Spinal Nerve Origins of the Muscular Branches of the Radial Nerve

Neurosurgery ◽  
2012 ◽  
Vol 70 (6) ◽  
pp. 1438-1441 ◽  
Author(s):  
Lei Zhang ◽  
Cheng-Gang Zhang ◽  
Zhen Dong ◽  
Yu-Dong Gu
Keyword(s):  
Brachial Plexus ◽  
Radial Nerve ◽  
Compound Muscle Action Potential ◽  
Electrophysiological Study ◽  
Spinal Nerve ◽  
Posterior Interosseous Nerve ◽  
Triceps Brachii ◽  
Nerve Roots ◽  
Extensor Pollicis Longus ◽  
Significant Difference

Abstract BACKGROUND: In injuries of the lower brachial plexus, finger flexion can be restored by nerve or tendon transfer. However, there is no technique that can guarantee good recovery of finger and thumb extension. OBJECTIVE: To determine the spinal nerve origins of the muscular branches of the radial nerve and identify potential intraplexus donor nerves for neurotization of the posterior interosseous nerve in patients with lower brachial plexus injuries. METHODS: An intraoperative electrophysiological study was carried out during 16 contralateral C7 nerve transfers. The compound muscle action potential of each muscle innervated by the radial nerve was recorded while the C5-T1 nerves were individually stimulated. RESULTS: The triceps brachii muscle primarily received root contributions from C7. The C5 and C6 nerve roots displayed greater amplitudes for the brachioradialis and supinator muscles compared with those of the C7, C8, and T1 nerve roots (P < .05). The extensor carpi radialis branch was innervated by C5, C6, and C7, and no significant differences were detected between them (P > .05). The amplitudes obtained for the extensor digitorum communis branch were the largest from C7 and C8, without a significant difference between them (P > .05), whereas the amplitudes of the extensor carpi ulnaris and extensor pollicis longus were largest from the C8 root (P < .05). CONCLUSION: The supinator muscle branch is likely the best donor nerve for the repair of lower brachial plexus injuries affecting muscles that are innervated by the posterior interosseous nerve.

The Innervation Pattern of the Radial Nerve at the Elbow and in the Forearm

1998 ◽  
Vol 23 (2) ◽  
pp. 167-169 ◽  
Author(s):  
G. BRANOVACKI ◽  
M. HANSON ◽  
R. CASH ◽  
M. GONZALEZ
Keyword(s):  
Radial Nerve ◽  
Sensory Nerve ◽  
Extensor Digitorum ◽  
Sensory Nerves ◽  
Posterior Interosseous Nerve ◽  
Extensor Pollicis Longus ◽  
Abductor Pollicis Longus ◽  
Extensor Carpi Ulnaris ◽  
Wide Variability ◽  
Extensor Carpi Radialis

Sixty paired cadaver forearms were dissected to examine the distribution of the radial nerve branches to the muscles at the elbow and forearm. Emphasis was placed on the innervation of the extensor carpi radialis brevis and the supinator muscles because of discrepancies in the literature concerning these muscles. The most common branching pattern (from proximal to distal) was to brachioradialis, extensor carpi radialis longus, superficial sensory, extensor carpi radialis brevis, supinator, extensor digitorum/extensor carpi ulnaris, extensor digiti minimi, abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus and extensor indicis. The branch to extensor digitorum and extensor carpi ulnaris came off as a common stem often with the branch to extensor digiti minimi. The branch to the ECRB muscle was noted to arise from the posterior interosseous nerve in 45%, superficial sensory nerve in 25% and at the bifurcation of the posterior interosseous and superficial sensory nerves in 30% of specimens. The supinator had an average of 2.3 branches from the posterior interosseous nerve (range 1–6). The branches to the supinator showed a wide variability proximal to and within the supinator.

Effects of Anatomical Site and Loading Rate on Tensile Behavior of Fiber Bundles Isolated From Nerve Roots

2016 ◽  
Author(s):  
Atsutaka Tamura ◽  
Mizuki Sakaya ◽  
Takao Koide
Keyword(s):  
Fold Increase ◽  
Spinal Nerve ◽  
Tensile Behavior ◽  
Fiber Bundles ◽  
Anatomical Site ◽  
Human Body Model ◽  
Spinal Level ◽  
Nerve Roots ◽  
Thoracic Spinal ◽  
Significant Difference

The present study has investigated the characteristics of the tensile behavior of fiber bundles isolated from the spinal nerve roots. By conducting a series of uniaxial stretching tests at three different velocities, 0.2, 2, and 20 mm/s, we found a significant difference (P < 0.05) in failure strain (∼0.15), linear portion of elastic modulus (∼20 MPa), and tensile strength (∼2 MPa) between low (0.2 mm/s) and high (20 mm/s) loading rates. However, it was revealed that mechanical properties of fiber bundles were resultantly on the order of the same magnitude, indicating that their mechanical responses were relatively insensitive to a strain rate irrespective of a 100-fold increase in the applied stretching velocities. It was also confirmed that the “spinal level effect” does exist in the nerve roots, i.e., a fiber bundle isolated from the thoracic spinal level is the strongest in mechanical strength compared to that of the cervical and lumbar spinal levels (P < 0.01), which suggests we should pay more close attention to an anatomical site where excised samples are obtained. The mechanical data obtained here will be useful to improve a mathematical human body model and to assess the potential injury in crash simulations relevant to whiplash associated disorder.

Repair of ruptured spinal nerve roots in a brachial plexus lesion

1995 ◽  
Vol 82 (4) ◽  
pp. 661-663 ◽  
Author(s):  
Thomas Carlstedt ◽  
Georg Norén
Keyword(s):  
Brachial Plexus ◽  
Spinal Nerve ◽  
Sensory Loss ◽  
Spinal Root ◽  
Nerve Roots ◽  
Content Type ◽  
Nerve Grafts ◽  
Functional Gain ◽  
Plexus Lesion ◽  
Intrinsic Hand Muscles

✓ A 22-year-old woman sustained a brachial plexus injury with supraganglionic rupture of the C-8 and T-1 nerve roots as a result of a traffic accident. She was operated on approximately 1 week following the accident. After a hemilaminectomy, the intradural defects in the ruptured roots were bridged with sural nerve grafts. Within 3 years she recovered function in all muscles supplied from the lower roots in the plexus except for the intrinsic hand muscles, but she had a persisting, complete sensory loss in the ulnar nerve distribution. The possibility for functional gain after repair of spinal root lesions in brachial plexus patients is discussed.

scholarly journals The minute anatomy of the brachial plexus

1887 ◽  
Vol 41 (246-250) ◽  
pp. 423-441 ◽  
Keyword(s):  
Connective Tissue ◽  
Brachial Plexus ◽  
Spinal Nerve ◽  
Spinal Nerve Roots ◽  
Nerve Roots ◽  
Spinal Nerves ◽  
Final Destination ◽  
Naked Eye

It has for some time appeared probable that the spinal nerves which form the brachial plexus do not become confounded one with another, but retain each its separate course and its separate functions. To the naked eye a nerve is a bundle of parallel threads bound together, and at the same time divided by a sheath of connective tissue. It seemed to me possible that the course of the spinal nerve roots could be traced by a dissection which should follow each through the plexus to the nerves which branch therefrom, and in these to its final destination.

Detection of Root Avulsion in the Dominant C7 Obstetric Brachial Plexus Lesion: Experience with Three-dimensional Constructive Interference in Steady-state Magnetic Resonance Imaging and Electrophysiology

Neurosurgery ◽  
2005 ◽  
Vol 57 (5) ◽  
pp. 930-940 ◽  
Author(s):  
Willem J.R. van Ouwerkerk ◽  
Rob L.M. Strijers ◽  
Frederik Barkhof ◽  
Ulco Umans ◽  
W Peter Vandertop
Keyword(s):  
Magnetic Resonance Imaging ◽  
Steady State ◽  
Brachial Plexus ◽  
Three Dimensional ◽  
Spinal Nerve ◽  
Root Avulsion ◽  
Resonance Imaging ◽  
Constructive Interference ◽  
Nerve Roots ◽  
Obstetric Brachial Plexus

Abstract OBJECTIVE: Preoperative, reliable detection by ancillary investigations of spinal nerve root avulsions in infants with severe obstetric brachial plexus lesions to avoid ineffective operative repair from deceivingly intact but actually avulsed nerve roots. METHODS: Ten infants were selected with an infrequent, severe dominant C7 lesion, primarily because of the anatomically distinct supraclavicular course of this spinal nerve. Three-dimensional constructive interference in steady-state magnetic resonance imaging (3D CISS MRI) studies under mild sedation were performed and evaluated for detection of avulsed nerve roots by two experienced neuroradiologists. Preoperative electrodiagnostics (electromyography and somatosensory evoked potentials) as well as intraoperative somatosensory potentials and muscle contractions after electrostimulation were recorded. Preoperative and intraoperative ancillary investigations were correlated with intraoperative findings in eight patients and clinical status in two children who recovered spontaneously. RESULTS: Despite two minor motion artifacts, the quality of the 3D CISS MRI studies was good. In 8 of 10 patients, prediction of root continuity was consistent with operative or clinical findings, and 2 remained doubtful. Preoperative and intraoperative electrodiagnostics tended not to correlate with intraoperative findings in this small, selected group. CONCLUSION: 3D CISS MRI provides good images of anterior and posterior spinal roots in infants with obstetric brachial plexus lesions. Images seem to allow accurate prediction of root avulsion in the majority of patients. In this study, electrodiagnostics were of limited value.

Origination of the Muscular Branches of the Median Nerve

Neurosurgery ◽  
2014 ◽  
Vol 76 (2) ◽  
pp. 196-200 ◽  
Author(s):  
Bin Xu ◽  
Zhen Dong ◽  
Cheng-Gang Zhang ◽  
Yi Zhu ◽  
Dong Tian ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Median Nerve ◽  
Brachial Plexus Injury ◽  
Electrophysiological Study ◽  
Nerve Roots ◽  
Motor Branch ◽  
Lower Trunk ◽  
Pronator Teres ◽  
Finger Flexion ◽  
Flexor Digitorum

ABSTRACT BACKGROUND: In lower brachial plexus injury, finger flexion after brachialis motor branch transfer is relatively weak. We sought to screen potential branches of the median nerve from the upper trunk for strengthening finger flexion in addition to the brachialis motor branch. However, the spinal origin of the muscular branches of the median nerve based on electrophysiological study was unclear. OBJECTIVE: To determine the spinal origin of the muscular branches of the median nerve. METHODS: An intraoperative electrophysiological study was carried out in 18 patients who underwent contralateral C7 nerve transfer. After exposure of the brachial plexus nerve roots on the healthy side, the amplitude of the compound muscle action potential of each median nerve-innervated muscle was recorded while the different nerve roots were stimulated. RESULTS: The pronator teres received fibers from C5, C6, and C7. It had more contribution from C5 and C6 than from C7 (P &lt; .05). The flexor carpi radialis was innervated mainly by C6 and C7. The nerve branches of the palmaris longus and flexor digitorum superficialis stemmed primarily from C7 and the lower trunk, and no significant difference was found between them (P &gt; .05). The flexor digitorum profundus, flexor pollicis longus, pronator quadratus, and abductor pollicis brevis were innervated predominantly by the lower trunk (P &lt; .05). CONCLUSION: This electrophysiological study indicates that the pronator teres branch might be the most feasible alternative donor nerve to supplement the brachialis motor branch and strengthen finger flexion after lower brachial plexus injury.

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