Almost of brachial plexus injuries occurred in traffic accidents while driving high speed motorcycles. Their treatments were usually difficult with poor outcomes. Thanks to microsurgical techniques, these injuries could be treated early to restore the movement capability of patients. Clinical signs included paralysis of upper collar; behind clavicle and lower collar areas, and the signs of spinal cord injuries. Paraclinical tests included standard X ray; MRI; spinal radiography; electromusculography; muscle test; respiratory function tests. Regime: in the first examination: clinical examination, EMG test, muscle test, respiratory function tests, X ray studies of cervical spine, heart and lungs, other necessary films; myelography; MRI
Brachial Plexus ; Wounds and Injuries ; Therapeutics

Brachial Plexus/injuries* ; Disabled Persons ; Humans

Adult ; Brachial Plexus ; injuries ; Brachial Plexus Neuropathies ; rehabilitation ; surgery ; Female ; Humans ; Male ; Middle Aged ; Young Adult

Traction injuries of the brachial plexus have recognized since the classic descriptions of Duchenne, Erb and Klumpke. The original cases resulted from birth injuries, presumably from traction forces. In recent years, automobile accidents have resulted in and increase in traction or closed injuries to the brachial plexus. This paper reviews our experiences with 3 cases of injuries characteristically demonstrated by Pantopaque myelography.
Automobiles ; Birth Injuries ; Brachial Plexus ; Iophendylate ; Myelography ; Traction*

This paper reviews the mechanisms of brachial plexus injury which includes the traumatic: stretch/contusions with or without avulsion, gunshot wounds(GSWs) and lacerations and the nontraumatic from tumors and the various etiologies of thoracic outlet syndrome(TOS). Another type of brachial plexus injury is that of obstetrical birth injury. The paper also reviews the anatomy of the brachial plexus and operative approaches with the anterior approach used in the majority of cases. The posterior subscapular approach with resection of the first rib is occasionally used for tumor resection, GSWs of the lower roots and trunk and the majority of patients with TOS. Surgical techniques and their indications in brachial plexus surgery are presented including nerve action potential(NAP) recording, neurolysis, end-to-end suture anastomosis repair and graft repair including split-repair. The mechanisms of brachial plexus injury are individually reviewed and results for each type of repair of same from the Louisiana State University Health Sciences Center(LSUHSC) experience with 1, 019 patients between 1968-1998 are summarized. There were 509 (49%) stretch/contusion injuries, which was the majority lesion followed in number by brachial plexus GSWs (12%) and lacerations (7%). Nontraumatic brachial plexus injuries included tumors (16%) and TOS (16%). Obstetrical brachial plexus injury though not included with the 1, 019 patients presented in a paper by Kim and Kline et al (J Neurosurg 98: 1005-1016, 2003) are presented and the LSUHSC experience with these are included as well.
Birth Injuries ; Brachial Plexus* ; Humans ; Lacerations ; Louisiana ; Ribs ; Sutures ; Transplants

Dislocation of the scapula between the ribs and into the thoracic cage is a very rare event. Scapulothoracic dissociation though has been reported, usually occurs after a severe injury and is often associated with other serious injuries like brachial plexus or chest injury, etc. Ainscow has described a rare type that may occur due to slight violence with a pre-existing condition. Cases of isolated scapular dislocation after minor trauma have not been reported frequently in the literature. It is a distinct clinical entity and needs to be differentiated from other similar conditions. Here, we present a case of painless scapular dislocation associated with trivial trauma followed by spontaneous reduction in a 10 years old girl. The patient had a recurrence of the dislocation before presenting to us. But she did not have any pre-existing condition for scapular dislocation.
Brachial Plexus ; Humans ; Joint Dislocations ; Multiple Trauma ; Scapula ; Thoracic Injuries

BACKGROUNDBrachial plexus injury is one of the difficult medical problems in the world. The aim of this study was to observe the clinical therapeutic effect of comprehensive rehabilitation in treating dysfunction after brachial plexus injury.

METHODSForty-three cases of dysfunction after brachial plexus injury were divided into two groups randomly. The treatment group, which totaled 21 patients (including 14 cases of total brachial plexus injury and seven cases of branch brachial plexus injury), was treated with comprehensive rehabilitation including transcutaneous electrical nerve stimulation, mid-frequency electrotherapy, Tuina therapy, and occupational therapy. The control group, which totaled 22 patients (including 16 cases of total brachial plexus injury and six cases of branch brachial plexus injury), was treated with home-based electrical nerve stimulation and occupational therapy. Each course was of 30 days duration and the patients received four courses totally. After four courses, the rehabilitation effect was evaluated according to the brachial plexus function evaluation standard and electromyogram (EMG) assessment.

RESULTSIn the treatment group, there was significant difference in the scores of brachial plexus function pre- and post-treatment (P < 0.01) in both "total" and "branch" injury. The scores of two "total injury" groups had statistical differences (P < 0.01), while the scores of two "branch injury" groups had statistical differences (P < 0.05) after four courses. EMG suggested that the appearance of regeneration potentials of the recipient nerves in the treatment group was earlier than the control group and had significant differences (P < 0.05).

CONCLUSIONComprehensive rehabilitation was more effective in treating dysfunction after brachial plexus injury than nonintegrated rehabilitation.

Adult ; Brachial Plexus ; injuries ; Brachial Plexus Neuropathies ; rehabilitation ; Electromyography ; Female ; Humans ; Male ; Middle Aged ; Nerve Regeneration ; physiology ; Young Adult

OBJECTIVE: To study injuries involving brachial plexus and its branches. METHODS: 66 cases collected from 2003 to 2005 in our department were analyzed statistically. RESULTS: 94% of injuries involved young adult males; 94% were blunt force injuries; 34% involved both nerve and bone mainly involving ulnar nerve and ulnar bone (50%); 40% of the injured nerves received electromyogram and 15 nerves were diagnosed with injuries clinically. CONCLUSION Forensic determination on severity of brachial plexus injuries mainly depends on movement recovery of limb. The best time for forensic appraisal is 20 d post operation+L (length of nerve severed distally)/R (growth rate)+90 d.
Adult ; Brachial Plexus/physiopathology* ; Brachial Plexus Neuropathies/physiopathology* ; Electromyography ; Female ; Forearm Injuries/physiopathology* ; Forensic Medicine ; Humans ; Male ; Median Nerve/injuries* ; Trauma Severity Indices ; Ulnar Nerve/injuries* ; Young Adult

Brachial plexus neuritis is reportedly caused by various factors; however, it has not been described in association with Streptococcus agalactiae. This is a case report of a patient diagnosed with brachial plexus neuritis associated with pyogenic arthritis of the shoulder. A 57-year-old man visited the hospital complaining of sudden weakness and painful swelling of the left arm. The diagnosis was pyogenic arthritis of the left shoulder, and the patient was treated with open irrigation and debridement accompanied by intravenous antibiotic therapy. S. agalactiae was isolated from a wound culture, and an electrodiagnostic study showed brachial plexopathy involving the left upper and middle trunk. Nine weeks after onset, muscle strength improved in most of the affected muscles, and an electrodiagnostic study showed signs of reinnervation. In conclusion, S. agalactiae infection can lead to various complications including brachial plexus neuritis.
Arm ; Arthritis ; Brachial Plexus Neuritis* ; Brachial Plexus Neuropathies ; Debridement ; Diagnosis ; Humans ; Middle Aged ; Muscle Strength ; Muscles ; Shoulder ; Streptococcus agalactiae* ; Wounds and Injuries

BACKGROUNDThere are few effective methods for treating injuries to the lower trunk of brachial plexus, and the curative effect is usually poor. The purpose of this study was to provide anatomic references for transferring the brachialis muscle branch of musculocutaneous nerve (BMBMCN) for selective neurotization of finger flexion in brachial plexus lower trunk injury, and to evaluate its clinical curative effects.

METHODSMicroanatomy and measurement were done on 50 limbs from 25 adult human cadavers to observe the origin, branch, type of the BMBMCN and median nerve, as well as their adjacent structures. Internal topographic features of the fascicular groups of the median nerve at the level of the BMBMCN were observed. In addition, the technique of BMBMCN transfer for selective neurotization of finger flexion of the median nerve was designed and tested in 6 fresh adult human cadavers. Acetylcholinesterase (AchE) staining of the BMBMCN and median nerve was done to observe the features of the nerve fibers. This technique was clinically tried to restore digital flexion in 6 cases of adult brachial plexus lower trunk injury. These cases were followed up for 3, 6, 9 and 12 months postoperatively. Recovery of function, grip strength, nerve electrophysiology and muscle power of the affected limbs were observed and measured.

RESULTSThe brachialis muscle was totally innervated by the musculocutaneous nerve (MCN). Based on the Hunter's line, the level of the origin of the BMBMCN was (13.18 +/- 2.77) cm. AchE histochemical staining indicated that the BMBMCN were totally made up of medullated nerve fibers. At the level of the BMBMCN, the median nerve consistently collected into three fascicular groups as shown by microanatomy in combination with AchE stain. The posterior fascicular group was mainly composed of anterior interosseous nerves and branches to the palmaris longus. The technique was tested in six fresh cadavers successfully, except that stoma split occurred in one case. Five of the six cases recovered digital flexion 12 months after operation, and at the same time grip strength, muscle power, and nerve electrophysiology also recovered markedly.

CONCLUSIONSThe technique of transferring the BMBMCN for selective neurotization of finger flexion is anatomically safe and effective, with satisfactory clinical outcomes.

Acetylcholinesterase ; analysis ; Adult ; Brachial Plexus ; anatomy & histology ; injuries ; Brachial Plexus Neuropathies ; surgery ; Clinical Trials as Topic ; Female ; Humans ; Male ; Middle Aged ; Musculocutaneous Nerve ; transplantation ; Nerve Transfer ; methods ; Retrospective Studies