scholarly journals Analysis of Patient-Dependent and Trauma-Dependent Risk Factors for Persistent Brachial Plexus Injury after Shoulder Dislocation

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Olga Gutkowska ◽  
Jacek Martynkiewicz ◽  
Marek Stępniewski ◽  
Jerzy Gosk
Keyword(s):  
Risk Factors ◽  
Brachial Plexus ◽  
Shoulder Dislocation ◽  
Relevant Literature ◽  
Axillary Nerve ◽  
Operative Intervention ◽  
Time Interval ◽  
Nerve Injuries ◽  
Accompanying Injuries ◽  
Single Nerve

Brachial plexus injuries (BPIs) caused by shoulder dislocation usually have a transient character and tend to resolve spontaneously. However, in some patients the symptoms can persist and require operative intervention. This work aims to determine the risk factors for persistent BPIs resulting from shoulder dislocation. The study comprised 73 patients (58 men, 15 women; mean age: 50 years) treated operatively between the years 2000 and 2016 for persistent BPIs resulting from shoulder dislocation. Patient age, gender, type of initial trauma, number of affected nerves, presence of accompanying injuries, and time interval from dislocation to its reduction were analysed. Elderly patients more often sustained multiple-nerve injuries, while single nerve injuries were more often observed in younger patients. Injury to a single nerve was diagnosed in 30% of the patients. Axillary nerve was most commonly affected. Fracture of the greater tuberosity of humerus coincided with total BPI in 50% of the cases. Longer unreduced period caused injury to multiple nerves. Analysis of our patient group against relevant literature revealed that persistent BPI after shoulder dislocation is more common in older patients. Injuries to ulnar and median nerves more often require operative intervention due to low potential for spontaneous recovery of these nerves.

Brachial plexus injury in the child

2021 ◽  
pp. 266-268
Author(s):  
Robert Bains ◽  
Simon Kay
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Brachial Plexus ◽  
Axillary Nerve ◽  
High Birth Weight ◽  
Root Avulsion ◽  
Obstetric Brachial Plexus Palsy ◽  
Previous Child ◽  
Obstetric Brachial Plexus ◽  
Ligamentous Attachment

Obstetric brachial plexus palsy (OBPP) was first described by the Scottish obstetrician William Smellie in 1779 who described, in a newborn, a case of unilateral arm paralysis which rapidly recovered. He attributed this palsy to compression of the axillary nerve against the humerus, probably wrongly in light of subsequent knowledge. The main risk factor for OBPP is high birth weight (>4000 g) and intrapartum shoulder dystocia causing traction on the brachial plexus. It has been demonstrated in cadaveric models that traction on the arm with the neck laterally flexed in the opposite direction causes rupture or avulsion of the brachial plexus. Upper roots are more likely to rupture due to strong ligamentous attachment to the spine whereas the lower roots are more likely to be avulsed. For unknown reasons, however, in the rare circumstance of small babies born breech, upper root avulsion is common. Other risk factors for OBPP include a previous child affected, prolonged labour, instrumented delivery, and multiparity, although each of these may be a surrogate for large birth weight.

Arachnoid cyst masquerading as obstetric brachial plexus palsy

2012 ◽  
Vol 10 (1) ◽  
pp. 62-63 ◽  
Author(s):  
Natarajan Muthukumar ◽  
Alwar Govindan Santhanakrishnan ◽  
Krishnaswamy Sivakumar
Keyword(s):  
Risk Factors ◽  
Brachial Plexus ◽  
Arachnoid Cyst ◽  
Relevant Literature ◽  
Neurological Status ◽  
Brachial Plexus Palsy ◽  
Mri Scan ◽  
Obstetric Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus ◽  
The Right

Obstetric brachial plexus palsy is not uncommon. However, lesions masquerading as obstetric brachial plexus palsy are rare. A child with a cervicothoracic arachnoid cyst masquerading as obstetric brachial plexus palsy is presented, and the relevant literature is reviewed. A girl born by vaginal delivery at full term without any antecedent risk factors for obstetric brachial plexus palsy was noted to have decreased movements of the right upper extremity. After 7 months, there was no improvement. An MRI scan was obtained, which revealed a cervicothoracic spinal extradural arachnoid cyst. During surgery, the cyst was found to communicate with the dura at the axilla of the C-7 nerve root. The cyst was excised in toto. Six months later, there was improvement in the infant's neurological status. This case illustrates that spinal arachnoid cysts should be entertained in the differential diagnosis when a child presents with obstetric brachial plexus palsy without known antecedent risk factors for obstetric palsy.

scholarly journals Brachial Plexus Anatomy: Normal and Variant

2009 ◽  
Vol 9 ◽  
pp. 300-312 ◽  
Author(s):  
Steven L. Orebaugh ◽  
Brian A. Williams
Keyword(s):  
Brachial Plexus ◽  
Relevant Literature ◽  
Axillary Nerve ◽  
Cochrane Library ◽  
Anatomic Variations ◽  
Normal Anatomy ◽  
Nerve Blocks ◽  
Mesh Terms ◽  
Brachial Plexus Blockade ◽  
Real Time Ultrasonography

Effective brachial plexus blockade requires a thorough understanding of the anatomy of the plexus, as well as an appreciation of anatomic variations that may occur. This review summarizes relevant anatomy of the plexus, along with variations and anomalies that may affect nerve blocks conducted at these levels. The Medline, Cochrane Library, and PubMed electronic databases were searched in order to compile reports related to the anatomy of the brachial plexus using the following free terms: "brachial plexus", "median nerve", "ulnar nerve", "radial nerve", "axillary nerve", and "musculocutanous nerve". Each of these was then paired with the MESH terms "anatomy", "nerve block", "anomaly", "variation", and "ultrasound". Resulting articles were hand searched for additional relevant literature. A total of 68 searches were conducted, with a total of 377 possible articles for inclusion. Of these, 57 were found to provide substantive information for this review. The normal anatomy of the brachial plexus is briefly reviewed, with an emphasis on those features revealed by use of imaging technologies. Anomalies of the anatomy that might affect the conduct of the various brachial plexus blocks are noted. Brachial plexus blockade has been effectively utilized as a component of anesthesia for upper extremity surgery for a century. Over that period, our understanding of anatomy and its variations has improved significantly. The ability to explore anatomy at the bedside, with real-time ultrasonography, has improved our appreciation of brachial plexus anatomy as well.

scholarly journals Distribution of Peripheral Nerve Injuries in Patients with a History of Shoulder Trauma Referred to a Tertiary Care Electrodiagnostic Laboratory

Diagnostics ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 887
Author(s):  
Chul-Hyun Cho ◽  
Don-Kyu Kim ◽  
Du Hwan Kim
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Nerve Injury ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Axillary Nerve ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries ◽  
Shoulder Trauma ◽  
History Of

Peripheral nerve injury after shoulder trauma is an underestimated complication. The distribution of the affected nerves has been reported to be heterogeneous in previous studies. This study aimed to describe the distribution of peripheral nerve injuries in patients with a history of shoulder trauma who were referred to a tertiary care electrodiagnostic laboratory. A retrospective chart review was performed for all cases referred to a tertiary care electrodiagnostic laboratory between March 2012 and February 2020. The inclusion criteria were a history of shoulder trauma and electrodiagnostic evidence of nerve injury. Data on patient demographics, mechanism of injury, degree of weakness, clinical outcomes at the final follow-up, and electrodiagnostic results were retrieved from medical records. Fifty-six patients had peripheral nerve injuries after shoulder trauma. Overall, isolated axillary nerve injury was the most common. A brachial plexus lesion affecting the supraclavicular branches (pan-brachial plexus and upper trunk brachial plexus lesions) was the second most common injury. In cases of shoulder dislocation and proximal humerus fracture, isolated axillary nerve injury was the most common. Among acromioclavicular joint injuries and clavicular fractures, lower trunk brachial plexus injuries and ulnar neuropathy were more common than axillary nerve or upper trunk brachial plexus injuries. Patients with isolated axillary nerve lesions showed a relatively good recovery; those with pan-brachial plexus injuries showed a poor recovery. Our study demonstrated the distribution of peripheral nerve injuries remote from displaced bony structures. Mechanisms other than direct compression by displaced bony structures might be involved in nerve injuries associated with shoulder trauma. Electrodiagnostic tests are useful for determining the extent of nerve damage after shoulder trauma.

scholarly journals Radiation necrosis after a combination of external beam radiotherapy and iodine-125 brachytherapy in gliomas

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Indrawati Hadi ◽  
Daniel Reitz ◽  
Raphael Bodensohn ◽  
Olarn Roengvoraphoj ◽  
Stefanie Lietke ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radiation Necrosis ◽  
Irradiation Time ◽  
External Beam Radiotherapy ◽  
High Grade Glioma ◽  
Metabolic Imaging ◽  
Time Interval ◽  
Low Grade ◽  
External Beam ◽  
Iodine 125

Abstract Purpose Frequency and risk profile of radiation necrosis (RN) in patients with glioma undergoing either upfront stereotactic brachytherapy (SBT) and additional salvage external beam radiotherapy (EBRT) after tumor recurrence or vice versa remains unknown. Methods Patients with glioma treated with low-activity temporary iodine-125 SBT at the University of Munich between 1999 and 2016 who had either additional upfront or salvage EBRT were included. Biologically effective doses (BED) were calculated. RN was diagnosed using stereotactic biopsy and/or metabolic imaging. The rate of RN was estimated with the Kaplan Meier method. Risk factors were obtained from logistic regression models. Results Eighty-six patients (49 male, 37 female, median age 47 years) were included. 38 patients suffered from low-grade and 48 from high-grade glioma. Median follow-up was 15 months after second treatment. Fifty-eight patients received upfront EBRT (median total dose: 60 Gy), and 28 upfront SBT (median reference dose: 54 Gy, median dose rate: 10.0 cGy/h). Median time interval between treatments was 19 months. RN was diagnosed in 8/75 patients. The 1- and 2-year risk of RN was 5.1% and 11.7%, respectively. Tumor volume and irradiation time of SBT, number of implanted seeds, and salvage EBRT were risk factors for RN. Neither of the BED values nor the time interval between both treatments gained prognostic influence. Conclusion The combination of upfront EBRT and salvage SBT or vice versa is feasible for glioma patients. The risk of RN is mainly determined by the treatment volume but not by the interval between therapies.

Outcome of axillary nerve injuries treated with nerve grafts

2011 ◽  
Vol 36 (7) ◽  
pp. 535-540 ◽  
Author(s):  
M. Okazaki ◽  
A. Al-Shawi ◽  
C. R. Gschwind ◽  
D. J. Warwick ◽  
M. A. Tonkin
Keyword(s):  
Reliable Method ◽  
Axillary Nerve ◽  
Nerve Grafting ◽  
Nerve Injuries ◽  
Nerve Grafts ◽  
The Mean

This study evaluates the outcome of axillary nerve injuries treated with nerve grafting. Thirty-six patients were retrospectively reviewed after a mean of 53 months (minimum 12 months). The mean interval from injury to surgery was 6.5 months. Recovery of deltoid function was assessed by the power of both abduction and retropulsion, the deltoid bulk and extension lag. The deltoid bulk was almost symmetrical in nine of 34 cases, good in 22 and wasted in three. Grade M4 or M5* was achieved in 30 of 35 for abduction and in 32 of 35 for retropulsion. There was an extension lag in four patients. Deltoid bulk continued to improve with a longer follow-up following surgery. Nerve grafting to the axillary nerve is a reliable method of regaining deltoid function when the lesion is distal to its origin from the posterior cord.

Obstetric brachial plexus palsy: A birth injury not explained by the known risk factors

2008 ◽  
Vol 87 (10) ◽  
pp. 1027-1032 ◽  
Author(s):  
Bjørn Backe ◽  
Elisabeth Balstad Magnussen ◽  
Ole Jakob Johansen ◽  
Gerd Sellaeg ◽  
Harald Russwurm
Keyword(s):  
Risk Factors ◽  
Brachial Plexus ◽  
Brachial Plexus Palsy ◽  
Birth Injury ◽  
Obstetric Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus
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