scholarly journals The Role of Functional Electrical Stimulation in Brachial Plexus Injury Repair

2021 ◽  
Author(s):  
Lin Yang ◽  
Yaxuan Li ◽  
Qianling Zhang ◽  
Mengnan Jiang ◽  
Jia He
Keyword(s):  
Electrical Stimulation ◽  
Brachial Plexus ◽  
Functional Electrical Stimulation ◽  
Brachial Plexus Injury ◽  
Nerve Repair ◽  
Motor Dysfunction ◽  
Research Progress ◽  
Choice Of Treatment ◽  
Stimulation Method ◽  
Autonomous Movement

Brachial plexus injury (BPI) is a type of peripheral nerve injury, which is mainly manifested as upper limb sensory and motor dysfunction. Although the injury will not endanger life, it can cause serious functional loss and high disability rate, and eventually lead to patients unable to live normally. At present, the treatment methods for BPI mainly include conservative treatment, such as limb massage, exercise, drug therapy, autonomous movement and strength training; In clinic, nerve repair, nerve transplantation and muscle transfer can also be used. Although surgical treatment can better restore the function of injured brachial plexus, there is a certain risk, so it is not the first choice of treatment. As a mature electrical stimulation method, functional electrical stimulation (FES) can play a good role in promoting injured nerve regeneration and preventing skeletal muscle denervation atrophy, so it can be widely used in the treatment and functional recovery of BPI. This article will review the research progress of FES in the treatment of BPI.

Effects of early nerve repair on experimental brachial plexus injury in neonatal rats

2017 ◽  
Vol 43 (3) ◽  
pp. 275-281 ◽  
Author(s):  
Gráinne Bourke ◽  
Aleksandra M. McGrath ◽  
Mikael Wiberg ◽  
Lev N. Novikov
Keyword(s):  
Spinal Cord ◽  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Neuroprotective Effect ◽  
Nerve Repair ◽  
Neonatal Rats ◽  
Spinal Motoneurons ◽  
Muscle Weight ◽  
Retrograde Degeneration ◽  
Dendritic Branches

Obstetrical brachial plexus injury refers to injury observed at the time of delivery, which may lead to major functional impairment in the upper limb. In this study, the neuroprotective effect of early nerve repair following complete brachial plexus injury in neonatal rats was examined. Brachial plexus injury induced 90% loss of spinal motoneurons and 70% decrease in biceps muscle weight at 28 days after injury. Retrograde degeneration in spinal cord was associated with decreased density of dendritic branches and presynaptic boutons and increased density of astrocytes and macrophages/microglial cells. Early repair of the injured brachial plexus significantly delayed retrograde degeneration of spinal motoneurons and reduced the degree of macrophage/microglial reaction but had no effect on muscle atrophy. The results demonstrate that early nerve repair of neonatal brachial plexus injury could promote survival of injured motoneurons and attenuate neuroinflammation in spinal cord.

scholarly journals Management of Brachial Plexus Injury in Adults

2008 ◽  
Vol 97 (4) ◽  
pp. 317-323 ◽  
Author(s):  
P. Songcharoen
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Nerve Repair ◽  
Hand Function ◽  
Nerve Transfer ◽  
Nerve Grafting ◽  
Muscle Transfer ◽  
Nerve Roots ◽  
Elbow Function ◽  
Motorcycle Accidents

Brachial plexus injury in adults is commonly caused by motorcycle accidents. Surgical management consists of nerve repair and nerve grafting for extraforaminal nerve root or trunk injury, and of neurotization or nerve transfer for nerve roots avulsion. In general, the results regarding restoration of shoulder and elbow function are good but reinnervation of the forearm muscles is less than safisfactory in respect to restoration of hand function. Functioning free muscle transfer in combination with selective nerve transfer is a reasonable alternative surgical procedure.

End-to-side neurorrhaphy in brachial plexus reconstruction

2013 ◽  
Vol 119 (3) ◽  
pp. 689-694 ◽  
Author(s):  
Pavel Haninec ◽  
Libor Mencl ◽  
Radek Kaiser
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Nerve Repair ◽  
Experimental Studies ◽  
Deltoid Muscle ◽  
Axillary Nerve ◽  
Musculocutaneous Nerve ◽  
Biceps Muscle ◽  
Nerve Reconstruction ◽  
Nerve Suture

Object Although a number of theoretical and experimental studies dealing with end-to-side neurorrhaphy (ETSN) have been published to date, there is still a considerable lack of clinical trials investigating this technique. Here, the authors describe their experience with ETSN in axillary and musculocutaneous nerve reconstruction in patients with brachial plexus palsy. Methods From 1999 to 2007, out of 791 reconstructed nerves in 441 patients treated for brachial plexus injury, the authors performed 21 axillary and 2 musculocutaneous nerve sutures onto the median, ulnar, or radial nerves. This technique was only performed in patients whose donor nerves, such as the thoracodorsal and medial pectoral nerves, which the authors generally use for repair of axillary and musculocutaneous nerves, respectively, were not available. In all patients, a perineurial suture was carried out after the creation of a perineurial window. Results The overall success rate of the ETSN was 43.5%. Reinnervation of the deltoid muscle with axillary nerve suture was successful in 47.6% of the patients, but reinnervation of the biceps muscle was unsuccessful in the 2 patients undergoing musculocutaneous nerve repair. Conclusions The authors conclude that ETSN should be performed in axillary nerve reconstruction but only when commonly used donor nerves are not available.

scholarly journals A Systematic Review of Nerve Transfer and Nerve Repair for the Treatment of Adult Upper Brachial Plexus Injury

Neurosurgery ◽  
2012 ◽  
Vol 71 (2) ◽  
pp. 417-429 ◽  
Author(s):  
Lynda J.-S. Yang ◽  
Kate W.-C. Chang ◽  
Kevin C. Chung
Keyword(s):  
Brachial Plexus ◽  
Scale Score ◽  
Brachial Plexus Injury ◽  
Nerve Repair ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Shoulder Abduction ◽  
Nerve Reconstruction ◽  
Operative Exploration ◽  
Significant Difference

Abstract Nerve reconstruction for upper brachial plexus injury consists of nerve repair and/or transfer. Current literature lacks evidence supporting a preferred surgical treatment for adults with such injury involving shoulder and elbow function. We systematically reviewed the literature published from January 1990 to February 2011 using multiple databases to search the following: brachial plexus and graft, repair, reconstruction, nerve transfer, neurotization. Of 1360 articles initially identified, 33 were included in analysis, with 23 nerve transfer (399 patients), 6 nerve repair (99 patients), and 4 nerve transfer + proximal repair (117 patients) citations (mean preoperative interval, 6 ± 1.9 months). For shoulder abduction, no significant difference was found in the rates ratio (comparative probabilities of event occurrence) among the 3 methods to achieve a Medical Research Council (MRC) scale score of 3 or higher or a score of 4 or higher. For elbow flexion, the rates ratio for nerve transfer vs nerve repair to achieve an MRC scale score of 3 was 1.46 (P = .03); for nerve transfer vs nerve transfer + proximal repair to achieve an MRC scale score of 3 was 1.45 (P = .02) and an MRC scale score of 4 was 1.47 (P = .05). Therefore, for elbow flexion recovery, nerve transfer is somewhat more effective than nerve repair; however, no particular reconstruction strategy was found to be superior to recover shoulder abduction. When considering nerve reconstruction strategies, our findings do not support the sole use of nerve transfer in upper brachial plexus injury without operative exploration to provide a clear understanding of the pathoanatomy. Supraclavicular brachial plexus exploration plays an important role in developing individual surgical strategies, and nerve repair (when donor stumps are available) should remain the standard for treatment of upper brachial plexus injury except in isolated cases solely lacking elbow flexion.

Axillary nerve repair by fascicle transfer from the ulnar or median nerve in upper brachial plexus palsy

2012 ◽  
Vol 117 (3) ◽  
pp. 610-614 ◽  
Author(s):  
Pavel Haninec ◽  
Radek Kaiser
Keyword(s):  
Brachial Plexus ◽  
Median Nerve ◽  
Brachial Plexus Injury ◽  
Nerve Repair ◽  
Deltoid Muscle ◽  
Axillary Nerve ◽  
Brachial Plexus Palsy ◽  
Nerve Reconstruction ◽  
Long Thoracic Nerve

Object Nerve repair using motor fascicles of a different nerve was first described for the repair of elbow flexion (Oberlin technique). In this paper, the authors describe their experience with a similar method for axillary nerve reconstruction in cases of upper brachial plexus palsy. Methods Of 791 nerve reconstructions performed by the senior author (P.H.) between 1993 and 2011 in 441 patients with brachial plexus injury, 14 involved axillary nerve repair by fascicle transfer from the ulnar or median nerve. All 14 of these procedures were performed between 2007 and 2010. This technique was used only when there was a deficit of the thoracodorsal or long thoracic nerve, which are normally used as donors. Results Nine patients were followed up for 24 months or longer. Good recovery of deltoid muscle strength was seen in 7 (77.8%) of these 9 patients, and in 4 patients with less follow-up (14–23 months), for an overall success rate of 78.6%. The procedure was unsuccessful in 2 of the 9 patients with at least 24 months of follow-up. The first showed no signs of reinnervation of the axillary nerve by either clinical or electromyographic evaluation in 26 months of follow-up, and the second had Medical Research Council (MRC) Grade 2 strength in the deltoid muscle 36 months after the operation. The last of the group of 14 patients has had 12 months of follow-up and is showing progressive improvement of deltoid muscle function (MRC Grade 2). Conclusions The authors conclude that fascicle transfer from the ulnar or median nerve onto the axillary nerve is a safe and effective method for reconstruction of the axillary nerve in patients with upper brachial plexus injury.

Analysis of shoulder abduction by dynamic shoulder radiograph following suprascapular nerve repair in brachial plexus injury

2017 ◽  
Vol 22 (5) ◽  
pp. 840-845 ◽  
Author(s):  
Takashi Shimoe ◽  
Kazuteru Doi ◽  
Tomas Madura ◽  
Kannan K. Kumar ◽  
Tristram D. Montales ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Nerve Repair ◽  
Suprascapular Nerve ◽  
Shoulder Abduction
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