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BMC Neurology May 2015The pain that commonly occurs after brachial plexus avulsion poses an additional burden on the quality of life of patients already impaired by motor, sensory and... (Review)
Review
REVIEW
The pain that commonly occurs after brachial plexus avulsion poses an additional burden on the quality of life of patients already impaired by motor, sensory and autonomic deficits. Evidence-based treatments for the pain associated with brachial plexus avulsion are scarce, thus frequently leaving the condition refractory to treatment with the standard methods used to manage neuropathic pain. Unfortunately, little is known about the pathophysiology of brachial plexus avulsion. Available evidence indicates that besides primary nerve root injury, central lesions related to the abrupt disconnection of nerve roots from the spinal cord may play an important role in the genesis of neuropathic pain in these patients and may explain in part its refractoriness to treatment.
CONCLUSIONS
The understanding of both central and peripheral mechanisms that contribute to the development of pain is of major importance in order to propose more effective treatments for brachial plexus avulsion-related pain. This review focuses on the current understanding about the occurrence of neuropathic pain in these patients and the role played by peripheral and central mechanisms that provides insights into its treatment. Pain after brachial plexus avulsion involves both peripheral and central components; thereby it is characterized as a mixed (central and peripheral) neuropathic pain syndrome.
Topics: Brachial Plexus; Brachial Plexus Neuropathies; Humans; Neuralgia
PubMed: 25935556
DOI: 10.1186/s12883-015-0329-x -
Hand (New York, N.Y.) Jan 2022The objective of this work was to perform a critical review of the 2-dimensional and 3-dimensional anatomy of the adult brachial plexus divisions and cords. Twelve... (Review)
Review
The objective of this work was to perform a critical review of the 2-dimensional and 3-dimensional anatomy of the adult brachial plexus divisions and cords. Twelve adult brachial plexuses from fresh cadavers were dissected. All were male and aged between 30 and 50 years. Only corpses without brachial plexus injuries were selected. The purpose of the dissections was to identify the origin of the anterior and posterior divisions of the adult brachial plexus in their respective trunks, as well as the positioning of the posterior, lateral, and medial cords. The posterior division of all trunks had a cranial and dorsal origin, while the anterior division of all trunks had a caudal and ventral origin. The posterior cord was the most cranial of all, the lateral cord was central, and the medial cord was the most caudal of all cords. The posterior division of the superior trunk was always between the suprascapular nerve and the anterior division. Brachial plexus diagrams in most textbooks and papers are different from what was found in our dissections. Contrary to the known diagram, the posterior divisions always had a cranial origin in the superior, middle, and inferior trunks.
Topics: Adult; Brachial Plexus; Cadaver; Dissection; Humans; Male; Middle Aged; Shoulder
PubMed: 32100569
DOI: 10.1177/1558944720906510 -
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 -
Anaesthesiology Intensive Therapy 2015Axillary brachial plexus block is one of the most popular and widely used approaches for brachial plexus blocks. Its main advantages are its versatility and high safety.... (Review)
Review
Axillary brachial plexus block is one of the most popular and widely used approaches for brachial plexus blocks. Its main advantages are its versatility and high safety. Brachial block facilitates analgesia for the distal arm, elbow, forearm and hand. Numerous upper limb procedures, particularly orthopedic ones, can be carried out under axillary block. Axillary block is well suited for the ultrasound-guided technique. Because the brachial plexus in the axillary region is located superficially, the nerves, block needle, and local anesthetic spread are all relatively easy to visualize. A high-frequency linear probe can be used during block procedure, so the quality and resolution of the ultrasound images are excellent. An important feature of the axillary approach is its high level of safety. In the axillary area, there are no anatomical structures other than vessels, to which damage during block placement could pose a risk for the patient. For this reason, axillary block is one of the techniques that are recommended for learning ultrasound-guided regional anesthesia. This paper summarizes anatomical fundamentals and provides basic sonoanatomic knowledge that is essential for successful ultrasound-guided axillary block.
Topics: Brachial Plexus; Humans; Nerve Block; Peripheral Nerves; Ultrasonography, Interventional
PubMed: 26401746
DOI: 10.5603/AIT.2015.0052 -
Nigerian Journal of Clinical Practice Dec 2022The primary aim of this study was to determine the risk factors for the occurrence of brachial plexus injury in cases of shoulder dystocia. Secondly, it was aimed to...
AIM
The primary aim of this study was to determine the risk factors for the occurrence of brachial plexus injury in cases of shoulder dystocia. Secondly, it was aimed to determine the factors affecting the occurrence of permanent sequelae in cases with brachial plexus injury.
SUBJECTS AND METHODS
ICD-10 codes were scanned from the records of patients who gave birth between 2012 and 2018, and the records of patients with brachial plexus injury and shoulder dystocia were reached. Shoulder dystocia cases with brachial plexus damage were accepted as the study group, and shoulder dystocia cases without brachial plexus damage were considered the control group. Shoulder dystocia patients with brachial plexus injury and without injury were compared for 2-year orthopedics clinic follow-up reports, surgical intervention, permanent sequelae status as well as birth data, maternal characteristics, and maneuvers applied to the management of shoulder dystocia.
RESULTS
Five hundred sixty births with shoulder dystocia were detected. Brachial plexus injury was observed in 88 of them, and permanent sequelae were detected in 12 of these patients. Maneuvers other than McRobert's (advanced maneuvers) were used more and clavicle fracture was seen more in the group with plexus injury (P < 0.05, P < 0.05, respectively). Logistic regression analysis was performed to determine the risk factors of brachial plexus injury. Brachial plexus injury was observed 4.746 times more in infants who were delivered with advanced maneuvers and 3.58 times more in infants with clavicle fractures at birth.
CONCLUSION
In patients with shoulder dystocia, the risk of brachial plexus injury increased in deliveries in which advanced maneuvers were used and clavicle fracture occurred.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Shoulder Dystocia; Delivery, Obstetric; Dystocia; Brachial Plexus; Fractures, Bone; Disease Progression; Risk Factors
PubMed: 36537460
DOI: 10.4103/njcp.njcp_464_22 -
Scientific Reports May 2023The dorsal scapular artery can either be a direct branch of the subclavian artery or a branch of the transverse cervical artery. Origin variation is related to its...
The dorsal scapular artery can either be a direct branch of the subclavian artery or a branch of the transverse cervical artery. Origin variation is related to its relationship with the brachial plexus. Anatomical dissection was performed on 79 sides of 41 formalin-embalmed cadavers in Taiwan. The origin of the dorsal scapular artery and the variations of its brachial plexus relationship were scrutinized and analyzed. Results showed that the dorsal scapular artery originated most frequently from the transverse cervical artery (48%), followed by the direct branch from the third part (25%) and the second part (22%) of the subclavian artery and from the axillary artery (5%). Only 3% of the dorsal scapular artery passed through the brachial plexus if its origin was the transverse cervical artery. However, 100% and 75% of the dorsal scapular artery passed through the brachial plexus when they were direct branches of the second and the third part of the subclavian artery, respectively. Suprascapular arteries were also found to pass through the brachial plexus when they were direct branches from the subclavian artery, but all passed over or under the brachial plexus if they originated from the thyrocervical trunk or transverse cervical artery. Variations in the origin and course of arteries around the brachial plexus are of immense value not only to the basic anatomical knowledge but also to clinical practices such as supraclavicular brachial plexus block and head and neck reconstruction with pedicled or free flaps.
Topics: Humans; Subclavian Artery; Shoulder; Neck; Brachial Plexus; Brachial Plexus Block; Cadaver
PubMed: 37179441
DOI: 10.1038/s41598-023-35054-2 -
The Journal of Hand Surgery Feb 2021Brachial plexus birth injury can differ in presentation, depending on whether the nerve ruptures distal to, or avulses proximal to, the dorsal root ganglion. More...
PURPOSE
Brachial plexus birth injury can differ in presentation, depending on whether the nerve ruptures distal to, or avulses proximal to, the dorsal root ganglion. More substantial contracture and bone deformity at the shoulder is typical in postganglionic injuries. However, changes to the underlying muscle structure that drive these differences in presentation are unclear.
METHODS
Seventeen Sprague-Dawley rats received preganglionic or postganglionic neurectomy on a single limb on postnatal days 3 and 4. Muscles crossing the shoulder were retrieved once the rats were sacrificed at 8 weeks after birth. External rotation range of motion, muscle mass, muscle length, muscle sarcomere length, and calculated optimal muscle length were measured bilaterally.
RESULTS
Average shoulder range of motion in the postganglionic group was 61.8% and 56.2% more restricted at 4 and 8 weeks, respectively, compared with that in the preganglionic group, but affected muscles after preganglionic injury were altered more severely (compared with the unaffected limb) than after postganglionic injury. Optimal muscle length in preganglionic injury was shorter in the affected limb (compared with the unaffected limb: -18.2% ± 9.2%) and to a greater extent than in postganglionic injury (-5.1% ± 6.2%). Muscle mass in preganglionic injury was lower in the affected limb (relative to the unaffected limb: -57.2% ± 24.1%) and to a greater extent than in postganglionic injury (-28.1% ± 17.7%).
CONCLUSIONS
The findings suggest that the presence of contracture does not derive from restricted longitudinal muscle growth alone, but also depends on the extent of muscle mass loss occurring simultaneously after the injury.
CLINICAL RELEVANCE
This study expands our understanding of differences in muscle architecture and the role of muscle structure in contracture formation for preganglionic and postganglionic brachial plexus birth injury.
Topics: Animals; Birth Injuries; Brachial Plexus; Brachial Plexus Neuropathies; Muscle, Skeletal; Range of Motion, Articular; Rats; Rats, Sprague-Dawley; Shoulder; Shoulder Joint
PubMed: 32919794
DOI: 10.1016/j.jhsa.2020.07.017 -
Diagnostic and Interventional Imaging Mar 2014Ultrasound examination of the brachial plexus, although at first sight difficult, is perfectly feasible with fairly rapid practical and theoretical training. The roots... (Comparative Study)
Comparative Study Review
Ultrasound examination of the brachial plexus, although at first sight difficult, is perfectly feasible with fairly rapid practical and theoretical training. The roots are accurately identified due to the shape (a single tubercle) of the transverse process of C7 in the paravertebral space, and the superficial position of C5 in the interscalene groove. The téléphérique technique allows the roots, trunks and cords to be followed easily into the supraclavicular fossa. In just a few years, ultrasound imaging of the plexus has become a routine anesthesia examination for guiding nerve blocks. In trained hands, it also provides information in thoracic outlet syndromes, traumatic conditions (particularly for postganglionic lesions) and tumoral diseases. Even if MRI remains the standard examination in these indications, ultrasound, with its higher definition and dynamic character, is an excellent additional method which is still under-exploited.
Topics: Adult; Brachial Plexus; Brachial Plexus Neuropathies; Female; Humans; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Male; Peripheral Nervous System Neoplasms; Reference Values; Spinal Nerve Roots; Thoracic Outlet Syndrome; Tomography, X-Ray Computed; Ultrasonography, Doppler; Ultrasonography, Interventional; Young Adult
PubMed: 24603038
DOI: 10.1016/j.diii.2014.01.020 -
Neurology India 2019The purpose of the study is to conduct the systematic review of literature available on resting-state functional MRI (fMRI) and brachial plexus injury.
OBJECTIVE
The purpose of the study is to conduct the systematic review of literature available on resting-state functional MRI (fMRI) and brachial plexus injury.
METHODS
We reviewed all the literature that are available on PubMed; keywords used were resting state, brachial plexus injury, and functional imaging. The reference papers listed were also reviewed. The research items were restricted to publications in English. Some papers have also incorporated studies such as task-based fMRI and transcranial magnetic stimulation (TMS), but only resting-state studies were included for this review.
RESULTS
A total of 13 papers were identified, and only 10 were reviewed based on the criteria. The reviewed papers were further categorized on the basis of whether or not any surgical intervention was done. Seven papers have surgical management such as contralateral cervical 7 (CC7) neurotisation or intercostal nerve (ICN) musculocutaneous nerve (MCN) neurotisation.
CONCLUSION
There is conclusive evidence showing that there is cortical reorganisation following brachial plexus injury in both birth and traumatic cases. The changes are restricted to some of the resting-state networks only (default mode network, sensorimotor network, in particular). However, no study till date has focused on a far more longitudinal approach at studying these changes. It will be interesting to see the exact time and effect of these changes.
Topics: Brachial Plexus; Brain; Brain Mapping; Consensus; Humans; Magnetic Resonance Imaging; Neuronal Plasticity
PubMed: 31347534
DOI: 10.4103/0028-3886.263178 -
Journal of Anatomy Jan 2022Brachial plexus injury (BPI) occurs when the brachial plexus is compressed, stretched, or avulsed. Although rodents are commonly used to study BPI, these models poorly...
Brachial plexus injury (BPI) occurs when the brachial plexus is compressed, stretched, or avulsed. Although rodents are commonly used to study BPI, these models poorly mimic human BPI due to the discrepancy in size. The objective of this study was to compare the brachial plexus between human and Wisconsin Miniature Swine (WMS ), which are approximately the weight of an average human (68-91 kg), to determine if swine would be a suitable model for studying BPI mechanisms and treatments. To analyze the gross anatomy, WMS brachial plexuses were dissected both anteriorly and posteriorly. For histological analysis, sections from various nerves of human and WMS brachial plexuses were fixed in 2.5% glutaraldehyde, and postfixed with 2% osmium tetroxide. Subsequently paraffin sections were counter-stained with Masson's Trichrome. Gross anatomy revealed that the separation into three trunks and three cords is significantly less developed in the swine than in human. In swine, it takes the form of upper, middle, and lower systems with ventral and dorsal components. Histological evaluation of selected nerves revealed differences in nerve trunk diameters and the number of myelinated axons in the two species. The WMS had significantly fewer myelinated axons than humans in median (p = 0.0049), ulnar (p = 0.0002), and musculocutaneous nerves (p = 0.0454). The higher number of myelinated axons in these nerves for humans is expected because there is a high demand of fine motor and sensory functions in the human hand. Due to the stronger shoulder girdle muscles in WMS, the WMS suprascapular and axillary nerves were larger than in human. Overall, the WMS brachial plexus is similar in size and origin to human making them a very good model to study BPI. Future studies analyzing the effects of BPI in WMS should be conducted.
Topics: Animals; Brachial Plexus; Hand; Humans; Shoulder; Swine; Swine, Miniature; Upper Extremity
PubMed: 34355792
DOI: 10.1111/joa.13525