Ischemia of The Right Upper Limb in A Newborn With Down Syndrome A Case Report

Brachial plexus is the plexus of nerves, that supplies the upper limb.Variations in the branches of brachial plexus are common but variations in the roots and trunks are very rare. Here, we report one of the such rare variations in the formations of the lower trunk of the brachial plexus in the right upper limb of a male cadaver. In the present case the lower trunk was formed by the union of ventral rami of C7,C8 and T1 nerve roots. The middle trunk was absent. Upper trunk formation was normal. Journal of College of Medical Sciences-Nepal,2011,Vol-6,No-4, 49-52 DOI: http://dx.doi.org/10.3126/jcmsn.v6i4.6727

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Bilateral Anatomical Variation in the Formation of Trunks of the Brachial Plexus - A Case Report

Journal of Morphological Sciences ◽

10.1055/s-0038-1660485 ◽

2018 ◽

Vol 35 (01) ◽

pp. 9-13

Author(s):

E. Lasch ◽

M. Nazer ◽

L. Bartholdy

Keyword(s):

Case Report ◽

Brachial Plexus ◽

Upper Limb ◽

Scientific Literature ◽

Case Reports ◽

Anatomical Variation ◽

Male Cadaver ◽

Motor Nerves ◽

The Right

AbstractThis study presents a bilateral variation in the formation of trunks of brachial plexus in a male cadaver. The right brachial plexus was composed of six roots (C4-T1) and the left brachial plexus of five roots (C5-T1). Both formed four trunks thus changing the contributions of the anterior divisions of the cervical nerves involved in the formation of the cords and the five main somatic motor nerves for the upper limb. There are very few case reports in the scientific literature on this topic; thus making the present study very relevant.

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ARTERIAL AND NEURAL VARIATIONS IN THE RIGHT UPPER LIMB: A CASE REPORT

International Journal of Anatomy and Research ◽

10.16965/ijar.2019.158 ◽

2019 ◽

Vol 7 (2.2) ◽

pp. 6527-6530

Author(s):

Mohd Arshad ◽

◽

Fateh Mohammad ◽

Rajesh Kumar ◽

Kamil Khan ◽

...

Keyword(s):

Case Report ◽

Upper Limb ◽

The Right

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Benign monomelic amyotrophy with proximal upper limb involvement: case report

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2007000300032 ◽

2007 ◽

Vol 65 (2b) ◽

pp. 524-527 ◽

Cited By ~ 6

Author(s):

Marco Antonio Orsini Neves ◽

Marcos R.G. de Freitas ◽

Mariana Pimentel de Mello ◽

Carlos Henrique Dumard ◽

Gabriel R. de Freitas ◽

...

Keyword(s):

Case Report ◽

Upper Limb ◽

Lower Limb ◽

Clinical Manifestations ◽

Rare Condition ◽

Insidious Onset ◽

Rare Location ◽

Muscle Groups ◽

Clinical Stabilization ◽

The Right

Monomelic amyotrophy (MA) is a rare condition in which neurogenic amyotrophy is restricted to an upper or lower limb. Usually sporadic, it usually has an insidious onset with a mean evolution of 2 to 4 years following first clinical manifestations, which is, in turned, followed by stabilization. We report a case of 20-years-old man who presented slowly progressive amyotrophy associated with proximal paresis of the right upper limb, which was followed by clinical stabilization 4 years later. Eletroneuromyography revealed denervation along with myofasciculations in various muscle groups of the right upper limb. We call atention to this rare location of MA, as well as describe some theories concerning its pathophysiology .

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Symbrachydactyly: A Case Report

Journal of Neonatology ◽

10.1177/0973217920980919 ◽

2020 ◽

Vol 34 (4) ◽

pp. 246-247

Author(s):

Kariman Ghazal ◽

Mariam Rajab ◽

Amal Naous ◽

Loubna Sinno

Keyword(s):

Case Report ◽

Upper Limb ◽

Prenatal Period ◽

Right Hand ◽

The Right

Symbrachydactyly is a disruption of embryonic formation and differentiation that leads to a shorter and smaller upper limb with underdeveloped digits such as short or webbed digits, nubbins, or absence of digits. We report a case of a newborn who had symbrachydactyly of multiple digits in the right hand that was not diagnosed during the prenatal period.

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O09 Recurring brachial plexopathy- the zebra among the horses

Rheumatology Advances in Practice ◽

10.1093/rap/rkab067.008 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Brooke Mara

Keyword(s):

Case Report ◽

Brachial Plexus ◽

Upper Limb ◽

Brachial Plexus Injury ◽

Mechanism Of Injury ◽

Limb Pain ◽

History Of ◽

Upper Limb Pain ◽

The Right

Abstract Case report - Introduction A case study of a teenage boy presenting with severe upper limb pain and recurring loss of upper limb function with no clear mechanism of injury. His progress in therapy was initially as expected; however, symptoms would recur despite consistency and compliance with treatment from the patient. This led to a referral for further investigations where a diagnosis of a rare inflammatory neurological condition was made. This case study is relevant for paediatric physiotherapists working in non-inflammatory, musculoskeletal and pain services as it highlights a lesser-known pathology that presents in a similar way to a more common condition. Case report - Case description M is a 13-year-old boy that presented with a 5-week history of stabbing pains followed by loss of motor function and sensation in his right arm after swinging a remote. A diagnosis of brachial nerve plexopathy had been suggested. M had been diagnosed with Hypermobile Ehlers-Danlos Syndrome (hEDS) but was otherwise fit and well with no significant birth, developmental or family history. He experienced similar episodes of loss of motor function throughout the entire right upper limb following an episode of acute pain aged 4 and aged 12. The episodes were presumed to be a brachial plexus injury following a shoulder subluxation; however, there was no real mechanism of injury to suggest this and symptoms self-resolved after several months in both instances. Age 8 he lost function and sensation in the left arm after a minor pulled elbow, he underwent elbow surgery at another centre to help restore the function of the left arm; however, function didn’t return for approximately 1 year. On examination he had diminished reflexes throughout the right upper limb and reduced sensation along a C3-8 & T1 distribution. He had a correctable thoracic spine kyphosis with significant medial boarder scapula winging on the right. His right shoulder sat lower than the left and he had muscle atrophy at right supraspinatus, infraspinatus, and serratus anterior and deltoid with tight pectoral muscles. He was compensating using upper trapezius to achieve 90—100 degrees of shoulder flexion and abduction with 2/5 muscle power. His elbow muscle strength was reduced to 4/5 in all movements on the right. He could only actively extend his right wrist to 30 degrees and only had flickers of active radial deviation. He lacked active finger extension in digits 2-5 and had 0/5 muscle activity at the right thumb. Case report - Discussion M underwent exercise therapy with a focus on regaining scapula control in lying and isometric rotator cuff strengthening as he had such significant wasting and was unable to control the upper limb in sitting. We also worked on improving his thoracic spine posture and on active assisted finger and wrist exercises to prevent contractures. I initially provided a sling to be worn at school and in busy environments to prevent any subluxations in view of his significant rotator cuff weakness and history of hEDS. The sling also served as a thoracic posture reminder for M. After just 2—3 weeks of input and initially making gains in strength and function, M had an episode of severe pain in the right shoulder followed by worsening motor and sensory symptoms. The recurrent nature of episodes and the weak mechanism of injury, led me to discuss M with a consultant. The consultant referred M to genetics where it was discovered he had idiopathic neuralgic amyotrophy (INA; also known as Parsonage—Turner Syndrome), a rare inflammatory neurological disorder. M had the classic signs and symptoms of INA but as he had presented to various different clinicians and centres with each episode a correlation wasn’t made until this latest presentation to pain clinic Case report - Key learning points The insubstantial mechanism of injury for his current presentation (motor loss from swinging a remote) led me to probe further into past episodes of his upper limb pain. This information spurred me to research alternative causes of his symptoms and discuss the case with a consultant who made an onward referral. As physiotherapists we are highly likely to receive referrals for patients like M, with little more information than ‘shoulder pain’ or ‘brachial plexus injury’ given, which is why our subjective is such an important part of the overall assessment. M’s case highlights how important collating an extensive medical history is to proper investigation and eventual diagnosis. M had a long history of upper limb events for which he had seen a variety of clinicians at various centres. Each event had been treated as an individual episode rather than one larger recurring pattern. Drawing that history together gave a more holistic picture which triggered the referral that identified a diagnosis 8 years after his first presentation to healthcare. M’s case also highlighted the importance of a good patient—therapist relationship. Motivating a patient with this type of condition is challenging; their progress is not linear and they often have to take steps backwards before they can progress again. This is exceptionally difficult for children and their parents, as it is a frustrating and repetitive cycle. They need to trust that you are giving them the correct therapy and as a therapist you need to trust that the patient is compliant with recommendations and exercise. Finally, the shoulder rehabilitation for M was, clinically speaking, the same as any other brachial plexus type injury. The main key difference was the need to intermittently take the exercises down a level in the incidence of a new episode of pain and motor loss.

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Treatment of a patient with COVID-19 and adverse premorbid background: A case report

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care ◽

10.17816/psaic988 ◽

2021 ◽

Vol 11 (3) ◽

pp. 395-402

Author(s):

Julia S. Tulokhonova ◽

Oksana G. Obarchuk ◽

Irina A. Averina

Keyword(s):

Down Syndrome ◽

Case Report ◽

Lung Ventilation ◽

Primary Hypothyroidism ◽

Lung Damage ◽

Oxygen Flow ◽

Satisfactory Condition ◽

Pressure Indicators ◽

The Right ◽

Antihypertensive Treatments

BACKGROUND: In the presence of severe comorbid pathology, children get sick with coronavirus disease 2019 (COVID-19) as severe as adults. CASE REPORT: This paper describes the treatment of a 17-year-old patient with severe bilateral pneumonia caused by severe acute respiratory syndrome coronavirus 2 that damage a large volume of the lung tissue (69% on the right, 87.1% on the left, and grade IV lung lesions according to computed tomography) with an unfavorable premorbid background (grade IV obesity with a body mass index of 54.5 kg/m2, Down syndrome, moderate mental retardation, and primary hypothyroidism). The child was admitted to the hospital on day 10 of illness in an extremely serious condition. On admission, she received artificial lung ventilation and then high-flow mask ventilation with an oxygen flow of 12 L/min. In addition to respiratory support, she received etiotropic (hydroxychloroquine), anticoagulant (enoxaparin), antibacterial, (ceftriaxone), and antihypertensive treatments. Levothyroxine sodium was administered for hypothyroidism. Permanent monitoring of the acidbase balance, general and biochemical blood tests, and coagulography were performed. Gradual positive dynamics of the respiratory status was observed, and oxygen flow decreased. The case was constantly consulted to a pulmonologist, endocrinologist, and cardiologist, who corrected antihypertensive therapy depending on blood pressure indicators. Oxygen support was given for 13 days. After receiving a double-negative PCR test for COVID-19, the patient was transferred to the pulmonology department, from which she was discharged in satisfactory condition for outpatient observation. CONCLUSION: Our patient with COVID-19, severe lung damage with a combination of comorbid pathologies, extremely unfavorable prognosis (grade IV obesity, Down syndrome, and hypothyroidism), who received active complex treatment in accordance with modern guidelines, recovered despite late admission to the hospital.

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Congenital Unilateral Synostosis of Elbow Associated with Multiple Hand Anomalies (Case Report)

Hand Surgery ◽

10.1142/s0218810497000082 ◽

1997 ◽

Vol 02 (01) ◽

pp. 47-52

Author(s):

Emre Togrul ◽

Yaman Sarpel ◽

Huseyin Bayram

Keyword(s):

Case Report ◽

Upper Limb ◽

Rare Malformation ◽

The Right ◽

Hand Anomalies

Congenital synostosis of the elbow is a very rare malformation of the upper limb. We present two similar cases with congenital humeroradial synostosis in association with absence of the ulnar carpals, fourth and fifth metacarpals and phalanges, and syndactily between the second and third fingers. Both cases were male and their anomalies were on the right side. In the second case, an Aitken type-2 proximal focal deficiency of femur was also present.

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Absence of musculocutaneous nerve and accessory head of biceps brachii: a case report

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699123 ◽

2005 ◽

Vol 38 (02) ◽

pp. 114-146

Author(s):

L Arora ◽

R Dhingra

Keyword(s):

Case Report ◽

Median Nerve ◽

Upper Limb ◽

Biceps Brachii ◽

Musculocutaneous Nerve ◽

Nerve Supply ◽

Biceps Brachii Muscle ◽

Nerve Roots ◽

Lateral Cutaneous Nerve ◽

The Right

ABSTRACTDuring dissection of a 55-year-old female cadaver, we observed that three nerve roots contributed to the formation of Median nerve in her right upper limb. Along with this variation, absence of Musculocutaneous nerve was noticed. The muscles of front of arm i.e. Biceps Brachii, Brachialis and Coracobrachialis received their nerve supply from Median nerve. The Lateral cutaneous nerve of forearm was derived from Median nerve. Also an accessory head of Biceps Brachii muscle was present in the right arm of the same cadaver. It is extremely important to be aware of these variations while planning a surgery in the region of axilla or arm as these nerves are more liable to be injured during operations.

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