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Seminars in Ultrasound, CT, and MR Dec 1996The brachial plexus arises from the lower cervical and upper thoracic spinal nerve roots. It courses between the anterior and middle scalene muscles and adjacent to the... (Review)
Review
The brachial plexus arises from the lower cervical and upper thoracic spinal nerve roots. It courses between the anterior and middle scalene muscles and adjacent to the subclavian artery. The brachial plexus may be visualized by both MRI and CT. Symptoms of a brachial plexopathy commonly are nonlocalizing. Traumatic injuries and involvement by tumors probably account for the majority of etiologies responsible for these plexopathies. Inflammatory processes also involve the brachial plexus. This article reviews the anatomy of the brachial plexus from both surgical and radiographic approaches and also addresses the symptomatology of brachial plexopathy underlying it.
Topics: Brachial Plexus; Diagnostic Imaging; Humans; Inflammation; Peripheral Nervous System Diseases
PubMed: 9023866
DOI: 10.1016/s0887-2171(96)90002-5 -
Neuroimaging Clinics of North America Feb 2014Continuous improvements in magnetic resonance scanner, coil, and pulse sequence technology have resulted in the ability to perform routine, high-quality imaging of the... (Review)
Review
Continuous improvements in magnetic resonance scanner, coil, and pulse sequence technology have resulted in the ability to perform routine, high-quality imaging of the brachial plexus. With knowledge of the anatomy of the plexus, and a familiarity with common pathologic conditions affecting this area, radiologists can provide valuable imaging evaluation of patients with brachial plexus pathologies.
Topics: Adult; Brachial Plexus; Brachial Plexus Neuropathies; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neuroimaging; Treatment Outcome
PubMed: 24210315
DOI: 10.1016/j.nic.2013.03.024 -
Handbook of Clinical Neurology 2013Obstetrical brachial plexus palsy is considered to be the result of a trauma during the delivery, even if there remains some controversy surrounding the causes. Although... (Review)
Review
Obstetrical brachial plexus palsy is considered to be the result of a trauma during the delivery, even if there remains some controversy surrounding the causes. Although most babies recover spontaneously in the first 3 months of life, a small number remains with poor recovery which requires surgical brachial plexus exploration. Surgical indications depend on the type of lesion (producing total or partial palsy) and particularly the nonrecovery of biceps function by the age of 3 months. In a global palsy, microsurgery will be mandatory and the strategy for restoration will focus first on hand reinnervation and secondarily on providing elbow flexion and shoulder stability. Further procedures may be necessary during growth in order to avoid fixed contractured deformities or to give or increase strength of important muscle functions like elbow flexion or wrist extension. The author reviews the history of obstetrical brachial plexus injury, epidemiology, and the specifics of descriptive and functional anatomy in babies and children. Clinical manifestations at birth are directly correlated with the anatomical lesion. Finally, operative procedures are considered, including strategies of reconstruction with nerve grafting in infants and secondary surgery to increase functional capacity at later ages. However, normal function is usually not recovered, particularly in total brachial plexus palsy.
Topics: Adult; Birth Injuries; Brachial Plexus; Brachial Plexus Neuropathies; Female; Humans; Infant, Newborn; Pregnancy; Treatment Outcome
PubMed: 23622302
DOI: 10.1016/B978-0-444-52910-7.00014-3 -
Plastic and Reconstructive Surgery Dec 2009Obstetrical brachial plexus palsy is commonly attributed to excessive traction applied to the baby's neck during a difficult delivery. The majority of infants with... (Review)
Review
Obstetrical brachial plexus palsy is commonly attributed to excessive traction applied to the baby's neck during a difficult delivery. The majority of infants with brachial plexus palsy recover spontaneously within the first 3 months of life. However, in 10 to 30 percent of cases, the recovery is incomplete. Global palsy and the absence of biceps muscle function at 3 months of age have been adopted as the main indications for early brachial plexus microsurgery. In late cases or when primary reconstruction has not yielded satisfactory results, secondary reconstruction will intervene as an enhancement of a specific functional deficit or of the overall function of the upper extremity. In this article, the authors review the history of obstetrical brachial plexus palsy, the epidemiology and cause, and the indications for and the timing of surgery. The current diagnostic modalities and clinical evaluation of plexus injuries are also considered. The advances in electrophysiology, myelography, and computed tomographic scanning and magnetic resonance imaging are presented, all of which are important diagnostic modalities that facilitate a more accurate diagnosis. Obstetrical brachial plexus injuries may require multistaged reconstructive procedures, including neurolysis, resection of neuromas, identification of intraplexus and extraplexus donor nerves, selective neurotizations, selective nerve transfers, and nerve grafting. Finally, the various secondary procedures in terms of anatomical location in the upper extremity are described. Whatever the reports and results, the complex doctrine of obstetrical brachial plexus palsy continues to evolve with notable functional outcomes, but return to normal function remains a challenge for the future.
Topics: Birth Injuries; Brachial Plexus; Brachial Plexus Neuropathies; Child; Humans; Infant; Infant, Newborn; Microsurgery; Plastic Surgery Procedures
PubMed: 19952705
DOI: 10.1097/PRS.0b013e3181bcf01f -
Medical Archives (Sarajevo, Bosnia and... 2023Traumatic brachial plexus injuries are common among young adults, with a majority of patients succumbing to chronic pain syndromes. Conservative management is usually... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Traumatic brachial plexus injuries are common among young adults, with a majority of patients succumbing to chronic pain syndromes. Conservative management is usually not satisfactory in these cases and surgical interventions are often required. We have conducted a systematic review and meta-analysis examining one of the neurosurgical techniques, spinal cord stimulation (SCS), in chronic pain neuromodulation in cases of chronic pain syndrome after traumatic brachial plexus injuries.
OBJECTIVE
This systematic review aims to explore the reported use of cervical spinal cord stimulation as a neuromodulator in patients with chronic pain syndromes following traumatic brachial plexus injury.
METHODS
A systematic literature search was conducted using MEDLINE through the OVID interface, ProQuest, Web of Science, The Cochrane Library, and Scopus. Our own files and reference lists of identified key articles were also searched.
RESULTS
A total of 13 studies (8 case reports and 5 case series), comprising 29 patients were included. Most brachial plexus injuries were sustained in motor vehicle accidents. 86% (25/29) of patients showed a good initial response to SCS, however, the response decreased over time, and 69% (20/29) of the patients reported a good response at the end of follow-up. Lead migration was the only complication reported in two studies.
CONCLUSION
SCS is a less invasive procedure with significantly fewer neurological side effects. A trial period of SCS is suggested in patients who have failed conservative treatment modalities before other neurosurgical interventions are considered.
Topics: Young Adult; Humans; Chronic Pain; Brachial Plexus; Spinal Cord; Neurosurgical Procedures
PubMed: 38299090
DOI: 10.5455/medarh.2023.77.370-376 -
The Journal of Hand Surgery, European... Jan 2020Major nerve injuries such as those of the brachial plexus present a significant challenge for both rehabilitation and evaluation of outcome. With these often complex and... (Review)
Review
Major nerve injuries such as those of the brachial plexus present a significant challenge for both rehabilitation and evaluation of outcome. With these often complex and multi-faceted injuries, correct selection of outcome measures is important. Healthy nerve function in humans heightens our interactions with the world, creating quality and enjoyment through our experiences of movement and touch. Therefore, assessments should be holistic and representative of all of these features. This article considers the assessment and evaluation of all of the features of nerve injury: sensorimotor, sensation (including that of pain), function and the psychosocial aspects. Current practice is described and combined with clinical experience and research findings to provide suggestions and recommendations for the selection of the most appropriate tools for use with this patient group.
Topics: Brachial Plexus; Brachial Plexus Neuropathies; Humans; Neurologic Examination; Pain Measurement; Patient Reported Outcome Measures
PubMed: 31597518
DOI: 10.1177/1753193419879645 -
Child's Nervous System : ChNS :... Sep 2020This historical review presents the relevant data about the evolution of the surgical treatment of neonatal brachial plexus palsy. Starting with the first clinical... (Review)
Review
This historical review presents the relevant data about the evolution of the surgical treatment of neonatal brachial plexus palsy. Starting with the first clinical description by Smellie in 1754, we will present the initial enthusiasm for the surgery followed by a lack of interest that lasted many years, the resurgence of interest in operative management in the 1970s, and the consolidation in the 1980s of surgery as the standard indication in cases of neonatal brachial plexus palsy without a functional spontaneous recovery.
Topics: Birth Injuries; Brachial Plexus; Brachial Plexus Neuropathies; Humans; Infant, Newborn; Neonatal Brachial Plexus Palsy; Recovery of Function
PubMed: 32468240
DOI: 10.1007/s00381-020-04685-5 -
Seminars in Musculoskeletal Radiology Apr 2015Pathologic conditions of the brachial plexus often result in serious and disabling complications. With the increasing availability and use of new and powerful MRI... (Review)
Review
Pathologic conditions of the brachial plexus often result in serious and disabling complications. With the increasing availability and use of new and powerful MRI sequences and coils, understanding and assessment of the complex anatomy and pathology of the brachial plexus have been greatly facilitated. These new technical developments have led to an improved assessment of brachial plexus lesions, thereby improving patient care. In this article we describe various MRI techniques for the evaluation of the brachial plexus obtained at 1.5 T and 3 T, and we explain differences and similarities between sequences and protocols performed on MRI equipment from different vendors. The main characteristics of pathologic conditions affecting the brachial plexus are discussed and illustrated, as well as their differential diagnoses, with an emphasis on key imaging findings and relevance for patient management. Pitfalls related to suboptimal technique and image interpretation are also addressed.
Topics: Brachial Plexus; Brachial Plexus Neuropathies; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Peripheral Nervous System Neoplasms
PubMed: 25764238
DOI: 10.1055/s-0035-1546300 -
Archives of Neurology Jul 2002
Topics: Brachial Plexus; Brachial Plexus Neuropathies; History, 18th Century; History, 19th Century; History, 20th Century; Humans
PubMed: 12117369
DOI: 10.1001/archneur.59.7.1186 -
Hand Clinics Feb 2005Imaging the brachial plexus is challenging because of the complex anatomy of the region and the wide variety of pathology that can affect it. For the purpose of imaging,... (Review)
Review
Imaging the brachial plexus is challenging because of the complex anatomy of the region and the wide variety of pathology that can affect it. For the purpose of imaging, it is helpful to divide traumatic and nontraumatic entities affect-ing the brachial plexus. Improvements in imaging technology, including multidetector CT for CT myelography and the availability of full-field-strength MRI systems with fast gradients and dedicated surface coils for optimal spatial resolution, have led to more accurate prospective diagnoses and improved aid for neurosurgical planning for traumatic and nontraumatic brachial plexopathies. CT myelography is the current gold standard for the diagnosis of nerve root avulsions affecting the brachial plexus. MRI is the preferred modality for nontraumatic brachial plexopathy. Other modalities, such as US and PET, have a limited role in the evaluation of brachial plexus pathology. High-quality, high-resolution CT and MRI remain the mainstays for imaging the brachial plexus.
Topics: Brachial Plexus; Brachial Plexus Neuropathies; Diagnostic Imaging; Humans
PubMed: 15668063
DOI: 10.1016/j.hcl.2004.09.005