Good sensory recovery of the hand in brachial plexus surgery using the intercostobrachial nerve as the donor

ABSTRACT Objective: Restoration of the sensitivity to sensory stimuli in complete brachial plexus injury is very important. The objective of our study was to evaluate sensory recovery in brachial plexus surgery using the intercostobrachial nerve (ICBN) as the donor. Methods: Eleven patients underwent sensory reconstruction using the ICBN as a donor to the lateral cord contribution to the median nerve, with a mean follow-up period of 41 months. A protocol evaluation was performed. Results: Four patients perceived the 1-green filament. The 2-blue, 3-purple and 4-red filaments were perceptible in one, two and three patients, respectively. According to Highet's scale, sensation recovered to S3 in two patients, to S2+ in two patients, to S2 in six patients, and S0 in one patient. Conclusion: The procedure using the ICBN as a sensory donor restores good intensity of sensation and shows good results in location of perception in patients with complete brachial plexus avulsion.

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Axillary nerve repair by fascicle transfer from the ulnar or median nerve in upper brachial plexus palsy

Journal of Neurosurgery ◽

10.3171/2012.5.jns111572 ◽

2012 ◽

Vol 117 (3) ◽

pp. 610-614 ◽

Cited By ~ 8

Author(s):

Pavel Haninec ◽

Radek Kaiser

Keyword(s):

Brachial Plexus ◽

Median Nerve ◽

Brachial Plexus Injury ◽

Nerve Repair ◽

Deltoid Muscle ◽

Axillary Nerve ◽

Brachial Plexus Palsy ◽

Nerve Reconstruction ◽

Long Thoracic Nerve

Object Nerve repair using motor fascicles of a different nerve was first described for the repair of elbow flexion (Oberlin technique). In this paper, the authors describe their experience with a similar method for axillary nerve reconstruction in cases of upper brachial plexus palsy. Methods Of 791 nerve reconstructions performed by the senior author (P.H.) between 1993 and 2011 in 441 patients with brachial plexus injury, 14 involved axillary nerve repair by fascicle transfer from the ulnar or median nerve. All 14 of these procedures were performed between 2007 and 2010. This technique was used only when there was a deficit of the thoracodorsal or long thoracic nerve, which are normally used as donors. Results Nine patients were followed up for 24 months or longer. Good recovery of deltoid muscle strength was seen in 7 (77.8%) of these 9 patients, and in 4 patients with less follow-up (14–23 months), for an overall success rate of 78.6%. The procedure was unsuccessful in 2 of the 9 patients with at least 24 months of follow-up. The first showed no signs of reinnervation of the axillary nerve by either clinical or electromyographic evaluation in 26 months of follow-up, and the second had Medical Research Council (MRC) Grade 2 strength in the deltoid muscle 36 months after the operation. The last of the group of 14 patients has had 12 months of follow-up and is showing progressive improvement of deltoid muscle function (MRC Grade 2). Conclusions The authors conclude that fascicle transfer from the ulnar or median nerve onto the axillary nerve is a safe and effective method for reconstruction of the axillary nerve in patients with upper brachial plexus injury.

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The intercostobrachial nerve as a sensory donor for hand reinnervation in brachial plexus reconstruction is a feasible technique and may be useful for restoring sensation

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20170073 ◽

2017 ◽

Vol 75 (7) ◽

pp. 439-445 ◽

Cited By ~ 5

Author(s):

Luciano Foroni ◽

Mário Gilberto Siqueira ◽

Roberto Sérgio Martins ◽

Gabriela Pintar Oliveira

Keyword(s):

Brachial Plexus ◽

Median Nerve ◽

Lateral Cord ◽

Intercostobrachial Nerve ◽

Restoration Of Sensibility

ABSTRACT Objective Few donors are available for restoration of sensibility in patients with complete brachial plexus injuries. The objective of our study was to evaluate the anatomical feasibility of using the intercostobrachial nerve (ICBN) as an axon donor to the lateral cord contribution to the median nerve (LCMN). Methods Thirty cadavers were dissected. Data of the ICBN and the LCMN were collected, including diameters, branches and distances. Results The diameters of the ICBN and the LCMN at their point of coaptation were 2.7mm and 3.7mm, respectively. The ICBN originated as a single trunk in 93.3% of the specimens and bifurcated in 73.3%. The distance between the ICBN origin and its point of coaptation to the LCMN was 54mm. All ICBNs had enough extension to reach the LCMN. Conclusion Transfer of the ICBN to the LCMN is anatomically feasible and may be useful for restoring sensation in patients with complete brachial plexus injuries.

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First Study of the Prevalence and Characterization of Brachial Plexus Injuries in Guatemala

Journal of Brachial Plexus and Peripheral Nerve Injury ◽

10.1055/s-0041-1731746 ◽

2021 ◽

Vol 16 (01) ◽

pp. e46-e50

Author(s):

Carmen Joanna González Lemus ◽

Fernando Xavier Romero Prieto

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Injury ◽

Main Mode ◽

Cross Sectional ◽

Speed Up ◽

Male Patients ◽

Mode Of Transportation ◽

Surgery Department

Abstract Objective This study aimed to estimate the prevalence of brachial plexus injuries and to characterize clinically and epidemiologically patients with brachial plexus injury. Materials and Methods In this cross-sectional descriptive study, 2,923 medical records of patients aged 1 to 64 years who presented at outpatient peripheral nerve unit of the Orthopedic Surgery Department of Hospital Roosevelt, Guatemala, from January 2017 to December 2017, were prospectively analyzed to identify the prevalence and factors associated with brachial plexus injuries. Results The prevalence rate of brachial plexus injuries in patients was 5.74%. This injury is more common in men (90.5%) aged 24 to 64 years. Brachial plexus injuries occurred secondary to motorcycle accident in 72% of the cases, with the majority affecting the dominant upper extremity. In addition, 64.28% of the patients took 1 to 6 months to seek consultation, whereas only 16.07% requested medical assistance <1 month from the onset of symptoms, and this result was associated with early diagnosis and adequate recovery during follow-up. Furthermore, 66.67% presented upper brachial plexus injury with no associated fractures or vascular injury, manifesting distress while performing daily activities that required hand, arm, and elbow movements. Conclusion The risk of suffering BPIs in Guatemala increases in economically active male patients that use motorcycles as main mode of transportation. Patients should consult immediately after injury onset to optimize management results. For this reason, hospitals must develop specialized clinical guidelines to speed up the identification and treatment of BPI injuries.

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Total brachial plexus injury: contralateral C7 root transfer to the lower trunk versus the median nerve

Neural Regeneration Research ◽

10.4103/1673-5374.239444 ◽

2018 ◽

Vol 13 (11) ◽

pp. 1968 ◽

Cited By ~ 4

Author(s):

Jie Lao ◽

Ye Jiang ◽

Li Wang ◽

Xin Zhao

Keyword(s):

Brachial Plexus ◽

Median Nerve ◽

Brachial Plexus Injury ◽

Lower Trunk

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Minimum Ten-Year Outcomes of Partial Ulnar Nerve Transfer for Restoration of Elbow Flexion in Patients with Upper Brachial Plexus Injury

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835519500358 ◽

2019 ◽

Vol 24 (03) ◽

pp. 283-288

Author(s):

Yusuke Nagano ◽

Daisuke Kawamura ◽

Alaa Terkawi ◽

Atsushi Urita ◽

Yuichiro Matsui ◽

...

Keyword(s):

Muscle Strength ◽

Brachial Plexus ◽

Ulnar Nerve ◽

Functional Outcomes ◽

Brachial Plexus Injury ◽

Nerve Transfer ◽

Elbow Flexion ◽

The Mean ◽

Flexion Strength

Background: Partial ulnar nerve transfer to the biceps motor branch of the musculocutaneous nerve (Oberlin’s transfer) is a successful approach to restore elbow flexion in patients with upper brachial plexus injury (BPI). However, there is no report on more than 10 years subjective and objective outcomes. The purpose of this study was to clarify the long-term outcomes of Oberlin’s transfer based on the objective evaluation of elbow flexion strength and subjective functional evaluation of patients. Methods: Six patients with BPI who underwent Oberlin’s transfer were reviewed retrospectively by their medical records. The mean age at surgery was 29.5 years, and the mean follow-up duration was 13 years. The objective functional outcomes were evaluated by biceps muscle strength using the Medical Research Council (MRC) grade at preoperative, postoperative, and final follow-up. The patient-derived subjective functional outcomes were evaluated using the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire at final follow-up. Results: All patients had MRC grade 0 (M0) or 1 (M1) elbow flexion strength before operation. Four patients gained M4 postoperatively and maintained or increased muscle strength at the final follow-up. One patient gained M3 postoperatively and at the final follow-up. Although one patient achieved M4 postoperatively, the strength was reduced to M2 due to additional disorder. The mean score of QuickDASH was 36.5 (range, 7–71). Patients were divided into two groups; three patients had lower scores and the other three patients had higher scores of QuickDASH. Conclusions: Oberlin’s transfer is effective in the restoration of elbow flexion and can maintain the strength for more than 10 years. Patients with upper BPI with restored elbow flexion strength and no complicated nerve disorders have over ten-year subjective satisfaction.

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Cadaveric Study of Anatomical Variations in the Musculocutaneous Nerve and in the Median Nerve

Journal of Morphological Sciences ◽

10.1055/s-0039-1688799 ◽

2019 ◽

Vol 36 (02) ◽

pp. 122-125

Author(s):

Abhilasha Priya ◽

Chandni Gupta ◽

Antony Sylvan D'souza

Keyword(s):

Brachial Plexus ◽

Median Nerve ◽

Peripheral Nerves ◽

Anatomical Variations ◽

Musculocutaneous Nerve ◽

Branching Pattern ◽

Kasturba Medical College ◽

Upper Limbs ◽

Medical College ◽

Lateral Cord

Introduction The musculocutaneous nerve and the median nerve are branches from the lateral cord of the brachial plexus with a root value of C5, C6, and C7. The medial root of the median nerve is a branch of the medial cord. The present study aims at observing any variations in these peripheral nerves, so that this knowledge can be utilized by surgeons, anesthesiologists, and orthopedicians during surgical procedures and nerve block. Materials and Methods The present study was carried on 30 adult embalmed cadavers (60 upper limbs) in the department of anatomy of the Kasturba Medical College , Manipal, India. The infraclavicular part of the brachial plexus was dissected, and any anatomical variations in the formation and in the branching pattern of the musculocutaneous nerve and of the median nerve were noted and photographs were taken. Results The median nerve was noted to be formed from 3 roots in 8 out of 60 dissected upper limbs (13.33%). The musculocutaneous nerve was absent in 5% of the dissected limbs, and communications between these 2 nerves were noted in 13.33% of the dissected limbs. Conclusions Noted variations of the nerves may be of help to surgeons operating in the axillas and in the arms.

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End-to-side neurorrhaphy as a salvage procedure for irreparable nerve injuries

Journal of Neurosurgery ◽

10.3171/jns.2003.99.1.0180 ◽

2003 ◽

Vol 99 (1) ◽

pp. 180-185 ◽

Cited By ~ 21

Author(s):

Tunç C. Öğün ◽

Mustafa Özdemir ◽

Hakan Şenaran ◽

Mehmet E. Üstün

Keyword(s):

Median Nerve ◽

Nerve Repair ◽

Salvage Procedure ◽

Nerve Grafting ◽

Nerve Injuries ◽

Abductor Pollicis Brevis ◽

Content Type ◽

Sensory Recovery ◽

Abductor Pollicis Brevis Muscle

✓ After a few reports on end-to-side nerve repair at the beginning of the last century, the technique was put aside until its recent reintroduction. The authors present their results in three patients with median nerve defects that were between 15 and 22 cm long and treated using end-to-side median-to-ulnar neurorrhaphy through an epineurial window. The follow-up times were between 32 and 38 months. Sensory evaluation involved superficial touch, pinprick, and two-point discrimination tests. Motor evaluation was completed by assessing the presence of opposition and by palpating the abductor pollicis brevis muscle. Sensory recovery was observed in all patients in the median nerve dermatome, and motor recovery was absent, except in Case 1. End-to-side nerve repair can be a viable alternative to nerve grafting in patients with long gaps between the ends of the injured nerve.

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