Pub Date : 2017-10-02eCollection Date: 2017-01-01DOI: 10.1055/s-0037-1606841
Lukas Rasulic
Peripheral nerve injuries and brachial plexus injuries are relatively frequent. Significance of these injuries lies in the fact that the majority of patients with these types of injuries constitute working population. Since these injuries may create disability, they present substantial socioeconomic problem nowadays. This article will present current state-of-the-art achievements of minimal invasive brachial plexus and peripheral nerve surgery. It is considered that the age of the patient, the mechanism of the injury, and the associated vascular and soft-tissue injuries are factors that primarily influence the extent of recovery of the injured nerve. The majority of patients are treated using classical open surgical approach. However, new minimally invasive open and endoscopic approaches are being developed in recent years-endoscopic carpal and cubital tunnel release, targeted minimally invasive approaches in brachial plexus surgery, endoscopic single-incision sural nerve harvesting, and there were even attempts to perform endoscopic brachial plexus surgery. The use of the commercially available nerve conduits for bridging short nerve gap has shown promising results. Multidisciplinary approach individually designed for every patient is of the utmost importance for the successful treatment of these injuries. In the future, integration of biology and nanotechnology may fabricate a new generation of nerve conduits that will allow nerve regeneration over longer nerve gaps and start new chapter in peripheral nerve surgery.
{"title":"Current Concept in Adult Peripheral Nerve and Brachial Plexus Surgery.","authors":"Lukas Rasulic","doi":"10.1055/s-0037-1606841","DOIUrl":"https://doi.org/10.1055/s-0037-1606841","url":null,"abstract":"<p><p>Peripheral nerve injuries and brachial plexus injuries are relatively frequent. Significance of these injuries lies in the fact that the majority of patients with these types of injuries constitute working population. Since these injuries may create disability, they present substantial socioeconomic problem nowadays. This article will present current state-of-the-art achievements of minimal invasive brachial plexus and peripheral nerve surgery. It is considered that the age of the patient, the mechanism of the injury, and the associated vascular and soft-tissue injuries are factors that primarily influence the extent of recovery of the injured nerve. The majority of patients are treated using classical open surgical approach. However, new minimally invasive open and endoscopic approaches are being developed in recent years-endoscopic carpal and cubital tunnel release, targeted minimally invasive approaches in brachial plexus surgery, endoscopic single-incision sural nerve harvesting, and there were even attempts to perform endoscopic brachial plexus surgery. The use of the commercially available nerve conduits for bridging short nerve gap has shown promising results. Multidisciplinary approach individually designed for every patient is of the utmost importance for the successful treatment of these injuries. In the future, integration of biology and nanotechnology may fabricate a new generation of nerve conduits that will allow nerve regeneration over longer nerve gaps and start new chapter in peripheral nerve surgery.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"12 1","pages":"e7-e14"},"PeriodicalIF":0.7,"publicationDate":"2017-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0037-1606841","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35466734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-16eCollection Date: 2017-01-01DOI: 10.1055/s-0036-1597838
Yigit Uyanikgil, Turker Cavusoglu, Kubilay Dogan Kılıc, Gurkan Yigitturk, Servet Celik, Richard Shane Tubbs, Mehmet Turgut
Abstract This review summarizes the role of melatonin (MLT) in defense against toxic-free radicals and its novel effects in the development of the nervous system, and the effect of endogenously produced and exogenously administered MLT in reducing the degree of tissue and nerve injuries. MLT was recently reported to be an effective free radical scavenger and antioxidant. Since endogenous MLT levels fall significantly in senility, these findings imply that the loss of this antioxidant could contribute to the incidence or severity of some age-related neurodegenerative diseases. Considering the high efficacy of MLT in overcoming much of the injury not only to the peripheral nerve but also to other organs, clinical trials for this purpose should be seriously considered.
{"title":"Useful Effects of Melatonin in Peripheral Nerve Injury and Development of the Nervous System.","authors":"Yigit Uyanikgil, Turker Cavusoglu, Kubilay Dogan Kılıc, Gurkan Yigitturk, Servet Celik, Richard Shane Tubbs, Mehmet Turgut","doi":"10.1055/s-0036-1597838","DOIUrl":"https://doi.org/10.1055/s-0036-1597838","url":null,"abstract":"Abstract This review summarizes the role of melatonin (MLT) in defense against toxic-free radicals and its novel effects in the development of the nervous system, and the effect of endogenously produced and exogenously administered MLT in reducing the degree of tissue and nerve injuries. MLT was recently reported to be an effective free radical scavenger and antioxidant. Since endogenous MLT levels fall significantly in senility, these findings imply that the loss of this antioxidant could contribute to the incidence or severity of some age-related neurodegenerative diseases. Considering the high efficacy of MLT in overcoming much of the injury not only to the peripheral nerve but also to other organs, clinical trials for this purpose should be seriously considered.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"12 1","pages":"e1-e6"},"PeriodicalIF":0.7,"publicationDate":"2017-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0036-1597838","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35078744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anne-Marie A Verenna, D. Alexandru, A. Karimi, Justin M. Brown, G. Bove, F. Daly, A. Pastore, Helen E. Pearson, M. Barbe
Abstract Rationale Knowledge of the relationship of the dorsal scapular artery (DSA) with the brachial plexus is limited. Objective We report a case of a variant DSA path, and revisit DSA origins and under-investigated relationship with the plexus in cadavers. Methods The DSA was examined in a male patient and 106 cadavers. Results In the case, we observed an unusual DSA compressing the lower plexus trunk, that resulted in intermittent radiating pain and paresthesia. In the cadavers, the DSA originated most commonly from the subclavian artery (71%), with 35% from the thyrocervical trunk. Nine sides of eight cadavers (seven females) had two DSA branches per side, with one branch from each origin. The most typical DSA path was a subclavian artery origin before passing between upper and middle brachial plexus trunks (40% of DSAs), versus between middle and lower trunks (23%), or inferior (4%) or superior to the plexus (1%). Following a thyrocervical trunk origin, the DSA passed most frequently superior to the plexus (23%), versus between middle and lower trunks (6%) or upper and middle trunks (4%). Bilateral symmetry in origin and path through the brachial plexus was observed in 13 of 35 females (37%) and 6 of 17 males (35%), with the most common bilateral finding of a subclavian artery origin and a path between upper and middle trunks (17%). Conclusion Variability in the relationship between DSA and trunks of the brachial plexus has surgical and clinical implications, such as diagnosis of thoracic outlet syndrome.
{"title":"Dorsal Scapular Artery Variations and Relationship to the Brachial Plexus, and a Related Thoracic Outlet Syndrome Case","authors":"Anne-Marie A Verenna, D. Alexandru, A. Karimi, Justin M. Brown, G. Bove, F. Daly, A. Pastore, Helen E. Pearson, M. Barbe","doi":"10.1055/s-0036-1583756","DOIUrl":"https://doi.org/10.1055/s-0036-1583756","url":null,"abstract":"Abstract Rationale Knowledge of the relationship of the dorsal scapular artery (DSA) with the brachial plexus is limited. Objective We report a case of a variant DSA path, and revisit DSA origins and under-investigated relationship with the plexus in cadavers. Methods The DSA was examined in a male patient and 106 cadavers. Results In the case, we observed an unusual DSA compressing the lower plexus trunk, that resulted in intermittent radiating pain and paresthesia. In the cadavers, the DSA originated most commonly from the subclavian artery (71%), with 35% from the thyrocervical trunk. Nine sides of eight cadavers (seven females) had two DSA branches per side, with one branch from each origin. The most typical DSA path was a subclavian artery origin before passing between upper and middle brachial plexus trunks (40% of DSAs), versus between middle and lower trunks (23%), or inferior (4%) or superior to the plexus (1%). Following a thyrocervical trunk origin, the DSA passed most frequently superior to the plexus (23%), versus between middle and lower trunks (6%) or upper and middle trunks (4%). Bilateral symmetry in origin and path through the brachial plexus was observed in 13 of 35 females (37%) and 6 of 17 males (35%), with the most common bilateral finding of a subclavian artery origin and a path between upper and middle trunks (17%). Conclusion Variability in the relationship between DSA and trunks of the brachial plexus has surgical and clinical implications, such as diagnosis of thoracic outlet syndrome.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"11 1","pages":"e21 - e28"},"PeriodicalIF":0.7,"publicationDate":"2016-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0036-1583756","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58154181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peripheral nerve research as well as nerve repair simulation has relied heavily on the rat animal model, more specifically on the rat sciatic nerve.1 As the use of animals in experiments and training has received much criticism from animal rights activists and society at large, the field of surgical simulation is currently emerging. In microsurgery, high-fidelity Silastic models, animal parts such as chicken thighs or wings, and cadaveric specimens have been used. Based on the available experience with Thiel embalmed cadaveric tissue in simulation,2–4 we experimented with Thiel embalmed peripheral nerves for the purpose of microsurgical skill training. We used median, ulnar, and tibial nerves from cadavers that had been used for anatomic and surgical training and had not touched the peripheral nerve tissue. The donors had previously consented to tissue utilization in postmortem research. The tissues originated from cadavers prepared with the embalming method described by Thiel.5 This technique preserves texture, volume, color, and shape of the body as perfect as possible, with the advantage of avoiding decay observed with fresh cadaveric specimens. There is no shrinking or soaking of the soft tissues. Thirteen nerve sections measuring 5 cm eachwere prepared on a foam board. Needles (25 G) are used to fix the nerves to the foam board. A blue background was used for the exercise, as it improves contrast. An operating microscope (Opmi Pico, Carl Zeiss, Oberkochen, German) at 10 magnification was used for all microneurorrhaphies. Under magnification, the nerves were crushed in the midsection to simulate an injured nerve. The participants transected the nerve using a 15-blade scalpel, and trimmed the damagednerve tissue. The two endswere inspected for the fascicular architecture and oriented appropriately for the repair. The epineurium was then gently reflected back and the proud fascicles trimmed. Nylon 8–0 sutures were used to perform a simple epineural repair, starting with the 0and 180-degree orientation sutures and then filling in the required sutures to obtain a well-oriented microneurorrhaphy. Under magnification of the operative microscope, we found the Thiel nerve tissue to show a slight gray-brown discoloration with an epineural layer that was hydrophilic, giving the impression of edematous tissue (►Fig. 1). This thicker-than-normal epineural layer, however, offers adequate support for manipulation. Unfortunately, the cadaveric nature of themodel precludes the use of the vasa nervorum,which are not visible, for adequate orientation of the nerve. Upon transection of the nerve, it can be observed that the fascicles arewell preserved and bound byfirm endoneurium and perineurium which have not undergone the same edema as the epineurium (►Fig. 1). Despite therebeing no immediate herniation of nerve fascicles upon transection, the fascicles have a tendency to bemorehygroscopic, and by the end of the neurorrhaphy, one can observe some protrusion of
周围神经的研究以及神经修复模拟在很大程度上依赖于大鼠动物模型，特别是大鼠坐骨神经由于在实验和训练中使用动物受到了动物权利活动家和整个社会的许多批评，手术模拟领域目前正在兴起。在显微外科手术中，高保真的硅胶模型，动物部位，如鸡腿或翅膀，和尸体标本被使用。基于已有的Thiel尸体组织防腐的模拟经验，2-4我们对Thiel尸体组织防腐的周围神经进行了显微外科技能训练。我们使用了来自尸体的正中神经、尺神经和胫骨神经，这些神经曾用于解剖和外科训练，并且没有接触周围神经组织。捐赠者先前已经同意将组织用于死后研究。这些组织来自用thiel描述的防腐方法制备的尸体。这种技术尽可能完美地保留了尸体的质地、体积、颜色和形状，其优点是避免了用新鲜尸体标本观察到的腐烂。软组织无萎缩、浸泡现象。在泡沫板上制备了13个神经切片，每个5厘米。针头(25g)用于将神经固定在泡沫板上。练习中使用了蓝色背景，因为它可以提高对比度。手术显微镜(Opmi Pico, Carl Zeiss, Oberkochen，德国)10倍放大用于所有显微缝合。在放大镜下，神经在中段被压碎，以模拟受伤的神经。参与者使用15刃手术刀横切神经，并修整受损的神经组织。检查了两端的束状结构，并适当地定位修复。然后将神经外膜轻轻向后反射，并修剪骄傲的神经束。使用尼龙8-0缝线进行简单的神经外修复，从0度和180度方向缝线开始，然后填充所需缝线，以获得定向良好的微神经缝合。在手术显微镜下，我们发现Thiel神经组织显示轻微的灰褐色变色，神经外层亲水，给人水肿组织的印象(图1)。然而，这层比正常的神经外膜厚，为操作提供了足够的支持。不幸的是，该模型的尸体性质排除了使用不可见的神经血管来充分定位神经。横断神经时，可以观察到神经束保存完好，并被坚固的神经内膜和神经周围膜结合，它们没有像神经外膜那样经历水肿(图1)。1).尽管在横断时神经束没有立即突出，但神经束有吸湿的倾向，在神经缝合结束时，可以观察到缝合线之间有一些神经束突出。束状图很容易识别，在缝合前可以使神经很好地对准。13名整形外科、耳鼻喉科和骨科住院医生志愿者分别使用了该模型一次，并填写了模拟后的调查问卷。调查结果以李克特五分制进行评分(非常同意、不同意、既不同意也不反对、同意、非常同意)。一个关于参与者使用实验室的频率的问题，答案分为五类。模拟后调查的内容见表1。对调查问题的结果进行了描述性统计。所有参与者(100.0%)同意他们每年至少使用该模块两次，53.9%(7名居民)表示他们每月使用一次以上，38.5%(5名居民)每月使用一次，7.7%(1名居民)每年使用两次。在过去的三十年中，显微外科手术的快速发展与一些用于显微外科手术技能教学和磨练的模拟模型的发展相呼应。在大多数整形外科中心，免费皮瓣是常规手术，住院医生有充分的机会参与和执行这些手术。作为一个
{"title":"Thiel Cadaveric Nerve Tissue: A Model for Microsurgical Simulation","authors":"A. Odobescu, Sami P Moubayed, M. Danino","doi":"10.1055/s-0036-1580626","DOIUrl":"https://doi.org/10.1055/s-0036-1580626","url":null,"abstract":"Peripheral nerve research as well as nerve repair simulation has relied heavily on the rat animal model, more specifically on the rat sciatic nerve.1 As the use of animals in experiments and training has received much criticism from animal rights activists and society at large, the field of surgical simulation is currently emerging. In microsurgery, high-fidelity Silastic models, animal parts such as chicken thighs or wings, and cadaveric specimens have been used. Based on the available experience with Thiel embalmed cadaveric tissue in simulation,2–4 we experimented with Thiel embalmed peripheral nerves for the purpose of microsurgical skill training. We used median, ulnar, and tibial nerves from cadavers that had been used for anatomic and surgical training and had not touched the peripheral nerve tissue. The donors had previously consented to tissue utilization in postmortem research. The tissues originated from cadavers prepared with the embalming method described by Thiel.5 This technique preserves texture, volume, color, and shape of the body as perfect as possible, with the advantage of avoiding decay observed with fresh cadaveric specimens. There is no shrinking or soaking of the soft tissues. Thirteen nerve sections measuring 5 cm eachwere prepared on a foam board. Needles (25 G) are used to fix the nerves to the foam board. A blue background was used for the exercise, as it improves contrast. An operating microscope (Opmi Pico, Carl Zeiss, Oberkochen, German) at 10 magnification was used for all microneurorrhaphies. Under magnification, the nerves were crushed in the midsection to simulate an injured nerve. The participants transected the nerve using a 15-blade scalpel, and trimmed the damagednerve tissue. The two endswere inspected for the fascicular architecture and oriented appropriately for the repair. The epineurium was then gently reflected back and the proud fascicles trimmed. Nylon 8–0 sutures were used to perform a simple epineural repair, starting with the 0and 180-degree orientation sutures and then filling in the required sutures to obtain a well-oriented microneurorrhaphy. Under magnification of the operative microscope, we found the Thiel nerve tissue to show a slight gray-brown discoloration with an epineural layer that was hydrophilic, giving the impression of edematous tissue (►Fig. 1). This thicker-than-normal epineural layer, however, offers adequate support for manipulation. Unfortunately, the cadaveric nature of themodel precludes the use of the vasa nervorum,which are not visible, for adequate orientation of the nerve. Upon transection of the nerve, it can be observed that the fascicles arewell preserved and bound byfirm endoneurium and perineurium which have not undergone the same edema as the epineurium (►Fig. 1). Despite therebeing no immediate herniation of nerve fascicles upon transection, the fascicles have a tendency to bemorehygroscopic, and by the end of the neurorrhaphy, one can observe some protrusion of","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"38 1","pages":"e18 - e20"},"PeriodicalIF":0.7,"publicationDate":"2016-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0036-1580626","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58134417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Multifactorial motion analysis was first established for gait and then developed in the upper extremity. Recordings of infrared light reflecting sensitive passive markers in space, combined with surface eletromyographic recordings and/or transmitted forces, allow eclectic study of muscular coordination in the upper limb. Brachial plexus birth injury is responsible for various patterns of muscle weakness, imbalance, and/or simultaneous activation, soft tissue contractures, and bone-joint deformities, leading to individual motion patterns and adaptations, which we studied by means of motion analysis tools. We describe the technical development and examination setup to evaluate motion impairment and present first clinical results. Motion analysis is a reliable objective assessment tool allowing precise pre- and postoperative multimodal evaluation of upper limb function. Level of evidence: II.
{"title":"Upper Limb Multifactorial Movement Analysis in Brachial Plexus Birth Injury","authors":"J. Bahm","doi":"10.1055/s-0036-1579762","DOIUrl":"https://doi.org/10.1055/s-0036-1579762","url":null,"abstract":"Abstract Multifactorial motion analysis was first established for gait and then developed in the upper extremity. Recordings of infrared light reflecting sensitive passive markers in space, combined with surface eletromyographic recordings and/or transmitted forces, allow eclectic study of muscular coordination in the upper limb. Brachial plexus birth injury is responsible for various patterns of muscle weakness, imbalance, and/or simultaneous activation, soft tissue contractures, and bone-joint deformities, leading to individual motion patterns and adaptations, which we studied by means of motion analysis tools. We describe the technical development and examination setup to evaluate motion impairment and present first clinical results. Motion analysis is a reliable objective assessment tool allowing precise pre- and postoperative multimodal evaluation of upper limb function. Level of evidence: II.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"11 1","pages":"e1 - e9"},"PeriodicalIF":0.7,"publicationDate":"2016-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0036-1579762","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58132370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract In upper brachial plexus birth injury, rotational balance of the glenohumeral joint is frequently affected and contracture in medial rotation of the arm develops, due to a severe palsy or insufficient recovery of the lateral rotators. Some of these children present with a severe glenohumeral joint contracture in the first months, although regular physiotherapy has been provided, a condition associated with a posteriorly subdislocated or dislocated humeral head. These conditions should be screened early by a pediatrician or specialized physiotherapist. Both aspects of muscular weakness affecting the lateral rotators and the initial or progressive glenohumeral deformity and/or subdislocation must be identified and treated accordingly, focusing on the reestablishment of joint congruence and strengthening of the lateral rotators to improve rotational balance, thus working against joint dysplasia and loss of motor function of the shoulder in a growing child. Our treatment strategy adapted over the last 20 years to results from retrospective studies, including biomechanical aspects on muscular imbalance and tendon transfers. With this review, we confront our actual concept to recent literature.
{"title":"The Surgical Strategy to Correct the Rotational Imbalance of the Glenohumeral Joint after Brachial Plexus Birth Injury","authors":"J. Bahm","doi":"10.1055/s-0036-1579763","DOIUrl":"https://doi.org/10.1055/s-0036-1579763","url":null,"abstract":"Abstract In upper brachial plexus birth injury, rotational balance of the glenohumeral joint is frequently affected and contracture in medial rotation of the arm develops, due to a severe palsy or insufficient recovery of the lateral rotators. Some of these children present with a severe glenohumeral joint contracture in the first months, although regular physiotherapy has been provided, a condition associated with a posteriorly subdislocated or dislocated humeral head. These conditions should be screened early by a pediatrician or specialized physiotherapist. Both aspects of muscular weakness affecting the lateral rotators and the initial or progressive glenohumeral deformity and/or subdislocation must be identified and treated accordingly, focusing on the reestablishment of joint congruence and strengthening of the lateral rotators to improve rotational balance, thus working against joint dysplasia and loss of motor function of the shoulder in a growing child. Our treatment strategy adapted over the last 20 years to results from retrospective studies, including biomechanical aspects on muscular imbalance and tendon transfers. With this review, we confront our actual concept to recent literature.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"11 1","pages":"e10 - e17"},"PeriodicalIF":0.7,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0036-1579763","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58132380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I am grateful to Rolfe Birch who gave me the opportunity to participate as a board member in a journal dedicated to brachial plexus surgery, as this field concerns my daily clinical and scientific activities over the last ten years. Six months ago, I discovered the online Journal of Brachial Plexus and Peripheral Nerve Injury and was pleased by the idea of such a specific journal, providing open access and facilitating reaching colleagues all over the world, where our traditional and respected journals might not go. I also appreciate the technical opportunity, feasible within this journal, of publishing video documentation, as our operative results might be actually better expressed through this medium. I have to congratulate Dr Nath for his excellent initiative. I propose my input for this journal:-I expect that the journal will fulfill criteria of a scientifically honest, balanced and innovative platform for all interested colleagues;-I believe that an online journal with free access in all countries has large possibilities to share data, high quality photos and videos with critical readers-My goal is to join the Journal and uphold international scientific standards and basic rules when sharing high level medical and scientific expertise. I would like to encourage all colleagues to participate in the discussion by sharing their experience, comments, criticisms, starting with questions, observations, empiric conclusions and scientific contributions. The JBP&PNI started as an initiative to be an open-minded platform for an exchange of ideas and techniques in this particular field of clinics and surgery, brachial plexus pathology and related issues in severe peripheral nerve injuries. Colleagues from all countries who are involved in these treatment plans should feel free to communicate their experience and analysis of the existing literature. Senior colleagues should share their comments about trials and pitfalls, for the benefit of our continued education and thus better serve patients hit by severe nerve injuries, either children or adults. During the past 10 years, I have become aware of how many controversies might exist even between international colleagues sharing one particular medical problem, and this is for many reasons. I believe, however, that we should overcome these differences just by focusing on common, noble targets of scientific education, giving our very best, and respecting established rules that good medical practice has taught us. which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
我很感谢Rolfe Birch，他给了我一个机会，让我成为一个致力于臂丛外科的期刊的董事会成员，因为这个领域关系到我过去十年来的日常临床和科学活动。六个月前，我在网上发现了《臂丛神经和周围神经损伤杂志》(Journal of Brachial Plexus and Peripheral Nerve Injury)，我很高兴能有这样一份特别的杂志，它提供了开放获取的途径，便于全世界的同事接触，而我们传统的、受人尊敬的期刊可能无法做到这一点。我也很欣赏在这个杂志中可行的技术机会，发布视频文档，因为我们的手术结果实际上可以通过这种媒介更好地表达。我必须祝贺纳特博士出色的主动性。我提出我对这本杂志的看法:-我希望这本杂志能够满足所有感兴趣的同事在科学上诚实、平衡和创新的平台的标准;-我相信一本在所有国家免费访问的在线期刊有很大的可能性与关键的读者分享数据、高质量的照片和视频-我的目标是加入该杂志，在分享高水平的医学和科学专业知识时坚持国际科学标准和基本规则。我想鼓励所有同事参与讨论，从问题、观察、经验性结论和科学贡献开始，分享他们的经验、评论和批评。JBP&PNI最初是作为一个开放的平台，在这一特定领域的临床和外科、臂丛病理和严重周围神经损伤的相关问题上交流思想和技术。参与这些治疗计划的各国同事应随时交流他们的经验和对现有文献的分析。资深同事应该分享他们对试验和陷阱的评论，以便我们继续教育，从而更好地服务于严重神经损伤的患者，无论是儿童还是成人。在过去的10年里，我已经意识到，即使是在共享一个特定医疗问题的国际同事之间，也可能存在许多争议，这有很多原因。然而，我相信，我们应该通过关注科学教育的共同的、崇高的目标，尽我们最大的努力，并尊重良好的医疗实践教给我们的既定规则，来克服这些差异。它允许在任何媒介上不受限制地使用、分发和复制，只要正确地引用原始作品。
{"title":"Journal of Brachial Plexus and Peripheral Nerve Injury","authors":"Jörg Bahm","doi":"10.1055/s-0035-1570130","DOIUrl":"https://doi.org/10.1055/s-0035-1570130","url":null,"abstract":"I am grateful to Rolfe Birch who gave me the opportunity to participate as a board member in a journal dedicated to brachial plexus surgery, as this field concerns my daily clinical and scientific activities over the last ten years. Six months ago, I discovered the online Journal of Brachial Plexus and Peripheral Nerve Injury and was pleased by the idea of such a specific journal, providing open access and facilitating reaching colleagues all over the world, where our traditional and respected journals might not go. I also appreciate the technical opportunity, feasible within this journal, of publishing video documentation, as our operative results might be actually better expressed through this medium. I have to congratulate Dr Nath for his excellent initiative. I propose my input for this journal:-I expect that the journal will fulfill criteria of a scientifically honest, balanced and innovative platform for all interested colleagues;-I believe that an online journal with free access in all countries has large possibilities to share data, high quality photos and videos with critical readers-My goal is to join the Journal and uphold international scientific standards and basic rules when sharing high level medical and scientific expertise. I would like to encourage all colleagues to participate in the discussion by sharing their experience, comments, criticisms, starting with questions, observations, empiric conclusions and scientific contributions. The JBP&PNI started as an initiative to be an open-minded platform for an exchange of ideas and techniques in this particular field of clinics and surgery, brachial plexus pathology and related issues in severe peripheral nerve injuries. Colleagues from all countries who are involved in these treatment plans should feel free to communicate their experience and analysis of the existing literature. Senior colleagues should share their comments about trials and pitfalls, for the benefit of our continued education and thus better serve patients hit by severe nerve injuries, either children or adults. During the past 10 years, I have become aware of how many controversies might exist even between international colleagues sharing one particular medical problem, and this is for many reasons. I believe, however, that we should overcome these differences just by focusing on common, noble targets of scientific education, giving our very best, and respecting established rules that good medical practice has taught us. which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"10 1","pages":"e1 - e1"},"PeriodicalIF":0.7,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0035-1570130","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58121403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract This report describes a patient who had an open repair of a small supraspinatus tendon tear performed 6 months after an arthroscopic acromioplasty with debridement had failed to provide pain relief. Three months prior to the tendon repair, he had a two-level cervical spine discectomy and fusion (C4–5, C5–6) that improved his neck pain. Florid suprascapular neuropathy was detected 10 weeks after the open rotator cuff repair. Evidence of some nerve recovery resulted in a long period of observation. But unsatisfactory improvement warranted decompression of the suprascapular notch, which was found to be very stenotic. At surgery, there was no evidence of neuroma, cyst, or other compressing lesion or tissue. Therefore, it was ultimately hypothesized that there was an exacerbation of a preexisting, but clinically unrecognized, entrapment of the suprascapular nerve in the suprascapular notch in the setting of cervical radiculopathy (primarily C5). Retrospectively it was also concluded that had this compressive etiology been recognized, it would have favored prompt decompression rather than the long observation period. Three years was required to achieve a good result following suprascapular notch decompression. The underlying C5 radiculopathy may have created a “double crush syndrome” that contributed to the propensity for injury and the prolonged recovery. There should be heightened awareness of this problem in patients who do not have satisfactory improvement in shoulder pain from previous shoulder and neck surgery.
{"title":"Florid Suprascapular Neuropathy after Primary Rotator Cuff Repair Attributed to Suprascapular Notch Constriction in the Setting of Double Crush Syndrome","authors":"J. Skedros, C. Kiser, Bryce B Hill","doi":"10.1055/s-0035-1567807","DOIUrl":"https://doi.org/10.1055/s-0035-1567807","url":null,"abstract":"Abstract This report describes a patient who had an open repair of a small supraspinatus tendon tear performed 6 months after an arthroscopic acromioplasty with debridement had failed to provide pain relief. Three months prior to the tendon repair, he had a two-level cervical spine discectomy and fusion (C4–5, C5–6) that improved his neck pain. Florid suprascapular neuropathy was detected 10 weeks after the open rotator cuff repair. Evidence of some nerve recovery resulted in a long period of observation. But unsatisfactory improvement warranted decompression of the suprascapular notch, which was found to be very stenotic. At surgery, there was no evidence of neuroma, cyst, or other compressing lesion or tissue. Therefore, it was ultimately hypothesized that there was an exacerbation of a preexisting, but clinically unrecognized, entrapment of the suprascapular nerve in the suprascapular notch in the setting of cervical radiculopathy (primarily C5). Retrospectively it was also concluded that had this compressive etiology been recognized, it would have favored prompt decompression rather than the long observation period. Three years was required to achieve a good result following suprascapular notch decompression. The underlying C5 radiculopathy may have created a “double crush syndrome” that contributed to the propensity for injury and the prolonged recovery. There should be heightened awareness of this problem in patients who do not have satisfactory improvement in shoulder pain from previous shoulder and neck surgery.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"10 1","pages":"e66 - e73"},"PeriodicalIF":0.7,"publicationDate":"2015-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0035-1567807","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58114385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-06eCollection Date: 2015-12-01DOI: 10.1055/s-0035-1567806
Shiro Nawa
Background: In neurological diseases, winging of the scapula occurs because of serratus anterior muscle dysfunction due to long thoracic nerve palsy, or trapezius muscle dysfunction due to accessory nerve palsy. Several sports can cause long thoracic nerve palsy, including archery and tennis. To our knowledge, this is the first report of long thoracic nerve palsy in an aquatic sport.
Objective: The present study is a rare case of winging of the scapula that occurred during synchronized swimming practice.
Methods: The patient's history with the present illness, examination findings, rehabilitation progress, and related medical literature are presented.
Results: A 14-year-old female synchronized swimmer had chief complaints of muscle weakness, pain, and paresthesia in the right scapula. Upon examination, marked winging of the scapula appeared during anterior arm elevation, as did floating of the superior angle. After 1 year of therapy, right shoulder girdle pain and paresthesia had disappeared; however, winging of the scapula remained.
Conclusions: Based on this observation and the severe pain in the vicinity of the second dorsal rib, we believe the cause was damage to the nerve proximal to the branch arising from the upper nerve trunk that innervates the serratus anterior.
{"title":"Scapular Winging Secondary to Apparent Long Thoracic Nerve Palsy in a Young Female Swimmer.","authors":"Shiro Nawa","doi":"10.1055/s-0035-1567806","DOIUrl":"10.1055/s-0035-1567806","url":null,"abstract":"<p><strong>Background: </strong> In neurological diseases, winging of the scapula occurs because of serratus anterior muscle dysfunction due to long thoracic nerve palsy, or trapezius muscle dysfunction due to accessory nerve palsy. Several sports can cause long thoracic nerve palsy, including archery and tennis. To our knowledge, this is the first report of long thoracic nerve palsy in an aquatic sport.</p><p><strong>Objective: </strong> The present study is a rare case of winging of the scapula that occurred during synchronized swimming practice.</p><p><strong>Methods: </strong> The patient's history with the present illness, examination findings, rehabilitation progress, and related medical literature are presented.</p><p><strong>Results: </strong> A 14-year-old female synchronized swimmer had chief complaints of muscle weakness, pain, and paresthesia in the right scapula. Upon examination, marked winging of the scapula appeared during anterior arm elevation, as did floating of the superior angle. After 1 year of therapy, right shoulder girdle pain and paresthesia had disappeared; however, winging of the scapula remained.</p><p><strong>Conclusions: </strong> Based on this observation and the severe pain in the vicinity of the second dorsal rib, we believe the cause was damage to the nerve proximal to the branch arising from the upper nerve trunk that innervates the serratus anterior.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"10 1","pages":"e57-e61"},"PeriodicalIF":0.7,"publicationDate":"2015-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0035-1567806","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58114372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract A 20-year-old man suffered the combined axillary and suprascapular nerve palsies associated with scapulothoracic dissociation by motorcycle accident. The dislocated shoulder girdle was reduced and stabilized with osteosynthesis of the fractured clavicle and reattachment of the trapezius avulsed from the scapular spine for removal of continuous traction force to these damaged nerves. Because of no evidence of recovery on manual muscle test and electromyogram, exploration for these nerves was administered 6 weeks after injury. Although neurolysis of both nerves revealed neural continuity, excessive tension still existed on the suprascapular nerve. It was thought that previous operation in which the shoulder girdle had been reduced and stabilized as much as possible could not achieve complete anatomical reduction of the scapula. As an additional treatment, medial walls of the suprascapular and spinoglenoid notches were shaven to relax the suprascapular nerve. After a year, complete recovery of both the axillary and suprascapular nerve was identified. Although scapulothoracic dissociation is commonly recognized as massive injury of the shoulder girdle with poor prognosis because of existence of accompanied severe neurovascular injuries, there are more than a few cases in which partial damage on the infraclavicular brachial plexus is only accompanied. In case of them, there is the possibility of lesions in continuity of the nerves in which good prognosis might be expected with surgical intervention including early reduction of the shoulder girdle for removal of excessive tension to the damaged nerve.
{"title":"Treatment of Combined Injuries of the Axillary and Suprascapular Nerves with Scapulothoracic Dissociation","authors":"K. Sano, S. Ozeki","doi":"10.1055/s-0035-1566740","DOIUrl":"https://doi.org/10.1055/s-0035-1566740","url":null,"abstract":"Abstract A 20-year-old man suffered the combined axillary and suprascapular nerve palsies associated with scapulothoracic dissociation by motorcycle accident. The dislocated shoulder girdle was reduced and stabilized with osteosynthesis of the fractured clavicle and reattachment of the trapezius avulsed from the scapular spine for removal of continuous traction force to these damaged nerves. Because of no evidence of recovery on manual muscle test and electromyogram, exploration for these nerves was administered 6 weeks after injury. Although neurolysis of both nerves revealed neural continuity, excessive tension still existed on the suprascapular nerve. It was thought that previous operation in which the shoulder girdle had been reduced and stabilized as much as possible could not achieve complete anatomical reduction of the scapula. As an additional treatment, medial walls of the suprascapular and spinoglenoid notches were shaven to relax the suprascapular nerve. After a year, complete recovery of both the axillary and suprascapular nerve was identified. Although scapulothoracic dissociation is commonly recognized as massive injury of the shoulder girdle with poor prognosis because of existence of accompanied severe neurovascular injuries, there are more than a few cases in which partial damage on the infraclavicular brachial plexus is only accompanied. In case of them, there is the possibility of lesions in continuity of the nerves in which good prognosis might be expected with surgical intervention including early reduction of the shoulder girdle for removal of excessive tension to the damaged nerve.","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"10 1","pages":"e62 - e65"},"PeriodicalIF":0.7,"publicationDate":"2015-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0035-1566740","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58112349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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