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Cureus Apr 2024C5 palsy is a potential complication of cervical decompression surgery from which many patients do not recover or partially recover function. We present the case of a...
C5 palsy is a potential complication of cervical decompression surgery from which many patients do not recover or partially recover function. We present the case of a 48-year-old patient who developed elbow flexion paralysis after anterior decompression surgery with fusion of the C5-C7 levels. Muscle function was not spontaneously restored until eight months after surgery. In this case, we performed an Oberlin procedure to restore the function of the arm. Muscle strength (5/5) and volume were obtained 13 months after surgery. A reasonable waiting period is required after C5 palsy in case spontaneous recovery occurs. Treatment decision should be based on the patient's symptoms. Nerve transfers have been shown to be effective when performed after six months, especially in Oberlin transfer.
PubMed: 38807835
DOI: 10.7759/cureus.59217 -
Journal of Clinical Medicine May 2024We present a case of a healthy young male professional water polo player who presented with swelling and pain in the upper arm and elbow after vigorous exercise....
We present a case of a healthy young male professional water polo player who presented with swelling and pain in the upper arm and elbow after vigorous exercise. Diagnostic workup included an MRI and dynamic duplex ultrasound, which revealed compression of the axillary vein by a hypertrophic pectoralis minor muscle without thrombosis, constituting McCleery syndrome. This is a rare entity within the multiple thoracic outlet syndrome aetiologies. Taking a detailed history and physical examination complemented with diagnostic imaging are vital to the diagnosis. Afterward, the patient was treated with multimodal physical therapy and fully recovered and even exceeded his previous training and play level.
PubMed: 38792435
DOI: 10.3390/jcm13102894 -
Journal of Clinical Medicine May 2024Internal rotation contractures of the shoulder are common sequelae of conservatively treated obstetric brachial plexus palsy (OBPP) with incomplete spontaneous...
Internal rotation contractures of the shoulder are common sequelae of conservatively treated obstetric brachial plexus palsy (OBPP) with incomplete spontaneous neurological recovery. Humerus derotation osteotomy has been suggested as a possible treatment option to improve arm positioning. However, consensus as to whether humerus derotation osteotomy can successfully restore limb function is missing. In the present controlled cohort study, we aimed at analyzing global upper extremity kinematics with a 3D-video analysis system in children with shoulder internal rotation contractures secondary to OBPP before, and one year after, humerus derotation osteotomy. Patients under 18 years of age that presented to our center with conservatively treated internal rotation contractures of the shoulder and subsequently underwent humerus derotation osteotomy were included. The unimpaired arm served as a respective control. Pre-operatively, all patients showed severe internal rotation contractures of the shoulder of almost 60° at rest. At the follow-up, the position of the shoulder at rest was greatly shifted to 9° of internal rotation. The patients showed statistically significant improvement in maximum external rotation and abduction of the shoulder, as well as in maximum flexion of the elbow, and the range of motion of pro/supination. The maximum internal rotation of the shoulder, however, was diminished after the osteotomy. Our data indicated that derotational osteotomy is a promising procedure which can be used to correct for internal rotation contractures secondary to OBPP. Moreover, 3D-video analysis proved to be a useful tool that supplies the surgeon with both precise information about the degree of distortion pre-operatively, thus helping to decide on the amount of correction, and secondly, a measurement of the post-operative gain in upper extremity function.
PubMed: 38792301
DOI: 10.3390/jcm13102759 -
Veterinary Sciences May 2024Locoregional anaesthetic techniques are invaluable for providing multimodal analgesia for painful surgical procedures. This prospective, randomised study describes a...
Locoregional anaesthetic techniques are invaluable for providing multimodal analgesia for painful surgical procedures. This prospective, randomised study describes a nerve stimulator-guided brachial plexus blockade (BPB) in rabbits undergoing orthopaedic surgery in comparison to systemic lidocaine. Premedication was provided with intramuscular (IM) medetomidine, fentanyl, and midazolam. Anaesthesia was induced (propofol IV) and maintained with isoflurane. Nine rabbits received a lidocaine BPB (2%; 0.3 mL kg), and eight received a lidocaine constant rate infusion (CRI) (2 mg kg IV, followed by 100 µg kg min). Rescue analgesia was provided with fentanyl IV. Carprofen was administered at the end of the surgery. Postoperative pain was determined using the Rabbit Grimace Scale (RGS) and a composite pain scale. Buprenorphine was administered according to the pain score for two hours after extubation. Rabbits were filmed during the first two hours to measure distance travelled and behaviours. Food intake and faeces output were compared. Every rabbit in CRI required intraoperative rescue analgesia compared to none in BPB. However, rabbits in both groups had similar pain scores, and there was no difference in the administration of postoperative analgesia. There were no significant differences in food intake or faeces production over 18 h, and no significant differences in distance travelled or behaviours examined during the first two hours. BPB seems superior for intraoperative analgesia. Postoperatively, both groups were comparable.
PubMed: 38787185
DOI: 10.3390/vetsci11050213 -
Veterinary Sciences Apr 2024Nerve sheath tumors (NSTs) are well-recognized primary nervous system tumors, but there is relatively limited information in dogs including comparison of NSTs in...
Nerve sheath tumors (NSTs) are well-recognized primary nervous system tumors, but there is relatively limited information in dogs including comparison of NSTs in different anatomical locations. This retrospective study describes the clinical features and outcomes in a group of dogs with NSTs affecting the cranial nerves or spinal nerves. Thirty dogs were included, 25 with a presumptive diagnosis and five confirmed by histopathologic analysis. Seven dogs also had cytology of tumor samples, which were supportive of the NST diagnosis in four. Eight dogs had cranial nerve-associated NSTs, with six involving the trigeminal nerve. Twenty-two dogs had spinal nerve-associated NSTs including 13 invading the spinal canal and nine peripheral to the spinal canal, with the majority affecting nerves or nerve roots of the brachial plexus. The prognosis was poor, with dogs being euthanized eventually because of disease progression. Among dogs alive 1 week after diagnosis, the median survival time was 4 months but ranged from 2 weeks to >2 years. While there was a broad overlap between NST locations, survival was generally longer for dogs without spinal canal or intracranial involvement. The results expand available information on NSTs in dogs but should be interpreted with caution given the small number of dogs with a definitive diagnosis. Further investigation is warranted to determine how tumor location, invasiveness, and treatments pursued impact outcome.
PubMed: 38787164
DOI: 10.3390/vetsci11050192 -
Frontiers in Neurology 2024Carbon monoxide (CO) is a gas that has no odor or color, making it difficult to detect until exposure leads to coma or death. CO poisoning is one of the most common and...
Carbon monoxide (CO) is a gas that has no odor or color, making it difficult to detect until exposure leads to coma or death. CO poisoning is one of the most common and deadly poisonings around the world. CO poisoning is a common and often fatal form of poisoning worldwide. A toxic effect of CO is tissue hypoxia, which leads to systemic complications. Additionally, there may be severe neurological symptoms and delayed complications following CO poisoning. However, peripheral neuropathy is relatively rare after CO poisoning. Previously, only one case of unilateral plexopathy after CO poisoning, accompanied by rhabdomyolysis and cognitive dysfunction, has been reported. In this report, an isolated unilateral brachial plexopathy following CO intoxication is described. A key mechanism in this case may be CO-induced spinal cord ischemia. Immediate administration of hyperbaric oxygen therapy (HBOT) is crucial to prevent peripheral neuropathy after acute CO intoxication. Hyperbaric oxygen therapy (HBOT) should be administered immediately after acute CO intoxication to prevent peripheral neuropathy. Additionally, peripheral neuropathy following acute CO intoxication may benefit from consistent rehabilitation training.
PubMed: 38784901
DOI: 10.3389/fneur.2024.1346353 -
Journal of Orthopaedic Case Reports May 2024Traumatic glenohumeral dislocation is very rare in skeletally immature patients, and there are no reports in the literature describing the risk of associated nerve...
INTRODUCTION
Traumatic glenohumeral dislocation is very rare in skeletally immature patients, and there are no reports in the literature describing the risk of associated nerve injuries. In the general population, the most commonly affected nerve is the axillary, but anatomical variations with a common origin between the musculocutaneous and median nerves exist that alter the respective positions and courses of these nerves and can make them more prone to injury during a glenohumeral dislocation.
CASE REPORT
A 10-year-old girl presented with incomplete median nerve palsy without any recuperation 8 months after an anterior glenohumeral dislocation. Surgical exploration was performed and revealed a common origin of the musculocutaneus and median nerve, with bifurcation just distal to the glenohumeral joint, making it susceptible to compression-elongation trauma during dislocation. A careful neurolysis was performed, and there was a complete recovery of median nerve function.
CONCLUSION
Glenohumeral dislocation associated with nerve injury is very rare in children. When a nerve injury occurs, one should be aware of possible anatomical variations of the infraclavicular plexus.
PubMed: 38784891
DOI: 10.13107/jocr.2024.v14.i05.4416 -
Plastic and Reconstructive Surgery.... May 2024A 13-year-old girl with a painful left neck mass was referred to our institution due to suspicions of malignancy. The patient reported pain that accompanied her frequent...
A 13-year-old girl with a painful left neck mass was referred to our institution due to suspicions of malignancy. The patient reported pain that accompanied her frequent neck spasms. Computed tomography revealed a large, soft-tissue mass in the left neck, deep to the sternocleidomastoid. The lesion anteriorly displaced the internal carotid artery and both displaced and crushed the internal left jugular vein. Uniquely, a three-dimensional virtual reality model combining magnetic resonance imaging and computed tomography data was used to determine the lesion's resectability and visualize which structures would be encountered or require protection while ensuring total resection. During operation, we confirmed that the mass also laterally displaced the brachial plexus, cranial nerves X and XI, and spinal nerves C3-C5 (including the phrenic) of the cervical plexus. Postsurgical pathological analysis confirmed a diagnosis of desmoid tumor, also known as aggressive fibromatosis, whereas DNA sequencing revealed a mutation, a somatic genetic marker found in approximately 90% of desmoid tumor cases. When possible, the most widely used method for the treatment of desmoid tumors has been gross resection. Chemotherapy, radiotherapy, and local excision are also used in the treatment of fibromatoses when complete resection is judged infeasible. In this case, a complete surgical resection with tumor-free surgical margins was performed. A standard cervical approach with a modified posterolateral incision site was implemented to avoid a conspicuous anterior neck scar. No flap, nerve repair, or reconstruction was warranted. At 1 year of postsurgical follow-up, the patient showed minimal scarring and no signs of recurrence.
PubMed: 38784831
DOI: 10.1097/GOX.0000000000005763 -
British Journal of Anaesthesia May 2024The efficacy of perineural vs intravenous dexamethasone as a local anaesthetic adjunct to increase duration of analgesia could be particular to specific peripheral nerve... (Review)
Review
Intravenous versus perineural dexamethasone to prolong analgesia after interscalene brachial plexus block: a systematic review with meta-analysis and trial sequential analysis.
BACKGROUND
The efficacy of perineural vs intravenous dexamethasone as a local anaesthetic adjunct to increase duration of analgesia could be particular to specific peripheral nerve blocks because of differences in systemic absorption depending on the injection site. Given this uncertainty, we performed a systematic review with meta-analysis and trial sequential analysis comparing dexamethasone administered perineurally or intravenously combined with local anaesthetic for interscalene brachial plexus block.
METHODS
Following a search of various electronic databases, we included 11 trials (1145 patients). The primary outcome was the duration of analgesia defined as the time between peripheral nerve block or onset of sensory blockade and the time to first analgesic request or initial report of pain.
RESULTS
The primary outcome, duration of analgesia, was greater in the perineural dexamethasone group, with a mean difference (95% confidence interval) of 122 (62-183) min, I=73%, P<0.0001. Trial sequential analysis indicated that firm evidence had been reached. The quality of evidence was downgraded to low, mainly because of moderate inconsistency and serious publication bias. No significant differences were present for any of the secondary outcomes, except for onset time of sensory and motor blockade and resting pain score at 12 h, but the magnitude of differences was not clinically relevant.
CONCLUSIONS
There is low-quality evidence that perineural administration of dexamethasone as a local anaesthetic adjunct increases duration of analgesia by an average of 2 h compared with intravenous injection for interscalene brachial plexus block. Given the limited clinical relevance of this difference, the off-label use of perineural administration, and the risk of drug crystallisation, we recommend intravenous dexamethasone administration.
SYSTEMATIC REVIEW PROTOCOL
PROSPERO (CRD42023466147).
PubMed: 38782616
DOI: 10.1016/j.bja.2024.03.042 -
Galen Medical Journal 2023While there are multiple guidelines for the management of bleeding complications and hematoma if being treated with antithrombotic and anticoagulant drugs, these risks...
BACKGROUND
While there are multiple guidelines for the management of bleeding complications and hematoma if being treated with antithrombotic and anticoagulant drugs, these risks are not yet stratified for procedures with regional anesthesia.
MATERIALS AND METHODS
This study was an umbrella review of systematic studies and meta-analysis based on PRISMA guidelines in databases of Scopus, PubMed, Medline, Cochrane Library, and Web of Science databases. Due to heterogeneity in evaluated outcomes and methods of studies, only the qualitative evidence synthesis was performed. AMSTAR checklist was used to assess the risk of bias in included systematic reviews.
RESULTS
After an extensive search of relevant studies, 971 primary cases were identified. Following a thorough screening process, 5 systematic reviews were selected. The evidence suggests that head and neck punctures generally do not result in bleeding complications, except for rare cases of hematoma associated with Infraclavicular brachial plexus block. A deep cervical plexus block is not recommended. Interscalene blocks have varying findings, with some studies reporting hematoma incidence and spinal injury, while others consider them low risk. Supraclavicular brachial plexus block might be associated with hemothorax and infraclavicular blocks are not favored by reviews. Axillary brachial plexus blocks have a minor incidence of hematoma. Abdomen blocks, TAP blocks, ilioinguinal blocks, and rectus sheath blocks carry a higher risk of hematoma. Pectoral nerve (PECS) blocks have a relatively high risk, while paravertebral and intercostal blocks are considered high risk, but further research is needed regarding paravertebral blocks.
CONCLUSION
The available evidence from systematic reviews and studies suggests varying levels of risk for different blocks and procedures that should be considered before decision-making.
PubMed: 38774839
DOI: 10.31661/gmj.v12i.2958