impairment.

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Cervical Ganglia and Nerve Root Injury: Evidence for Respiratory Arrest as Initiating Injury in Pediatric Head Trauma

Academic Forensic Pathology ◽

10.23907/2014.066 ◽

2014 ◽

Vol 4 (4) ◽

pp. 514-519

Author(s):

Mary Ann Sens ◽

Sarah E. Meyers ◽

Mark A. Koponen ◽

Arne H. Graff ◽

Ryan D. Reynolds ◽

...

Keyword(s):

Head Trauma ◽

Nerve Root ◽

Respiratory Arrest ◽

Nerve Root Injury ◽

Root Injury ◽

Pediatric Head Trauma ◽

Cervical Ganglia

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Effects of Yiqi Huayu Decoction on brain-derived neurotrophic factor expression in rats with lumbar nerve root injury

Journal of Chinese Integrative Medicine ◽

10.3736/jcim20100314 ◽

2010 ◽

Vol 8 (3) ◽

pp. 280-286 ◽

Cited By ~ 2

Author(s):

B Shu

Keyword(s):

Neurotrophic Factor ◽

Nerve Root ◽

Brain Derived Neurotrophic Factor ◽

Nerve Root Injury ◽

Root Injury ◽

Lumbar Nerve Root ◽

Factor Expression

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Triple Conjoined Nerve Root—An Unreported Anatomical Variant and Its Surgical Implications

Indian Journal of Neurosurgery ◽

10.1055/s-0040-1713056 ◽

2020 ◽

Vol 9 (03) ◽

pp. 215-218

Author(s):

Kelly Gassie ◽

Krishnan Ravindran ◽

Gazanfar Rahmathulla ◽

H. Gordon Deen

Keyword(s):

Nerve Root ◽

Root Anatomy ◽

Neurological Injury ◽

Herniated Disc ◽

Anatomical Variant ◽

Nerve Root Injury ◽

Root Injury ◽

Conjoined Nerve Roots ◽

High Degree ◽

Conjoined Nerve Root

AbstractConjoined nerve roots are an infrequent and uncommon finding, rarely noted preoperatively. The conjoined root anomaly has potential for significant neurological injury during surgery. Preoperative recognition may avert disastrous nerve root injury but requires a high degree of clinical suspicion. We present the case of a 44-year-old patient with left L5/S1 radiculopathy caused by a herniated disc. During surgery we identified a triple conjoined nerve root anatomy. This anatomical variant, to our knowledge, has not been reported in literature. We describe the anatomical findings and surgical implications.

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Nerve root injury severity differentially modulates spinal glial activation in a rat lumbar radiculopathy model: considerations for persistent pain

Brain Research ◽

10.1016/s0006-8993(02)03560-6 ◽

2002 ◽

Vol 956 (2) ◽

pp. 294-301 ◽

Cited By ~ 61

Author(s):

Beth A Winkelstein ◽

Joyce A DeLeo

Keyword(s):

Nerve Root ◽

Injury Severity ◽

Persistent Pain ◽

Glial Activation ◽

Lumbar Radiculopathy ◽

Nerve Root Injury ◽

Root Injury

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A comparison of pain registration by Visual Analog Scale and Numeric Rating Scale – a cross-sectional study of primary triage registration

10.1101/2020.11.03.20225367 ◽

2020 ◽

Author(s):

Jofrid Kollltveit ◽

Malin Osaland ◽

Marianne Reimers ◽

Magnus Berle

Keyword(s):

Emergency Department ◽

Visual Analog Scale ◽

Rating Scale ◽

Emergency Admission ◽

Numeric Rating Scale ◽

University Hospital ◽

Analog Scale ◽

Cross Sectional ◽

Significant Difference ◽

Numeric Rating

BackgroundPain is a subjective sensation; self-reporting is important for quantifying pain intensity. There are several different validated tools for this, such as Visual Analog Scale and Numeric Rating Scale. In the clinic, these terms are often used as equivalent. The objective of this study was to examine correlation and agreement between the pain registration tools in triage in an emergency department.Materials and MethodsThe study was performed in the Department of Emergency Medicine at Haukeland University Hospital in the period June-August 2019. We registered the pain score with two tools in 200 unselected patients in emergency admission with pain. In addition, we registrered gender, age, triage and general department affiliation.ResultsWe found a strong correlation between the pain registration tools by Spearmans correlation test (rho=0,930, p<0,001). There were no significant difference between the pain registration tools within the subgroups. Bland-Altman analysis show agreement between the two pain registration tools.ConclusionsIn an Emergency Department triage is it acceptable to use Visual Analog Scale and Numeric Rating Scale as equivalent, as long as the correct terminology is used.

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