Surgical Anatomy of the Posterior Intermuscular Approach to the Brachial Plexus

Hand ◽  
2020 ◽  
pp. 155894471989561
Author(s):  
Ilhan Akaslan ◽  
Ahmet Ertas ◽  
Mehmet Uzel ◽  
Cagatay Ozdol ◽  
Kamran Aghayev
Keyword(s):  
Brachial Plexus ◽  
Posterior Approach ◽  
Dimensional Space ◽  
Trapezius Muscle ◽  
Surgical Anatomy ◽  
Reference Points ◽  
Direct Access ◽  
Lateral Border ◽  
First Rib ◽  
Splenius Capitis

Background: First rib resection and scalenectomy is a well-established treatment option for thoracic outlet syndrome. The posterior approach is rarely used due to extensive muscle sacrifice resulting in significant procedural morbidity. In this paper, we report the surgical anatomy of modified and less-invasive muscle-sparing posterior approach. Methods: Eleven human cadavers were used in this study. With specific care to preserve muscles’ integrity, the brachial plexus was exposed by dissecting through the posterior neck musculature. A muscular triangle was found under the trapezius muscle, which provided direct access to deeper structures. Four anatomical reference points were identified to denote a 3-dimensional space enclosing proximal brachial plexus. Results: A muscular triangle was found under the trapezius muscle in all cadavers. It was bordered infero-medially by rhomboid minor, supero-medially by splenius capitis, and laterally by levator scapula muscles. The inferomedial border (rhomboid) was 55 mm (48-80), superomedial border (splenius capitis) was 60.5 mm (42-89), and the lateral border (levator scapulae) was 99 mm (60-130). A consistent vein was present inside the triangle and could be used as an anatomical landmark. The 4 reference points were C5, T1 intervertebral foramina, transverse tubercle, and scalene tubercle of the first rib. Removal of the first rib could be performed without brachial plexus retraction. The latter was exposed from neural foramina to lateral border of the first rib. Conclusions: The posterior approach provides ample space to for exposure and manipulation with the first rib and proximal brachial plexus.

scholarly journals Filtering Biomechanical Signals in Movement Analysis

Sensors ◽  
2021 ◽  
Vol 21 (13) ◽  
pp. 4580
Author(s):  
Francesco Crenna ◽  
Giovanni Battista Rossi ◽  
Marta Berardengo
Keyword(s):  
Measurement Uncertainty ◽  
Dimensional Space ◽  
Three Dimensional ◽  
Movement Analysis ◽  
Analytical Signal ◽  
Human Movement ◽  
Reference Points ◽  
Biomechanical Analysis ◽  
Method Performance ◽  
Acceleration Signal

Biomechanical analysis of human movement is based on dynamic measurements of reference points on the subject’s body and orientation measurements of body segments. Collected data include positions’ measurement, in a three-dimensional space. Signal enhancement by proper filtering is often recommended. Velocity and acceleration signal must be obtained from position/angular measurement records, needing numerical processing effort. In this paper, we propose a comparative filtering method study procedure, based on measurement uncertainty related parameters’ set, based upon simulated and experimental signals. The final aim is to propose guidelines to optimize dynamic biomechanical measurement, considering the measurement uncertainty contribution due to the processing method. Performance of the considered methods are examined and compared with an analytical signal, considering both stationary and transient conditions. Finally, four experimental test cases are evaluated at best filtering conditions for measurement uncertainty contributions.

scholarly journals Motion Analytics of Trapezius Muscle Activity in an 18-Year-Old Female with Extended Upper Brachial Plexus Birth Palsy

2021 ◽  
Vol 16 (01) ◽  
pp. e51-e55
Author(s):  
Jasmine J. Lin ◽  
Gromit Y.Y. Chan ◽  
Cláudio T. Silva ◽  
Luis G. Nonato ◽  
Preeti Raghavan ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Upper Extremity ◽  
Muscle Activity ◽  
Visual Analytics ◽  
Three Dimensional ◽  
Trapezius Muscle ◽  
Shoulder Abduction ◽  
Upper Trapezius ◽  
Brachial Plexus Birth Palsy ◽  
Birth Palsy

Abstract Background The trapezius muscle is often utilized as a muscle or nerve donor for repairing shoulder function in those with brachial plexus birth palsy (BPBP). To evaluate the native role of the trapezius in the affected limb, we demonstrate use of the Motion Browser, a novel visual analytics system to assess an adolescent with BPBP. Method An 18-year-old female with extended upper trunk (C5–6–7) BPBP underwent bilateral upper extremity three-dimensional motion analysis with Motion Browser. Surface electromyography (EMG) from eight muscles in each limb which was recorded during six upper extremity movements, distinguishing between upper trapezius (UT) and lower trapezius (LT). The Motion Browser calculated active range of motion (AROM), compiled the EMG data into measures of muscle activity, and displayed the results in charts. Results All movements, excluding shoulder abduction, had similar AROM in affected and unaffected limbs. In the unaffected limb, LT was more active in proximal movements of shoulder abduction, and shoulder external and internal rotations. In the affected limb, LT was more active in distal movements of forearm pronation and supination; UT was more active in shoulder abduction. Conclusion In this female with BPBP, Motion Browser demonstrated that the native LT in the affected limb contributed to distal movements. Her results suggest that sacrificing her trapezius as a muscle or nerve donor may affect her distal functionality. Clinicians should exercise caution when considering nerve transfers in children with BPBP and consider individualized assessment of functionality before pursuing surgery.

Safety of the Posterior Approach to the Brachial Plexus

2006 ◽  
Vol 103 (4) ◽  
pp. 1046
Author(s):  
Nicol C. Voermans ◽  
Ben J. Crul ◽  
Baziel G. van Engelen
Keyword(s):  
Brachial Plexus ◽  
Posterior Approach

Surgical Anatomy of the Brachial Plexus

2021 ◽  
pp. 19-39
Author(s):  
Manuel Llusá ◽  
M. Rosa Morro ◽  
Joaquin Casañas ◽  
Amy M. Moore
Keyword(s):  
Brachial Plexus ◽  
Surgical Anatomy

Improved Technique for Harvesting the Accessory Nerve for Transfer in Brachial Plexus Injuries

2006 ◽  
Vol 58 (suppl_4) ◽  
pp. ONS-366-ONS-370 ◽  
Author(s):  
Jayme Augusto Bertelli ◽  
Marcos Flavio Ghizoni
Keyword(s):  
Brachial Plexus ◽  
Lymphatic Vessels ◽  
Trapezius Muscle ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
Accessory Nerve ◽  
Fat Tissue ◽  
Anterior Border ◽  
Improved Technique ◽  
Nerve Identification

Abstract Objective: The accessory nerve is frequently used as a donor for nerve transfer in brachial plexus injuries. In currently available techniques, nerve identification and dissection is difficult because fat tissue, lymphatic vessels, and blood vessels surround the nerve. We propose a technique for location and dissection of the accessory nerve between the deep cervical fascia and the trapezius muscle. Methods: Twenty-eight patients with brachial plexus palsy had the accessory nerve surgically transplanted to the suprascapular nerve. To harvest the accessory nerve, the anterior border of the trapezius muscle was located 2 to 3 cm above the clavicle. The fascia over the trapezius muscle was incised and detached from the anterior surface of the muscle, initially, close to the clavicle, then proximally. The trapezius muscle was detached from the clavicle for 3 to 4 cm. The accessory nerve and its branches entering the trapezius muscle were identified. The accessory nerve was sectioned as distally as possible. To allow for accessory nerve mobilization, one or two proximal branches to the trapezius muscle were cut. The most proximal branch was always identified and preserved. A tunnel was created in the detached fascia, and the accessory nerve was passed through this tunnel to the brachial plexus. Results: In all of the cases, the accessory nerve was easily identified under direct vision, without the use of electric stimulation. Direct coaptation of the accessory nerve with the suprascapular nerve was possible in all patients. Conclusion: The technique proposed here for harvesting the accessory nerve for transfer made its identification and dissection easier.

Anterior Lumbar Interbody Fusion (ALIF): Technique Video: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (4) ◽  
pp. E404-E404 ◽  
Author(s):  
Pingguo Duan ◽  
Jeremy M V Guinn ◽  
Brenton Pennicooke ◽  
Ratnesh N Mehra ◽  
Chih-Chang Chang ◽  
...  
Keyword(s):  
Surface Area ◽  
Interbody Fusion ◽  
Ventral Surface ◽  
Surgical Anatomy ◽  
Anterior Lumbar Interbody Fusion ◽  
Direct Access ◽  
Lumbar Interbody Fusion ◽  
Disc Space ◽  
Implant Size ◽  
Segmental Lordosis

Abstract This surgical video demonstrates the technique of an anterior lumbar interbody fusion (ALIF). This video demonstrates the surgical approach, technical nuances of ALIF, and pearls. The main surgical anatomy and approach-related risks are discussed. The video demonstrates the nuances of ALIF, discussing the importance of the release of the disc space to allow for height restoration and lordosis, endplate preparation to enhance arthrodesis, and choice of implant size. The incision is made via a left paramedian approach with a retroperitoneal dissection and mobilization of the vasculature for access to the disc space. The ALIF provides direct access to the ventral surface of the exposed disc, allowing for an incision of the anterior longitudinal ligament, bilateral release of the annulus fibrosus, and access to a large surface area of the vertebral endplate. This anterior access allows for the placement of implants with a greater surface area for fusion, and this facilitates restoration of segmental lordosis, disc height improvement, and foraminal height increase. We have received informed consent from this patient for the video of this case.

Video-Assisted Thoracoscopic Dissection Of The Brachial Plexus:Cadaveric Study And Illustrative Case

2006 ◽  
Vol 58 (suppl_4) ◽  
pp. ONS-287-ONS-291 ◽  
Author(s):  
Chad J. Morgan ◽  
Jefferson Lyons ◽  
Benjamin C. Ling ◽  
P. Colby Maher ◽  
Robert J. Bohinski ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Brachial Plexus ◽  
Thoracoscopic Surgery ◽  
Surgical Approaches ◽  
Illustrative Case ◽  
Lower Trunk ◽  
Video Assisted ◽  
First Rib ◽  
Soft Tissue Dissection ◽  
Tissue Dissection

Abstract Objective: Standard surgical approaches to the brachial plexus require an open operative technique with extensive soft tissue dissection. A transthoracic endoscopic approach using video-assisted thoracoscopic surgery (VATS) was studied as an alternative direct operative corridor to the proximal inferior brachial plexus. Methods: VATS was used in cadaveric dissections to study the anatomic details of the brachial plexus at the thoracic apex. After placement of standard thoracoscopic ports, the thoracic apex was systematically dissected. The limitations of the VATS approach were defined before and after removal of the first rib. The technique was applied in a 22-year-old man with neurofibromatosis who presented with a large neurofibroma of the left T1 nerve root. Results: The cadaveric study demonstrated that VATS allowed for a direct cephalad approach to the inferior brachial plexus. The C8 and T1 nerve roots as well as the lower trunk of the brachial plexus were safely identified and dissected. Removal of the first rib provided exposure of the entire lower trunk and proximal divisions. After the fundamental steps to the dissection were identified, the patient underwent a successful gross total resection of a left T1 neurofibroma with VATS. Conclusion: VATS provided an alternative surgical corridor to the proximal inferior brachial plexus and obviated the need for the extensive soft tissue dissection associated with the anterior supraclavicular and posterior subscapular approaches.

Surgical anatomy of the platysma motor branch as a donor for transfer in brachial plexus repair

2008 ◽  
Vol 30 (8) ◽  
pp. 669-674 ◽  
Author(s):  
Mariano Pablo Socolovsky ◽  
Jayme Augusto Bertelli ◽  
Gilda Di Masi ◽  
Alvaro Campero ◽  
Lucas Garategui ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Surgical Anatomy ◽  
Motor Branch ◽  
Brachial Plexus Repair

scholarly journals The Algorithm for Determining the Coordinates of a Point in Three-Dimensional Space by Using the Auxiliary Point

2013 ◽  
Vol 48 (4) ◽  
pp. 141-145 ◽  
Author(s):  
Bartlomiej Oszczak ◽  
Eliza Sitnik
Keyword(s):  
Fixed Point ◽  
Precise Measurement ◽  
Dimensional Space ◽  
Three Dimensional ◽  
Satellite Navigation ◽  
Reference Points ◽  
Two Dimensional ◽  
Approximate Location ◽  
The Many ◽  
Three Dimensional Space

ABSTRACT During the process of satellite navigation, and also in the many tasks of classical positioning, we need to calculate the corrections to the initial (or approximate) location of the point using precise measurement of distances to the permanent points of reference (reference points). In this paper the authors have provided a way of developing Hausbrandt's equations, on the basis of which the exact coordinates of the point in two-dimensional space can be determined by using the computed correction to the coordinates of the auxiliary point. The authors developed generalised equations for threedimensional space introducing additional fixed point and have presented proof of derived formulas.

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