Transfer of the pronator quadratus motor branch for wrist extension reconstruction in brachial plexus palsy.

BACKGROUND: In extended upper-type lesions of the brachial plexus, nerve transfers and root grafting have improved the results of shoulder and elbow reconstruction. However, wrist extension reconstruction has received little attention. METHODS: In 20 cadaveric upper limbs, we dissected the anterior interosseous nerve and extensor carpi radialis brevis motor branch. Four patients with upper-type lesions of the brachial plexus with paralysis of wrist and finger extension were operated on within 10 months of trauma and followed up for 12 months after surgery. The terminal division of the anterior interosseous nerve, which innervates the pronator quadratus muscle, was transferred to the extensor carpi radialis brevis, and the distal stump was connected to a motor fascicle of the median nerve (n = 2) or to the distal branch of the flexor superficialis of the index finger (n = 2). RESULTS: The anterior interosseous nerve and extensor carpi radialis brevis had similar diameters (roughly 1 mm). The number of myelinated fibers in the nerve averaged 670, whereas the number in the extensor carpi radialis brevis averaged 183. The length of the nerve was approximately 80 mm, allowing for direct transfer to the extensor carpi radialis brevis with redundant length. At last evaluation, pronation scored M4 according to the Medical Research Council grading system. All patients recovered active wrist extension, scoring M4 with full, independent motor control. CONCLUSION: In C5 to C8 root injuries of the brachial plexus, transfer of the motor branch of the pronator quadratus to the extensor carpi radialis brevis can restore active wrist extension, and pronation is preserved. CLINICAL QUESTION/LEVEL OF EVIDENCE: : Therapeutic, IV.

Transfer of the distal terminal motor branch of the extensor carpi radialis brevis to the nerve of the flexor pollicis longus: an anatomic study and clinical application in a tetraplegic patient.

BACKGROUND: In tetraplegics, thumb and finger motion traditionally has been reconstructed via orthopedic procedures. Although rarely used, nerve transfers are a viable method for reconstruction in tetraplegia. OBJECTIVE: To investigate the anatomic feasibility of transferring the distal branch of the extensor carpi radialis brevis (ECRB) to the flexor pollicis longus (FPL) nerve and to report our first clinical case. METHODS: We studied the motor branch of the ECRB and FPL in 14 cadaveric upper limbs. Subsequently, a 24-year-old tetraplegic man with preserved motion in his shoulder, elbow, wrist, and finger extension, but paralysis of thumb and finger flexion underwent surgery. Seven months after trauma, we transferred the brachialis muscle with a tendon graft to the flexor digitorum profundus. The distal nerve of the ECRB was transferred to the FPL nerve. RESULTS: The branch to the ECRB entered the muscle in its anterior and proximal third. After sending out a first collateral, the nerve runs for 2.4 cm alongside the muscle and bifurcates intramuscularly. A main branch from the anterior interosseous nerve, which entered the muscle 3 cm from its origin on the radius, innervated the FPL. The ECRB and FPL nerves had similar diameters (∼1 mm) and numbers of myelinated fibers (∼180). In our patient, 14 months after surgery, pinching and grasping were restored and measured 2 and 8 kg strength, respectively. CONCLUSION: Transfer of the ECRB distal branch to the FPL is a viable option to reconstruct thumb flexion.

Transfer of axillary nerve branches to reconstruct elbow extension in tetraplegics: a laboratory investigation of surgical feasibility.

In spinal cord injuries at the C6 level, elbow extension is lost and needs reconstruction. Traditionally, elbow extension has been reconstructed by muscle transfers, which improve function only moderately. We have hypothesized that outcomes could be ameliorated by nerve transfers rather than muscle transfers. We anatomically investigated nerve branches to the teres minor and posterior deltoid as donors for transfer to triceps motor branches. In eight formalin-fixed cadavers, the axillary nerve, the teres minor branch, the posterior deltoid branch, the triceps long and upper medial head motor branches, and the thoracodorsal nerve were dissected bilaterally, their diameters measured and their myelinated fibers counted. To simulate surgery, using an axillary approach in two fresh cadavers, we transferred the teres minor or the posterior deltoid branch to the triceps long head and to the thoracodorsal nerve. The posterior division of the axillary nerve gave off the teres minor motor branch and then the branch to the posterior deltoid, terminating as the superior lateral brachial cutaneous nerve. The diameters of the teres minor motor branch, posterior deltoid, triceps long and upper medial head branches, and the thoracodorsal nerve all were ∼2 mm, with minimal variation. The nerves varied little in their numbers of myelinated fibers, being consistently about 1,000. Via an axillary approach, either the teres minor or the posterior deltoid branch could be transferred directly to the thoracodorsal nerve or to triceps branches without any tension.

Anatomical feasibility of transferring supinator motor branches to the posterior interosseous nerve in C7-T1 brachial plexus palsies. Laboratory investigation.

OBJECT: In C7-T1 palsies of the brachial plexus, shoulder and elbow function is preserved, but finger motion is absent. Finger flexion has been reconstructed using tendon or nerve transfers. Finger extension has been restored ineffectively by attaching the extensor tendons to the distal side of the dorsal radius (that is, tenodesis). In these types of nerve palsy, supinator muscle function is preserved because innervation stems from the C-6 root. In the present study, the authors investigated the anatomy and the feasibility of transferring the supinator motor branches to the posterior interosseous nerve. Sacrifice of the supinator motor branches does not abolish supination because biceps muscle function is preserved in lower-type injuries of the brachial plexus. METHODS: The posterior interosseous nerve was dissected in 20 formalin-fixed forearms. Through posterior forearm access, the posterior interosseous nerve and its motor branches to the supinator muscle were dissected. Specimens were removed for histological study. RESULTS: In the vicinity of the supinator muscle's proximal margin (that is, the Frohse arcade), 2 nerve branches arose laterally and medially from the posterior interosseous nerve to innervate the superficial and deep heads of the supinator muscle, respectively. The supinator motor nerves, when divided, could be coapted directly to the posterior interosseous nerve. The number of myelinated fibers in the supinator motor branches corresponded to 70% that of the posterior interosseous nerve. CONCLUSIONS: The supinator motor nerves can be transferred directly to the posterior interosseous nerve to restore thumb and finger extension in patients with C7-T1 brachial plexus lesions.

Anatomical study of the plantaris tendon: reliability as a tendo-osseous graft.

PURPOSE: The purpose of this study was to investigate the insertion of the plantaris tendon in terms of shape, length, width and size, to define if there is available bony insertion for future use as reconstructive procedure in secondary tendon graft in hand surgery. METHODS: In 30 limbs, the plantaris tendon was anatomically dissected to investigate its bony attachments to the calcaneus. RESULTS: The plantaris was present in 29 of 30 dissections and regularly inserted in the calcaneus. CONCLUSIONS: The tendo-osseous plantaris graft is, according to this research, amenable to be used as a viable choice in reconstruction of secondary flexor tendon injuries related to its length shape and size and especially due to the bone stock adequate to strong phalanx fixation.

Axillary nerve repair by triceps motor branch transfer through an axillary access: anatomical basis and clinical results.

OBJECT: Grafting or nerve transfers to the axillary nerve have been performed using a deltopectoral approach and/or a posterior arm approach. In this report, the surgical anatomy of the axillary nerve was studied with the goal of repairing the nerve through an axillary access. METHODS: The axillary nerve was bilaterally dissected in 10 embalmed cadavers to study its variations. Three patients with axillary nerve injuries then underwent surgical repair through an axillary access; the axillary nerve was repaired by transfer of the triceps long head motor branch. RESULTS: At the lateral margin of the subscapularis muscle, the axillary nerve was found in the center of a triangle bounded medially by the subscapular artery, laterally by the latissimus dorsi tendon, and cephalad by the posterior circumflex humeral artery. At the entrance of the quadrangular space, the axillary nerve divisions were loosely connected to each other, and could be clearly separated and correctly identified. Surgery for the axillary nerve repair through the axillary access was straightforward. Eighteen months after surgery, all three patients had recovered deltoid strength to a score of M4 on the Medical Research Council scale and had improved abduction strength by 50%. No deficit was evident in elbow extension. CONCLUSIONS: The axillary nerve and its branches can be safely dissected and repaired by triceps motor nerve transfer through an axillary access.

Triceps motor nerve branches as a donor or receiver in nerve transfers.

OBJECTIVE: The pattern of triceps innervation is complex and, as yet, has not been fully elucidated. The purposes of this study were 1) to clarify the anatomy of the triceps motor branches, and 2) to evaluate their possible uses as a donor or receiver for nerve transfer. METHODS: The radial nerve and its motor and cutaneous branches were bilaterally dissected from the axilla and posterior arm regions of 10 embalmed cadavers. RESULTS: A single branch innervates the triceps long head, whereas double innervation was identified for the lateral and medial heads. The upper branch to the lateral head originated from the radial nerve, whereas the lower branch to the lateral head stemmed from the lower medial head motor branch, which ultimately innervated the anconeus muscle. Both the long head and the upper medial head motor branches originated in the axillary region in the vicinity of the latissimus dorsi tendon. CONCLUSION: Each of the triceps' motor branches might be used as a donor for transfer. The triceps long head motor branch should be used preferentially when the intention is to establish triceps reinnervation.

Estudo comparativo macroscópio e histológico da origem labial do tendão da cabeça longa do bíceps braquial / Histological and macroscopic comparative study of labral origin from long head biceps brachii tendon

A região superior do lábio da glenóide pode apresentar lesões labiais e tendinosas do bíceps braquial, sendo o conhecimento das variações anatômicas de grande importância para a realização de procedimentos artroscópicos. O objetivo do trabalho é determinar a origem labial do tendão da cabeça longa do bíceps braquial, comparando a visão macroscópica com a avaliação histológica. Foram realizadas dissecções de 36 ombros de 18 cadáveres conservados em formaldeído, no Laboratório de Ciências Morfológicas da Universidade Federal de Santa Catarina (LCM-UFSC). Foram avaliadas a estrutura macroscópica e a histológica da região do lábio superior, incluindo o local de origem labial do tendão da cabeça longa do bíceps braquial (CLB). A classificação anatômica utilizada foi a de Vangsness, que considera quatro tipos de origem labial da CLB. Foram feitos cortes histológicos seriados da região superior do lábio, com o objetivo de estudar a origem do tendão. Macroscopicamente, a principal origem labial da CLB foi na porção póstero-superior. A histologia mostrou que na maioria dos casos havia origem associada na porção ântero-superior. A avaliação macroscópica não é, portanto, confiável para determinar a origem labial do tendão da cabeça longa do bíceps braquial

Cervicalgia crônica: principais causas e prevenções / Chronic cervicalgy main causes and preventions

Foram estudados 50 pacientes portadores de cervicalgia crônica na região da Grande Florianópolis, no período de julho de 1997 a abril de 1998. Objetivo: o trabalho foi investigar e descrever as causas mais freqüentes e prevenções da cervicalgia crônica, verificando-se a faixa etária de maior incidência. Métodos: a coleta de dados foi realizada em clínicas, consultórios médicos, Associação Santa Catarina de Reabilitação e no ambulatório do Hospital Universitário. Resultados: os resultados demonstram que a faixa etária de maior incidência situa-se entre 45 e 65 anos, sendo mais freqüente no sexo feminino (74%). Vinte e cinco pacientes (50%) tinham problemas ergonômicos e/ou posturais associados ou não a outros problemas; 44% possuíam alterações degenerativas nas vértebras ou discos cervicais e 6% apresentaram lesão traumática como fator desencadeante do processo. Observouse ainda que o fator emocional quando não é a causa primária da cervicalgia, ou de sua cronicidade, contribui bastante para tal...

Sobre a disposiçäo dos capilares testiculares do cäo (Canis familiaris, L.) / About testicular capillaries disposition of the dog (Canis familiaris, L.)

As redes no interstício tubular seminífero do cao sao formadas conforme segue: (1) capilares arranjados com disposiçao espacial irregular e arboriforme, e (2) capilares com orientaçoes paralelas e perpendiculares relativamente ao tecido circundante dos túbulos seminíferos.

Condideraçöes sobre a disposiçäo dos vasos sangüíneos no funículo espermático e no testículo do cäo (Canis familiaris, L) / On the arterial and venous patterns in the spermatic cord and testis of the dog (Canis familiaris, L)

Neste trabalho säo descritas observaçöes anatômicas macroscópicas e mesoscópicas sobre o suprimento arterial e a drenagem venosa testiculares no cäo. As disposiçöes dos vasos arteriais e venosos em nível da cápsula testicular e na intimidade do cordäo espermático säo comparadas com descriçöes preexistentes

Estrutura microscópica da parede da veia porta no cao (Canis familiaris, L.) / Microscopic struture of the portal vein wall in the dog (Canis familiaris, L.)

No cao, o estudo microscópico revela que a parede da veia porta apresenta três túnicas: (1) uma túnica íntima onde o endotélio repousa sobre fina rede de fibras elásticas, subendotelial; (2) uma túnica média e (3) uma túnica externa. Estas últimas túnicas sao formadas por numerosas células musculares lisas entremeadas por fibra elásticas e colágenas