scholarly journals Brachial Plexus Injury Associated with Median Sternotomy during Cardiac Surgery: Three Cases of C8 Radiculopathy Due to the Fracture of the First Rib

Diagnostics ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1896
Author(s):  
Yu Jin Im ◽  
Min Soo Kang ◽  
Sun Woong Kim ◽  
Duk Hyun Sung

In cardiac surgery, median sternotomy is often necessary during certain surgical processes and it can cause the rare complication of brachial plexus injury. Retraction of the rib cage during median sternotomy may produce a fracture of the first thoracic rib at the costovertebral junction which might penetrate or irritate the lower root of the brachial plexus. Because the C8 ventral root is located immediately superior to the first thoracic rib, the extraforaminal C8 root is thought to be the key location of brachial plexus injury by the first rib fracture. This report describes three cases of brachial plexus injury after median sternotomy in a single center. In our cases, fracture of the first rib and consequent brachial plexus injury is confirmed with imaging and electrophysiologic studies. The fracture of the first rib is not detected with standard plain images and it is confirmed only with CT or MRI studies. Advanced imaging tools are recommended to assess the first rib fracture when brachial plexus injury is suspected after median sternotomy.

2002 ◽  
Vol 27 (3) ◽  
pp. 293-295 ◽  
Author(s):  
H. SEKI ◽  
S. SAITOH ◽  
Y. HATA ◽  
N. MURAKAMI ◽  
T. SHIMIZU ◽  
...  

A 27-year-old man presented with a lower trunk brachial plexus injury due to excessive callus formation following a stress-induced first rib fracture. The callus, but not the first rib, was resected through a supraclavicular approach. His symptoms resolved in 2 months, and no recurrence was seen at 2 years follow-up.


2021 ◽  
Vol 14 (11) ◽  
pp. e243408
Author(s):  
Anna Katrina Hay ◽  
Anna McDougall ◽  
Peter Hinstridge ◽  
Sanjeev Rajakuldendran ◽  
Wai Yoong

Brachial plexus injury is a rare but potentially serious complication of laparoscopic surgery. Loss of motor and/or sensory innervation can have a significant impact on the patient’s quality of life following otherwise successful surgery. A 38-year-old underwent elective laparoscopic management of severe endometriosis during which she was placed in steep head-down tilt Lloyd-Davies position for a prolonged period. On awakening from anaesthesia, the patient had no sensation or movement of her dominant right arm. A total plexus brachialis injury was suspected. As advised by a neurologist, an MRI brachial plexus, nerve conduction study and electromyography were requested. She was managed conservatively and made a gradual recovery with a degree of residual musculocutaneous nerve neuropathy. The incidence of brachial plexus injury following laparoscopy is unknown but the brachial plexus is particularly susceptible to injury as a result of patient positioning and prolonged operative time. Patient positioning in relation to applied clinical anatomy is explored and risk reduction strategies described.


1993 ◽  
Vol 18 (2) ◽  
pp. 282-284 ◽  
Author(s):  
D.A. Hudson ◽  
R. Boome ◽  
I. Sanpera

1989 ◽  
Vol 3 (3) ◽  
pp. 286-289 ◽  
Author(s):  
H. Rieke ◽  
R. Benecke ◽  
E.R. DeVivie ◽  
E. Turner ◽  
T. Crozier ◽  
...  

1971 ◽  
Vol 11 (4) ◽  
pp. 315-319 ◽  
Author(s):  
Marvin M. Kirsh ◽  
Kenneth R. Magee ◽  
Otto Gago ◽  
Donald R. Kahn ◽  
Herbert Sloan

2008 ◽  
Vol 33 (4) ◽  
pp. 501-506 ◽  
Author(s):  
J. MCCAUL ◽  
H. SHARMA ◽  
T. E. HEMS

Forty of 136 consecutive patients referred for management of brachial plexus injuries had closed supraclavicular injuries. The results of the initial chest X-rays were available for 29 patients. Nine had avulsion of the C8 and T1 nerve roots from the spinal cord. Eight cases had MR confirmation of lower root avulsion, six of these cases were confirmed surgically and none had any long-term clinical recovery. Twenty had partial brachial plexus injuries without avulsion of these roots. Seven of nine patients with avulsion of C8 and T1 had an extrapleural apical fluid collection. One of these had a fractured first rib. Two of 20 without avulsion had an extrapleural apical fluid collection. Both had fractured the first rib. The difference in incidence of extrapleural apical fluid collection between the two groups, excluding those cases with first rib fractures, was statistically significant. Without a first rib fracture, an ipsilateral extrapleural apical haematoma on a plain chest X-ray of patients with brachial plexus injury strongly suggests pre-ganglionic injury to the lower roots.


1991 ◽  
Vol 39 (06) ◽  
pp. 360-364 ◽  
Author(s):  
R. Stangl ◽  
A. Altendorf-Hofmann ◽  
J. von der Emde

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