Quantitation of the lower subscapular nerve for potential use in neurotization procedures

2006 ◽  
Vol 105 (6) ◽  
pp. 881-883 ◽  
Author(s):  
R. Shane Tubbs ◽  
Charles A. Khoury ◽  
E. George Salter ◽  
Leslie Acakpo-Satchivi ◽  
John C. Wellons ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Axillary Nerve ◽  
Musculocutaneous Nerve ◽  
Upper Extremities ◽  
Subscapularis Muscle ◽  
New Information ◽  
Teres Major ◽  
Left And Right ◽  
The Mean ◽  
Potential Use

Object New information regarding nerve branches of the brachial plexus can be useful to the surgeon performing neurotization procedures following patient injury. Nerves in the vicinity of the axillae have been commonly used for neural grafting procedures, with the exception of the lower subscapular nerve (LSN). Methods The authors dissected and measured the LSN in 47 upper extremities (left and right sides) obtained in 27 adult cadavers, and determined distances between the LSN and surrounding nerves to help quantify it for possible use in neurotization procedures. The mean diameter of the LSN was 2.3 mm. The mean length of the LSN from its origin at the posterior cord until it branched to the subscapularis muscle was 3.5 cm, and the mean distance from this branch until its termination in the teres major muscle was 6 cm. Therefore, the mean length of the entire LSN from the posterior cord to the teres major was 9.5 cm. When the LSN was mobilized to explore its possible use in neurotization, it reached the entrance site of the musculocutaneous nerve into the coracobrachialis muscle in all but three sides and was within 1.5 cm from this point in these three. In the other specimens, the mean length of the LSN distal to this site of the musculocutaneous nerve was 2 cm. The mobilized LSN reached the axillary nerve trunk as it entered the quadrangular space in all specimens. The mean length of the LSN distal to this point on the axillary nerve was 2.5 cm. Furthermore, on all but one side the LSN was found within the confines of an anatomical triangle previously described by the authors. Conclusions The authors hope that these data will prove useful to the surgeon for both identifying the LSN and planning for potential neurotization procedures of the brachial plexus.

Nerve transfers to the biceps and brachialis branches to improve elbow flexion strength after brachial plexus injuries

2004 ◽  
Vol 16 (5) ◽  
pp. 313-318
Author(s):  
Thomas H. Tung ◽  
Christine B. Novak ◽  
Susan E. Mackinnon
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Elbow Flexion ◽  
Musculocutaneous Nerve ◽  
Nerve Transfers ◽  
Brachialis Muscle ◽  
Nerve Fascicle ◽  
The Mean ◽  
Mean Time ◽  
Flexion Strength

Object In this study the authors evaluated the outcome in patients with brachial plexus injuries who underwent nerve transfers to the biceps and the brachialis branches of the musculocutaneous nerve. Methods The charts of eight patients who underwent an ulnar nerve fascicle transfer to the biceps branch of the musculocutaneous nerve and a separate transfer to the brachialis branch were retrospectively reviewed. Outcome was assessed using the Medical Research Council (MRC) grade to classify elbow flexion strength in conjunction with electromyography (EMG). The mean patient age was 26.4 years (range 16–45 years) and the mean time from injury to surgery was 3.8 months (range 2.5–7.5 months). Recovery of elbow flexion was MRC Grade 4 in five patients, and Grade 4+in three. Reinnervation of both the biceps and brachialis muscles was confirmed on EMG studies. Ulnar nerve function was not downgraded in any patient. Conclusions The use of nerve transfers to reinnervate the biceps and brachialis muscle provides excellent elbow flexion strength in patients with brachial plexus nerve injuries.

Use of intercostal nerves for neurotization of the musculocutaneous nerve in infants with birth-related brachial plexus palsy

2001 ◽  
Vol 94 (3) ◽  
pp. 386-391 ◽  
Author(s):  
Hidehiko Kawabata ◽  
Toru Shibata ◽  
Yoshito Matsui ◽  
Natsuo Yasui
Keyword(s):  
Brachial Plexus ◽  
Muscle Power ◽  
Musculocutaneous Nerve ◽  
Biceps Muscle ◽  
Brachial Plexus Palsy ◽  
Content Type ◽  
Age At Surgery ◽  
The Mean ◽  
Intercostal Nerves ◽  
Fine Print

Object. The use of intercostal nerves (ICNs) for the neurotization of the musculocutaneous nerve (MCN) in adult patients with traumatic brachial plexus palsy has been well described. However, its use for brachial plexus palsy in infants has rarely been reported. The authors surgically created 31 ICN—MCN communications for birth-related brachial plexus palsy and present the surgical results. Methods. Thirty-one neurotizations of the MCN, performed using ICNs, were conducted in 30 patients with birth-related brachial plexus palsy. In most cases other procedures were combined to reconstruct all upper-extremity function. The mean patient age at surgery was 5.8 months and the mean follow-up period was 5.2 years. Intercostal nerves were transected 1 cm distal to the mammary line and their stumps were transferred to the axilla, where they were coapted directly to the MCN. Two ICNs were used in 26 cases and three ICNs in five cases. The power of the biceps muscle of the arm was rated Grade M4 in 26 (84%) of 31 patients. In the 12 patients who underwent surgery when they were younger than 5 months of age, all exhibited a grade of M4 (100%) in their biceps muscle power. These results are better than those previously reported in adults. Conclusions. Neurotization of the MCN by surgically connecting ICNs is a safe, reliable, and effective procedure for reconstruction of the brachial plexus in patients suffering from birth-related palsy.

End-to-side neurorrhaphy in brachial plexus reconstruction

2013 ◽  
Vol 119 (3) ◽  
pp. 689-694 ◽  
Author(s):  
Pavel Haninec ◽  
Libor Mencl ◽  
Radek Kaiser
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Nerve Repair ◽  
Experimental Studies ◽  
Deltoid Muscle ◽  
Axillary Nerve ◽  
Musculocutaneous Nerve ◽  
Biceps Muscle ◽  
Nerve Reconstruction ◽  
Nerve Suture

Object Although a number of theoretical and experimental studies dealing with end-to-side neurorrhaphy (ETSN) have been published to date, there is still a considerable lack of clinical trials investigating this technique. Here, the authors describe their experience with ETSN in axillary and musculocutaneous nerve reconstruction in patients with brachial plexus palsy. Methods From 1999 to 2007, out of 791 reconstructed nerves in 441 patients treated for brachial plexus injury, the authors performed 21 axillary and 2 musculocutaneous nerve sutures onto the median, ulnar, or radial nerves. This technique was only performed in patients whose donor nerves, such as the thoracodorsal and medial pectoral nerves, which the authors generally use for repair of axillary and musculocutaneous nerves, respectively, were not available. In all patients, a perineurial suture was carried out after the creation of a perineurial window. Results The overall success rate of the ETSN was 43.5%. Reinnervation of the deltoid muscle with axillary nerve suture was successful in 47.6% of the patients, but reinnervation of the biceps muscle was unsuccessful in the 2 patients undergoing musculocutaneous nerve repair. Conclusions The authors conclude that ETSN should be performed in axillary nerve reconstruction but only when commonly used donor nerves are not available.

Classification of Impairment of Shoulder Abduction in Obstetric Brachial Plexus Palsy and its Clinical Significance

2000 ◽  
Vol 25 (1) ◽  
pp. 46-48 ◽  
Author(s):  
Y-D. GU ◽  
L. CHEN ◽  
L-Y. SHEN
Keyword(s):  
Brachial Plexus ◽  
Shoulder Abduction ◽  
Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus Palsy ◽  
X Ray ◽  
Subscapularis Muscle ◽  
Dynamic Type ◽  
Obstetric Brachial Plexus ◽  
Teres Major

Shoulder abduction was studied in 25 cases of obstetric brachial plexus palsy (OBPP). According to muscle function, electromyographic features and X-ray examination, impairment of shoulder abduction could be classified into dynamic, resistant or combined types. Five cases were the dynamic type, which was characterized by paralysis of the shoulder abductors. Fifteen cases were categorized as the resistant type, with contracture of the subscapularis muscle, co-contraction of latissimus dorsi and teres major muscles and secondary disorders of the shoulder joint. Five cases were classified as the combined type in which there were both dynamic and resistant factors. Appropriate management and surgical procedures in the shoulder affected by OBPP depend on the pathological classification.

scholarly journals VARIATIONS OF ORIGIN AND DISTANCE OF AXILLARY NERVE: A DESCRIPTIVE STUDY

2018 ◽  
Vol 4 (4) ◽  
pp. 13-16
Author(s):  
Rakate Nilesh S ◽  
Gadekar Savita H ◽  
Gajbhiye Vivekanand M
Keyword(s):  
Brachial Plexus ◽  
Coracoid Process ◽  
Axillary Nerve ◽  
Common Trunk ◽  
Anterior Branch ◽  
Human Cadavers ◽  
Infraclavicular Brachial Plexus Block ◽  
The Mean ◽  
Plexus Block ◽  
Formalin Fixed

Background – Axillary nerve, one of the terminal branches of posterior cord of brachial plexus is more prone for injuries. Lack of proper anatomical knowledge and variations of axillary nerve leads to risk of nerve injuries. The present study describes the origin of axillary nerve, its distance of origin from tip of coracoids process. Method: Thirty brachial plexuses from fifteen formalin fixed human cadavers of both the sexes were studied by dissection method. Origin and branching pattern of axillary nerve and its distance of origin from the anteromedial aspect of tip of coracoid process & posterolateral aspect of acromion process was recorded. Results: Out of the 30 specimens studied, axillary nerve was originating from the posterior cord of brachial plexus in 90% of specimens, remaining 10% specimens showed a common trunk of origin of axillary nerve from posterior cord of brachial plexus. The mean distance of origin of axillary nerve from the anteromedial aspect of tip of coracoid process and posterolateral aspect of acromion process is 3.98cm & 6.30cm respectively. The axillary nerve terminated into anterior and posterior branch within quadrangular space in 29 specimens. In one specimen articular branch for shoulder joint was not directly arising from axillary nerve instead it is arising from anterior branch of axillary nerve. Conclusion: In studied population Axillary nerves display variations in the origin and distance of origin. Knowledge of this variation in axillary nerve is very important to clinicians, anaesthetists and orthopaedic surgeons during surgical exploration of neck, axilla and upper arm, shoulder dislocation, infraclavicular brachial plexus block and fracture of surgical neck of humerus.Keywords: Axillary nerve; Posterior cord; Coracoid process; Acromion process.

scholarly journals Posterior Cord of Brachial Plexus and Its Branches: Anatomical Variations and Clinical Implication

ISRN Anatomy ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Rakhi Rastogi ◽  
Virendra Budhiraja ◽  
Kshitij Bansal
Keyword(s):  
Brachial Plexus ◽  
Clinical Implication ◽  
Axillary Artery ◽  
Anatomical Variations ◽  
Axillary Nerve ◽  
Upper Extremities ◽  
Surgical Approaches ◽  
Lower Trunk ◽  
Medical Undergraduate ◽  
Posterior Division

Background. Knowledge of anatomical variations of posterior cord and its branches is important not only for the administration of anaesthetic blocks but also for surgical approaches to the neck, axilla, and upper arm. The present study aimed to record the prevalence of such variations with embryological explanation and clinical implication. Material and Method. 37 formalin-preserved cadavers, that is, 74 upper extremities from the Indian population, constituted the material for the study. Cadavers were dissected during routine anatomy classes for medical undergraduate. Dissection includes surgical incision in the axilla, followed by retraction of various muscles, to observe and record the formation and branching pattern of posterior cord of brachial plexus. Results. Posterior cord was formed by union of posterior division of C5 and C6 roots with posterior division of middle and lower trunk (there was no upper trunk) in 16.2% of upper extremities. Posterior cord of brachial plexus was present lateral to the second part of axillary artery in 18.9% of upper extremities. Axillary nerve was taking origin from posterior division of upper trunk in 10.8% upper extremities and thoracodorsal nerve arising from axillary nerve in 22.9% upper extremities. Conclusion. It is important to be aware of such variations while planning a surgery in the region of axilla as these nerves are more liable to be injured during surgical procedures.

scholarly journals Functional Outcome of Neurotization to The Musculocutaneous Nerve in Traumatic Brachial Plexus Injury

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Mohammad Azrul Bin Abdul Rashid ◽  
Kamarul Ariffin Khalid ◽  
Raffael Ismail
Keyword(s):  
Brachial Plexus ◽  
Functional Outcome ◽  
Brachial Plexus Injury ◽  
Cross Sectional Study ◽  
Elbow Flexor ◽  
Musculocutaneous Nerve ◽  
Dash Score ◽  
Elbow Flexors ◽  
Cross Sectional ◽  
The Mean

Introduction:  Neurotization procedures to the elbow flexors are commonly done in traumatic brachial plexus injury (BPI). The objective of this study was to evaluate the recovery of elbow flexors in patients who underwent neurotization procedure to musculocutaneous nerve in the panplexus and upper trunk BPI. Materials and Methods: This was a cross sectional study involving 70 patients who underwent neurotization to elbow flexor. A total of 31 patients (44%) had panplexus injury and 39 (56%) had upper trunk BPI. Elbow flexor motor power and post-operative Disabilities of the Arm, Shoulder and Hand (DASH) score were evaluated. Results:  The mean age of the patients was 22.7 years. Patients with panplexus BPI underwent neurotization to the elbow flexor using spinal accessory nerve as a donor and patients with upper trunk BPI used either ulnar or median nerve as a donor. The results of elbow flexors recovery in panplexus BPI were good (MRC grade 4 and 5) in 11 patients (35.5%) and poor in 20 patients (64.5%). Conversely, the recovery of elbow flexors in upper trunk BPI were better with 28 patients (71.8%). Good post-operative DASH score (score <50 points) were noted in 29 patients (74.4%) with upper trunk BPI. Only seven patients (22.6%) with panplexus BPI showed good post-operative DASH score. Majority of patients with panplexus BPI demonstrated poor recovery of elbow flexor and post-operative DASH score as compare to upper trunk BPI (p= 0.002). Conclusion:  Overall, this study showed significantly better functional outcome of neurotization procedure to elbow flexor in upper trunk BPI than in panplexus BPI.

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

2009 ◽  
Vol 110 (4) ◽  
pp. 749-753 ◽  
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.

scholarly journals Anatomical variations of the brachial plexus terminal branches in Ethiopian cadavers

1970 ◽  
Vol 6 (1) ◽  
pp. 896-905
Author(s):  
Edengenet Guday Demis ◽  
Asegedeche Bekele
Keyword(s):  
Brachial Plexus ◽  
Median Nerve ◽  
Surgical Procedures ◽  
Upper Limb ◽  
Anatomical Variations ◽  
Axillary Nerve ◽  
Musculocutaneous Nerve ◽  
Clinically Significant

Anatomical variations are clinically significant, but many are inadequately described or quantified. Variations in anatomy of the brachial plexus are important to surgeons and anesthesiologists performing surgical procedures in the neck, axilla and upper limb regions. It is also important for radiologists who interpret plain and computerized imaging and anatomists to teach anatomy. This study aimed to describe the anatomical variations of the terminal branches of brachial plexus on 20 Ethiopian cadavers. The cadavers were examined bilaterally for the terminal branches of brachial plexus. From the 40 sides studied for the terminal branches of the brachial plexus; 28 sides were found without variation, 10 sides were found with median nerve variation, 2 sides were found with musculocutaneous nerve variation and 2 sides were found with axillary nerve variation. We conclude that variation in the median nerve was more common than variations in other terminal branches.

Nerve transfers to the biceps and brachialis branches to improve elbow flexion strength after brachial plexus injuries

2003 ◽  
Vol 98 (2) ◽  
pp. 313-318 ◽  
Author(s):  
Thomas H. Tung ◽  
Christine B. Novak ◽  
Susan E. Mackinnon
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Elbow Flexion ◽  
Musculocutaneous Nerve ◽  
Content Type ◽  
Nerve Transfers ◽  
Nerve Fascicle ◽  
The Mean ◽  
Flexion Strength ◽  
Fine Print

Object. In this study the authors evaluated the outcome in patients with brachial plexus injuries who underwent nerve transfers to the biceps and the brachialis branches of the musculocutaneous nerve. Methods. The charts of eight patients who underwent an ulnar nerve fascicle transfer to the biceps branch of the musculocutaneous nerve and a separate transfer to the brachialis branch were retrospectively reviewed. Outcome was assessed using the Medical Research Council (MRC) grade to classify elbow flexion strength in conjunction with electromyography (EMG). The mean patient age was 26.4 years (range 16–45 years) and the mean time from injury to surgery was 3.8 months (range 2.5–7.5 months). Recovery of elbow flexion was MRC Grade 4 in five patients, and Grade 4+ in three. Reinnervation of both the biceps and brachialis muscles was confirmed on EMG studies. Ulnar nerve function was not downgraded in any patient. Conclusions. The use of nerve transfers to reinnervate the biceps and brachialis muscle provides excellent elbow flexion strength in patients with brachial plexus nerve injuries.

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