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Anatomical Record (Hoboken, N.J. : 2007) Mar 2017Twenty thoracic limbs of ten Lycalopex gymnocercus were dissected to describe origin and distribution of the nerves forming brachial plexuses. The brachial plexus...
Twenty thoracic limbs of ten Lycalopex gymnocercus were dissected to describe origin and distribution of the nerves forming brachial plexuses. The brachial plexus resulted from the connections between the ventral branches of the last three cervical nerves (C6, C7, and C8) and first thoracic nerve (T1). These branches connected the suprascapular, subscapular, axillary, musculocutaneous, radial, median and ulnar nerves to the intrinsic musculature and connected the brachiocephalic, thoracodorsal, lateral thoracic, long thoracic, cranial pectoral and caudal pectoral nerves to the extrinsic musculature. The C7 ventral branches contribute most to the formation of the nerves (62.7%), followed by C8 (58.8%), T1 (40.0%) and C6 (24.6%). Of the 260 nerves dissected, 69.2% resulted from a combination of two or three branches, while only 30.8% originated from a single branch. The origin and innervation area of the pampas fox brachial plexus, in comparison with other domestic and wild species, were most similar to the domestic dog and wild canids from the neotropics. The results of this study can serve as a base for comparative morphofunctional analysis involving this species and development of nerve block techniques. Anat Rec, 300:537-548, 2017. © 2016 Wiley Periodicals, Inc.
Topics: Animals; Brachial Plexus; Female; Forelimb; Foxes; Male
PubMed: 27788289
DOI: 10.1002/ar.23509 -
RoFo : Fortschritte Auf Dem Gebiete Der... Aug 2018
Topics: Adult; Brachial Plexus; Diagnosis, Differential; Humans; Lung Neoplasms; Magnetic Resonance Imaging; Male; Tomography, X-Ray Computed
PubMed: 30045401
DOI: 10.1055/a-0620-8967 -
The Journal of Hand Surgery Feb 2015To better understand the manner in which outcomes are reported after brachial plexus reconstruction, we conducted a systematic review of the scientific literature. (Review)
Review
PURPOSE
To better understand the manner in which outcomes are reported after brachial plexus reconstruction, we conducted a systematic review of the scientific literature.
METHODS
We included English-language articles describing treatment of brachial plexus injuries to restore motor function of the shoulder, elbow, forearm, and/or wrist with nerve repair, nerve graft, and/or nerve transfer. We recorded the anatomical location of injury, the treatment used, and the manner in which motor function, active and passive range of motion, pain, quality of life, function or disability, patient satisfaction, and psychosocial health was reported.
RESULTS
In reviewing 88 papers with outcomes for 5,189 patients, 83 (94%) of the papers reported postoperative motor function. Of these, 49 (59%) did not include any other measures of patient outcome. Active range of motion was reported in 24 (27%) studies, pain was reported in 15 (17%) studies, quality of life was reported in 4 (5%) studies, function or disability was reported in 5 (6%) studies, patient satisfaction in 3 (3%) studies, and psychosocial health in 1 study.
CONCLUSIONS
To date, outcome reporting for brachial plexus surgery has largely centered on motor recovery and typically has not included measures of function or nonmusculoskeletal recovery. Incorporating currently used measures of physical recovery with patient-derived outcomes measures such as quality of life, function, pain, and satisfaction will likely help provide a more comprehensive understanding of the effect of brachial plexus reconstruction surgery.
TYPE OF STUDY/LEVEL OF EVIDENCE
Diagnostic III.
Topics: Arm; Brachial Plexus; Disability Evaluation; Humans; Microsurgery; Nerve Transfer; Patient Satisfaction; Peripheral Nerves; Postoperative Complications; Quality of Life; Suture Techniques
PubMed: 25510158
DOI: 10.1016/j.jhsa.2014.10.033 -
World Neurosurgery Jul 2017Complete brachial plexus avulsion injury is a severe disabling injury due to traction to the brachial plexus. Brachial plexus reimplantation is an emerging surgical...
BACKGROUND
Complete brachial plexus avulsion injury is a severe disabling injury due to traction to the brachial plexus. Brachial plexus reimplantation is an emerging surgical technique for the management of complete brachial plexus avulsion injury.
OBJECTIVE
We assessed the functional recovery in 15 patients who underwent brachial plexus reimplantation surgery after complete brachial plexus avulsion injury with clinical examination and electrophysiological testing.
METHODS
We included all patients who underwent brachial plexus reimplantation in our institution between 1997 and 2010. Patients were assessed with detailed motor and sensory clinical examination and motor and sensory electrophysiological tests.
RESULTS
We found that patients who had reimplantation surgery demonstrated an improvement in Medical Research Council power in the deltoid, pectoralis, and infraspinatous muscles and global Medical Research Council score. Eight patients achieved at least grade 3 MRC power in at least one muscle group of the arm. Improved reinnervation by electromyelography criteria was found in infraspinatous, biceps, and triceps muscles. There was evidence of ongoing innervation in 3 patients. Sensory testing in affected dermatomes also showed better recovery at C5, C6, and T1 dermatomes. The best recovery was seen in the C5 dermatome.
CONCLUSIONS
Our results demonstrate a definite but limited improvement in motor and sensory recovery after reimplantation surgery in patients with complete brachial plexus injury. We hypothesize that further improvement may be achieved by using regenerative cell technologies at the time of repair.
Topics: Adolescent; Adult; Arm; Brachial Plexus; Electromyography; Humans; Male; Middle Aged; Muscle, Skeletal; Peripheral Nerve Injuries; Recovery of Function; Replantation; Retrospective Studies; Rotator Cuff; Treatment Outcome; Young Adult
PubMed: 28365432
DOI: 10.1016/j.wneu.2017.03.052 -
Acta Medica Portuguesa 2013The rat is probably the animal species most widely used in experimental studies on nerve repair. The aim of this work was to contribute to a better understanding of the...
INTRODUCTION
The rat is probably the animal species most widely used in experimental studies on nerve repair. The aim of this work was to contribute to a better understanding of the morphology and blood supply of the rat brachial plexus.
MATERIAL AND METHODS
Thirty adult rats were studied regarding brachial plexus morphology and blood supply. Intravascular injection and dissection under an operating microscope, as well as light microscopy and scanning electron microscopy techniques were used to define the microanatomy of the rat brachial plexus and its vessels.
RESULTS
The rat brachial plexus was slightly different from the human brachial plexus. The arterial and venous supply to the brachial plexus plexus was derived directly or indirectly from neighboring vessels. These vessels formed dense and interconnected plexuses in the epineurium, perineurium, and endoneurium. Several brachial plexus components were accompanied for a relatively long portion of their length by large and constant blood vessels that supplied their epineural plexus, making it possible to raise these nerves as flaps.
DISCUSSION
The blood supply to the rat brachial plexus is not very different from that reported in humans, making the rat a useful animal model for the experimental study of peripheral nerve pathophysiology and treatment.
CONCLUSION
Our results support the homology between the rat and the human brachial plexus in terms of morphology and blood supply. This work suggests that several components of the rat brachial plexus can be used as nerve flaps, including predominantly motor, sensory or mixed nerve fibers. This information may facilitate new experimental procedures in this animal model.
Topics: Animals; Brachial Plexus; Peripheral Nerves; Rats; Rats, Wistar
PubMed: 23815839
DOI: No ID Found -
Journal of Neuropathology and... Jan 2016Neonatal brachial plexus avulsion injury (BPAI) commonly occurs as a consequence of birth trauma and can result in lifetime morbidity; however, little is known regarding... (Comparative Study)
Comparative Study
Neonatal brachial plexus avulsion injury (BPAI) commonly occurs as a consequence of birth trauma and can result in lifetime morbidity; however, little is known regarding the evolving neuropathological processes it induces. In particular, mechanical forces during BPAI can concomittantly damage the spinal cord and may contribute to outcome. Here, we describe the functional and neuropathological outcome following BPAI, with or without spinal cord injury, in a novel pediatric animal model. Twenty-eight-day-old piglets underwent unilateral C5–C7 BPAI with and without limited myelotomy. Following avulsion, all animals demonstrated right forelimb monoparesis. Injury extending into the spinal cord conferred greater motor deficit, including long tract signs. Consistent with clinical observations, avulsion with myelotomy resulted in more severe neuropathological changes with greater motor neuron death, progressive axonopathy, and persistent glial activation. These data demonstrate neuropathological features of BPAI associated with poor functional outcome. Interestingly, in contrast to adult small animal models of BPAI, a degree of motor neuron survival was observed, even following severe injury in this neonatal model. If this is also the case in human neonatal BPAI, repair may permit functional restoration. This model also provides a clinically relevant platform for exploring the complex postavulsion neuropathological responses that may inform therapeutic strategies.
Topics: Animals; Animals, Newborn; Brachial Plexus; Male; Motor Neurons; Spinal Cord Injuries; Swine; White Matter
PubMed: 26671984
DOI: 10.1093/jnen/nlv002 -
Neurosurgical Focus Mar 2017OBJECTIVE The authors aimed to understand the alterations of brain resting-state networks (RSNs) in patients with pan-brachial plexus injury (BPI) before and after...
OBJECTIVE The authors aimed to understand the alterations of brain resting-state networks (RSNs) in patients with pan-brachial plexus injury (BPI) before and after surgery, which might provide insight into cortical plasticity after peripheral nerve injury and regeneration. METHODS Thirty-five patients with left pan-BPI before surgery, 30 patients after surgery, and 25 healthy controls underwent resting-state functional MRI (rs-fMRI). The 30 postoperative patients were subdivided into 2 groups: 14 patients with improvement in muscle power and 16 patients with no improvement in muscle power after surgery. RSNs were extracted using independent component analysis to evaluate connectivity at a significance level of p < 0.05 (familywise error corrected). RESULTS The patients with BPI had lower connectivity in their sensorimotor network (SMN) and salience network (SN) and greater connectivity in their default mode network (DMN) before surgery than the controls. Connectivity of the left supplementary motor cortex in the SMN and medial frontal gyrus and in the anterior cingulate cortex in the SN increased in patients whose muscle power had improved after surgery, whereas no significant changes were noted in the unimproved patients. There was a trend toward reduction in DMN connectivity in all the patients after surgery compared with that in the preoperative patients; however, this result was not statistically significant. CONCLUSIONS The results of this study highlight the fact that peripheral nerve injury, its management, and successful treatment cause dynamic changes within the brain's RSNs, which includes not only the obvious SMN but also the higher cognitive networks such as the SN and DMN, which indicates brain plasticity and compensatory mechanisms at work.
Topics: Adolescent; Adult; Brachial Plexus; Brain Mapping; Cerebral Cortex; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Neuronal Plasticity; Young Adult
PubMed: 28245732
DOI: 10.3171/2016.12.FOCUS16430 -
Injury Apr 2020Brachial plexus injuries will cause a significantly decreased quality of life. Patients with upper arm type brachial plexus injuries, which means C5 and C6 roots injury,... (Review)
Review
Brachial plexus injuries will cause a significantly decreased quality of life. Patients with upper arm type brachial plexus injuries, which means C5 and C6 roots injury, will lose their shoulder elevation/abduction/external rotation, and elbow flexion function. Additional elbow, wrist, and hand extension function deficit will occur in patients with C7 root injury. With the advances of reconstructive procedures, the upper arm brachial plexus injuries can be successfully restored through nerve repair, nerve grafting, nerve transfer, muscle / tendon transfer and free functioning muscle transfer. In this review article, we summarized the various reconstructive procedures to restore the function of shoulder and elbow. Nowadays, the upper arm type BPI can be treat with satisfied outcomes (80-90% successful rate).
Topics: Accessory Nerve; Adult; Axilla; Brachial Plexus; Elbow Joint; Humans; Muscle Strength; Muscle, Skeletal; Nerve Transfer; Range of Motion, Articular; Shoulder Joint; Spinal Nerve Roots; Ulnar Nerve
PubMed: 32156416
DOI: 10.1016/j.injury.2020.02.076 -
Bioscience Reports Jun 2020Ultrasound-guided costoclavicular block (CC-approach) is a recently described brachial plexus block (BPB) and an alternative approach to the supraclavicular approach... (Comparative Study)
Comparative Study
Ultrasound-guided costoclavicular block (CC-approach) is a recently described brachial plexus block (BPB) and an alternative approach to the supraclavicular approach (SC-approach). The relevant sonoanatomy is analogous in terms of the brachial plexus and its adjacent artery for both approaches. In the present study, we hypothesized that the two approaches will result in similar block dynamics when used the modified double-injection (MDI) technique. One hundred and twelve patients were randomly allocated to receive either a SC- or CC-approach with MDI technique. In the CC group, half the volume was injected adjacent to the medial cord of the brachial plexus, the procedure was guided by ultrasound and verified by nerve stimulator, subsequently the second half was injected close to the lateral cord. In the SC group, the MDI technique was carried out as described in our previous study. Sensory and motor blockade of all four terminal nerves were assessed with a 3-point scale. The primary outcome was the proportion of complete sensory blockade at 15 min with a predefined non-inferiority margin of -13%. The proportion of subjects at 15 min was comparable between the SC group and the CC group (91 vs 87%, absolute difference: -3%). No significant differences were found for complete motor blockade and onset times of the individual nerves within 30 min, and block-related serious adverse events (all P>0.05). We conclude that the MDI technique applied to a costoclavicular and supraclavicular block resulted in similar block dynamics. In addition, it may provide a promising alternative technique when considering the use of multipoint injection.
Topics: Adult; Anesthetics, Local; Brachial Plexus; China; Double-Blind Method; Female; Humans; Injections; Male; Middle Aged; Motor Activity; Nerve Block; Sensory Thresholds; Time Factors; Treatment Outcome; Ultrasonography, Interventional
PubMed: 32441302
DOI: 10.1042/BSR20200084 -
Annals of Palliative Medicine Jan 2021Ultrasound-guided costoclavicular (CC) brachial plexus blocks (BPBs) are a novel approach for nerve block in upper extremity surgery. However, comparisons between CC-BPB...
Comparison of ultrasound-guided costoclavicular and supraclavicular brachial plexus block for upper extremity surgery: a propensity score matched retrospective cohort study.
BACKGROUND
Ultrasound-guided costoclavicular (CC) brachial plexus blocks (BPBs) are a novel approach for nerve block in upper extremity surgery. However, comparisons between CC-BPB and conventional supraclavicular (SC) BPB have not clearly delineated the benefits or costs of either method.
METHODS
This retrospective cohort study enrolled patients receiving BPB due to upper extremity fracture between June 2019 and May 2020. Data were collected from the medical records of patients, including age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status, side of block, and operative location. Enrolled patients were matched in a 1:2 ratio using propensity score matching models. The primary outcomes in this study were the proportions of complete sensory and motor blocks and the secondary outcomes included other block-related outcomes, pain-related outcomes, and side effects or complications.
RESULTS
The study enrolled 235 patients with upper extremity fracture and there was a significant difference in the side of block when comparing ultrasound-guided CC-BPB and SC-BPB. After propensity score matching, 62 patients receiving ultrasound-guided CC-BPB and 124 receiving ultrasound-guided SC-BPB were enrolled. The proportions of complete sensory and motor block at each interval after injection showed no significant difference when the groups were compared. Although CC-BPB involved a longer procedure time than SC-BPB (6.2±0.7 vs. 5.1±0.5 min, P<0.001), it provided a longer duration of nerve block (duration of sensory block: 468.2±103.5 vs. 396.5±83.4 min, P<0.001; duration of motor block: 554.6±99.5 vs. 469.7±96.0 min, P<0.001). Patients with Horner's syndrome were also more prevalent in the SC-BCB group (n=11) (8.9%) in comparison to one patient (1.6%) in CC-BPB group (P=0.04).
CONCLUSIONS
CC-BPB is a safe and efficient approach for upper extremity surgery.
Topics: Anesthetics, Local; Brachial Plexus; Brachial Plexus Block; Humans; Propensity Score; Retrospective Studies; Ultrasonography, Interventional; Upper Extremity
PubMed: 33474956
DOI: 10.21037/apm-20-2376