Callus Resection for Brachial Plexus Compression Following Stress-Induced First Rib Fracture

2002 ◽  
Vol 27 (3) ◽  
pp. 293-295 ◽  
Author(s):  
H. SEKI ◽  
S. SAITOH ◽  
Y. HATA ◽  
N. MURAKAMI ◽  
T. SHIMIZU ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Callus Formation ◽  
Rib Fracture ◽  
Supraclavicular Approach ◽  
Lower Trunk ◽  
First Rib

A 27-year-old man presented with a lower trunk brachial plexus injury due to excessive callus formation following a stress-induced first rib fracture. The callus, but not the first rib, was resected through a supraclavicular approach. His symptoms resolved in 2 months, and no recurrence was seen at 2 years follow-up.

scholarly journals Brachial Plexus Injury Associated with Median Sternotomy during Cardiac Surgery: Three Cases of C8 Radiculopathy Due to the Fracture of the First Rib

Diagnostics ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1896
Author(s):  
Yu Jin Im ◽  
Min Soo Kang ◽  
Sun Woong Kim ◽  
Duk Hyun Sung
Keyword(s):  
Cardiac Surgery ◽  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Rare Complication ◽  
Median Sternotomy ◽  
Rib Fracture ◽  
Advanced Imaging ◽  
First Rib ◽  
Lower Root ◽  
Electrophysiologic Studies

In cardiac surgery, median sternotomy is often necessary during certain surgical processes and it can cause the rare complication of brachial plexus injury. Retraction of the rib cage during median sternotomy may produce a fracture of the first thoracic rib at the costovertebral junction which might penetrate or irritate the lower root of the brachial plexus. Because the C8 ventral root is located immediately superior to the first thoracic rib, the extraforaminal C8 root is thought to be the key location of brachial plexus injury by the first rib fracture. This report describes three cases of brachial plexus injury after median sternotomy in a single center. In our cases, fracture of the first rib and consequent brachial plexus injury is confirmed with imaging and electrophysiologic studies. The fracture of the first rib is not detected with standard plain images and it is confirmed only with CT or MRI studies. Advanced imaging tools are recommended to assess the first rib fracture when brachial plexus injury is suspected after median sternotomy.

scholarly journals First Study of the Prevalence and Characterization of Brachial Plexus Injuries in Guatemala

2021 ◽  
Vol 16 (01) ◽  
pp. e46-e50
Author(s):  
Carmen Joanna González Lemus ◽  
Fernando Xavier Romero Prieto
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Main Mode ◽  
Cross Sectional ◽  
Speed Up ◽  
Male Patients ◽  
Mode Of Transportation ◽  
Surgery Department

Abstract Objective This study aimed to estimate the prevalence of brachial plexus injuries and to characterize clinically and epidemiologically patients with brachial plexus injury. Materials and Methods In this cross-sectional descriptive study, 2,923 medical records of patients aged 1 to 64 years who presented at outpatient peripheral nerve unit of the Orthopedic Surgery Department of Hospital Roosevelt, Guatemala, from January 2017 to December 2017, were prospectively analyzed to identify the prevalence and factors associated with brachial plexus injuries. Results The prevalence rate of brachial plexus injuries in patients was 5.74%. This injury is more common in men (90.5%) aged 24 to 64 years. Brachial plexus injuries occurred secondary to motorcycle accident in 72% of the cases, with the majority affecting the dominant upper extremity. In addition, 64.28% of the patients took 1 to 6 months to seek consultation, whereas only 16.07% requested medical assistance <1 month from the onset of symptoms, and this result was associated with early diagnosis and adequate recovery during follow-up. Furthermore, 66.67% presented upper brachial plexus injury with no associated fractures or vascular injury, manifesting distress while performing daily activities that required hand, arm, and elbow movements. Conclusion The risk of suffering BPIs in Guatemala increases in economically active male patients that use motorcycles as main mode of transportation. Patients should consult immediately after injury onset to optimize management results. For this reason, hospitals must develop specialized clinical guidelines to speed up the identification and treatment of BPI injuries.

Minimum Ten-Year Outcomes of Partial Ulnar Nerve Transfer for Restoration of Elbow Flexion in Patients with Upper Brachial Plexus Injury

2019 ◽  
Vol 24 (03) ◽  
pp. 283-288
Author(s):  
Yusuke Nagano ◽  
Daisuke Kawamura ◽  
Alaa Terkawi ◽  
Atsushi Urita ◽  
Yuichiro Matsui ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Functional Outcomes ◽  
Brachial Plexus Injury ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
The Mean ◽  
Flexion Strength

Background: Partial ulnar nerve transfer to the biceps motor branch of the musculocutaneous nerve (Oberlin’s transfer) is a successful approach to restore elbow flexion in patients with upper brachial plexus injury (BPI). However, there is no report on more than 10 years subjective and objective outcomes. The purpose of this study was to clarify the long-term outcomes of Oberlin’s transfer based on the objective evaluation of elbow flexion strength and subjective functional evaluation of patients. Methods: Six patients with BPI who underwent Oberlin’s transfer were reviewed retrospectively by their medical records. The mean age at surgery was 29.5 years, and the mean follow-up duration was 13 years. The objective functional outcomes were evaluated by biceps muscle strength using the Medical Research Council (MRC) grade at preoperative, postoperative, and final follow-up. The patient-derived subjective functional outcomes were evaluated using the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire at final follow-up. Results: All patients had MRC grade 0 (M0) or 1 (M1) elbow flexion strength before operation. Four patients gained M4 postoperatively and maintained or increased muscle strength at the final follow-up. One patient gained M3 postoperatively and at the final follow-up. Although one patient achieved M4 postoperatively, the strength was reduced to M2 due to additional disorder. The mean score of QuickDASH was 36.5 (range, 7–71). Patients were divided into two groups; three patients had lower scores and the other three patients had higher scores of QuickDASH. Conclusions: Oberlin’s transfer is effective in the restoration of elbow flexion and can maintain the strength for more than 10 years. Patients with upper BPI with restored elbow flexion strength and no complicated nerve disorders have over ten-year subjective satisfaction.

Role of tacrolimus in return of hand function after brachial plexus injury in a lung transplantation patient

2020 ◽  
Vol 13 (5) ◽  
pp. e233788
Author(s):  
Tiam M Saffari ◽  
Christopher J Arendt ◽  
Robert J Spinner ◽  
Alexander Y Shin
Keyword(s):  
Lung Transplantation ◽  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Hand Function ◽  
Left Hand ◽  
Lower Trunk ◽  
Bilateral Lung Transplantation ◽  
Bilateral Lung ◽  
Transplantation Patient

We report a patient who has been on tacrolimus for bilateral lung transplantation and presented with a brachial plexus injury (BPI), with unusual improvement of lower trunk innervated hand function. The lower trunk injury with resultant left hand paralysis had developed after his sternotomy 18 months ago. He has been treated with tacrolimus as part of his immunosuppression protocol since the surgery, without severe side effects. Physical examination at 18 months demonstrated unusual excellent grip pattern and full opposition of his thumb with slight claw deformity of his ulnar two digits. While the neurotoxic effects of tacrolimus are more emphasised, the neuroregenerative properties have been recently explored. The recovery in this patient is unique and unusual after BPI and is most likely as a result of the low dose tacrolimus treatment.

Video-Assisted Thoracoscopic Dissection Of The Brachial Plexus:Cadaveric Study And Illustrative Case

2006 ◽  
Vol 58 (suppl_4) ◽  
pp. ONS-287-ONS-291 ◽  
Author(s):  
Chad J. Morgan ◽  
Jefferson Lyons ◽  
Benjamin C. Ling ◽  
P. Colby Maher ◽  
Robert J. Bohinski ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Brachial Plexus ◽  
Thoracoscopic Surgery ◽  
Surgical Approaches ◽  
Illustrative Case ◽  
Lower Trunk ◽  
Video Assisted ◽  
First Rib ◽  
Soft Tissue Dissection ◽  
Tissue Dissection

Abstract Objective: Standard surgical approaches to the brachial plexus require an open operative technique with extensive soft tissue dissection. A transthoracic endoscopic approach using video-assisted thoracoscopic surgery (VATS) was studied as an alternative direct operative corridor to the proximal inferior brachial plexus. Methods: VATS was used in cadaveric dissections to study the anatomic details of the brachial plexus at the thoracic apex. After placement of standard thoracoscopic ports, the thoracic apex was systematically dissected. The limitations of the VATS approach were defined before and after removal of the first rib. The technique was applied in a 22-year-old man with neurofibromatosis who presented with a large neurofibroma of the left T1 nerve root. Results: The cadaveric study demonstrated that VATS allowed for a direct cephalad approach to the inferior brachial plexus. The C8 and T1 nerve roots as well as the lower trunk of the brachial plexus were safely identified and dissected. Removal of the first rib provided exposure of the entire lower trunk and proximal divisions. After the fundamental steps to the dissection were identified, the patient underwent a successful gross total resection of a left T1 neurofibroma with VATS. Conclusion: VATS provided an alternative surgical corridor to the proximal inferior brachial plexus and obviated the need for the extensive soft tissue dissection associated with the anterior supraclavicular and posterior subscapular approaches.

Neurogenic Thoracic Outlet Syndrome

2018 ◽  
Author(s):  
Pascal Lavergne ◽  
Hélène T. Khuong
Keyword(s):  
Brachial Plexus ◽  
Thoracic Outlet Syndrome ◽  
Botulinum Toxin Injection ◽  
Signs And Symptoms ◽  
Nerve Blocks ◽  
Initial Management ◽  
Supraclavicular Approach ◽  
Lower Trunk ◽  
Neurogenic Thoracic Outlet Syndrome ◽  
Electrophysiologic Studies

Neurogenic thoracic outlet syndrome is an entrapment neuropathy involving the brachial plexus along its trajectory from the cervical spine to the axilla. Clinical presentation includes cervical and upper extremity pain as well as neurologic signs and symptoms in the lower trunk territory. Radiologic and electrophysiologic studies are helpful adjuncts in correctly identifying the site of compression. Initial management is usually conservative, with medication, physical therapy, nerve blocks, or botulinum toxin injection. Surgery often consists of brachial plexus neurolysis and removal of compression points through the supraclavicular approach. Good outcomes can be expected with careful patient selection, but available literature is of limited quality.

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