A Funhouse Mirror: Muscular Co-Contractions as a Reflection of a Spontaneous Aberrant Regeneration of the Brachial Plexus Injury in the Adults: Anatomical Background, an Attempt to Classify and their Clinical Relevance within the Reconstruction Strategies

Mapping Intimacies ◽

10.5772/intechopen.100609 ◽

2021 ◽

Author(s):

Alexander A. Gatskiy ◽

Ihor B. Tretyak

Keyword(s):

Treatment Strategies ◽

Nerve Transfer ◽

Elbow Flexion ◽

Surgical Reconstruction ◽

Clinical Classification ◽

Donor Pool ◽

Surgical Strategies ◽

Aberrant Regeneration ◽

Spontaneous Regeneration

A certain number of spontaneously recovering birth injuries to the brachial (BPI) plexus are known to be accompanied by muscle co-contractions (Co-Cs). The process of aberrant spontaneous regeneration contributes to the appearance of this phenomenon. Treatment strategies are mostly narrowed down to temporarily “switching off” the antagonist, allowing the agonist to perform. Less is known about the incidence of BPI-associated Co-Cs in adults (a-BPI), the control of which mainly presumes the extrapolation of a treatment strategy that has been shown to be effective in infants. Nowadays, surgical reconstruction of independent elbow flexion at BPIs relies heavily on redirection (transfer) of nerves that produce their own Co-Cs. These induced Co-Cs could potentially be reduced. Selecting the appropriate nerve transfer strategy (when the donor pool is narrowing), with its potential impact on the already complex and intricate global and segmental biomechanics of the upper extremity, becomes challenging. The chapter presents the anatomical background for the occurrence of muscular Co-Cs, a work on clinical classification of both regeneration associated and induced Co-Cs, possible surgical strategies, their benefits and limitations, in the presence of regeneration-associated muscle Co-Cs at a-BPI and clinical examples.

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The Outcome of Biofeedback Muscle Re-Education after Brachial Plexus Reconstruction: a Case Series

Surabaya Physical Medicine and Rehabilitation Journal ◽

10.20473/spmrj.v2i1.2020.35-41 ◽

2020 ◽

Vol 2 (1) ◽

pp. 35

Author(s):

Lydia Arfianti ◽

Ratna Darjanti Haryadi

Keyword(s):

Brachial Plexus ◽

Median Time ◽

Data Extraction ◽

Case Series ◽

Nerve Transfer ◽

Elbow Flexion ◽

Rehabilitation Program ◽

Surgical Reconstruction ◽

Muscle Transfer ◽

Functional Muscle Transfer

The purpose of this report was to evaluate the outcome of biofeedback muscle re-education after brachial plexus reconstruction. A case series was conducted based on registry data of Rehabilitation Outpatient Clinic. A total of 20 subjects underwent surgical reconstruction to restore elbow flexion in the period of 2012-2014 were included in the study. All 20 subjects received biofeedback muscle re-education until end June 2015 (data extraction). Oucome measures were time to recovery (months) after surgical reconstruction and patients’ compliance. Recovery is considered when muscle contraction of biceps (nerve transfer) and gracilis (free functional muscle transfer/ FFMT) are ≥ 100μV, recorded using EMG-surface electrode. Of 4 subjects underwent nerve transfer, all showed recovery with median time of 9 months. Of 16 subjects underwent FFMT, 5 showed recovery with median time of 9 months. The majority of subjects in both groups could comply with once in 2 weeks rehabilitation program.

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Upper brachial plexus injury in adults: comparative effectiveness of different repair techniques

Journal of Neurosurgery ◽

10.3171/2014.9.jns132823 ◽

2015 ◽

Vol 122 (1) ◽

pp. 195-201 ◽

Cited By ~ 48

Author(s):

Zarina S. Ali ◽

Gregory G. Heuer ◽

Ryan W. F. Faught ◽

Shriya H. Kaneriya ◽

Umar A. Sheikh ◽

...

Keyword(s):

Brachial Plexus ◽

Controlled Trial ◽

Treatment Strategies ◽

Nerve Transfer ◽

Elbow Flexion ◽

Surgical Approaches ◽

Shoulder Abduction ◽

Nerve Grafting ◽

Nerve Transfers ◽

Repair Techniques

OBJECT Adult upper trunk brachial plexus injuries result in significant disability. Several surgical treatment strategies exist, including nerve grafting, nerve transfers, and a combination of both approaches. However, no existing data clearly indicate the most successful strategy for restoring elbow flexion and shoulder abduction in these patients. The authors reviewed the literature to compare outcomes of the three surgical repair techniques listed above to determine the optimal approach to traumatic injury to the upper brachial plexus in adults. METHODS Both PubMed and EMBASE databases were searched for English-language articles containing the MeSH topic “brachial plexus” in conjunction with the word “injury” or “trauma” in the title and “surgery” or “repair” as a MeSH subheading or in the title, excluding pediatric articles and those articles limited to avulsions. The search was also limited to articles published after 1990 and containing at least 10 operated cases involving upper brachial plexus injuries. The search was supplemented with articles obtained through the “Related Articles” feature on PubMed and the bibliographies of selected publications. From the articles was collected information on the operation performed, number of operated cases, mean subject ages, sex distribution, interval between injury and surgery, source of nerve transfers, mean duration of follow-up, year of publication, and percentage of operative success in terms of elbow flexion and shoulder abduction of the injured limb. The recovery of elbow flexion and shoulder abduction was separately analyzed. A subanalysis was also performed to assess the recovery of elbow flexion following various neurotization techniques. RESULTS As regards the restoration of elbow flexion, nerve grafting led to significantly better outcomes than either nerve transfer or the combined techniques (F = 4.71, p = 0.0097). However, separating the Oberlin procedure from other neurotization techniques revealed that the former was significantly more successful (F = 82.82, p < 0.001). Moreover, in comparing the Oberlin procedure to nerve grafting or combined procedures, again the former was significantly more successful than either of the latter two approaches (F = 53.14; p < 0.001). In the restoration of shoulder abduction, nerve transfer was significantly more successful than the combined procedure (p = 0.046), which in turn was significantly better than nerve grafting procedures (F = 5.53, p = 0.0044). CONCLUSIONS According to data in this study, in upper trunk brachial plexus injuries in adults, the Oberlin procedure and nerve transfers are the more successful approaches to restore elbow flexion and shoulder abduction, respectively, compared with nerve grafting or combined techniques. A prospective, randomized controlled trial would be necessary to fully elucidate differences in outcome among the various surgical approaches.

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PHRENIC NERVE TRANSFER IN THE RESTORATION OF ELBOW FLEXION IN BRACHIAL PLEXUS AVULSION INJURIES

Neurosurgery ◽

10.1227/01.neu.0000338865.19411.7f ◽

2009 ◽

Vol 65 (suppl_4) ◽

pp. A125-A131 ◽

Cited By ~ 40

Author(s):

Mario G. Siqueira ◽

Roberto S. Martins

Keyword(s):

Pulmonary Function ◽

Brachial Plexus ◽

Phrenic Nerve ◽

Pulmonary Function Tests ◽

Major Complication ◽

Nerve Transfer ◽

Elbow Flexion ◽

Surgical Reconstruction ◽

Small Series ◽

The Mean

Abstract OBJECTIVE Phrenic nerve transfer has been used for treating lesions of the brachial plexus since 1970. Although, today, surgeons are more experienced with the technique, there are still widespread concerns about its effects on pulmonary function. This study was undertaken to evaluate the effectiveness and safety of this procedure. METHODS Fourteen patients with complete palsy of the upper limb were submitted to phrenic nerve transfer as part of a strategy for surgical reconstruction of their plexuses. Two patients were lost to follow-up, and 2 patients were followed for less than 2 years. Of the remaining 10 patients, 9 (90%) were male. The lesions affected both sides equally. The mean age of the patients was 24.8 years (range, 14–43 years), and the mean interval from injury to surgery was 6 months (range, 3–9 months). The phrenic nerve was always transferred to the musculocutaneous nerve, and a nerve graft (mean length, 8 cm; range, 4.5–12 cm) was necessary in all cases. RESULTS There was no major complication related to the surgery. Seven patients (70%) recovered functional level biceps strength (Medical Research Council grade ≥3). All of the patients exhibited a transient decrease in pulmonary function tests, but without clinical respiratory problems. CONCLUSION On the basis of our small series and data from the literature, we conclude that phrenic nerve transfer in well-selected patients is a safe and effective procedure for recovering biceps function.

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