Journal of Brachial Plexus and Peripheral Nerve Injury

Introduction  Brachial plexus lipomas are extremely rare benign tumors that may cause slow progression of neurological deficits leading to thoracic outlet syndrome. Up to now, surgery remains challenging. The aim of this study is to present our surgical treatment regime and long-term neurological outcome in three cases of giant brachial plexus lipomas and to show results of systematic review. Patients and Methods  Retrospective analysis of our database "peripheral nerve lesion" to identify patients suffering from brachial plexus lipomas between January 1, 2012, and December 31, 2019...

Objectives  The purpose of this study was to report the functional outcomes of phrenic nerve transfer (PNT) to suprascapular nerve (SSN) for shoulder reconstruction in brachial plexus injury (BPI) patients with total and C5-8 palsies, and its pulmonary complications. Methods  Forty-four out of 127 BPI patients with total and C5-8 palsies who underwent PNT to SSN for shoulder reconstruction were evaluated for functional outcomes in comparison with other types of nerve transfers. Their pulmonary function was analyzed using vital capacity in the percentage of predicted value and Hugh-Jones (HJ) breathless classification...

Background  An addition of analgesic to anesthetic agents is likely to increase the effects of anesthesia and reduce associated adverse outcomes. Several adjuvants are studied in this regard. The aim of this study is to investigate the effects of adding a magnesium adjunct to lidocaine for the induction of infraclavicular block. Methods  Patients referred to Shohada Ashayer Hospital, Khorramabad, for wrist and hand surgery were enrolled in this study. The intervention/case group included patients who received 18 mL lidocaine (2%) + 2 mL magnesium sulfate (50%), 10 mL normal saline; control group: 18 mL lidocaine (2%) + 12 mL of normal saline...

Background  Brachial plexopathy causes pain and loss of function in the affected extremity. Entrapment of the brachial plexus terminal branches within the surrounding connective tissue, or medial brachial fascial compartment, may manifest in debilitating symptoms. Open fasciotomy and external neurolysis of the neurovascular bundle in the medial brachial fascial compartment were performed as a surgical treatment for pain and functional decline in the upper extremity. The aim of this study was to evaluate pain outcomes after surgery in patients diagnosed with brachial plexopathy...

Background  Diagnosing ulnar neuropathy at the elbow (UNE) remains challenging despite guidelines from national organizations. Motor testing of hand intrinsic muscles remains a common diagnostic method fraught with challenges. Objective  The aim of the study is to demonstrate utility of an uncommon nerve conduction study (NCS), mixed across the elbow, when diagnosing UNE. Methods  Retrospective analysis of 135 patients, referred to an outpatient University-based electrodiagnostic laboratory with suspected UNE between January 2013 and June 2019 who had motor to abductor digiti minimi (ADM), motor to first dorsal interosseus (FDI), and mixed across the elbow NCS completed...

Background  Nerve root tethering upon dorsal spinal cord (SC) migration has been proposed as a potential mechanism for postoperative C5 palsy (C5P). To our knowledge, this is the first study to investigate this relationship by anatomically comparing C5-C6 nerve root translation before and after root untethering by cutting the cervical foraminal ligaments (FL). Objective  The aim of this study is to determine if C5 root untethering through FL cutting results in increased root translation. Methods  Six cadaveric dissections were performed...

Background  Interstitial cystitis (IC) or bladder pain syndrome (BPS) is highly painful and disabling and probably the most misdiagnosed urologic condition. Its classic symptoms of perineal pain, urinary urgency, and frequency despite sterile urine cultures were already described more than a century ago in a report on soldiers during World War (WW) I due to chronic pudendal nerve compression. Objectives  This article translates a report from 1915 on pudendal neuropathy and discusses its author Georg Zülzer (1870-1949)...

Median nerve anatomy is of great interest to clinicians and scientists given the importance of this nerve and its association with diseases. A rare anatomical variant of the median nerve in the distal forearm and wrist was discovered during a cadaveric dissection. The median nerve was deep to the flexor digitorum superficialis (FDS) in the carpal tunnel. It underwent a 360-degree spin before emerging at the lateral edge of FDS. The recurrent motor branch moved from medial to lateral on the deep surface of the median nerve, as it approached the distal carpal tunnel...

Background  Traumatic brachial plexus injuries (BPIs) represent a major cause of disability in young patients. The purpose of this study was to compare two populations (from Argentina and Germany) who suffered a traumatic BPI after a motorcycle accident to identify predictors of BPI and brain injury severity. Methods  Univariate and multivariable intergroup comparisons were conducted, and odds ratios were calculated to assess the associations between the different demographic, morphometric, and trauma-related variables, and the type and severity of patients' injuries...

Background  Obstetric brachial plexus injuries result from traction injury during delivery; 30% of these children sustain persisting functional limitations related to an external rotation deficit of the shoulder. The aim of this study was to compare the intraoperative gain in external rotation after a posterior subscapular release and an anterior coracohumeral ligament release. Methods  This is a prospective study on 102 children with an internal rotation contracture of the shoulder who received either a posterior subscapular release (posterior skin incision along the medial border of the scapula of 3-5 cm) or an anterior (5-mm skin incision) coracohumeral ligament release between 1996 and 2010...

Contractures of the shoulder joint and glenohumeral joint dysplasia are well known complications to obstetrical brachial plexus palsy. Despite extensive description of these sequelae, the exact pathogenesis remains unknown. The prevailing theory to explain the contractures and glenohumeral joint dysplasia states that upper trunk injury leads to nonuniform muscle recovery and thus imbalance between internal and external rotators of the shoulder. More recently, another explanation has been proposed, hypothesizing that denervation leads to reduced growth of developing muscles and that reinnervation might suppress contracture formation...

Background  Brachial plexus (BP) is composed of intercommunications among the ventral roots of the nerves C5, C6, C7, C8, and T1 in the neck. The in vivo and in vitro evaluation of axons of the peripheral nervous system is performed using different techniques. Recently, many studies describing the application of fiber tractography and stereological axon number estimation to peripheral nerves have been published. Methods  Various quantitative parameters of nerve fibers, including axon number, density, axonal area, and myelin thickness, can be estimated using stereological techniques...

No abstract text is available yet for this article.

Schwannomatosis is a distinct syndrome characterized by multiple peripheral nerve schwannomas that can be sporadic or familial in nature. Cases affecting the lower cranial nerves are infrequent. Here, the authors present a rare case of schwannomatosis affecting the left spinal accessory nerve. Upon genetic screening, an in-frame insertion at codon p.R177 of the Sox 10 gene was observed. There were no identifiable alterations in NF1, NF2, LZTR1, and SMARCB1. This case demonstrates a rare clinical presentation of schwannomatosis in addition to a genetic aberration that has not been previously reported in this disease context...

Rationale  Carpal tunnel syndrome (CTS) is the most frequently encountered compressive neuropathy of the upper limb. The treatment of CTS ranges from conservative management to carpal tunnel release. Many patients with misconception about the potential morbidity and with the hope of successful conservative treatment delay the surgical release of carpal tunnel. This delay results in reduced recovery of sensory and motor median nerve function. Objective  The aim of this study was to evaluate the influence of preoperative duration and severity of symptom on the outcome of carpal tunnel surgery...

Brachial plexus injuries can be debilitating. We have observed that manual reduction of the patients' shoulder subluxation improves their pain and have used this as a second reason to perform the trapezius to deltoid muscle transfer beyond motion. The authors report a series of nine patients who all had significant improvement of pain in the shoulder girdle and a decrease in pain medication use after a trapezius to deltoid muscle transfer. All patients were satisfied with the outcomes and stated that they would undergo the procedure again if offered the option...

Anterior tibial artery is a nonvital artery which is one of the three arteries of the leg. This artery has a short proximal l segment in the popliteal region and a long segment in the anterior compartment of the leg designated as distal segment. With consideration of the deep location of the proximal segment in the popliteal fossa, it is less susceptible to trauma and subsequent formation of an aneurysm. On the contrary, the superficial long distal segment is more susceptible to trauma with high chance of pseudoaneurysm formation at the site of unrecognized injury...

This study investigated the biomechanical responses of neonatal piglet brachial plexus (BP) segments-root/trunk, chord, and nerve at two different rates, 0.01 mm/second (quasistatic) and 10 mm/second (dynamic)-and compared their response to another peripheral nerve (tibial). Comparisons of mechanical responses at two different rates reported a significantly higher maximum load, maximum stress, and Young's modulus (E) values when subjected to dynamic rate. Among various BP segments, maximum stress was significantly higher in the nerve segments, followed by chord and then the root/trunk segments except no differences between chord and root/trunk segments at quasistatic rate...

Thoracic outlet syndrome (TOS) is caused by compression of the brachial plexus and/or subclavian vessels as they pass through the cervicothoracobrachial region, exiting the chest. There are three main types of TOS: neurogenic TOS, arterial TOS, and venous TOS. Neurogenic TOS accounts for approximately 95% of all cases, and it is usually caused by physical trauma (posttraumatic etiology), chronic repetitive motion (functional etiology), or bone or muscle anomalies (congenital etiology). We present two cases in which neurogenic TOS was elicited by vascular compression of the inferior portion of the brachial plexus...

Background  In rare, selected cases of severe (extended) upper obstetric brachial plexus palsy (OBPP), after supraclavicular exposure and distal mobilization of the traumatized trunks and careful neuroma excision, we decided to perform direct nerve coaptation with tolerable tension and immobilized the affected arm positioned in adduction and 90-degree elbow flexion for three weeks. Objectives  We present our surgical technique and preliminary results in a prospective open patient series, including 22 patients (14 right and 8 left side affected) between 2009 and 2016, operated at a mean age of 8...