Unipolar pedicled latissimus dorsi transfer for elbow reanimation in traumatic brachial plexus injuries

Background: Brachial plexus injuries are troubling for the patients socially, economically and emotionally. Elbow joint being a large and vital joint needs to be reanimated so that the patient can carry out his routine work and bring the hand to the mouth. Number of procedures have been defined but latissimus dorsi being a large muscle is the muscle of choice for transfer in cases who present late. Bipolar latissimus dorsi transfers have often been reported but unipolar latissimus dorsi transfer has also been described. Authors have studied the unipolar muscle transfer, it’s surgical technique and results.Methods: In this study 18 patients were studied for demographic data, pre- and post-operative flexion of the elbow and the MRC grade of the corresponding movements. Diagnostic work up in the form of nerve conduction velocity, electromyography and magnetic resonance imaging were carried out and evaluated for their significance in traumatic brachial plexus injuries.Results: In this study 13 patients had avulsion of the C5-6 roots on magnetic resonance imaging. The patients presented after a period of 128.83±56.76 days. Substantial time elapsed and ruled out primary brachial plexus reconstruction or nerve transfers. The average elbow flexion improved from 6.67±5.69 degrees (range: 0-20 degrees) to 86.94±12.38 degrees (range: 65-110 degrees) following unipolar latissimus dorsi transfer. 12 patients (66.67%) developed M4 or M4+ power.Conclusions: Unipolar latissimus dorsi muscle transfer is a reliable method and most of the patients develop adequate strength and satisfactory function at the elbow joint.

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Top-Ten Tips for Imaging the Brachial Plexus with Ultrasound and MRI

Seminars in Musculoskeletal Radiology ◽

10.1055/s-0039-1694753 ◽

2019 ◽

Vol 23 (04) ◽

pp. 405-418 ◽

Cited By ~ 1

Author(s):

James F. Griffith ◽

Radhesh Krishna Lalam

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Brachial Plexus ◽

Muscle Denervation ◽

Resonance Imaging ◽

Neural Injury ◽

Clinical Indications ◽

Magnetic Resonance Imaging Mri ◽

High Level ◽

Extensive Involvement

AbstractWhen it comes to examining the brachial plexus, ultrasound (US) and magnetic resonance imaging (MRI) are complementary investigations. US is well placed for screening most extraforaminal pathologies, whereas MRI is more sensitive and accurate for specific clinical indications. For example, MRI is probably the preferred technique for assessment of trauma because it enables a thorough evaluation of both the intraspinal and extraspinal elements, although US can depict extraforaminal neural injury with a high level of accuracy. Conversely, US is probably the preferred technique for examination of neurologic amyotrophy because a more extensive involvement beyond the brachial plexus is the norm, although MRI is more sensitive than US for evaluating muscle denervation associated with this entity. With this synergy in mind, this review highlights the tips for examining the brachial plexus with US and MRI.

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Musculotendinous Disorders in the Upper Extremity: Part 1. MRI of the Shoulder and Upper Arm

Seminars in Musculoskeletal Radiology ◽

10.1055/s-0037-1604009 ◽

2017 ◽

Vol 21 (04) ◽

pp. 359-375

Author(s):

Robert Boutin ◽

Russell Fritz

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Rotator Cuff ◽

Latissimus Dorsi ◽

Deltoid Muscle ◽

Tendon Injuries ◽

Resonance Imaging ◽

Upper Arm ◽

Teres Major ◽

Crush Injuries

AbstractMuscle and tendon injuries about the shoulder and upper arm are commonly evaluated and characterized with magnetic resonance imaging. This article reviews our experience with abnormalities of the rotator cuff tendons and muscles as well as the deltoid muscle in the shoulder. We discuss and illustrate abnormalities of the upper arm such as strain injuries of the pectoralis major, strain injuries of the teres major and latissimus dorsi, and contusion and crush injuries of the biceps and brachialis muscles in the upper arm.

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Effectiveness of low-field magnetic resonance imaging in diagnosing brachial plexus tumours in dogs – short communication

Bulletin of the Veterinary Institute in Pulawy ◽

10.1515/bvip-2015-0046 ◽

2015 ◽

Vol 59 (2) ◽

pp. 317-319

Author(s):

Zbigniew Adamiak ◽

Yauheni Zhalniarovich ◽

Paulina Przyborowska ◽

Joanna Głodek ◽

Adam Przeworski

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Brachial Plexus ◽

Resonance Imaging ◽

Gadolinium Contrast ◽

Gadolinium Contrast Agent ◽

Low Field ◽

Mri Sequences ◽

Magnetic Resonance Imaging Mri ◽

Brachial Plexus Tumours

AbstractThe aim of the study was to identify magnetic resonance imaging (MRI) sequences that contribute to a quick and reliable diagnosis of brachial plexus tumours in dogs. The tumours were successfully diagnosed in 6 dogs by the MRI with the use of SE, FSE, STIR, Turbo 3 D, 3D HYCE, and GE sequences and the gadolinium contrast agent

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Postoperative changes on functional mapping of the motor cortex in patients with brachial plexus injury: comparative study of magnetoencephalography and functional magnetic resonance imaging

Journal of Orthopaedic Science ◽

10.1007/s007760170005 ◽

2001 ◽

Vol 6 (5) ◽

pp. 397-402 ◽

Cited By ~ 15

Author(s):

Yoshiyuki Iwase ◽

Takunori Mashiko ◽

Naoyuki Ochiai ◽

Hisashi Kurosawa

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Motor Cortex ◽

Functional Magnetic Resonance Imaging ◽

Comparative Study ◽

Brachial Plexus ◽

Brachial Plexus Injury ◽

Functional Magnetic Resonance ◽

Resonance Imaging ◽

Postoperative Changes

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The Supraclavicular Lateral Paravascular Approach for Brachial Plexus Regional Anesthesia: A Simulation Study Using Magnetic Resonance Imaging

Anesthesia & Analgesia ◽

10.1097/00000539-200108000-00041 ◽

2001 ◽

Vol 93 (2) ◽

pp. 442-446 ◽

Cited By ~ 1

Author(s):

??ivind Klaastad ◽

??rjan Smedby

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Brachial Plexus ◽

Regional Anesthesia ◽

Simulation Study ◽

Resonance Imaging

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Accessory Nerve to Suprascapular Nerve Transfer to Restore Shoulder Exorotation in Otherwise Spontaneously Recovered Obstetric Brachial Plexus Lesions

Neurosurgery ◽

10.1227/01.neu.0000232988.46219.e4 ◽

2006 ◽

Vol 59 (4) ◽

pp. 858-869 ◽

Cited By ~ 20

Author(s):

Willem J.R. van Ouwerkerk ◽

Bernard M.J. Uitdehaag ◽

Rob L.M. Strijers ◽

Frans Nollet ◽

Kurt Holl ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Brachial Plexus ◽

Spontaneous Recovery ◽

Nerve Transfer ◽

Suprascapular Nerve ◽

Resonance Imaging ◽

Obstetric Brachial Plexus ◽

Plexus Lesion

Abstract OBJECTIVE: A systematic follow-up of infants with an obstetric brachial plexus lesion of C5 and C6 or the superior trunk showing satisfactory spontaneous recovery of shoulder and arm function except for voluntary shoulder exorotation, who underwent an accessory to suprascapular nerve transfer to improve active shoulder exorotation, to evaluate for functional recovery, and to understand why other superior trunk functions spontaneously recover in contrast with exorotation. METHODS: In 54 children, an accessory to suprascapular nerve transfer was performed as a separate procedure at a mean age of 21.7 months. Follow-up examinations were conducted before and at 4, 8, 12, 24, and 36 months after operation and included scoring of shoulder exorotation and abduction. Intraoperative reactivity of spinatus muscles and additional needle electromyographic responses were registered after electrostimulation of suprascapular nerves. Histological examination of suprascapular nerves was performed. Trophy of spinatus muscles was followed by magnetic resonance imaging scanning. The influence of perinatal variables and results of ancillary investigations on outcome were evaluated. RESULTS: Exorotation improved from 70 degrees to functional levels exceeding 0 degrees, except in two patients. Abduction improved in 27 patients, with results of 90 degrees or more in 49 patients. Electromyography at 4 months did not show signs of denervation in 39 out of 40 patients. Intraoperative electrostimulation of suprascapular nerves elicited spinatus muscle reaction in 44 out of 48 patients. Histology of suprascapular nerves was normal. Preoperative magnetic resonance imaging scans showed only minor wasting of spinatus muscles in contrast with major wasting after successful operations. CONCLUSION: An accessory to suprascapular nerve transfer is effective to restore active exorotation when performed as the primary or a separate secondary procedure in children older than 10 months of age. Contradictory spontaneous recovery of other superior trunk functions and integrity of suprascapular nerves, as well as absence of spinatus muscle wasting direct to central nervous changes are possible main causes for the lack of exorotation.

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