RESUMO
PURPOSE: Self-biting behavior in patients with neonatal brachial plexus palsy (NBPP) has been associated with finger amputation. Our objective is to describe the incidence of this complication, risk factors, and clinical management. METHODS: We retrospectively analyzed 612 patients with NBPP. There were 303 males and 309 females. 51.8% of patients had C5-C6 lesions, 28.9% had C5-C7, 18.9% had C5-T1, and 0.3 had C7-T1 involvement. RESULTS: We identified 15 patients with self-biting behavior (2.5%). Ten patients had C5-T1 lesions, and five had C5-C7 lesions. Eight patents were submitted to brachial plexus surgery and seven were not. This behavior appeared between 8 and 46 months of life (mean 23.5), and it was always temporary. There was no difference between operated and non-operated patients (p > 0.05), and no correlation between age at surgery and age of appearance of self-biting behavior (p > 0.05). Physical restriction was effective in treating this complication and we had no case of finger amputation. CONCLUSION: Self-biting behavior is a rare complication of NBPP, and it is usually associated with severe motor involvement. The behavior duration is limited to a few months. This condition can be effectively treated with physical restriction to prevent hand biting.
Assuntos
Neuropatias do Plexo Braquial , Plexo Braquial , Paralisia do Plexo Braquial Neonatal , Plexo Braquial/cirurgia , Neuropatias do Plexo Braquial/etiologia , Neuropatias do Plexo Braquial/cirurgia , Feminino , Humanos , Recém-Nascido , Masculino , Estudos RetrospectivosRESUMO
This historical review presents the relevant data about the evolution of the surgical treatment of neonatal brachial plexus palsy. Starting with the first clinical description by Smellie in 1754, we will present the initial enthusiasm for the surgery followed by a lack of interest that lasted many years, the resurgence of interest in operative management in the 1970s, and the consolidation in the 1980s of surgery as the standard indication in cases of neonatal brachial plexus palsy without a functional spontaneous recovery.
Assuntos
Traumatismos do Nascimento , Neuropatias do Plexo Braquial , Plexo Braquial , Paralisia do Plexo Braquial Neonatal , Traumatismos do Nascimento/cirurgia , Plexo Braquial/lesões , Plexo Braquial/cirurgia , Neuropatias do Plexo Braquial/etiologia , Neuropatias do Plexo Braquial/cirurgia , Humanos , Recém-Nascido , Recuperação de Função FisiológicaRESUMO
PURPOSE: Long-term evaluation of hand function in children who underwent transfer procedures to reinnervate the biceps muscle, using fascicles from the ulnar and median nerves as donors. METHODS: In the last follow-up evaluation, the children underwent a neurological examination, and their hand status was classified according to the Raimondi grading system for hand function. Two physical measurements, the child health assessment questionnaire (CHAQ) and the Sollerman hand function test, were applied to assess upper extremity function. RESULTS: Eight children were re-evaluated. In four the donor fascicle was from the ulnar nerve and in four from the median nerve. The average interval between surgery and the last evaluation was 8.3 years (range 6-10 years). Five patients scored 5 points in the Raimondi grading system, and 3 patients scored 4 points. The results from the CHAQ ranged from 0.03 to 0.41. The results from the Sollerman test were between 60 and 77 for the affected upper limb and between 65 and 79 for the dominant upper limb. CONCLUSION: Nerve transfer of a fascicle from the ulnar or median nerve to the biceps motor branch in children with neonatal brachial plexus palsy does not result in hand dysfunction.
Assuntos
Neuropatias do Plexo Braquial , Transferência de Nervo , Braço , Neuropatias do Plexo Braquial/cirurgia , Criança , Humanos , Recém-Nascido , Músculo Esquelético , Resultado do Tratamento , Nervo Ulnar/cirurgiaRESUMO
BACKGROUND: There is no consensus about which type of imaging study, computed tomography myelography (CTM) or magnetic resonance imaging (MRI), provides better information concerning root avulsion in adult brachial plexus injuries. METHODS: Patients with upper brachial plexus traumatic injuries underwent both CTM and MRI and surgical exploration. The imaging studies were analyzed by two independent radiologists and the data were compared with the intraoperative findings. The statistical analysis was based on dichotomous classification of the nerve roots (normal or altered). The interobserver agreement was assessed using Cohen's Kappa. The accuracy of CTM and MRI in comparison with the intraoperative findings was evaluated using the same methodology. RESULTS: Fifty-two adult patients were included. CTM tended to yield slightly higher percentages of alterations than MRI The interobserver agreement was better on CTM than on MRI for all nerve roots: C5, 0.9960 (strong) vs. 0.145 (poor); C6, 0.970 (strong) vs. 0.788 (substantial); C7, 0.969 (strong) vs. 0.848 (strong). The accuracy regarding the intraoperative findings was also higher on CTM (moderate, kappa 0.40-0.59) than on MRI (minimal, kappa 0.20-0.39) for all nerve roots. Accordingly, the overall percentage concordance (both normal or both altered) was superior in the CTM evaluation (approx. 70-75% vs. 60-65%). CTM was superior for both sensitivity and specificity at all nerve roots. CONCLUSION: CTM had greater interobserver agreement and higher diagnostic accuracy than MRI in adult patients with root avulsions due to brachial plexus injury.
Assuntos
Plexo Braquial/diagnóstico por imagem , Plexo Braquial/lesões , Radiculopatia/diagnóstico por imagem , Adolescente , Adulto , Plexo Braquial/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Mielografia , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
Background: Although reinnervation of the suprascapular nerve is frequently obtained through brachial plexus surgery, reestablishment of infraspinatus muscle function is rarely achieved.Methods: The viability of transfer of the radial nerve to the nerve branch to the infraspinatus muscle was determined anatomically, including histomorphometrical analysis on 30 adult cadavers. Eleven adult patients were then treated using the proposed nerve transfer.Results: The branch to the medial head was more suitable for the nerve transfer. In one cadaver, nerve transfer was impossible because there was no donor of sufficient length. According to axon counts, the branches to the lateral and medial heads had sufficient numbers of axons (means = 994.2 ± 447.6 and 1030.8 ± 258.5, respectively) for reinnervation of the branch to the infraspinatus (means = 830.2 ± 241.2 axons). In the surgical series, one patient was lost in the follow-up and only two patients achieved a good result from the transfer. Recovery of external shoulder rotation started 14 months after surgery in one patient and 8 months in the other. The first patient reached 90° of external rotation 6 months later and the second, achieved 120°of shoulder external rotation 6 months after surgery . Four other patients recovered small amounts of movement: 20, 35, 40 and 45°.Conclusions: Although anatomically feasible, the proposed nerve transfer resulted in a small number of good clinical outcomes.
Assuntos
Ombro/cirurgia , Neuropatias do Plexo Braquial/cirurgia , Humanos , Transferência de Nervo , Nervo Radial/cirurgia , Rotação , Manguito Rotador/cirurgiaRESUMO
PURPOSE: The outcome from microsurgical reconstruction of neonatal brachial plexus palsy (NBPP) varies, and comparison between different series is difficult, given the differences in preoperative evaluation, surgical strategies, and outcome analysis. To evaluate our results, we reviewed a series of children who underwent surgical treatment in a period of 14 years. METHODS: We made a retrospective review of 104 cases in which microsurgical repair of the brachial plexus was performed. Strength was graded using the Active Movement Scale. Whenever possible, upper palsies underwent surgery 4 to 6 months after birth and total lesions around 3 months. The lesions were repaired, according to the type of injury: neurolysis, nerve grafting, nerve transfer, or a combination of techniques. The children were followed for at least 24 months. RESULTS: The majority of cases were complete lesions (56/53.8%). Erb's palsy was present in 10 cases (9.6%), and 39 infants (37.5%) presented an extended Erb's palsy. The surgical techniques applied were neurolysis (10.5%), nerve grafts (25.9%), nerve transfers (34.6%), and a combination of grafts and transfers (30.7%). The final outcome was considered poor in 41.3% of the cases, good in 34.3%, and excellent in 24%. A functional result (good plus excellent) was achieved in 58.3% of the cases. CONCLUSIONS: There is no consensus regarding strategies for treatment of NBPP. Our surgical outcomes indicated a good general result comparing with the literature. However, our results were lower than the best results reported. Maybe the explanation is our much higher number of total palsy cases (53.8% vs. 25% in the literature).
Assuntos
Paralisia do Plexo Braquial Neonatal/cirurgia , Procedimentos Neurocirúrgicos/métodos , Procedimentos de Cirurgia Plástica/métodos , Feminino , Humanos , Recém-Nascido , Masculino , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Shoulder stability, abduction and external rotation are vital for the performance of usual daily tasks. AIMS: To compare the functional outcomes in the shoulder following spinal accessory to suprascapular nerve transfer (SASNT). PATIENTS AND METHODS: Comparison of the outcome of adult patients with upper traumatic brachial plexus palsy undergoing SASNT with patients with complete palsy submitted to the same procedure. STATISTICAL ANALYSIS: Ranges of motion were compared via the Mann-Whitney U test. The percentages of patients with a favorable outcome were compared by the chi-square test. All tests were two-tailed and P values <0.05 were considered statistically significant. RESULTS: SASNT was performed in 76 patients: 23 cases (30.2%) of upper-plexus injuries and 53 cases (69.7%) of complete brachial plexus palsy. Good shoulder abduction was achieved in 15 patients (65.2%) with upper plexus palsy and a good external rotation in 5 (21.7%). In those patients with a good recovery, the average range of motion (ROM) was 53° for shoulder abduction and 71.2° for external rotation. Thirty-six patients (67.9%) with complete palsy had a good shoulder abduction recovery with 30.7° of average ROM, but only 3 patients (5.6%) recovered a good shoulder external rotation with 68.3° of average ROM. There was no statistical difference for the abduction outcome, but the external rotation outcome was superior in the upper plexus palsy group. CONCLUSION: SASNT is a consistent procedure to achieve functional recovery of shoulder abduction after a partial or complete plexus injury, but the outcomes of external rotation were quite disappointing in both the groups.
Assuntos
Nervo Acessório/cirurgia , Plexo Braquial/cirurgia , Traumatismos dos Nervos Periféricos/cirurgia , Ombro/inervação , Ombro/cirurgia , Adulto , Plexo Braquial/lesões , Humanos , Transferência de Nervo , Recuperação de Função Fisiológica , Ombro/fisiopatologia , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: Ulnar and median nerve transfers to arm muscles have been used to recover elbow flexion in infants with neonatal brachial plexus palsy, but there is no direct outcome comparison with the classical supraclavicular nerve grafting approach. METHODS: We retrospectively analyzed patients with C5-C7 neonatal brachial plexus palsy submitted to nerve surgery and recorded elbow flexion recovery using the active movement scale (0-7) at 12 and 24 months after surgery. We compared 13 patients submitted to supraclavicular nerve grafting with 21 patients submitted to distal ulnar or median nerve transfer to biceps motor branch. We considered elbow flexion scores of 6 or 7 as good results. RESULTS: The mean elbow flexion score and the proportion of good results were better using distal nerve transfers than supraclavicular grafting at 12 months (p < 0.01), but not at 24 months. Two patients with failed supraclavicular nerve grafting at 12 months showed good elbow flexion recovery after ulnar nerve transfers. CONCLUSION: Distal nerve transfers provided faster elbow flexion recovery than supraclavicular nerve grafting, but there was no significant difference in the outcome after 24 months of surgery. Patients with failed supraclavicular grafting operated early can still benefit from late distal nerve transfers. Supraclavicular nerve grafting should remain as the first line surgical treatment for children with neonatal brachial plexus palsy.
Assuntos
Neuropatias do Plexo Braquial/cirurgia , Nervo Mediano/transplante , Transferência de Nervo/métodos , Nervo Ulnar/transplante , Articulação do Cotovelo , Feminino , Humanos , Lactente , Masculino , Amplitude de Movimento Articular , Estudos RetrospectivosRESUMO
PURPOSE: This study aims to discuss the diagnosis and management of radial nerve compression neuropathy in the newborn. METHODS: A personal case is presented, followed by a review and analysis of clinically similar cases identified via a PubMed search of published medical literature. RESULTS: We report a case of a term newborn with bilateral radial neuropathy at the humerus level. Despite severe axonal involvement in the electrophysiological evaluation, the patient showed complete bilateral recovery after 3 months of follow-up. CONCLUSIONS: Isolated radial nerve palsy is a rare event in the newborn. The condition does not require surgical treatment and usually proceeds to full and rapid spontaneous recovery.
Assuntos
Artrogripose/complicações , Neuropatia Hereditária Motora e Sensorial/complicações , Neuropatia Radial/complicações , Artrogripose/diagnóstico , Artrogripose/terapia , Neuropatia Hereditária Motora e Sensorial/diagnóstico , Neuropatia Hereditária Motora e Sensorial/terapia , Humanos , Lactente , Masculino , Neuropatia Radial/diagnóstico , Neuropatia Radial/terapiaRESUMO
BACKGROUND: Body mass index (BMI) has recently been identified as a predictor of outcomes following reconstructive surgery of shoulder palsies. In this study, we sought to determine if the same holds true for the reconstruction of elbow flexion. METHODS: Forty patients who had undergone partial ulnar-to-biceps nerve transfer (Oberlin's procedure) for shoulder palsy were assessed and compared against 18 previously reported patients who had undergone reconstruction for elbow palsies. The British Medical Research Council (BMRC) scale and an index dividing shoulder abduction strength in the affected arm by healthy arm were recorded. All patients had undergone surgery within 12 months of injury and had ≥ 12 months of follow-up. RESULTS: M4 or M3 biceps strength was obtained in 90 % of patients. Final strength on the affected side averaged 5.8 kg, versus 20.2 kg on the normal side, for a mean recovery index score of 0.30. In this sample of 40 patients, BMI did not predict percentage strength or BMRC grade recovery. Neither did age, number of roots involved, the affected side, nor time to surgery. Comparing patients with elbow versus shoulder reconstruction, there were no differences, except that patients undergoing Oberlin's procedure had a statistically longer duration of time between injury and surgical repair (7.4 vs 5.1 months, p < 0.006). CONCLUSIONS: Our data suggest that proximal muscle re-innervation is functionally more dependent upon BMI than distal re-innervation, likely because proximal muscles must support the weight of the entire extremity, while more distal muscles do not. BMI should be taken into consideration when planning surgery.
Assuntos
Índice de Massa Corporal , Plexo Braquial/cirurgia , Transferência de Nervo , Procedimentos de Cirurgia Plástica , Ombro/cirurgia , Adulto , Idoso , Plexo Braquial/lesões , Neuropatias do Plexo Braquial/cirurgia , Cotovelo/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Recuperação de Função FisiológicaRESUMO
INTRODUCTION: Adult traumatic brachial plexus lesions are devastating injuries. Their real incidence is difficult to ascertain, but are certainly growing due to the increasing number of high-speed motor-vehicle accidents, especially in big cities. OBJECTIVES: Analysis of the epidemiological characteristics of patients with traumatic brachial plexus lesions in São Paulo, Brazil, the sixth largest city in the world. METHODS: This was a retrospective analysis of the epidemiological characteristics of patients submitted to surgical treatment of traumatic brachial plexus lesions in the Peripheral Nerve Surgery Unit of the Department of Neurosurgery of the University of São Paulo Medical School. RESULTS: In the period from 2004 to 2012, 406 patients underwent surgery. There were 384 (94.6 %) men and 22 (5.4 %) women. In 45.9 % the compromised plexus was the right and in 54.1 %, the left. The average age was 28.38 years. Among the causes, the most frequent was motorcycle accidents (79 %). Most of the lesions were supraclavicular. In 46.1 % of cases the lesions were complete, in 30.1 % the lesions compromised C5/C6 roots, in 20.9 % the C5/C6/C7 roots were lesioned and in 2.9 % the lesion was in the lower roots, C8/T1. Among the associated lesions the most prevalent were head trauma, observed in 34.2 % of the cases; lesions of long bones in 38.8 %; clavicle fractures in 25.9 %; and thoracic trauma in 12.9 %. CONCLUSION: In a population of adult patients with brachial plexus lesions with surgical indication, most of them comprise young male adults involved in high-energy motorcycle accidents.
Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Plexo Braquial/lesões , Traumatismos dos Nervos Periféricos/epidemiologia , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Idoso , Plexo Braquial/cirurgia , Brasil/epidemiologia , Criança , Traumatismos Craniocerebrais/complicações , Feminino , Fraturas Ósseas/complicações , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Motocicletas , Neurocirurgia , Traumatismos dos Nervos Periféricos/complicações , Traumatismos dos Nervos Periféricos/cirurgia , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Although peripheral schwannomas can be resected without postoperative neurological complications, surgeons must anticipate the possibility that new neurological deficits could develop. In order to evaluate the risk of neurological complications in the surgical treatment of these tumours, we performed a retrospective review of cases involving schwannomas in the extremities, as well as an analysis of the related literature. METHOD: We reviewed a combined series of 72 schwannomas from the extremities presenting for surgical excision. Meticulous analysis of the files was undertaken, searching for pre-operative findings that could be more frequent in patients with surgical complications. The incidence, severity, and transitory nature of post-operative complications in our series was observed and compared against the literature. RESULTS: Eleven patients (15.2 %) developed new neurological deficits after surgery: sensory disturbance in seven cases, motor weakness in three, and a single wound hematoma. Most of these complications were temporary. Statistical analysis demonstrated a positive relationship between the presence of complications and both patient age under 50 years (p = 0.02) and tumours greater than 3 cm in greatest diameter (p = 0.02). CONCLUSIONS: Although relatively infrequent, the potential for novel post-operative deficits after the surgical treatment of peripheral schwannomas does exist and should be included during pre-operative counseling.
Assuntos
Neurilemoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Período Pós-Operatório , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: To establish the correlation between clinical evaluation of motor function recovery and daily living activities in 30 patients with upper traumatic brachial plexus injury submitted to surgery. METHODS: The score of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Louisiana State University Health Sciences Center (LSUHSC) scale were determined in 30 patients. Epidemiologic factors were also examined and correlations were determined. RESULTS: There was a significant correlation between the clinical evaluation and the daily living activities after a 12-month period (r = 0.479 and p = 0.007). A direct correlation was observed between the functional recovery of the upper limb and the time between injury and surgery (r = 0.554 and p = 0.001). The LSUHSC scores (p = 0.049) and scores from the DASH questionnaire (p = 0.013) were better among patients who returned to work. CONCLUSIONS: Clinical evaluation and daily living activities in adult patients who underwent nerve transfer after brachial plexus injury showed significant and measurable improvements.
Assuntos
Atividades Cotidianas , Plexo Braquial/cirurgia , Transferência de Nervo/métodos , Recuperação de Função Fisiológica/fisiologia , Adulto , Idoso , Plexo Braquial/lesões , Neuropatias do Plexo Braquial/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Regeneração Nervosa/fisiologia , Inquéritos e Questionários , Extremidade Superior , Adulto JovemRESUMO
This prospective study evaluates the possible advantages of wrist immobilization after open carpal tunnel release comparing the results of two weeks immobilization and no immobilization. Fifty two patients with idiopathic carpal tunnel syndrome were randomly selected in two groups after open carpal tunnel release. In one group (A, n=26) the patients wore a neutral-position wrist splint continuously for two weeks. In the other group (B, n=26) no wrist immobilization was used. Clinical assessment was done pre-operatively and at 2 weeks follow-up and included the two-point discrimination test at the second finger and two questionnaires as an outcome measurement of symptoms severity and intensity. All the patients presented improvement in the postoperative evaluations in the three analyzed parameters. There was no significant difference between the two groups for any of the outcome measurements at the final follow-up. We conclude that wrist immobilization in the immediate post-operative period have no advantages when compared with no immobilization in the end result of carpal tunnel release.
Assuntos
Síndrome do Túnel Carpal/terapia , Descompressão Cirúrgica , Imobilização/métodos , Contenções , Articulação do Punho , Adulto , Idoso , Síndrome do Túnel Carpal/cirurgia , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
BACKGROUND: The occurrence, incidence, and relevance of the arcade of Struthers as a point of compression of the ulnar nerve at the elbow region are still controversial. This study was conducted to determine the incidence of the arcade of Struthers on anatomical dissections and to analyze the data from the literature concerning this anatomical structure. METHODS: The medial surface of the distal third of the arm was dissected in 60 limbs of frozen nonfixed cadavers, and the region was surveyed for the existence of musculotendinous and fibrous structures resembling an arch. When present, its appearance, extension, distance from the medial humeral epicondyle, and relation with the ulnar nerve were recorded. RESULTS: A musculotendinous arcade, defined as arcade of Struthers, was identified in 8 limbs (13.5%). The extension of the arcade ranged from 2.5 to 5.0 cm (median 3.75 cm), and the distance between its distal limit and the medial humeral epicondyle ranged from 3 to 10 cm (median 6.82 cm). No evidence of ulnar nerve compression was found in the specimens where an arcade was identified. CONCLUSION: Although the use of the term arcade of Struthers seems to be historically incorrect, this relatively rare anatomical structure does exist. Well recognized as a potential secondary site of compression of the ulnar nerve at the elbow in patients submitted to anterior transposition surgery, its importance as a primary site of compression probably has been underestimated.
Assuntos
Cotovelo/anormalidades , Fáscia/anormalidades , Ligamentos/anormalidades , Músculo Esquelético/anormalidades , Tendões/anormalidades , Nervo Ulnar/anatomia & histologia , Adulto , Idoso , Idoso de 80 Anos ou mais , População Negra/estatística & dados numéricos , Síndrome do Túnel Ulnar/etiologia , Humanos , Úmero/anatomia & histologia , Masculino , Pessoa de Meia-Idade , População Branca/estatística & dados numéricosRESUMO
BACKGROUND: Nerve repair with fibrin glue is an alternative to conventional suture technique, although there is no definitive experimental evaluation of the 2 techniques. This experimental study was undertaken to evaluate nerve regeneration after sciatic nerve repair with fibrin glue and to compare it with repair performed with suture and a combination of both techniques. METHODS: Eighty-six male Wistar rats were subjected to right sciatic nerve transection and immediate repair with 4-stitch nylon suture (group A), fibrin glue (group B), or a combination of both techniques (group C). Walking track analysis to access functional recovery was performed preoperatively and 12 weeks postoperatively. Before nerve section and after a 24-week interval, the nerve and motor action potentials (MAPs) were evaluated. Histomorphometric evaluation was carried out 24 weeks after nerve section. Differences between groups were evaluated for significance using the Kruskal-Wallis or analysis of variance methods. RESULTS: Animals of group B presented better results than those of group A when the functional evaluation was applied (P < .05). When nerve conduction velocity was evaluated at reoperation and the ratio between conduction velocity at reoperation and before the nerve section in MAP evaluation were measured and compared in the 3 groups, the rats of group B presented better results than those of group A (P < .05). Animals of group C presented better results than those of group A when the ratio between nerve conduction velocities was considered. There was no difference between the nerve repair methods when histomorphometric evaluation was performed. CONCLUSION: In a rat model, nerve repair using fibrin glue provided better conditions for regeneration than suture after sciatic nerve transection.
Assuntos
Adesivo Tecidual de Fibrina/farmacologia , Regeneração Nervosa/fisiologia , Procedimentos Neurocirúrgicos/métodos , Nervo Isquiático/efeitos dos fármacos , Nervo Isquiático/cirurgia , Neuropatia Ciática/cirurgia , Técnicas de Sutura/estatística & dados numéricos , Potenciais de Ação/fisiologia , Animais , Modelos Animais de Doenças , Adesivo Tecidual de Fibrina/uso terapêutico , Transtornos Neurológicos da Marcha/tratamento farmacológico , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/cirurgia , Membro Posterior/inervação , Membro Posterior/fisiopatologia , Locomoção/fisiologia , Masculino , Regeneração Nervosa/efeitos dos fármacos , Condução Nervosa/efeitos dos fármacos , Condução Nervosa/fisiologia , Ratos , Ratos Wistar , Recuperação de Função Fisiológica/efeitos dos fármacos , Recuperação de Função Fisiológica/fisiologia , Nervo Isquiático/fisiologia , Neuropatia Ciática/tratamento farmacológico , Neuropatia Ciática/fisiopatologia , Suturas/estatística & dados numéricos , Resultado do TratamentoRESUMO
The harvesting of the sural nerve for autologous grafting usually produces symptoms of low intensity and short duration. In rare occasions that procedure may lead to the formation of a symptomatic neuroma in the proximal stump. The symptoms of this complication are usually controlled by clinical treatment and the surgical procedure is left for the therapeutic failures. In this paper we present the case of a patient with a sural nerve neuroma submitted to surgical treatment by a variant of the centro-central anastomosis technique, developed for the treatment of amputation neuromas, that resulted in remission of the painful symptomatology. The different options of surgical treatment for this rare entity are discussed.
Assuntos
Neuroma/etiologia , Neoplasias Parotídeas/cirurgia , Neoplasias do Sistema Nervoso Periférico/etiologia , Complicações Pós-Operatórias , Nervo Sural/cirurgia , Anastomose Cirúrgica , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias do Sistema Nervoso Periférico/cirurgiaRESUMO
Objective To present the functional outcomes of distal nerve transfer techniques for restoration of elbow flexion after upper brachial plexus injury. Method The files of 78 adult patients with C5, C6, C7 lesions were reviewed. The attempt to restore elbow flexion was made by intraplexus distal nerve transfers using a fascicle of the ulnar nerve (group A, n » 43), or a fascicle of themedian nerve (group B, n » 16) or a combination of both (group C, n » 19). The result of the treatment was defined based on the British Medical Research Council grading system: muscle strength < M3 was considered a poor result. Results The global incidence of good/excellent results with these nerve transfers was 80.7%, and for different surgical techniques (groups A, B, C), it was 86%, 56.2% and 100% respectively. Patients submitted to ulnar nerve transfer or double transfer (ulnar þ median fascicles transfer) had a better outcome than those submitted to median nerve transfer alone (p < 0.05). There was no significant difference between the outcome of ulnar transfer and double transfer. Conclusion In cases of traumatic injury of the upper brachial plexus, good and excelent results in the restoration of elbow flexion can be obtained using distal nerve transfers.
Assuntos
Nervo Ulnar/transplante , Transferência de Nervo/reabilitação , Transferência de Nervo/estatística & dados numéricos , Articulação do Cotovelo , Nervo Mediano/transplante , Prontuários Médicos , Interpretação Estatística de Dados , Transferência de Nervo/métodos , Estatísticas não Paramétricas , Neuropatias do Plexo Braquial/cirurgiaRESUMO
ABSTRACT Objective To establish the correlation between clinical evaluation of motor function recovery and daily living activities in 30 patients with upper traumatic brachial plexus injury submitted to surgery. Methods The score of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Louisiana State University Health Sciences Center (LSUHSC) scale were determined in 30 patients. Epidemiologic factors were also examined and correlations were determined. Results There was a significant correlation between the clinical evaluation and the daily living activities after a 12-month period (r = 0.479 and p = 0.007). A direct correlation was observed between the functional recovery of the upper limb and the time between injury and surgery (r = 0.554 and p = 0.001). The LSUHSC scores (p = 0.049) and scores from the DASH questionnaire (p = 0.013) were better among patients who returned to work. Conclusions Clinical evaluation and daily living activities in adult patients who underwent nerve transfer after brachial plexus injury showed significant and measurable improvements.
RESUMO Objetivo Avaliar a correlação entre a avaliação clínica e as atividades de vida diária em 30 paciente adultos com lesão do plexo braquial superior. Métodos O valor do questionário Dash (Disabilities of the Arm, Shoulder and Hand) e da escala Louisiana State University Health Sciences Center (LSUHSC) foram quantificados prospectivamente em 30 pacientes. Fatores epidemiológicos foram também examinados e correlações específicas determinadas. Resultados Houve correlação significativa entre avaliação clínica e as atividades de vida diária 12 meses após a cirurgia (r = 0.479 e p = 0.007). Uma correlação direta foi observada entre a recuperação funcional do membro superior e o tempo entre a lesão e a cirurgia (r = 0.554 e p = 0.001). Os valores da escala LSUHSC (p = 0.049) e do DASH (p = 0.013) foram melhores entre aqueles que retornaram ao trabalho. Conclusões A avaliação clínica e as atividades de vida diária em pacientes submetidos à cirurgia de transferência de nervos após lesão do plexo braquial mostraram correlação significativa.