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AJNR. American Journal of Neuroradiology Feb 2008
Review
Topics: Brachial Plexus; Brachial Plexus Neuropathies; Humans; Image Enhancement; Magnetic Resonance Imaging; Practice Guidelines as Topic; Practice Patterns, Physicians'
PubMed: 18272570
DOI: No ID Found -
Singapore Medical Journal Oct 2016Adult-onset brachial plexopathy can be classified into traumatic and non-traumatic aetiologies. Traumatic brachial plexopathies can affect the pre- or postganglionic... (Review)
Review
Adult-onset brachial plexopathy can be classified into traumatic and non-traumatic aetiologies. Traumatic brachial plexopathies can affect the pre- or postganglionic segments of the plexus. Non-traumatic brachial plexopathies may be due to neoplasia, radiotherapy, thoracic outlet syndrome and idiopathic neuralgic amyotrophy. Conventional magnetic resonance imaging (MRI) is useful to localise the area of injury or disease, and identify the likely cause. This review discusses some of the common causes of adult-onset brachial plexopathy and their imaging features on MRI. We also present a series of cases to illustrate some of these causes and their MRI findings.
Topics: Adult; Aged; Brachial Plexus; Brachial Plexus Neuropathies; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Thoracic Outlet Syndrome; Wounds and Injuries
PubMed: 27779278
DOI: 10.11622/smedj.2016166 -
Hand (New York, N.Y.) Jan 2023There is variability in treatment strategies for patients with brachial plexus injury (BPI). We used qualitative research methods to better understand surgeons'...
BACKGROUND
There is variability in treatment strategies for patients with brachial plexus injury (BPI). We used qualitative research methods to better understand surgeons' rationale for treatment approaches. We hypothesized that distal nerve transfers would be preferred over exploration and nerve grafting of the brachial plexus.
METHODS
We conducted semi-structured interviews with BPI surgeons to discuss 3 case vignettes: pan-plexus injury, upper trunk injury, and lower trunk injury. The interview guide included questions regarding overall treatment strategy, indications and utility of brachial plexus exploration, and the role of nerve grafting and/or nerve transfers. Interview transcripts were coded by 2 researchers. We performed inductive thematic analysis to collate these codes into themes, focusing on the role of brachial plexus exploration in the treatment of BPI.
RESULTS
Most surgeons routinely explore the supraclavicular brachial plexus in situations of pan-plexus and upper trunk injuries. Reasons to explore included the importance of obtaining a definitive root level diagnosis, perceived availability of donor nerve roots, timing of anticipated recovery, plans for distal reconstruction, and the potential for neurolysis. Very few explore lower trunk injuries, citing concern with technical difficulty and unfavorable risk-benefit profile.
CONCLUSIONS
Our analysis suggests that supraclavicular exploration remains a foundational component of surgical management of BPI, despite increasing utilization of distal nerve transfers. Availability of abundant donor axons and establishing an accurate diagnosis were cited as primary reasons in support of exploration. This analysis of surgeon interviews characterizes contemporary practices regarding the role of brachial plexus exploration in the treatment of BPI.
Topics: Humans; Brachial Plexus; Nerve Transfer; Brachial Plexus Neuropathies; Neurosurgical Procedures
PubMed: 34018448
DOI: 10.1177/15589447211014613 -
Orthopaedics & Traumatology, Surgery &... Feb 2016Brachial plexus birth palsy (BPBP) is defined as an injury to any nerve root of the brachial plexus during difficult delivery. BPBP is relatively rare; its incidence has... (Review)
Review
Brachial plexus birth palsy (BPBP) is defined as an injury to any nerve root of the brachial plexus during difficult delivery. BPBP is relatively rare; its incidence has remained constant over the last few decades, mostly due to unpredictable risk factors, such as shoulder dystocia. Both diagnosis and assessment of spontaneous recovery is based on clinical examination. Electromyography is difficult to interpret in the newborn and is therefore not meaningful. MRI of the cervical spine requires sedation or general anesthesia. Searching for a pre-ganglion tear prior to surgery is indicted. Prognosis depends on the level of the injury (pre- or post-ganglion), size and severity of the post-ganglion tears, speed of recovery, and quality of initial management. Although spontaneous recovery is frequent, some children suffer various degrees of sequelae, up to complete loss of function of the affected upper limb. Recent publications have improved general knowledge and indications for surgery. However, some aspects, such as indication and timing of nerve repair continue to be debated.
Topics: Birth Injuries; Brachial Plexus; Brachial Plexus Neuropathies; Disease Management; Disease Progression; Dystocia; Female; Humans; Incidence; Infant; Infant, Newborn; Neurological Rehabilitation; Pregnancy; Prognosis; Plastic Surgery Procedures; Recovery of Function; Risk Factors; Severity of Illness Index; Time Factors
PubMed: 26774906
DOI: 10.1016/j.otsr.2015.05.008 -
Adult peripheral nerve disorders: nerve entrapment, repair, transfer, and brachial plexus disorders.Plastic and Reconstructive Surgery May 2011After reading this article, the participant should be able to: 1. Describe the pathophysiologic bases for nerve injury and how they apply to patient evaluation and... (Review)
Review
LEARNING OBJECTIVES
After reading this article, the participant should be able to: 1. Describe the pathophysiologic bases for nerve injury and how they apply to patient evaluation and management. 2. Recognize the wide variety of injury patterns and associated patient complaints and physical findings associated with peripheral nerve pathology. 3. Evaluate and recommend further tests to aid in defining the diagnosis. 4. Specify treatment options and potential risks and benefits.
SUMMARY
Peripheral nerve disorders comprise a gamut of problems, ranging from entrapment neuropathy to direct open traumatic injury and closed brachial plexus injury. The pathophysiology of injury defines the patient's symptoms, examination findings, and treatment options and is critical to accurate diagnosis and treatment. The goals of treatment include management of the often associated pain and improvement of sensory and motor function. Understanding peripheral nerve anatomy is critical to adopting novel nerve transfer procedures, which may provide superior options for a variety of injury patterns.
Topics: Adult; Brachial Plexus Neuropathies; Humans; Nerve Compression Syndromes; Nerve Transfer; Neurosurgical Procedures; Peripheral Nerves; Peripheral Nervous System Diseases
PubMed: 21532404
DOI: 10.1097/PRS.0b013e31820cf556 -
The Journal of Bone and Joint Surgery.... May 2008Neuralgic amyotrophy is an uncommon condition characterised by the acute onset of severe pain in the shoulder and arm, followed by weakness and atrophy of the affected...
Neuralgic amyotrophy is an uncommon condition characterised by the acute onset of severe pain in the shoulder and arm, followed by weakness and atrophy of the affected muscles, and sensory loss as the pain subsides. The diversity of its clinical manifestations means that it may present to a variety of different specialties within medicine. This article describes the epidemiology, aetiopathogenesis, clinical features, differential diagnoses, investigations, treatment, course and prognosis of the condition.
Topics: Adrenal Cortex Hormones; Analgesics; Brachial Plexus Neuritis; Diagnosis, Differential; Humans; Prognosis
PubMed: 18450616
DOI: 10.1302/0301-620X.90B5.20411 -
Anales de Pediatria Dec 2022Shoulder dystocia is a nonpreventable obstetric emergency that causes severe complications, such as obstetric brachial plexus palsy. The objective of the study was to... (Observational Study)
Observational Study
INTRODUCTION
Shoulder dystocia is a nonpreventable obstetric emergency that causes severe complications, such as obstetric brachial plexus palsy. The objective of the study was to determine the incidence of obstetric brachial plexus palsy and other neonatal complications associated with shoulder dystocia in deliveries managed in a university hospital after the implementation of a simulation-based training that was offered to all the labour and delivery staff on a voluntary basis.
MATERIAL AND METHODS
Retrospective observational study including all cases of shoulder dystocia and associated complications (mainly obstetric brachial plexus palsy) documented between January 2017 and December 2020, after the implementation of the training. In addition, we collected retrospective data on cases of obstetric brachial plexus palsy that developed in the hospital before the training (2008-2016).
RESULTS
In the 2017-2020 period, in the total of 125 cases of shoulder dystocia (amounting to 1.38% of vaginal deliveries), there were 14 cases of obstetric brachial plexus palsy (11.2% of the cases of shoulder dystocia), 7 clavicle fractures and 1 humerus fracture; none of the cases of obstetric brachial plexus palsy was permanent or required treatment or rehabilitation past six months. In the years preceding the training, there were 7 cases of obstetric brachial plexus palsy, 2 permanent and 5 temporary (3 of which required rehabilitation).
CONCLUSION
These results reflect the importance of knowing the morbidity present in the labour and delivery ward and the potential benefit of simulation-based training programmes in the resolution of these obstetric complications.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Shoulder Dystocia; Dystocia; Retrospective Studies; Brachial Plexus Neuropathies; Brachial Plexus; Paralysis
PubMed: 36266188
DOI: 10.1016/j.anpede.2022.06.011 -
AJNR. American Journal of Neuroradiology Mar 2013With advancement in 3D imaging, better fat-suppression techniques, and superior coil designs for MR imaging and the increasing availability and use of 3T magnets, the... (Review)
Review
With advancement in 3D imaging, better fat-suppression techniques, and superior coil designs for MR imaging and the increasing availability and use of 3T magnets, the visualization of the complexity of the brachial plexus has become facile. The relevant imaging findings are described for normal and pathologic conditions of the brachial plexus. These radiologic findings are supported by clinical and/or EMG/surgical data, and corresponding high-resolution MR neurography images are illustrated. Because the brachial plexus can be affected by a plethora of pathologies, resulting in often serious and disabling complications, a better radiologic insight has great potential in aiding physicians in rendering superior services to patients.
Topics: Algorithms; Brachial Plexus; Brachial Plexus Neuropathies; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Neuroimaging; Pattern Recognition, Automated; Reproducibility of Results; Sensitivity and Specificity
PubMed: 22976233
DOI: 10.3174/ajnr.A3287 -
The Bone & Joint Journal Feb 2016Between 2002 and 2011, 81 patients with a traumatic total brachial plexus injury underwent reconstruction by double free muscle transfer (DFMT, 47 cases), single muscle... (Comparative Study)
Comparative Study
AIMS
Between 2002 and 2011, 81 patients with a traumatic total brachial plexus injury underwent reconstruction by double free muscle transfer (DFMT, 47 cases), single muscle transfer (SMT, 16 cases) or nerve transfers (NT, 18 cases).
METHODS
They were evaluated for functional outcome and quality of life (QoL) using the Disability of Arm, Shoulder and Hand questionnaire, both pre- and post-operatively. The three groups were compared and followed-up for at least 24 months.
RESULTS
The mean shoulder abduction and flexion were comparable in all groups, but external rotation was significantly better in the DFMT group as were range and quantitative power of elbow flexion. Patients who had undergone DFMT had reasonable total active finger movement and hook grip strength. All groups showed improvement in function at a level greater than a minimum clinically important difference. The DFMT group showed the greatest improvement.
DISCUSSION
Patients in the DFMT group had a better functional outcome and QoL recovery than those in the NT and SMT groups.
TAKE HOME MESSAGE
Double free muscle transfer procedure is capable of restoring maximum function in patients of total brachial plexus palsy.
Topics: Adolescent; Adult; Brachial Plexus; Brachial Plexus Neuropathies; Elbow Joint; Female; Follow-Up Studies; Hand Strength; Humans; Male; Middle Aged; Muscle, Skeletal; Nerve Transfer; Postoperative Care; Preoperative Care; Quality of Life; Range of Motion, Articular; Recovery of Function; Surveys and Questionnaires; Treatment Outcome; Young Adult
PubMed: 26850426
DOI: 10.1302/0301-620X.98B2.35101 -
Physical Therapy Jan 2021The use of the prone position to treat patients with COVID-19 pneumonia who are critically ill and mechanically ventilated is well documented. This case series reports...
OBJECTIVE
The use of the prone position to treat patients with COVID-19 pneumonia who are critically ill and mechanically ventilated is well documented. This case series reports the location, severity, and prevalence of focal peripheral nerve injuries involving the upper limb identified in an acute COVID-19 rehabilitation setting. The purpose of this study was to report observations and to explore the challenges in assessing these patients.
METHODS
Participants were patients with suspected peripheral nerve injuries following discharge from COVID-19 critical care who were referred to the peripheral nerve injury multidisciplinary team. Data were collected retrospectively on what peripheral neuropathies were observed, with reference to relevant investigation findings and proning history.
RESULTS
During the first wave of the COVID-19 pandemic in the United Kingdom, 256 patients were admitted to COVID-19 critical care of Queen Elizabeth Hospital, Birmingham, United Kingdom. From March to June 2020, a total of 114 patients required prone ventilation. In this subgroup, a total of 15 patients were identified with clinical findings of peripheral nerve injuries within the upper limb. In total, 30 anatomical nerve injuries were recorded. The most commonly affected nerve was the ulnar nerve (12/30) followed by the cords of the brachial plexus (10/30). Neuropathic pain and muscle wasting were identified, signifying a high-grade nerve injury.
CONCLUSION
Peripheral nerve injuries can be associated with prone positioning on intensive care units, although other mechanisms, such as those of a neuroinflammatory nature, cannot be excluded.
IMPACT
Proning-related upper limb peripheral nerve injuries are not discussed widely in the literature and could be an area of further consideration when critical care units review their proning protocols. Physical therapists treating these patients play a key part in the management of this group of patients by optimizing the positioning of patients during proning, making early identification of peripheral nerve injuries, providing rehabilitation interventions, and referring to specialist services if necessary.
LAY SUMMARY
During the COVID-19 pandemic, patients who are very ill can be placed for long periods of time on their stomach to improve their chances of survival. The potential consequences of prolonged time in this position are weakness and pain in the arms due to potential nerve damage. There are some recommended treatments to take care of these problems.
Topics: Adult; Aged; Brachial Plexus; Brachial Plexus Neuropathies; COVID-19; Critical Care; Female; Humans; Male; Middle Aged; Patient Positioning; Peripheral Nerve Injuries; Retrospective Studies; United Kingdom; Upper Extremity
PubMed: 33395478
DOI: 10.1093/ptj/pzaa191