MR-Neurografie bei neuralgischer Schulteramyotrophie

HintergrundDas Parsonage-Turner-Syndrom (PTS) bzw. die neuralgische Schulteramyotrophie ist eine Erkrankung des peripheren Nervensystems, die typischerweise den Plexus brachialis sowie dessen Äste betrifft 1. Das Krankheitsbild scheint dabei häufiger zu sein als früher angenommen bei einer Prävalenz von bis zu ca. 1 Fall pro 100 000 pro Jahr 1. Die Pathophysiologie des PTS ist bisher unvollständig verstanden, jedoch wird angenommen, dass eine immun-vermittelte Genese ursächlich ist 2. Mögliche Trigger-Faktoren können u. a. virale Infekte, Impfungen, Traumata oder Operationen sein 3. Am häufigsten sind die Nn. thoracicus longus, suprascapularis und interosseus anterior betroffen 1. Charakterisiert ist das PTS durch akute, nachts eintretende Schmerzen im Schultergürtel, welche von Paresen und entsprechenden Atrophien gefolgt werden.

Prolonged brachial plexus neuropathy: a rare complication following protracted endometriosis surgery in Lloyd-Davies position

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.

Rare localization of neurofibroma and technique for its removal

In this message we are talking about a well-expressed case of Recknghausen's disease, which we had the opportunity to observe in the autumn of last year. Without going into the details of the literary review of neurofibromatosis, we decided to focus on the analysis of our patient only because this case is interesting for its pronounced familial and hereditary nature of the disease and the presence of significant tumor sizes emanating from the plexus brachialis sin., Which caused severe suffering to the patient. and therefore demanded surgical intervention.

Nerves transfers for functional hand recovery in traumatic lower brachial plexopathy

Background: Distal nerve transfers are an innovative modality for the treatment of C8-T1 brachial plexus lesions. The purpose of this case series is to report the authors’ results with hand restoration function by nerve transfer in patients with lower brachial plexus injury. Methods: Three consecutive nerve transfers were performed in a series of 11 patients to restore hand function after injury to the lower brachial plexus: brachialis motor branch to anterior interosseous nerve (AIN) and supinator branch to the posterior interosseous nerve (PIN) in a first surgical procedure, and AIN to pronator quadratus branch of ulnar nerve between 4 and 6 months later. Results: In all, 11 male patients underwent 33 surgical procedures. Time between brachial plexus injury and surgery was a mean of 11 months (range 4–13 months). Postoperative follow-up ranged from 12 to 24 months. We observed recovery of M3 or better finger flexion strength (AIN) and wrist extension (PIN) in 8 of the 11 surgically treated upper limbs. These patients recovered full thumb and finger extension between 6 and 12 months of surgery, without significant loss of donor function. Conclusion: Nerve transfers represent a way of restoring volitional control of upper extremity function in patients with C8-T1 brachial plexus injury.