scholarly journals Posterior Cord of Brachial Plexus and Its Branches: Anatomical Variations and Clinical Implication

ISRN Anatomy ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Rakhi Rastogi ◽  
Virendra Budhiraja ◽  
Kshitij Bansal
Keyword(s):  
Brachial Plexus ◽  
Clinical Implication ◽  
Axillary Artery ◽  
Anatomical Variations ◽  
Axillary Nerve ◽  
Upper Extremities ◽  
Surgical Approaches ◽  
Lower Trunk ◽  
Medical Undergraduate ◽  
Posterior Division

Background. Knowledge of anatomical variations of posterior cord and its branches is important not only for the administration of anaesthetic blocks but also for surgical approaches to the neck, axilla, and upper arm. The present study aimed to record the prevalence of such variations with embryological explanation and clinical implication. Material and Method. 37 formalin-preserved cadavers, that is, 74 upper extremities from the Indian population, constituted the material for the study. Cadavers were dissected during routine anatomy classes for medical undergraduate. Dissection includes surgical incision in the axilla, followed by retraction of various muscles, to observe and record the formation and branching pattern of posterior cord of brachial plexus. Results. Posterior cord was formed by union of posterior division of C5 and C6 roots with posterior division of middle and lower trunk (there was no upper trunk) in 16.2% of upper extremities. Posterior cord of brachial plexus was present lateral to the second part of axillary artery in 18.9% of upper extremities. Axillary nerve was taking origin from posterior division of upper trunk in 10.8% upper extremities and thoracodorsal nerve arising from axillary nerve in 22.9% upper extremities. Conclusion. It is important to be aware of such variations while planning a surgery in the region of axilla as these nerves are more liable to be injured during surgical procedures.

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.

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.

Upper trunk block for shoulder analgesia with potential phrenic nerve sparing: a preliminary anatomical report

2019 ◽  
Vol 44 (9) ◽  
pp. 872-874 ◽  
Author(s):  
José Cros Campoy ◽  
Oscar Domingo Bosch ◽  
Jaume Pomés ◽  
Jing Lee ◽  
Ben Fox ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Suprascapular Nerve ◽  
Nerve Sparing ◽  
Phrenic Nerve Palsy ◽  
Scalene Muscle ◽  
Lower Trunk ◽  
Anatomical Basis ◽  
Dye Staining ◽  
Posterior Division

Background and objectivesIpsilateral phrenic nerve palsy (PNP) is an undesirable side of conventional approaches to interscalene brachial plexus blocks. The purpose of this study was to demonstrate whether or not the phrenic nerve can be spared by dye when injected at the division of the upper trunk of the brachial plexus.MethodsUnder ultrasound guidance, 5 mL of radiolabeled dye was injected between the anterior and posterior division of the upper trunk in two fresh, cryopreserved cadavers. CT scan analysis, cadaveric dissection, and cryosectioning were performed to examine the spread of the injectate.ResultsWe found staining of the injectate over the entire upper trunk with its anterior and posterior divisions, the suprascapular nerve under the omohyoid muscle and the lateral pectoralis nerve, and the C5 and C6 roots. The middle trunk was partially stained. There was no evidence of dye staining of the lower trunk, anterior aspect of the anterior scalene muscle, or the phrenic nerve.ConclusionsOur study offers an anatomical basis for the possibility of providing shoulder analgesia and avoiding a PNP.

Radial to axillary nerve neurotization for brachial plexus injury in children: a combined case series

2014 ◽  
Vol 14 (5) ◽  
pp. 518-526 ◽  
Author(s):  
Scott L. Zuckerman ◽  
Ilyas M. Eli ◽  
Manish N. Shah ◽  
Nadine Bradley ◽  
Christopher M. Stutz ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Nerve Injury ◽  
Brachial Plexus Injury ◽  
Tertiary Care ◽  
Case Series ◽  
Deltoid Muscle ◽  
Axillary Nerve ◽  
Surgical Approaches ◽  
Shoulder Abduction ◽  
Older Children

Object Axillary nerve palsy, isolated or as part of a more complex brachial plexus injury, can have profound effects on upper-extremity function. Radial to axillary nerve neurotization is a useful technique for regaining shoulder abduction with little compromise of other neurological function. A combined experience of this procedure used in children is reviewed. Methods A retrospective review of the authors' experience across 3 tertiary care centers with brachial plexus and peripheral nerve injury in children (younger than 18 years) revealed 7 cases involving patients with axillary nerve injury as part of an overall brachial plexus injury with persistent shoulder abduction deficits. Two surgical approaches to the region were used. Results Four infants (ages 0.6, 0.8, 0.8, and 0.6 years) and 3 older children (ages 8, 15, and 17 years) underwent surgical intervention. No patient had significant shoulder abduction past 15° preoperatively. In 3 cases, additional neurotization was performed in conjunction with the procedure of interest. Two surgical approaches were used: posterior and transaxillary. All patients displayed improvement in shoulder abduction. All were able to activate their deltoid muscle to raise their arm against gravity and 4 of 7 were able to abduct against resistance. The median duration of follow-up was 15 months (range 8 months to 5.9 years). Conclusions Radial to axillary nerve neurotization improved shoulder abduction in this series of patients treated at 3 institutions. While rarely used in children, this neurotization procedure is an excellent option to restore deltoid function in children with brachial plexus injury due to birth or accidental trauma.

scholarly journals Complications of contralateral C-7 transfer through the modified prespinal route for repairing brachial plexus root avulsion injury: a retrospective study of 425 patients

2015 ◽  
Vol 122 (6) ◽  
pp. 1421-1428 ◽  
Author(s):  
Wenjun Li ◽  
Shufeng Wang ◽  
Jianyong Zhao ◽  
M. Fazlur Rahman ◽  
Yucheng Li ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Vertebral Artery ◽  
Upper Extremity ◽  
Nerve Root ◽  
Severe Bleeding ◽  
Root Avulsion ◽  
Avulsion Injury ◽  
Lower Trunk ◽  
Study Population ◽  
Posterior Division

OBJECT In this report, the authors review complications related to the modified prespinal route in contralateral C-7 transfer for repairing brachial plexus nerve root avulsion injury and suggest a prevention strategy. METHODS A retrospective, nonselected amalgamation of every case of modified contralateral C-7 transfer through the prespinal route was undertaken. The study population comprised 425 patients treated between February 2002 and August 2009. The patients were managed according to a standardized protocol by one senior professor. The surgical complications were grouped into one of the following categories: those associated with tunnel making through the prespinal route, those related to the dissection and transection of the contralateral C-7 nerve root, and those that occurred in the postoperative period. RESULTS The study population included 379 male and 46 female patients whose average age was 21 years (range 3 months to 56 years). A total of 401 patients were diagnosed with traumatic brachial plexus injury, the leading cause of which was motor vehicle accident, and 24 patients were diagnosed with obstetrical brachial plexus palsy. The contralateral C-7 nerve root was cut at the proximal side of the division portion of the middle trunk in 15 cases and sectioned at the distal end of the anterior and posterior divisions in 410 cases. The overall incidence of complications was 5.4% (23 of 425). Complications associated with making a prespinal tunnel occurred in 12 cases, including severe bleeding due to vertebral artery injury during the procedure in 2 cases (0.47%), temporary recurrent laryngeal nerve palsy in 5 cases (1.18%), pain and numbness in the donor upper extremity during swallowing in 4 cases (0.94%), and dyspnea caused by thrombosis of the brainstem 42 hours postoperatively in 1 case (0.24%); this last patient died 38 days after the operation. Complications related to exploration and transection of the contralateral C-7 nerve root occurred in 11 cases, including deficiency in extensor strength of the fingers and thumb in 4 cases (0.94%) due to injury to the posterior division of the lower trunk, unbearable pain on the donor upper extremity in 3 cases (0.71%), Horner's syndrome in 2 children (0.47%) who suffered birth palsy, a section of C-6 nerve root mistaken as C-7 in l case (0.24%), and atrophy of the sternocostal part of the pectoralis major in 1 case (0.24%). CONCLUSIONS The most serious complications of using the modified prespinal route in contralateral C-7 transfer were vertebral artery laceration and injury to the posterior division of the lower trunk. The prevention of such complications is necessary to popularize this surgical procedure and attain good long-term clinical results.

Brachial Plexus Variations in Human Fetuses

Neurosurgery ◽  
2003 ◽  
Vol 53 (3) ◽  
pp. 676-684 ◽  
Author(s):  
İsmihan İlknur Uysal ◽  
Muzaffer Şeker ◽  
Ahmet Kağan Karabulut ◽  
Mustafa Büyükmumcu ◽  
Taner Ziylan
Keyword(s):  
Brachial Plexus ◽  
Median Nerve ◽  
Surgical Procedures ◽  
Distal Part ◽  
Axillary Nerve ◽  
Human Fetuses ◽  
Anatomic Variations ◽  
Normal Position ◽  
Morphological Variations ◽  
Posterior Division

Abstract OBJECTIVE We examined the anatomic variations of the brachial plexus (BP) in human fetuses. METHODS This study was performed with 200 BPs from spontaneously aborted fetuses without detectable malformations. The plexuses were dissected, and the normal position and/or morphological variations of the BP were determined and photographed. RESULTS There were no variations in 93 plexuses, and 107 plexuses were observed to have different variations. Morphological variations were observed more frequently among female fetuses and right sides. The BPs were composed mostly of the C5, C6, C7, and C8 nerves and the T1 nerve (71.5%). A prefixed plexus was observed in 25.5% of cases, and a postfixed plexus was observed in 2.5% of cases. In one case (0.5%), the C4 and T2 nerves joined the formation. The inferior trunk was not formed in 9% of cases. The superior trunk was not formed in 1% of cases. In one plexus, the superior trunk was formed by the ventral rami of the C4 and C5 nerves. In one case, the inferior trunk was formed by the ventral rami of the T1 and T2 nerves. Division variations were observed most frequently. There were also variations in the terminal branches, such as the roots of the median nerve joining in the distal part of the arm (8.5%), the axillary nerve being separate from the posterior division of the superior trunk (2.5%), and a connection existing between the median and musculocutaneous nerves (1%). CONCLUSION Knowledge of BP variations is important for surgeons who perform surgical procedures in the cervical and axillary regions.

Quantitation of the lower subscapular nerve for potential use in neurotization procedures

2006 ◽  
Vol 105 (6) ◽  
pp. 881-883 ◽  
Author(s):  
R. Shane Tubbs ◽  
Charles A. Khoury ◽  
E. George Salter ◽  
Leslie Acakpo-Satchivi ◽  
John C. Wellons ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Axillary Nerve ◽  
Musculocutaneous Nerve ◽  
Upper Extremities ◽  
Subscapularis Muscle ◽  
New Information ◽  
Teres Major ◽  
Left And Right ◽  
The Mean ◽  
Potential Use

Object New information regarding nerve branches of the brachial plexus can be useful to the surgeon performing neurotization procedures following patient injury. Nerves in the vicinity of the axillae have been commonly used for neural grafting procedures, with the exception of the lower subscapular nerve (LSN). Methods The authors dissected and measured the LSN in 47 upper extremities (left and right sides) obtained in 27 adult cadavers, and determined distances between the LSN and surrounding nerves to help quantify it for possible use in neurotization procedures. The mean diameter of the LSN was 2.3 mm. The mean length of the LSN from its origin at the posterior cord until it branched to the subscapularis muscle was 3.5 cm, and the mean distance from this branch until its termination in the teres major muscle was 6 cm. Therefore, the mean length of the entire LSN from the posterior cord to the teres major was 9.5 cm. When the LSN was mobilized to explore its possible use in neurotization, it reached the entrance site of the musculocutaneous nerve into the coracobrachialis muscle in all but three sides and was within 1.5 cm from this point in these three. In the other specimens, the mean length of the LSN distal to this site of the musculocutaneous nerve was 2 cm. The mobilized LSN reached the axillary nerve trunk as it entered the quadrangular space in all specimens. The mean length of the LSN distal to this point on the axillary nerve was 2.5 cm. Furthermore, on all but one side the LSN was found within the confines of an anatomical triangle previously described by the authors. Conclusions The authors hope that these data will prove useful to the surgeon for both identifying the LSN and planning for potential neurotization procedures of the brachial plexus.

Surgical landmarks for the proximal portion of the axillary nerve

2001 ◽  
Vol 95 (6) ◽  
pp. 998-1000 ◽  
Author(s):  
R. Shane Tubbs ◽  
W. Jerry Oakes ◽  
Jeffrey P. Blount ◽  
Scott Elton ◽  
George Salter ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Axillary Artery ◽  
Coracoid Process ◽  
Axillary Nerve ◽  
Proximal Portion ◽  
Anatomical Structures ◽  
Content Type ◽  
Pectoralis Minor ◽  
Human Cadavers ◽  
Fine Print

Object. The proximal segment of the axillary nerve (ANp) is often difficult to identify without extensive dissection deep into the axilla. The present study was performed to find reliable surgical landmarks for this nerve. Methods. Thirty dissections of human cadavers were performed to determine the relationships between the ANp and specific anatomical structures. The authors found that the ANp is consistently located within an anatomical triangle constructed by lines passing between the coracobrachialis and pectoralis minor muscles and the axillary artery. In addition, the ANp was routinely found 4 cm distal to the coracoid process of the scapula. Conclusions. These findings should assist the surgeon in locating the ANp during brachial plexus reconstruction.

scholarly journals Abnormal formation of medial cord of brachial plexus - a case report

2016 ◽  
Vol 05 (02) ◽  
pp. 100-102
Author(s):  
Rupak Jyoti Baishya ◽  
Rubi Saikia ◽  
Shobhana Medhi
Keyword(s):  
Case Report ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Invasive Procedures ◽  
Medical College ◽  
Lower Trunk ◽  
Lateral Cord ◽  
Posterior Division ◽  
Anterior Division ◽  
Ethical Clearance

AbstractBrachial plexus is the plexus of nerves that supplies the upper limb. The anterior divisions of upper and middle trunks form lateral cord and that of the lower trunk form medial cord. Posterior divisions of all the three trunks form the posterior cord. Here we report a case of unilateral variation in the formation of medial cord of brachial plexus during dissection of a female perinatal cadaver of 34 weeks of gestation which was dissected as a part of Congenital Malformation Survey conducted in the Department of Anatomy, Assam Medical College, Dibrugarh with necessary ethical clearance. Medial cord was formed by the anterior division of lower trunk and this cord had a communication from the posterior division of middle trunk. It is very important to be aware of the variations of the cords of the brachial plexus during different invasive procedures in that region.

Direct Coaptation of the Phrenic Nerve With the Posterior Division of the Lower Trunk to Restore Finger and Elbow Extension Function in Patients With Total Brachial Plexus Injuries

Neurosurgery ◽  
2015 ◽  
Vol 78 (2) ◽  
pp. 208-215 ◽  
Author(s):  
Shu-feng Wang ◽  
Peng-cheng Li ◽  
Yun-hao Xue ◽  
Ji-yao Zou ◽  
Wen-jun Li ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Muscle Power ◽  
Nerve Transfer ◽  
Elbow Extension ◽  
Adult Group ◽  
Adolescent Group ◽  
Lower Trunk ◽  
Finger Extension ◽  
Posterior Division

ABSTRACT BACKGROUND: To overcome the mismatch in nerve sizes in phrenic nerve transfer to the radial nerve for elbow and finger extension reanimation for patients with total brachial plexus injuries (TBPI), a selective neurotization procedure was designed. OBJECTIVE: To investigate the long-term results of phrenic nerve transfer to the posterior division of the lower trunk with direct coaptation in restoring elbow and finger extension after TBPI. METHODS: Phrenic nerve was transferred to and directly coapted with the posterior division of the lower trunk in 27 patients with TBPI. Seven patients were <18 years old (adolescent group), and the remaining 20 patients ≥18 years (adult group). RESULTS: Postoperative mean follow-up period was 54 ± 9 months (range, 48-85 months). The motor function attained M3 or greater in 81.5% of patients for elbow extension and in 48% of patients for finger extension. The percentage of patients who regained M3 or greater muscle power of finger extension in the adolescent group and the adult group was 71.4%, and 40%, respectively. Meanwhile, 85.7% in the adolescent group and 80% in the adult group achieved M3 or greater muscle power of elbow extension. There were no significant differences between the 2 groups. The elbow extension and finger extension were synchronous contractions and did not become independent of respiratory effort. CONCLUSION: This procedure simultaneously and effectively restores the function of elbow and finger extension in patients after TBPI. However, the patients could not do elbow and finger extension separately.

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