scholarly journals Bionic Upper Limb Reconstruction: A Valuable Alternative in Global Brachial Plexus Avulsion Injuries—A Case Series

2019 ◽  
Vol 9 (1) ◽  
pp. 23 ◽  
Author(s):  
Laura A. Hruby ◽  
Clemens Gstoettner ◽  
Agnes Sturma ◽  
Stefan Salminger ◽  
Johannes A. Mayer ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Health Survey ◽  
Hand Function ◽  
Case Series ◽  
Assessment Procedure ◽  
Brachial Plexus Avulsion ◽  
Deafferentation Pain ◽  
Sf 36 ◽  
Bionic Reconstruction

Global brachial plexopathies including multiple nerve root avulsions may result in complete upper limb paralysis despite surgical treatment. Bionic reconstruction, which includes the elective amputation of the functionless hand and its replacement with a mechatronic device, has been described for the transradial level. Here, we present for the first time that patients with global brachial plexus avulsion injuries and lack of biological shoulder and elbow function benefit from above-elbow amputation and prosthetic rehabilitation. Between 2012 and 2017, forty-five patients with global brachial plexus injuries approached our centre, of which nineteen (42.2%) were treated with bionic reconstruction. While fourteen patients were amputated at the transradial level, the entire upper limb was replaced with a prosthetic arm in a total of five patients. Global upper extremity function before and after bionic arm substitution was assessed using two objective hand function tests, the action research arm test (ARAT), and the Southampton hand assessment procedure (SHAP). Other outcome measures included the DASH questionnaire, VAS to assess deafferentation pain and the SF-36 health survey to evaluate changes in quality of life. Using a hybrid prosthetic arm mean ARAT scores improved from 0.6 ± 1.3 to 11.0 ± 6.7 (p = 0.042) and mean SHAP scores increased from 4.0 ± 3.7 to 13.8 ± 9.2 (p = 0.058). After prosthetic arm replacement mean DASH scores improved from 52.5 ± 9.4 to 31.2 ± 9.8 (p = 0.003). Deafferentation pain decreased from mean VAS 8.5 ± 1.0 to 6.7 ± 2.1 (p = 0.055), while the physical and mental component summary scale as part of the SF-36 health survey improved from 32.9 ± 6.4 to 40.4 ± 9.4 (p = 0.058) and 43.6 ± 8.9 to 57.3 ± 5.5 (p = 0.021), respectively. Bionic reconstruction can restore simple but robust arm and hand function in longstanding brachial plexus patients with lack of treatment alternatives.

scholarly journals Dorsal Root Entry Zone Lesioning for Brachial Plexus Avulsion Injuries: Case Series and Literature Review

2021 ◽  
Vol 2 ◽  
Author(s):  
Alan Chalil ◽  
Qian Wang ◽  
Mohamad Abbass ◽  
Brendan G. Santyr ◽  
Keith W. MacDougall ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Pain Intensity ◽  
Dorsal Root ◽  
Case Series ◽  
Permanent Disability ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Brachial Plexus Avulsion ◽  
Deafferentation Pain ◽  
Root Entry Zone

Introduction: Brachial plexus avulsion (BPA) injuries commonly occur secondary to motor vehicle collisions, usually in the young adult population. These injuries are associated with significant morbidity, and up to 90% of patients suffer from deafferentation pain. Neuromodulation procedures can be efficacious in the treatment of refractory neuropathic pain, although the treatment of pain due to BPA can be challenging. Dorsal root entry zone (DREZ) lesioning is a classical and effective neurosurgical technique which has become underutilized in treating refractory root avulsion pain.Methods: A systematic review of the different technical nuances, procedural efficacy, and complication profiles regarding DREZ lesioning for BPA injuries in the literature is included. We also present an institutional case series of 7 patients with BPA injuries who underwent DREZ lesioning.Results: In the literature, 692 patients were identified to have undergone DREZ lesioning for pain related to BPA. In 567 patients, the surgery was successful in reducing pain intensity by over 50% in comparison to baseline (81.9%). Complications included transient motor deficits (11%) and transient sensory deficits (11%). Other complications including permanent disability, cardiovascular complications, infections, or death were rare (<1.9%). In our case series, all but one patient achieved >50% reduction in pain intensity, with the mean pre-operative pain of 7.9 ± 0.63 (visual analog scale) reduced to 2.1 ± 0.99 at last follow-up (p < 0.01).Conclusion: Both the literature and the current case series demonstrate excellent pain severity reduction following DREZ ablation for deafferentation pain secondary to BPA.

Bionic reconstruction to restore hand function after brachial plexus injury: a case series of three patients

The Lancet ◽  
2015 ◽  
Vol 385 (9983) ◽  
pp. 2183-2189 ◽  
Author(s):  
Oskar C Aszmann ◽  
Aidan D Roche ◽  
Stefan Salminger ◽  
Tatjana Paternostro-Sluga ◽  
Malvina Herceg ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Hand Function ◽  
Case Series ◽  
Bionic Reconstruction

scholarly journals Thalamic deep brain stimulation for neuropathic pain after amputation or brachial plexus avulsion

2013 ◽  
Vol 35 (3) ◽  
pp. E7 ◽  
Author(s):  
Erlick A. C. Pereira ◽  
Sandra G. Boccard ◽  
Paulo Linhares ◽  
Clara Chamadoira ◽  
Maria José Rosas ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Deep Brain Stimulation ◽  
Brachial Plexus ◽  
Brain Stimulation ◽  
Case Series ◽  
Brachial Plexus Avulsion ◽  
Vas Score ◽  
Sf 36 ◽  
The Mean ◽  
Deep Brain

Object Fifteen hundred patients have received deep brain stimulation (DBS) to treat neuropathic pain refractory to pharmacotherapy over the last half-century, but few during the last decade. Deep brain stimulation for neuropathic pain has shown variable outcomes and gained consensus approval in Europe but not the US. This study prospectively evaluated the efficacy at 1 year of DBS for phantom limb pain after amputation, and deafferentation pain after brachial plexus avulsion (BPA), in a single-center case series. Methods Patient-reported outcome measures were collated before and after surgery, using a visual analog scale (VAS) score, 36-Item Short-Form Health Survey (SF-36), Brief Pain Inventory (BPI), and University of Washington Neuropathic Pain Score (UWNPS). Results Twelve patients were treated over 29 months, receiving contralateral, ventroposterolateral sensory thalamic DBS. Five patients were amputees and 7 had BPAs, all from traumas. A postoperative trial of externalized DBS failed in 1 patient with BPA. Eleven patients proceeded to implantation and gained improvement in pain scores at 12 months. No surgical complications or stimulation side effects were noted. In the amputation group, after 12 months the mean VAS score improved by 90.0% ± 10.0% (p = 0.001), SF-36 by 57.5% ± 97.9% (p = 0.127), UWNPS by 80.4% ± 12.7% (p < 0.001), and BPI by 79.9% ± 14.7% (p < 0.001). In the BPA group, after 12 months the mean VAS score improved by 52.7% ± 30.2% (p < 0.001), SF-36 by 15.6% ± 30.5% (p = 1.000), UWNPS by 26.2% ± 40.8% (p = 0.399), and BPI by 38.4% ± 41.7% (p = 0.018). Mean DBS parameters were 2.5 V, 213 microseconds, and 25 Hz. Conclusions Deep brain stimulation demonstrated efficacy at 1 year for chronic neuropathic pain after traumatic amputation and BPA. Clinical trials that retain patients in long-term follow-up are desirable to confirm findings from prospectively assessed case series.

Congenital brachial plexus palsy

2011 ◽  
Author(s):  
Marco Sinisi
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Hand Function ◽  
Shoulder Function ◽  
Mechanism Of Injury ◽  
Brachial Plexus Palsy ◽  
Surgical Exploration

♦ The congenital brachial plexus palsy is significantly different from the adult injury♦ The mechanism of injury is invariably traction♦ Classifying the lesion at 1–2 weeks of age aids with prognosis and management♦ Surgical exploration and repair is indicated early in selected cases♦ Good shoulder function is essential for a useful upper limb♦ Recovery of hand function is slow and may continue until age 5 years.

scholarly journals Qualidade de vida e condições ergonômicas em trabalhadores de um laboratório de saúde pública

2021 ◽  
Vol 34 ◽  
pp. 1-10
Author(s):  
Hilda Aparecida Felício ◽  
Susilene Maria Tonelli Nardi ◽  
Pryscilla Mychelle da Silva Paula ◽  
Heloisa da Silveira Paro Pedro ◽  
Vânia Del’Arco Paschoal
Keyword(s):  
Upper Limb ◽  
Health Survey ◽  
Short Form ◽  
Short Form Health Survey ◽  
Form Health ◽  
Sf 36 ◽  
Short Form Health

Objetivo: Avaliar a qualidade de vida, a presença de dor e as condições ergonômicas dos profissionais de um laboratório de saúde pública. Métodos: Estudo transversal e descritivo que avaliou 49 (90,7%) profissionais de um laboratório de saúde pública, entre julho de 2014 e setembro de 2015, por meio de dados sociodemográficos e dos protocolos Short Form Health Survey (SF-36), Rapid Upper Limb Assessment (RULA) e Escala Visual Analógica da Dor (EVA). Para a análise descritiva das variáveis clínicas e sociodemográficas e a associação dos dados, utilizou-se o EPI Info, versão 7.2, considerando significantes p<0,05. O software Ergolândia, versão 6.0, analisou o resultado/escore Rapid Upper Limb Assessment (RULA). Resultados: Predomínio do sexo feminino (93,1%), casadas (57,1%), com média de idade 42,7(DP 13,4), 15 anos de estudo e renda acima de três salários (61,2%). Os participantes que apresentaram baixa qualidade de vida relacionada à “saúde mental” tiveram maior risco ergonômico avaliado pelo RULA (p<0,05). Nenhum participante apresentou postura laboral aceitável. Todos (100%) tinham algum grau de dor. As dores moderada e intensa têm relação de forma negativa com a qualidade de vida nos seguintes domínios do SF-36: “estado geral de saúde”, “dor,” “vitalidade” e “saúde mental” (p<0,05). Conclusão: Todos os participantes apresentam alguma dor, independente da idade ou da função. A saúde física autorrelatada e os escores obtidos por meio da EVA revelaram que as dores moderada e intensa influenciam de forma negativa a qualidade de vida e, de acordo com o RULA, nenhum participante apresenta postura laboral aceitável.

scholarly journals Brachial Plexus Injuries – Review of the Anatomy and the Treatment Options

PRILOZI ◽  
2021 ◽  
Vol 42 (1) ◽  
pp. 91-103
Author(s):  
Sofija Pejkova ◽  
Venko Filipce ◽  
Igor Peev ◽  
Bisera Nikolovska ◽  
Tomislav Jovanoski ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Tendon Transfer ◽  
Treatment Options ◽  
Axillary Nerve ◽  
Nerve Graft ◽  
Muscle Transfer ◽  
Lower Trunk ◽  
Functional Deficit ◽  
Bionic Reconstruction

Abstract 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.

scholarly journals Peripheral Nerve Stimulation of the Brachial Plexus for Chronic Refractory CRPS Pain of the Upper Limb: Description of a New Technique and Case Series

Pain Medicine ◽  
2020 ◽  
Vol 21 (Supplement_1) ◽  
pp. S18-S26
Author(s):  
Thiago Nouer Frederico ◽  
Tiago da Silva Freitas
Keyword(s):  
Neuropathic Pain ◽  
Conservative Treatment ◽  
Brachial Plexus ◽  
Complex Regional Pain Syndrome ◽  
Upper Limb ◽  
Case Series ◽  
Pain Syndrome ◽  
Pain Scale ◽  
New Technique ◽  
A New Technique

Abstract Objective Upper limb complex regional pain syndrome is an important cause of chronic pain, and its treatment is challenging. In this pilot case series, we preliminarily evaluated the feasibility, effectiveness, and safety of a new technique for brachial plexus neuromodulation in the treatment of this disease in patients refractory to conservative treatment. Methods Between 2017 and 2018, 14 patients considered to be refractory to optimized conservative treatment were recruited to this study. In the first stage, patients were trialed for seven days with a new technique of implant of the brachial plexus. Patients with ≥50% pain relief in visual analog scale (VAS) score received a definitive implantation in the second stage. Follow-ups were conducted at pre-implant and 12 months using the Neuropathic Pain Scale, SF-32, and the visual analogic scale for pain. Results After the initial trial, 10 patients had a pain reduction of ≥50% and received a permanent implant. At 12-month follow-up, VAS, Neuropathic Pain Scale, SF-12 physical and mental scores improved by 57.4% +/- 10% (P = 0.005), 60.2% +/- 12.9% (P = 0.006), and 21.9% +/- 5.9% (P = 0.015), respectively. Conclusions Our data suggest that this new technique of brachial plexus stimulation may have long-term utility in the treatment of painful upper limb complex regional pain syndrome. New more detailed comprehensive studies should be carried out to confirm our findings in a larger population and to further refine the clinical implementation of this technique.

scholarly journals The Vienna psychosocial assessment procedure for bionic reconstruction in patients with global brachial plexus injuries

PLoS ONE ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. e0189592 ◽  
Author(s):  
Laura Antonia Hruby ◽  
Anna Pittermann ◽  
Agnes Sturma ◽  
Oskar Christian Aszmann
Keyword(s):  
Brachial Plexus ◽  
Psychosocial Assessment ◽  
Assessment Procedure ◽  
Bionic Reconstruction

Alteration of metabolic connectivity in a rat model of deafferentation pain: a 18F-FDG PET/CT study

2020 ◽  
Vol 132 (4) ◽  
pp. 1295-1303 ◽  
Author(s):  
Bei-Bei Huo ◽  
Jun Shen ◽  
Xu-Yun Hua ◽  
Mou-Xiong Zheng ◽  
Ye-Chen Lu ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Brachial Plexus ◽  
Fdg Pet ◽  
Brachial Plexus Avulsion ◽  
Deafferentation Pain ◽  
Pet Ct ◽  
Pain Sensitization ◽  
Metabolic Connectivity ◽  
Fdg Pet Ct

OBJECTIVERefractory deafferentation pain has been evidenced to be related to central nervous system neuroplasticity. In this study, the authors sought to explore the underlying glucose metabolic changes in the brain after brachial plexus avulsion, particularly metabolic connectivity.METHODSRats with unilateral deafferentation following brachial plexus avulsion, a pain model of deafferentation pain, were scanned by small-animal 2-deoxy-[18F]fluoro-d-glucose (18F-FDG) PET/CT to explore the changes of metabolic connectivity among different brain regions. Thermal withdrawal latency (TWL) and mechanical withdrawal threshold (MWT) of the intact forepaw were also measured for evaluating pain sensitization. Brain metabolic connectivity and TWL were compared from baseline to 1 week after brachial plexus avulsion.RESULTSAlterations of metabolic connectivity occurred not only within the unilateral hemisphere contralateral to the injured forelimb, but also in the other hemisphere and even in the connections between bilateral hemispheres. Metabolic connectivity significantly decreased between sensorimotor-related areas within the left hemisphere (contralateral to the injured forelimb) (p < 0.05), as well as between areas across bilateral hemispheres (p < 0.05). Connectivity between areas within the right hemisphere (ipsilateral to the injured forelimb) significantly increased (p = 0.034). TWL and MWT of the left (intact) forepaw after surgery were significantly lower than those at baseline (p < 0.001).CONCLUSIONSThis study revealed that unilateral brachial plexus avulsion facilitates pain sensitization in the opposite limb. A specific pattern of brain metabolic changes occurred in this procedure. Metabolic connectivity reorganized not only in the sensorimotor area corresponding to the affected forelimb, but also in extensive areas involving the bilateral hemispheres. These findings may broaden our understanding of central nervous system changes, as well as provide new information and a potential intervention target for nosogenesis of deafferentation pain.

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