Occupational shoulder disability: functional recovery after decompression and neurolysis of the upper brachial plexus and the long thoracic nerve

Object There is insufficient information in the neurosurgical literature regarding the long thoracic nerve (LTN). Many neurosurgical procedures necessitate a thorough understanding of this nerve's anatomy, for example, brachial plexus exploration/repair, passes for ventriculoperitoneal shunt placement, pleural placement of a ventriculopleural shunt, and scalenotomy. In the present study the authors seek to elucidate further the surgical anatomy of this structure. Methods Eighteen cadaveric sides were dissected of the LTN, anatomical relationships were observed, and measurements were obtained between it and surrounding osseous landmarks. The LTN had a mean length of 27 ± 4.5 cm (mean ± standard deviation) and a mean diameter of 3 ± 2.5 mm. The distance from the angle of the mandible to the most proximal portion of the LTN was a mean of 6 ± 1.1 cm. The distance from this proximal portion of the LTN to the carotid tubercle was a mean of 3.3 ± 2 cm. The LTN was located a mean 2.8 cm posterior to the clavicle. In 61% of all sides the C-7 component of the LTN joined the C-5 and C-6 components of the LTN at the level of the second rib posterior to the axillary artery. In one right-sided specimen the C-5 component directly innervated the upper two digitations of the serratus anterior muscle rather than joining the C-6 and C-7 parts of this nerve. The LTN traveled posterior to the axillary vessels and trunks of the brachial plexus in all specimens. It lay between the middle and posterior scalene muscles in 56% of sides. In 11% of sides the C-5 and C-6 components of the LTN traveled through the middle scalene muscle and then combined with the C-7 contribution. In two sides, all contributions to the LTN were situated between the middle scalene muscle and brachial plexus and thus did not travel through any muscle. The C-7 contribution to the LTN was always located anterior to the middle scalene muscle. In all specimens the LTN was found within the axillary sheath superior to the clavicle. Distally, the LTN lay a mean of 15 ± 3.4 cm lateral to the jugular notch and a mean of 22 ± 4.2 cm lateral to the xiphoid process of the sternum. Conclusions The neurosurgeon should have knowledge of the topography of the LTN. The results of the present study will allow the surgeon to better localize this structure superior and inferior to the clavicle and decrease morbidity following invasive procedures.

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Long Thoracic Nerve Neurotization for Restoration of Shoulder Function in C5-7 Brachial Plexus Preganglionic Injuries: Case Report

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2010.05.024 ◽

2010 ◽

Vol 35 (9) ◽

pp. 1427-1431 ◽

Cited By ~ 3

Author(s):

Tetsuya Yamada ◽

Kazuteru Doi ◽

Yasunori Hattori ◽

Shushi Hoshino ◽

Soutetsu Sakamoto ◽

...

Keyword(s):

Case Report ◽

Brachial Plexus ◽

Shoulder Function ◽

Long Thoracic Nerve ◽

Thoracic Nerve

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Shrug radiographs for the diagnosis of long thoracic nerve palsy in traumatic brachial plexus injury

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2020.03.052 ◽

2020 ◽

Vol 29 (12) ◽

pp. 2595-2600

Author(s):

Kiminori Yukata ◽

Kazuteru Doi ◽

Toshitaka Okabayashi ◽

Yasunori Hattori ◽

Sotetsu Sakamoto

Keyword(s):

Brachial Plexus ◽

Nerve Palsy ◽

Brachial Plexus Injury ◽

Long Thoracic Nerve ◽

Thoracic Nerve

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Aberrant Dual Origin of the Dorsal Scapular Nerve and Its Communication with Long Thoracic Nerve: An Unusual Variation of the Brachial Plexus

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2015/13620.6027 ◽

2015 ◽

Author(s):

Poonam Shilal

Keyword(s):

Brachial Plexus ◽

Long Thoracic Nerve ◽

Thoracic Nerve ◽

Dual Origin

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The contralateral long thoracic nerve as a donor for upper brachial plexus neurotization procedures: cadaveric feasibility study

Journal of Neurosurgery ◽

10.3171/2008.4.17511 ◽

2009 ◽

Vol 110 (4) ◽

pp. 749-753 ◽

Cited By ~ 3

Author(s):

R. Shane Tubbs ◽

Marios Loukas ◽

Mohammadali M. Shoja ◽

Ghaffar Shokouhi ◽

John C. Wellons ◽

...

Keyword(s):

Brachial Plexus ◽

Long Thoracic Nerve ◽

Neural Connections ◽

Thoracic Nerve ◽

Mean Diameter ◽

Human Cadavers ◽

Neck Rotation ◽

Left And Right ◽

The Mean ◽

Neurovascular Structures

Object Various donor nerves, including the ipsilateral long thoracic nerve (LTN), have been used for brachial plexus neurotization procedures. Neurotization to proximal branches of the brachial plexus using the contralateral long thoracic nerve (LTN) has, to the authors' knowledge, not been previously explored. Methods In an attempt to identify an additional nerve donor candidate for proximal brachial plexus neurotization, the authors dissected the LTN in 8 adult human cadavers. The nerve was transected at its distal termination and then passed deep to the clavicle and axillary neurovascular bundle. This passed segment of nerve was then tunneled subcutaneously and contralaterally across the neck to a supra- and infraclavicular exposure of the suprascapular and musculocutaneous nerves. Measurements were made of the length and diameter of the LTN. Results All specimens were found to have a LTN that could be brought to the aforementioned contralateral nerves. Neural connections remained tension free with left and right neck rotation of ~ 45°. The mean length of the LTN was 22 cm with a range of 18–27 cm. The overall mean diameter of this nerve was 3.0 mm. No gross evidence of injury to surrounding neurovascular structures was identified in any specimen. Conclusions Based on the results of this cadaveric study, the use of the contralateral LTN may be considered for neurotization of the proximal musculocutaneous and suprascapular nerves.

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Two clinical tests assessing long thoracic nerve function to determine C5 and C6 root graft eligibility in patients with brachial plexus injury

Journal of Neurosurgery ◽

10.3171/2021.6.jns21956 ◽

2021 ◽

pp. 1-8

Author(s):

Jayme Augusto Bertelli ◽

Karine Rosa Gasparelo ◽

Anna Seltser

Keyword(s):

Brachial Plexus ◽

Pretest Probability ◽

Nerve Function ◽

Clinical Tests ◽

Mri Findings ◽

Long Thoracic Nerve ◽

Receiver Operating Characteristic Curves ◽

Thoracic Nerve ◽

The Status ◽

Brachial Plexus Repair

OBJECTIVE Identifying roots available for grafting is of paramount importance prior to reconstructing complex injuries involving the brachial plexus. This is traditionally achieved by combining input from both clinical examinations and imaging studies. In this paper, the authors describe and evaluate two new clinical tests to study long thoracic nerve function and, consequently, to predict the status of the C5 and C6 roots after global brachial plexus injuries. METHODS From March 2020 to December 2020, in 41 patients undergoing brachial plexus repair, preoperative clinical assessments were performed using modified C5 and C6 protraction tests, C5 and C6 Tinel’s signs, and MRI findings to predict whether graft-eligible C5 and C6 roots would be identified intraoperatively. Findings from these three assessments were then combined in a logistic regression model to predict graft eligibility, with overall predictive accuracies calculated as areas under receiver operating characteristic curves. RESULTS In the 41 patients, the pretest probability of C5 root availability for grafting was 85% but increased to 92% with a positive C5 protraction test and to 100% when that finding was combined with a positive C5 Tinel’s sign and favorable MRI findings. The pretest probability of C6 root availability was 40%, which increased to 84% after a positive C6 protraction test and to 93% when the protraction test result concurred with Tinel’s test and MRI findings. CONCLUSIONS Combining observations of the protraction tests with Tinel’s sign and MRI findings accurately predicts C5 and C6 root graft eligibility.

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Brachial plexus variations in its formation and main branches

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502003001200006 ◽

2003 ◽

Vol 18 (suppl 5) ◽

pp. 14-18 ◽

Cited By ~ 30

Author(s):

Valéria Paula Sassoli Fazan ◽

André de Souza Amadeu ◽

Adilson L. Caleffi ◽

Omar Andrade Rodrigues Filho

Keyword(s):

Brachial Plexus ◽

Phrenic Nerve ◽

Anatomical Variations ◽

Anatomical Structure ◽

The Body ◽

Long Thoracic Nerve ◽

Thoracic Nerve ◽

Close Relationship ◽

Axillary Region ◽

The Right

PURPOSE: The brachial plexus has a complex anatomical structure since its origin in the neck throughout its course in the axillary region. It also has close relationship to important anatomic structures what makes it an easy target of a sort of variations and provides its clinical and surgical importance. The aims of the present study were to describe the brachial plexus anatomical variations in origin and respective branches, and to correlate these variations with sex, color of the subjects and side of the body. METHODS: Twenty-seven adult cadavers separated into sex and color had their brachial plexuses evaluated on the right and left sides. RESULTS: Our results are extensive and describe a large number of variations, including some that have not been reported in the literature. Our results showed that the phrenic nerve had a complete origin from the plexus in 20% of the cases. In this way, a lesion of the brachial plexus roots could result in diaphragm palsy. It is not usual that the long thoracic nerve pierces the scalenus medius muscle but it occurred in 63% of our cases. Another observation was that the posterior cord was formed by the posterior divisions of the superior and middle trunks in 9%. In these cases, the axillary and the radial nerves may not receive fibers from C7 and C8, as usually described. CONCLUSION: Finally, the plexuses studied did not show that sex, color or side of the body had much if any influence upon the presence of variations.

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