Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 19 de 19
Filtrar
1.
Skeletal Radiol ; 51(6): 1179-1188, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34686889

RESUMO

OBJECTIVE: To determine the accuracy of preoperative ultrasound and MRI in surgically confirmed spinal accessory nerve injuries and present the benefits of a multimodality image review. MATERIALS AND METHODS: A retrospective review of 38 consecutive patients referred to a peripheral nerve surgical practice at an academic teaching hospital with surgically confirmed spinal accessory nerve injuries. All cases were reviewed for patient demographics, date and cause of injury, preoperative EMG, and surgical diagnosis and management. Additionally, prospective interpretation of preoperative ultrasound and MRI reports were reviewed for concordance or discordance with the surgical diagnosis. RESULTS: Iatrogenic injury was present in 37 (97%) cases and most commonly a result of an excisional lymph node biopsy (68%). Surgically confirmed spinal accessory nerve injury diagnoses consisted of 25 (66%) stump neuromas and 13 (34%) incomplete nerve injuries. Nine months was the average time from injury to surgery. Twenty-nine patients underwent preoperative ultrasound and/or MRI evaluation: 12 ultrasound only, 10 MRI only, and seven with both ultrasound and MRI. Eighteen (95%) preoperative ultrasound reports compared to four (24%) preoperative MRI reports were concordant with the surgical diagnosis. In the seven cases with both preoperative ultrasound and MRI, six had discordant ultrasound and MRI imaging diagnoses for which the ultrasound was concordant with the surgical diagnoses in all cases. CONCLUSION: Preoperative ultrasound more accurately characterizes spinal accessory nerve injuries compared to MRI and should serve as the modality of choice when a spinal accessory nerve injury is suspected.


Assuntos
Traumatismos do Nervo Acessório , Traumatismos do Nervo Acessório/diagnóstico por imagem , Traumatismos do Nervo Acessório/etiologia , Traumatismos do Nervo Acessório/cirurgia , Humanos , Nervos Periféricos , Estudos Prospectivos , Estudos Retrospectivos , Ultrassonografia
2.
Hand Surg Rehabil ; 41S: S34-S38, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34082158

RESUMO

The trapezius muscle produces upward scapular rotation that in turn allows complete lateral elevation (abduction) by maintaining the acromiohumeral distance and the deltoideus resting length. Loss of trapezius function leads to shoulder drooping, loss of scapular external rotation with secondary loss of abduction. When conservative treatment has failed and in cases where nerve surgery is not indicated, the most common procedure for treating this condition is the Eden-Lange (EL) procedure. This procedure entails transferring the levator scapulae (LS) to the lateral part of the scapular spine, and the rhomboid major (RM) and minor (Rm) to the infraspinatus fossa to restore the lost trapezius function. Recently, Elhassan et al. proposed a modification of the original EL procedure to recreate the line of pull of the different parts of the trapezius muscle. The modified transfer may yield successful outcomes in patients with trapezius paralysis who failed to improve after well-conducted conservative treatment. Longer follow-up is needed to confirm the stability of the good outcomes of this reconstruction.


Assuntos
Traumatismos do Nervo Acessório , Músculos Superficiais do Dorso , Traumatismos do Nervo Acessório/cirurgia , Humanos , Paralisia/cirurgia , Escápula , Transferência Tendinosa/métodos
3.
J Hand Surg Am ; 44(4): 321-330, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30292717

RESUMO

Scapular winging is a painful and debilitating condition. The composite scapular motion of rotation, abduction, and tilting is necessary for proper shoulder function. Weakness or loss of scapular mechanics can lead to difficulties with elevation of the arm and lifting objects. The most common causes reported in the literature for scapular winging are dysfunction of the serratus anterior from long thoracic nerve injury causing medial winging or dysfunction of the trapezius from spinal accessory nerve injury causing lateral winging. Most reviews and teaching focus on these etiologies. However, acute traumatic tears of the serratus anterior, trapezius, and rhomboids off of the scapula are important and under-recognized causes of scapular winging and dysfunction. This article will review the relevant anatomy, etiology, clinical evaluation, diagnostic testing, and treatment of scapular winging. It will also discuss the differences in diagnosis and management between scapular winging arising from neurogenic causes and traumatic muscular detachment.


Assuntos
Escápula/fisiopatologia , Traumatismos do Nervo Acessório/fisiopatologia , Traumatismos do Nervo Acessório/cirurgia , Eletromiografia , Humanos , Imageamento por Ressonância Magnética , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/lesões , Músculo Esquelético/fisiopatologia , Músculo Esquelético/cirurgia , Condução Nervosa , Procedimentos Ortopédicos , Paralisia/fisiopatologia , Paralisia/terapia , Exame Físico , Modalidades de Fisioterapia , Escápula/anatomia & histologia , Escápula/diagnóstico por imagem , Escápula/cirurgia , Nervos Torácicos/lesões , Nervos Torácicos/cirurgia
4.
J Shoulder Elbow Surg ; 28(1): 137-142, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30318275

RESUMO

BACKGROUND: Iatrogenic or traumatic injury to the spinal accessory nerve is a rare but debilitating injury. An effective treatment, known as the Eden-Lange modification triple-tendon transfer procedure, involves the transfer of the rhomboid major (RM), rhomboid minor (Rm), and levator scapulae (LS). Careful detachment of their insertions is necessary to avoid injury of the dorsal scapular nerve (DSN). This study evaluated the surgical anatomy and safety of the DSN relative to this procedure. METHODS: The study used 12 cadavers (22 shoulders). The RM, Rm, and LS were detached from their insertions, and the DSN was dissected. Measurements were taken to evaluate the anatomy of each relative to the triple-tendon transfer procedure. Additional measurements were taken to identify "danger zones" for DSN injury, regarding detachment of RM, Rm, and LS from their respective insertions. RESULTS: Measurements of the 22 shoulders included in the study showed wide variation in anatomy. The minimum distance between the scapula and the DSN at the vertebral scapular border was 0.7 cm, suggesting that care and precision are needed to perform this technique. The region where the DSN crosses the superior border of the Rm was shown to be the greatest "danger zone" of this technique, with a mean distance to the scapula of 1.61 ± 0.53 cm CONCLUSIONS: This study provides insight into the surgical anatomy of the DSN relative to a rare but successful procedure used to treat trapezius paralysis. The results of this study can inform the surgeon regarding potential anatomic considerations when performing the triple-tendon transfer.


Assuntos
Plexo Braquial/anatomia & histologia , Escápula/inervação , Transferência Tendinosa , Traumatismos do Nervo Acessório/cirurgia , Cadáver , Feminino , Humanos , Masculino , Traumatismos dos Nervos Periféricos/prevenção & controle
5.
Muscle Nerve ; 59(1): 64-69, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30216471

RESUMO

INTRODUCTION: The purpose of this study was to evaluate the application of ultrasound in the management of iatrogenic spinal accessory nerve palsy at the posterior cervical triangle area. METHODS: In this retrospective study, we compared ultrasonographic results with intraoperative findings in patients with iatrogenic spinal accessory nerve palsy during the time period from 2014 to 2018 at our hospital. RESULTS: Eleven patients were included. Ultrasound detected nerve transections in 9 patients and continuities in 2 patients. The ultrasonographic results were consistent with the intraoperative findings. Furthermore, ultrasound was able to accurately reveal lesion location in 8 of 9 patients with nerve transections. DISCUSSION: Ultrasound provides direct images about nerve lesions contributing to the diagnosis of iatrogenic spinal accessory nerve palsy at the posterior cervical triangle area and also reveals lesion location, assisting in formulating suitable surgical plans preoperatively. We recommend that ultrasound be integrated into the preoperative evaluation. Muscle Nerve 59:64-69, 2019.


Assuntos
Traumatismos do Nervo Acessório/diagnóstico por imagem , Traumatismos do Nervo Acessório/cirurgia , Medula Cervical/diagnóstico por imagem , Procedimentos Neurocirúrgicos/métodos , Ultrassonografia , Traumatismos do Nervo Acessório/fisiopatologia , Adulto , Idoso , Eletromiografia , Potencial Evocado Motor/fisiologia , Feminino , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade , Condução Nervosa/fisiologia , Estudos Retrospectivos , Adulto Jovem
6.
J Neurosurg Spine ; 28(5): 555-561, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29424673

RESUMO

OBJECTIVE Spinal accessory nerve (SAN) injury results in a series of shoulder dysfunctions and continuous pain. However, current treatments are limited by the lack of donor nerves as well as by undesirable nerve regeneration. Here, the authors report a modified nerve transfer technique in which they employ a nerve fascicle from the posterior division (PD) of the ipsilateral C-7 nerve to repair SAN injury. The technique, first performed in cadavers, was then undertaken in 2 patients. METHODS Six fresh cadavers (12 sides of the SAN and ipsilateral C-7) were studied to observe the anatomical relationship between the SAN and C-7 nerve. The length from artificial bifurcation of the middle trunk to the point of the posterior cord formation in the PD (namely, donor nerve fascicle) and the linear distance from the cut end of the donor fascicle to both sites of the jugular foramen and medial border of the trapezius muscle (d-SCM and d-Traps, respectively) were measured. Meanwhile, an optimal route for nerve fascicle transfer (NFT) was designed. The authors then performed successful NFT operations in 2 patients, one with an injury at the proximal SAN and another with an injury at the distal SAN. RESULTS The mean lengths of the cadaver donor nerve fascicle, d-SCM, and d-Traps were 4.2, 5.2, and 2.5 cm, respectively. In one patient who underwent proximal SAN excision necessitated by a partial thyroidectomy, early signs of reinnervation were seen on electrophysiological testing at 6 months after surgery, and an impaired left trapezius muscle, which was completely atrophic preoperatively, had visible signs of improvement (from grade M0 to grade M3 strength). In the other patient in whom a distal SAN injury was the result of a neck cyst resection, reinnervation and complex repetitive discharges were seen 1 year after surgery. Additionally, the patient's denervated trapezius muscle was completely resolved (from grade M2 to grade M4 strength), and her shoulder pain had disappeared by the time of final assessment. CONCLUSIONS NFT using a partial C-7 nerve is a feasible and efficacious method to repair an injured SAN, which provides an alternative option for treatment of SAN injury.


Assuntos
Traumatismos do Nervo Acessório/cirurgia , Transferência de Nervo/métodos , Nervos Espinhais/transplante , Traumatismos do Nervo Acessório/patologia , Traumatismos do Nervo Acessório/fisiopatologia , Idoso , Vértebras Cervicais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Nervos Espinhais/anatomia & histologia , Adulto Jovem
7.
J Hand Surg Eur Vol ; 43(6): 589-595, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29433411

RESUMO

Spinal accessory nerve grafting requires identification of both nerve stumps in the scar tissue, which is sometimes difficult. We propose a direct nerve transfer using a fascicle from the posterior division of the upper trunk. We retrospectively reviewed 11 patients with trapezius palsy due to an iatrogenic injury of the spinal accessory nerve in nine cases. The mean age was 38 years (range 21-59). Preoperatively, patients showed shoulder weakness and limited range of motion. At a mean follow-up of 25 months, active shoulder abduction improvement averaged 57°. Trapezius muscle strength graded M4 or M5 in 10 cases and M3 in one case. No deltoid or triceps impairment was reported. Scapula kinematics was considered normal in seven patients. This technique gave satisfactory functional results and may be an alternative to spinal accessory nerve grafting for the management of trapezius palsies if direct repair is not feasible. LEVEL OF EVIDENCE: IV.


Assuntos
Traumatismos do Nervo Acessório/cirurgia , Nervo Acessório/cirurgia , Doença Iatrogênica , Transferência de Nervo/métodos , Paralisia/cirurgia , Músculos Superficiais do Dorso/inervação , Adulto , Cicatriz/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Escápula/inervação , Ombro/inervação , Adulto Jovem
8.
World Neurosurg ; 103: 841-851.e6, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28450236

RESUMO

BACKGROUND: Iatrogenic nerve injuries are nerve injuries caused by medical interventions or inflicted accidentally by a treating physician. METHODS: We describe and analyze iatrogenic nerve injuries in a total of 122 consecutive patients who received surgical treatment at our Institution during a period of 10 years, from January 1, 2003, to December 31, 2013. The final outcome evaluation was performed 2 years after surgical treatment. RESULTS: The most common causes of iatrogenic nerve injuries among patients in the study were the operations of bone fractures (23.9%), lymph node biopsy (19.7%), and carpal tunnel release (18%). The most affected nerves were median nerve (21.3%), accessory nerve (18%), radial nerve (15.6%), and peroneal nerve (11.5%). In 74 (60.7%) patients, surgery was performed 6 months after the injury, and in 48 (39.3%) surgery was performed within 6 months after the injury. In 80 (65.6%) patients, we found lesion in discontinuity, and in 42 (34.4%) patients lesion in continuity. The distribution of surgical procedures performed was as follows: autotransplantation (51.6%), neurolysis (23.8%), nerve transfer (13.9%), direct suture (8.2%), and resection of neuroma (2.5%). In total, we achieved satisfactory recovery in 91 (74.6%), whereas the result was dissatisfactory in 31 (25.4%) patients. CONCLUSIONS: Patients with iatrogenic nerve injuries should be examined as soon as possible by experts with experience in traumatic nerve injuries, so that the correct diagnosis can be reached and the appropriate therapy planned. The timing of reconstructive surgery and the technique used are the crucial factors for functional recovery.


Assuntos
Doença Iatrogênica , Procedimentos Neurocirúrgicos/métodos , Traumatismos dos Nervos Periféricos/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Traumatismos do Nervo Acessório/cirurgia , Adulto , Biópsia/efeitos adversos , Síndrome do Túnel Carpal/cirurgia , Feminino , Fraturas Ósseas/cirurgia , Humanos , Linfonodos/patologia , Masculino , Nervo Mediano/lesões , Nervo Mediano/cirurgia , Pessoa de Meia-Idade , Procedimentos Ortopédicos/efeitos adversos , Traumatismos dos Nervos Periféricos/etiologia , Nervo Fibular/lesões , Nervo Fibular/cirurgia , Nervo Radial/lesões , Nervo Radial/cirurgia , Recuperação de Função Fisiológica , Estudos Retrospectivos
9.
J Neurosurg Spine ; 26(1): 112-115, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27472746

RESUMO

Spinal accessory nerve (SAN) injury results in loss of motor function of the trapezius muscle and leads to severe shoulder problems. Primary end-to-end or graft repair is usually the standard treatment. The authors present 2 patients who presented late (8 and 10 months) after their SAN injuries, in whom a lateral pectoral nerve transfer to the SAN was performed successfully using a supraclavicular approach.


Assuntos
Traumatismos do Nervo Acessório/cirurgia , Transferência de Nervo/métodos , Nervos Torácicos/transplante , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
10.
J Reconstr Microsurg ; 32(5): 358-60, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26890860

RESUMO

Background The lateral branch of the thoracodorsal nerve (LBTN) is used for nerve transfer in facial, musculocutaneous, axillary nerve injuries and for irreparable C5, C6 spinal nerve lesions and accessory nerve defects. For a successful surgical outcome, the nerve to be used in nerve transfer should be of adequate length and thickness for nerve coaptation. Aim Our objective was to evaluate the length of the LBTN that could be obtained as a donor nerve, externally and within the muscle. Method Eight (8) cadavers with intact upper limbs and thorax which could be positioned in the anatomical position were selected for the study. Cadavers with dissected axillae, brachial plexus or upper limbs were excluded. The thoracodorsal neurovascular bundle was dissected and the number of branches of the thoracodorsal nerve was identified along with its lateral branch. The lateral branch was dissected up to the latissimus dorsi muscle and further intramuscularly. All lengths were measured using a vernier caliper. Results The mean length of the LBTN, up to its first intramuscular branch, is 8.14 cm (range 5.99-12.29 cm). Beyond this, the intramuscular nerve branched further and was of very minute diameter. The mean unbranched intramuscular length of the nerve is 3.36 cm (range 1.3-7.71 cm) which is 41.28% of the total length of the LBTN. Conclusion A significant proportion of the LBTN is found within the latissimus dorsi muscle. This length could potentially be used for direct nerve coaptation by intrafascicular dissection.


Assuntos
Traumatismos do Nervo Acessório/cirurgia , Traumatismos do Nervo Facial/cirurgia , Microcirurgia , Transferência de Nervo/métodos , Traumatismos dos Nervos Periféricos/cirurgia , Procedimentos de Cirurgia Plástica , Traumatismos do Nervo Acessório/patologia , Cadáver , Dissecação , Traumatismos do Nervo Facial/patologia , Humanos , Microcirurgia/métodos , Traumatismos dos Nervos Periféricos/patologia
11.
J Ultrasound Med ; 34(12): 2305-12, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26543166

RESUMO

The spinal accessory nerve (SAN) is susceptible to iatrogenic injury in the posterior cervical triangle. Early diagnosis and management of suspected SAN transection injuries are crucial in the restoration of shoulder stability and function. Although neurologic examination and electrodiagnostic testing can assess SAN function, they cannot assess nerve continuity. We report the use of sonography to prospectively evaluate the SAN in 6 patients with suspected iatrogenic SAN injury. Sonography directly visualized SAN transection in 4 cases, whereas sonographic findings were reported as "probable" transection in the fifth case and was nondiagnostic in the sixth case in the setting of extensive scarring.


Assuntos
Traumatismos do Nervo Acessório/diagnóstico por imagem , Traumatismos do Nervo Acessório/cirurgia , Tomada de Decisão Clínica/métodos , Procedimentos Neurocirúrgicos/métodos , Cirurgia Assistida por Computador/métodos , Ultrassonografia/métodos , Adulto , Idoso , Feminino , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Prognóstico , Resultado do Tratamento
12.
J Neurosurg Spine ; 23(4): 518-25, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26115023

RESUMO

OBJECT: Iatrogenic injuries to the spinal accessory nerve (SAN) are not uncommon during lymph node biopsy of the posterior cervical triangle (PCT). In this study, the authors review the operative techniques and surgical outcomes of 156 surgical repairs of the SAN following iatrogenic injury during lymph node biopsy procedures. METHODS: This retrospective study examines the authors' clinical and surgical experience with 156 patients with SAN injury between 1980 and 2012. All patients suffered iatrogenic SAN injuries during lymph node biopsy, with the vast majority (154/156, 98.7%) occurring in Zone I of the PCT. Surgery was performed on the basis of anatomical and electro-physiological findings at the time of the operation. The mean follow-up period was 24 months (range 8-44 months). RESULTS: Of the 123 patients who underwent graft or suture repair, 107 patients (87%) improved to Grade 3 functionality or higher using the Louisiana State University Health Science Center (LSUHSC) grading system. Neurolysis was performed in 29 patients (19%) when the nerve was found in continuity with recordable nerve action potential (NAP) across the lesion. More than 95% of patients treated by neurolysis with positive NAP recordings recovered to LSUHSC Grade 3 or higher. Forty-one patients (26%) underwent end-to-end repair, while 82 patients (53%) underwent graft repair, and Grade 3 or higher recovery was assessed for 90% and 85% of these patients, respectively. The average graft length used was 3.81 cm. Neurotization was performed in 4 patients, 2 of whom recovered to Grade 2 and 3, respectively. CONCLUSIONS: SAN injuries present challenges for surgical exploration and repair because of the nerve's size and location in the PCT. However, through proper and timely intervention, patients with diminished or absent function achieved favorable functional outcomes. Surgeons performing lymph node biopsy procedures in Zone I of the PCT should be aware of the potential risk of injury to the SAN.


Assuntos
Traumatismos do Nervo Acessório/etiologia , Traumatismos do Nervo Acessório/cirurgia , Biópsia de Linfonodo Sentinela/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
Clin Anat ; 28(6): 761-6, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26060941

RESUMO

Iatrogenic injury of the spinal accessory nerve (SAN) is a significant reducible risk with any invasive procedure involving the posterior cervical triangle. Most commonly associated with cervical lymph node biopsy, it affects 3-6% of patients and serves as a major cause of avoidable medical malpractice litigation. Medical malpractice cases not only affect the primary surgeon but also may include the repairing surgeon through a shift of blame. For this reason, we discuss the strategies all clinicians may utilize in approaching iatrogenic SAN injuries. By taking basic precautionary measures based on simple application of anatomy in the management of these patients, clinicians may protect themselves from needless malpractice litigation. A thorough knowledge of the anatomy and application in preventative strategies may provide guidance for clinicians in reducing the incidence of iatrogenic injuries, providing effective postinjury management, and ensuring the salvaging surgeon is not at fault if litigation is pursued.


Assuntos
Traumatismos do Nervo Acessório/prevenção & controle , Traumatismos do Nervo Acessório/cirurgia , Nervo Acessório/anatomia & histologia , Procedimentos Neurocirúrgicos/métodos , Humanos , Doença Iatrogênica
14.
J Shoulder Elbow Surg ; 24(8): 1307-13, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25842024

RESUMO

BACKGROUND: This study describes the technique and evaluates the outcome of the triple-tendon (T3) transfer, an Eden-Lange variant, to the scapula to stabilize the scapulothoracic articulation in the treatment of symptomatic trapezius paralysis. METHODS: T3 transfers were performed in 22 patients with a history of persistent trapezius paralysis secondary to spinal accessory nerve injury. The indications for surgery included shoulder pain and weakness and limited range of motion of the shoulder. The T3 transfer included transfer of the levator scapulae to the lateral aspect of the spine of the scapula, the rhomboid minor to the spine of the scapula just medial to the levator scapulae insertion, and the rhomboid major to the medial spine of the scapula, including all muscles bony insertions. RESULTS: At an average follow-up of 35 months, winging was corrected in all patients, with improvement of shoulder asymmetry. All patients had significant improvement of pain (P < .01) and range of motion, including active shoulder abduction that improved from an average of 71° preoperatively to 118° postoperatively (P < .02) and shoulder flexion from an average of 102° to 150° (P < .01). There were also significant improvements in aggregate Constant Shoulder Score (P < .01), subjective shoulder value (P < .01), and Disabilities of the Arm, Shoulder and Hand score (P < .01). All patients were very satisfied with the outcome of surgery. CONCLUSION: This study shows that the T3 transfer is effective in stabilizing the scapulothoracic articulation and restoring the function of the trapezius, and thus, in improving pain and shoulder function in patients with symptomatic trapezius paralysis.


Assuntos
Paralisia/cirurgia , Articulação do Ombro/cirurgia , Dor de Ombro/cirurgia , Músculos Superficiais do Dorso/inervação , Transferência Tendinosa/métodos , Traumatismos do Nervo Acessório/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paralisia/etiologia , Paralisia/fisiopatologia , Amplitude de Movimento Articular , Escápula/cirurgia , Dor de Ombro/fisiopatologia , Músculos Superficiais do Dorso/fisiopatologia
15.
Neurocirugia (Astur) ; 25(1): 20-3, 2014.
Artigo em Espanhol | MEDLINE | ID: mdl-23474130

RESUMO

The C7 root in brachial plexus injuries has been used since 1986, since the first description by Gu at that time. This root can be used completely or partially in ipsilateral or contralateral lesions of the brachial plexus. A review of the literature and the case report of a 21-month-old girl with stab wounds to the neck and section of the C5 root of the right brachial plexus are presented. A transfer of the anterior fibres of the ipsilateral C7 root was performed. At 9 months there was complete recovery of abduction and external rotation of the shoulder.


Assuntos
Neuropatias do Plexo Braquial/cirurgia , Plexo Braquial/cirurgia , Transferência de Nervo/métodos , Raízes Nervosas Espinhais/cirurgia , Ferimentos Perfurantes/cirurgia , Traumatismos do Nervo Acessório/etiologia , Traumatismos do Nervo Acessório/cirurgia , Plexo Braquial/lesões , Neuropatias do Plexo Braquial/etiologia , Cicatriz/cirurgia , Feminino , Humanos , Lactente , Lacerações/complicações , Lesões do Pescoço/complicações , Nervo Frênico/lesões , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Reoperação , Articulação do Ombro/fisiopatologia
16.
J Hand Surg Eur Vol ; 39(2): 194-8, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23390150

RESUMO

The purpose of this study was to investigate the anatomical basis of intercostal nerve transfer to the suprascapular nerve and provide a case report. Thoracic walls of 30 embalmed human cadavers were used to investigate the anatomical feasibility for neurotization of the suprascapular nerve with intercostal nerves in brachial plexus root avulsions. We found that the 3rd and 4th intercostal nerves could be transferred to the suprascapular nerve without a nerve graft. Based on the anatomical study, the 3rd and 4th intercostal nerves were transferred to the suprascapular nerve via the deltopectoral approach in a 42-year-old man who had had C5-7 root avulsions and partial injury of C8, T1 of the right brachial plexus. Thirty-two months postoperatively, the patient gained 30° of shoulder abduction and 45° of external rotation. This procedure provided us with a reliable and convenient method for shoulder function reconstruction after brachial plexus root avulsion accompanied with spinal accessory nerve injury. It can also be used when the accessory nerve is intact but needs to be preserved for better shoulder stability or possible future trapezius transfer.


Assuntos
Traumatismos do Nervo Acessório/cirurgia , Neuropatias do Plexo Braquial/cirurgia , Plexo Braquial/anatomia & histologia , Nervos Intercostais/anatomia & histologia , Nervos Intercostais/cirurgia , Transferência de Nervo/métodos , Traumatismos do Nervo Acessório/fisiopatologia , Adulto , Idoso , Plexo Braquial/lesões , Neuropatias do Plexo Braquial/fisiopatologia , Cadáver , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Rotação
18.
J Hand Surg Eur Vol ; 37(5): 413-21, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22067298

RESUMO

The objective of this study was to evaluate outcomes of patients who suffered complete brachial plexus avulsion before and after nerve transfers by assessing upper extremity function and pain using the DASH and NRS questionnaires. Patients who underwent nerve transfers improved their DASH and NRS scores compared with before surgery. Although individually there was no correlation with improved scores, the triple combination of rehabilitation exercises, electrical stimulation therapy and neurotrophic drugs postoperatively correlated positively with improved functional outcomes. This study suggested a positive effect of the passage of time and nerve transfers in total brachial plexus avulsions from patients' self assessments.


Assuntos
Plexo Braquial/lesões , Traumatismos do Nervo Acessório/cirurgia , Adolescente , Adulto , Terapia por Estimulação Elétrica , Feminino , Humanos , Masculino , Transferência de Nervo , Nervo Frênico/lesões , Nervo Frênico/cirurgia , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...