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Neurosurgical Review Apr 2020Brachial plexus injuries are among the rarest but at the same time the most severe complications of shoulder dislocation. The symptoms range from transient weakening or... (Review)
Review
Brachial plexus injuries are among the rarest but at the same time the most severe complications of shoulder dislocation. The symptoms range from transient weakening or tingling sensation of the upper limb to total permanent paralysis of the limb associated with chronic pain and disability. Conflicting opinions exist as to whether these injuries should be treated operatively and if so when surgery should be performed. In this review, available literature dedicated to neurological complications of shoulder dislocation has been analysed and management algorithm has been proposed. Neurological complications were found in 5.4-55% of all dislocations, with the two most commonly affected patient groups being elderly women sustaining dislocation as a result of a simple fall and young men after high-energy injuries, often multitrauma victims. Infraclavicular part of the brachial plexus was most often affected. Neurapraxia or axonotmesis predominated, and complete nerve disruption was observed in less than 3% of the patients. Shoulder dislocation caused injury to multiple nerves more often than mononeuropathies. The axillary nerve was most commonly affected, both as a single nerve and in combination with other nerves. Older patient age, higher energy of the initial trauma and longer period from dislocation to its reduction have been postulated as risk factors. Brachial plexus injury resolved spontaneously in the majority of the patients. Operative treatment was required in 13-18% of the patients in different studies. Patients with suspected neurological complications require systematic control. Surgery should be performed within 3-6 months from the injury when no signs of recovery are present.
Topics: Brachial Plexus; Brachial Plexus Neuropathies; Humans; Neurosurgical Procedures; Shoulder Dislocation; Treatment Outcome
PubMed: 29961154
DOI: 10.1007/s10143-018-1001-x -
Women's Health (London, England) 2016Shoulder dystocia is a complication of vaginal delivery and the primary factor associated with brachial plexus injury. In this review, we discuss the risk factors for... (Review)
Review
Shoulder dystocia is a complication of vaginal delivery and the primary factor associated with brachial plexus injury. In this review, we discuss the risk factors for shoulder dystocia and propose a framework for the prediction and prevention of the complication. A recommended approach to management when shoulder dystocia occurs is outlined, with review of the maneuvers used to relieve the obstruction with minimal risk of fetal and maternal injury.
Topics: Birth Injuries; Brachial Plexus; Delivery, Obstetric; Dystocia; Female; Fetus; Humans; Pregnancy; Risk Factors; Shoulder Injuries
PubMed: 26901875
DOI: 10.2217/whe.15.103 -
Prilozi (Makedonska Akademija Na... Apr 2021Brachial plexus injuries are still challenging for every surgeon taking part in treating patients with BPI. Injuries of the brachial plexus can be divided into injuries... (Review)
Review
Brachial plexus injuries are still challenging for every surgeon taking part in treating patients with BPI. Injuries of the brachial plexus can be divided into injuries of the upper trunk, extended upper trunk, injuries of the lower trunk and swinging hand where all of the roots are involved in this type of the injury. Brachial plexus can be divided in five anatomical sections from its roots to its terminal branches: roots, trunks, division, cords and terminal branches. Brachial plexus ends up as five terminal branches, responsible for upper limb innervation, musculocutaneous, median nerve, axillary nerve, radial and ulnar nerve. According to the findings from the preoperative investigation combined with clinically found functional deficit, the type of BPI will be confirmed and that is going to determine which surgical procedure, from variety of them (neurolysis, nerve graft, neurotization, arthrodesis, tendon transfer, free muscle transfer, bionic reconstruction) is appropriate for treating the patient.
Topics: Brachial Plexus; Humans; Nerve Transfer
PubMed: 33894122
DOI: 10.2478/prilozi-2021-0008 -
Neurology India 2019Peripheral nerve and brachial plexus injuries typically cause severe impairment in the affected limb. The incidence of neuropathic pain is high, reaching up to 95% of... (Review)
Review
Peripheral nerve and brachial plexus injuries typically cause severe impairment in the affected limb. The incidence of neuropathic pain is high, reaching up to 95% of cases, especially if cervical root avulsion has occurred. Neuropathic pain results from damage to the somatosensory system, and its progression towards chronicity depends upon disruptions affecting both the peripheral and central nervous system. Managing these painful conditions is complex and must be accomplished by a multidisciplinary team, starting with first-line pharmacological therapies like tricyclic antidepressants and calcium channel ligands, combined physical and occupational therapy, transcutaneous electrical stimulation and psychological support. For patients refractory to the initial measures, several neurosurgical options are available, including nerve decompression or reconstruction and ablative/modulatory procedures.
Topics: Brachial Plexus; Ganglia, Spinal; Humans; Neuralgia; Peripheral Nerve Injuries; Treatment Outcome
PubMed: 30688230
DOI: 10.4103/0028-3886.250699 -
BMJ Case Reports Dec 2019We report a 28-year-old man admitted postmotorcycle versus car in September 2017. The patient sustained multiple injuries in both the upper and lower limbs. He sustained...
We report a 28-year-old man admitted postmotorcycle versus car in September 2017. The patient sustained multiple injuries in both the upper and lower limbs. He sustained a complex brachial plexus injury on his left side and was transferred immediately to Stanmore Hospital to undergo specialist surgery (supraclavicular brachial plexus exploration and neurolysis) to repair his brachial plexus injury. The patient was transferred back to the specialist trauma ward for additional surgeries for his subsequent injuries. Due to the complexity of the injury and surgery the patient was not able to start rehabilitation until six weeks post operation, at which point he was referred to outpatient physiotherapy. Prior to this his left upper limb was in a sling but was instructed to move it as able. The patient commenced his comprehensive physiotherapy programme in January 2018.
Topics: Accidents, Traffic; Adult; Brachial Plexus; Brachial Plexus Neuropathies; Electric Stimulation Therapy; Humans; Male; Motorcycles; Multiple Trauma; Tomography, X-Ray Computed
PubMed: 31874847
DOI: 10.1136/bcr-2019-232107 -
Minerva Anestesiologica Jul 2019Pain is the most common complaint amongst trauma patients throughout the perioperative period. Multimodal analgesia is currently being regarded the mainstay, with... (Review)
Review
Pain is the most common complaint amongst trauma patients throughout the perioperative period. Multimodal analgesia is currently being regarded the mainstay, with regional anesthesia techniques constituting an integral part of it. Ultrasound imaging techniques display a plethora of advantages that have pervaded regional anesthesia practice. In this review, we set out to provide several examples of injuries, to elucidate the precise anatomy of fractured bones (osteotomes), and to elaborate on certain peripheral nerve blocks employed in pain management of trauma patients. Controversies/special considerations pertaining to peripheral nerve blocks also dictate thorough analysis: as such, acute compartment syndrome, acute peripheral nerve injuries, regional anesthesia in awake or anesthetized patients, continuous peripheral nerve blocks, positioning limitations and, finally, ultrasound imaging versus neurostimulation techniques are extensively reviewed.
Topics: Acute Pain; Analgesia; Anesthesia, Conduction; Brachial Plexus; Compartment Syndromes; Emergency Medical Services; Fractures, Bone; Humans; Lower Extremity; Nerve Block; Pain Management; Pain, Postoperative; Patient Positioning; Peripheral Nerve Injuries; Peripheral Nerves; Ultrasonography, Interventional; Upper Extremity
PubMed: 30735016
DOI: 10.23736/S0375-9393.19.13145-8 -
Folia Neuropathologica 2021Brachial plexus avulsion (BPA), a severe acute peripheral nerve injury in adults, results in total loss of the motor function in the upper limb. Although immediate... (Review)
Review
Brachial plexus avulsion (BPA), a severe acute peripheral nerve injury in adults, results in total loss of the motor function in the upper limb. Although immediate re-implantation surgery is widely performed to repair this lesion, the motor function cannot be fully restored. The main cause is that the growth velocity of axon is extremely slow in order to re-innervate the target muscles before atrophy develops. Therefore, the survival of spinal motoneurons (MNs) is considered to be a prerequisite for the recovery of motor function. The introduction of survival-proactive agents with anti-oxidative stress and anti-inflammation properties has emerged as a new approach to the motor function recovery following BPA. In the current review, we summarized the treatments of BPA in both mouse and rat models following re-implantation surgery. Furthermore, the pain treatment options following BPA were discussed.
Topics: Animals; Axons; Brachial Plexus; Mice; Motor Neurons; Rats; Recovery of Function
PubMed: 35114780
DOI: 10.5114/fn.2021.111996 -
Thoracic Surgery Clinics Feb 2021The thoracic outlet is the space between the thorax and axilla through which the subclavian vein, subclavian artery, and brachial plexus travel from their central... (Review)
Review
The thoracic outlet is the space between the thorax and axilla through which the subclavian vein, subclavian artery, and brachial plexus travel from their central origins to their peripheral termini. Its bounds include the clavicle, first thoracic rib, insertion of the pectoralis minor muscle onto the coracoid process of the humerus, and the sternum. It contains three areas: the scalene triangle, the costoclavicular space, and the subcoracoid or pectoralis minor space. Aberrant anatomy is common in the thoracic outlet and may predispose patients to compression of the neurovascular bundle and development of clinical thoracic outlet syndrome (TOS). Much of this aberrancy is explained by the embryologic origins of the structures that comprise the thoracic outlet. A thorough understanding of this anatomy and embryology is therefore critical to the understanding of TOS.
Topics: Brachial Plexus; Clavicle; Humans; Ribs; Subclavian Artery; Subclavian Vein; Thoracic Outlet Syndrome; Thorax
PubMed: 33220766
DOI: 10.1016/j.thorsurg.2020.09.007 -
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 -
Hand (New York, N.Y.) May 2019Lipomas are common benign tumors. When they develop in proximity to peripheral nerves, they can cause neurologic symptoms secondary to mass effect. Previous reports have... (Review)
Review
BACKGROUND
Lipomas are common benign tumors. When they develop in proximity to peripheral nerves, they can cause neurologic symptoms secondary to mass effect. Previous reports have shown symptom resolution after removal of lipomas compressing various upper extremity peripheral nerves. However, brachial plexus lipomas are relatively rare. Our multidisciplinary experience with brachial plexus lipoma resection is reviewed in the largest case series to date.
METHODS
A retrospective chart review of all patients undergoing resection of brachial plexus lipomatous tumors between 2006 and 2016 was performed. Patient demographic data, diagnostic imaging, clinical presentation, operative details, surgical pathology, and clinical outcomes were reviewed.
RESULTS
Twelve brachial plexus lipomatous tumors were resected in 11 patients: 10 lipomas, 1 hibernoma, and 1 atypical lipomatous tumor. The most common tumor location was supraclavicular (50%), followed by axillary (42%), and proximal medial arm (8%). The most common brachial plexus segment involved was the upper trunk (50%), followed by posterior cord (25%), lateral pectoral nerve (8%), lower trunk (8%), and proximal median nerve (8%). Most patients presented with an enlarging painless mass (58%). Of the patients who presented with neurologic symptoms, symptoms resolved in the majority (80%).
CONCLUSIONS
Brachial plexus lipomas are rare causes of compression neuropathy in the upper extremity. Careful resection and knowledge of brachial plexus anatomy, which may be distorted by the tumor, are critical to achieving a successful surgical outcome with predictable symptom resolution. Finally, surveillance magnetic resonance imaging may be warranted for atypical lesions.
Topics: Adult; Arthrogryposis; Brachial Plexus; Female; Hereditary Sensory and Motor Neuropathy; Humans; Lipoma; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Upper Extremity
PubMed: 29058949
DOI: 10.1177/1558944717735946