scholarly journals The importance of early and long-lasting medical rehabilitation in patients with brachial plexus injury

2021 ◽  
Vol 12 (Vol.12, no.1) ◽  
pp. 107-110
Author(s):  
Roxana SCHEAU ◽  
Gabriela IELCIU ◽  
Madalina Gabriela ILIESCU
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Brachial Plexus Injury ◽  
Clavicle Fracture ◽  
Rehabilitation Program ◽  
Medical Rehabilitation ◽  
Motor Deficit ◽  
Motor Rehabilitation ◽  
Large Motor ◽  
Degrees Of Severity

Introduction. Brachial plexus lesions vary in severity, depending on the etiopathogenic mechanism and the level of force to which the plexus is exposed. In the same patient, several nerves of the plexus can be damaged in varying degrees of severity. Brachial plexus injuries lead to upper limb paralysis and disability. Material and Methods. We present the case of a 68-year-old woman diagnosed a year ago with multiple myeloma, clavicular plasmacytoma and secondary spontaneous clavicle fracture. At the same time she presented several dislocations of the shoulder and was diagnosed with brachial plexus palsy after the last dislocation. The patient was hospitalized in our department with a large motor deficit in the upper limb. A comprehensive motor rehabilitation program has been established three weeksafter installing the palsy. Results and discussion. The evolution of the patient was favorable. It was noticed the reduction of the symptoms and slight improvement in motor deficit of the affected upper limb. Thepatient rehabilitation should continue for several months because the nerve regenerates slowly. Conclusion. In patients with brachial plexus injury, motor rehabilitation should be instituted as early as possible and continued for a longer periodoftime until nerve regeneration occurs.It results that early and continuous medical rehabilitation is essential in patients with brachial plexus injury. Keywords: Brachial plexus injury, shoulder dislocation, rehabilitation,

scholarly journals Brachial plexus injury after clavicle fracture operation: a case report and literature review

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhenyu Cao ◽  
Yufei Hou ◽  
Xiaochen Su ◽  
Menghao Teng ◽  
Wenchen Ji ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Brachial Plexus Injury ◽  
Clavicle Fracture ◽  
Symptomatic Treatment ◽  
Movement Restriction ◽  
Functional Exercise ◽  
Clavicle Fractures ◽  
The Right ◽  
Upper Limb Dysfunction

Abstract Background Open reduction and internal fixation (ORIF) is the preferred choice for treating clavicle fractures. The brachial plexus injury caused by ORIF of a clavicle fracture is very rare. If it is not treated in time, the function of the brachial plexus will be challenging to recover, which will eventually lead to upper limb dysfunction and seriously affect the patient’s quality of life. Our team recently used ORIF to treat a patient with a clavicle fracture, who developed brachial plexus injury symptoms after surgery. Case presentation A 34-year-old female patient was admitted to the hospital for 13 h due to the right shoulder movement restriction after a fall. Due to the significant displacement of the fracture, we used ORIF to treat the fracture. The surgery went well. When the anaesthesia effect subsided 12 h after the operation, the patient developed right brachial plexus injury symptoms, decreased right upper limb muscle strength, dysfunction, and hypoesthesia. Symptomatic treatments, such as nourishing nerve and electrical stimulation, were given immediately. Sixty days after the operation, the patient’s brachial plexus injury symptoms disappeared, and the function of the right upper limb returned to the preoperative state. Conclusions Patients with clavicle fractures usually need to undergo a careful physical examination before surgery to determine whether symptoms of brachial plexus injury have occurred. Anaesthesia puncture requires ultrasound guidance to avoid direct damage to the brachial plexus. When the fracture end is sharp, reset should be careful to prevent nerve stump stabbed. When using an electric drill to drill holes, a depth limiter should be installed in advance to prevent the drill from damaging the subclavian nerve and blood vessels. When measuring the screw depth, the measuring instrument should be close to the bone surface and sink slowly to avoid intense hooks and damage to the brachial plexus. Try to avoid unipolar electrosurgical units to prevent heat conduction from damaging nerves, and bipolar electrocoagulation should be used instead. If symptoms of brachial plexus injury occur after surgery, initial symptomatic treatment is drugs and functional exercise, and if necessary, perform surgical exploration.

How to Do It: Microsurgical DREZotomy for Pain After Brachial Plexus Injury: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Manon Duraffourg ◽  
Andrei Brinzeu ◽  
Marc Sindou
Keyword(s):  
Spinal Cord ◽  
Pain Relief ◽  
Brachial Plexus ◽  
Dorsal Horn ◽  
Brachial Plexus Injury ◽  
Dorsal Column ◽  
Motor Deficit ◽  
Complete Disappearance ◽  
Burning Pain ◽  
Root Entry Zone

Abstract More than three-quarters of victims of brachial plexus injury suffer from refractory neuropathic pain.1-6 Main putative mechanism is paroxysmal hyperactivity in the dorsal horn neurons at the dorsal root entry zone (DREZ) as demonstrated by microelectrode recordings in animal models7 and patients.8 Pain relief can be achieved by lesioning the responsible neurons in the spinal cord segments with avulsed rootlets.9,10  This video illustrates the technique for microsurgical DREZotomy.11,12 A C3-C7 hemilaminectomy is performed to access the C4-Th1 medullary segments. After opening the dura and arachnoid, and freeing the cord from arachnoid adhesions, the dorsolateral sulcus is identified. Identification can be difficult when the spinal cord is distorted and/or has a loss of substance. The dorsolateral sulcus is then opened with a microknife, so that microcoagulations are performed: 4 mm deep, at 35° angle in the axis of the dorsal horn, every millimeter in a dotted fashion along the avulsed segments. Care should be taken not to damage the corticospinal tract, laterally, and the dorsal column, medially.  The patient consents to the procedure. In the presented case, surgery led to complete disappearance of the paroxysmal pain and reduced the background of burning pain to a bearable level without the need of opioid medication. There was no motor deficit or ataxia in the ipsilateral lower limb postoperatively. According to Kaplan-Meier analysis at 10 yr follow-up, in our overall series, microsurgical DREZotomy achieved total pain relief without any medication in 60% of patients, and in 85% without the need for opioids.10,13-15  Microelectrode recording at 1:26 reproduced from Guenot et al7 with permission from JNSPG.

Modern Technologies of Medical Rehabilitation of Upper Limb Injury in Children

2020 ◽  
Vol 98 (4) ◽  
pp. 42-47
Author(s):  
M.A. Khan ◽  
E.L. Vakhova ◽  
D.Yu. Vybornov ◽  
N.I. Tarasov ◽  
Е.О. Pochkin ◽  
...  
Keyword(s):  
Upper Limb ◽  
Elbow Joint ◽  
Rehabilitation Program ◽  
Medical Rehabilitation ◽  
Entire Period ◽  
Limb Injury ◽  
Rehabilitation Programs ◽  
Wide Range ◽  
Limb Trauma ◽  
Rehabilitation Measures

The relevance of the problem of children with upper limb trauma medical rehabilitation is determined by the high frequency elbow joint fractures; the risk of complications development, disabilityc of the patient. A comprehensive medical rehabilitation program assumes a personalized approach and a differentiated prescription of physical factors, depending on the time period of rehabilitation. Early physical rehabilitation is a key link in the complete recovery of the function of a patient’s limb with damage to the elbow joint. The purpose of this work is to analyze literature and summarize the results of our own research to determine the optimal approaches and methods for medical rehabilitation of children with upper limb injury. The medical rehabilitation program includes various methods of kinesiotherapy, robotic mechanotherapy, massage, a wide range of apparatus physiotherapy to improve the trophism of the periarticular tissues, to maintain mobility in joints free from immobilization; gain of the full range of motion in the damaged joint; normalizing tone and strengthening the muscles of the upper limb. Medical rehabilitation of children with elbow joint injury is carried out from the earliest stage, in stationary conditions, during the period of immobilization. The rehabilitation measures continue in outpatient and polyclinic conditions, during the entire period of immobilization (2–4 weeks) and then in the post-immobilization period until the limb function is fully restored. It is necessary to monitor the main indicators of the function of the upper limb during the entire period of rehabilitation to assess the effectiveness of rehabilitation measures, objectify the course of the rehabilitation process and the continuity of rehabilitation programs. Definition of the tasks of medical rehabilitation, differentiated for each stage; the choice of modern, pathogenetically grounded rehabilitation technologies with an assessment of their effectiveness contribute to a significant increase in the effectiveness of comprehensive rehabilitation programs for children with upper limb trauma.

Effect of augmented biofeedback for improvement of range of motion and upper extremity functionality in obstetric brachial plexus injury: a randomised control trial

2020 ◽  
Vol 27 (3) ◽  
pp. 1-11
Author(s):  
Reham Saeed Alsakhawi ◽  
Azza Mohamed Atya
Keyword(s):  
Physical Therapy ◽  
Brachial Plexus ◽  
Range Of Motion ◽  
Upper Limb ◽  
Brachial Plexus Injury ◽  
Control Group ◽  
Functional Activities ◽  
Obstetric Brachial Plexus ◽  
Therapy Programme ◽  
Obstetric Brachial Plexus Injury

Background/Aims The loss of mobility and functional activities of the upper limb are the main longstanding complications of obstetric brachial plexus injury. The aim of this study was to investigate the effect of the augmented biofeedback system in conjunction with traditional physical therapy on the range of motion and functional activities in children with obstetric brachial plexus injury. Methods A total of 45 children aged from 6 to 10 years with obstetric brachial plexus injury were assigned into two groups. The control group received a traditional physical therapy programme, and the study group received the same programme with augmented biofeedback for 6 weeks. The main outcome parameters were the upper limb active range of motion, Mallet scale and Active Movement scale. Results The children in the study group showed greater significant improvement in all measured parameters compared with those in the control group. Conclusions Adding augmented biofeedback to the physical therapy programme provided greater improvement in upper limb mobility and functional activities for children with obstetric brachial plexus injury children.

Risk factors for clavicle fracture concurrent with brachial plexus injury

2015 ◽  
Vol 293 (4) ◽  
pp. 783-787 ◽  
Author(s):  
Ertugrul Karahanoglu ◽  
Taner Kasapoglu ◽  
Safak Ozdemirci ◽  
Erdem Fadıloglu ◽  
Aysegul Akyol ◽  
...  
Keyword(s):  
Risk Factors ◽  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Clavicle Fracture

scholarly journals O09 Recurring brachial plexopathy- the zebra among the horses

2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Brooke Mara
Keyword(s):  
Case Report ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Brachial Plexus Injury ◽  
Mechanism Of Injury ◽  
Limb Pain ◽  
History Of ◽  
Upper Limb Pain ◽  
The Right

Abstract Case report - Introduction A case study of a teenage boy presenting with severe upper limb pain and recurring loss of upper limb function with no clear mechanism of injury. His progress in therapy was initially as expected; however, symptoms would recur despite consistency and compliance with treatment from the patient. This led to a referral for further investigations where a diagnosis of a rare inflammatory neurological condition was made. This case study is relevant for paediatric physiotherapists working in non-inflammatory, musculoskeletal and pain services as it highlights a lesser-known pathology that presents in a similar way to a more common condition. Case report - Case description M is a 13-year-old boy that presented with a 5-week history of stabbing pains followed by loss of motor function and sensation in his right arm after swinging a remote. A diagnosis of brachial nerve plexopathy had been suggested. M had been diagnosed with Hypermobile Ehlers-Danlos Syndrome (hEDS) but was otherwise fit and well with no significant birth, developmental or family history. He experienced similar episodes of loss of motor function throughout the entire right upper limb following an episode of acute pain aged 4 and aged 12. The episodes were presumed to be a brachial plexus injury following a shoulder subluxation; however, there was no real mechanism of injury to suggest this and symptoms self-resolved after several months in both instances. Age 8 he lost function and sensation in the left arm after a minor pulled elbow, he underwent elbow surgery at another centre to help restore the function of the left arm; however, function didn’t return for approximately 1 year. On examination he had diminished reflexes throughout the right upper limb and reduced sensation along a C3-8 & T1 distribution. He had a correctable thoracic spine kyphosis with significant medial boarder scapula winging on the right. His right shoulder sat lower than the left and he had muscle atrophy at right supraspinatus, infraspinatus, and serratus anterior and deltoid with tight pectoral muscles. He was compensating using upper trapezius to achieve 90—100 degrees of shoulder flexion and abduction with 2/5 muscle power. His elbow muscle strength was reduced to 4/5 in all movements on the right. He could only actively extend his right wrist to 30 degrees and only had flickers of active radial deviation. He lacked active finger extension in digits 2-5 and had 0/5 muscle activity at the right thumb. Case report - Discussion M underwent exercise therapy with a focus on regaining scapula control in lying and isometric rotator cuff strengthening as he had such significant wasting and was unable to control the upper limb in sitting. We also worked on improving his thoracic spine posture and on active assisted finger and wrist exercises to prevent contractures. I initially provided a sling to be worn at school and in busy environments to prevent any subluxations in view of his significant rotator cuff weakness and history of hEDS. The sling also served as a thoracic posture reminder for M. After just 2—3 weeks of input and initially making gains in strength and function, M had an episode of severe pain in the right shoulder followed by worsening motor and sensory symptoms. The recurrent nature of episodes and the weak mechanism of injury, led me to discuss M with a consultant. The consultant referred M to genetics where it was discovered he had idiopathic neuralgic amyotrophy (INA; also known as Parsonage—Turner Syndrome), a rare inflammatory neurological disorder. M had the classic signs and symptoms of INA but as he had presented to various different clinicians and centres with each episode a correlation wasn’t made until this latest presentation to pain clinic Case report - Key learning points The insubstantial mechanism of injury for his current presentation (motor loss from swinging a remote) led me to probe further into past episodes of his upper limb pain.  This information spurred me to research alternative causes of his symptoms and discuss the case with a consultant who made an onward referral. As physiotherapists we are highly likely to receive referrals for patients like M, with little more information than ‘shoulder pain’ or ‘brachial plexus injury’ given, which is why our subjective is such an important part of the overall assessment.  M’s case highlights how important collating an extensive medical history is to proper investigation and eventual diagnosis. M had a long history of upper limb events for which he had seen a variety of clinicians at various centres. Each event had been treated as an individual episode rather than one larger recurring pattern. Drawing that history together gave a more holistic picture which triggered the referral that identified a diagnosis 8 years after his first presentation to healthcare. M’s case also highlighted the importance of a good patient—therapist relationship. Motivating a patient with this type of condition is challenging; their progress is not linear and they often have to take steps backwards before they can progress again. This is exceptionally difficult for children and their parents, as it is a frustrating and repetitive cycle. They need to trust that you are giving them the correct therapy and as a therapist you need to trust that the patient is compliant with recommendations and exercise. Finally, the shoulder rehabilitation for M was, clinically speaking, the same as any other brachial plexus type injury. The main key difference was the need to intermittently take the exercises down a level in the incidence of a new episode of pain and motor loss.

scholarly journals Kinematic Changes in the Uninjured Limb After a Traumatic Brachial Plexus Injury

2021 ◽  
Vol 15 ◽  
Author(s):  
Lidiane Souza ◽  
Luiggi Lustosa ◽  
Ana Elisa Lemos Silva ◽  
José Vicente Martins ◽  
Thierry Pozzo ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Brachial Plexus Injury ◽  
Current Knowledge ◽  
Peak Velocity ◽  
Motor Planning ◽  
Whole Body ◽  
Control Group ◽  
Reaching Task ◽  
Time To Peak

Background: Traumatic brachial plexus injury (TBPI) typically causes sensory, motor and autonomic deficits of the affected upper limb. Recent studies have suggested that a unilateral TBPI can also affect the cortical representations associated to the uninjured limb.Objective: To investigate the kinematic features of the uninjured upper limb in participants with TBPI.Methods: Eleven participants with unilateral TBPI and twelve healthy controls matched in gender, age and anthropometric characteristics were recruited. Kinematic parameters collected from the index finger marker were measured while participants performed a free-endpoint whole-body reaching task and a cup-to-mouth task with the uninjured upper limb in a standing position.Results: For the whole-body reaching task, lower time to peak velocity (p = 0.01), lower peak of velocity (p = 0.003), greater movement duration (p = 0.04) and shorter trajectory length (p = 0.01) were observed in the TBPI group compared to the control group. For the cup-to-mouth task, only a lower time to peak velocity was found for the TBPI group compared to the control group (p = 0.02). Interestingly, no differences between groups were observed for the finger endpoint height parameter in either of the tasks. Taken together, these results suggest that TBPI leads to a higher cost for motor planning when it comes to movements of the uninjured limb as compared to healthy participants. This cost is even higher in a task with a greater postural balance challenge.Conclusion: This study expands the current knowledge on bilateral sensorimotor alterations after unilateral TBPI and should guide rehabilitation after a peripheral injury.

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