Adolescent ; Brachial Plexus ; physiopathology ; Encephalitis ; diagnosis ; physiopathology ; Facial Muscles ; physiopathology ; Humans ; Male

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

OBJECTIVETo compare the difference of therapeutic effect between acupuncture combined with Tuina and Nobex for treatment of birth brachial plexus injury.

METHODSForty cases with birth brachial plexus injury were randomly divided into a acupuncture combined with Tuina group (group A) and a Nobex group (group B), 20 cases in each group. The group A was treated with acupuncture at 3 points, i. e. Jianyu (LI 15), Jianliao (TE 14), Jianzhen (SI 9) on shoulder, Binao (LI 14), Shouwuli (LI 13), Quchi (LI 11), etc. combined with Tuina using a single thumb and rolling method, and the group B was treated with intramuscular injection of Nobex. The clinical effects and the changes of the symptom, scores and the electromyogram were observed before and after treatment.

RESULTSThe total effective rate of 90.0% (18/20) in the group A was better than that of 55.0% (11/20) in the group B, with a significant difference between the two groups (P < 0.05). The effective rate of the electromyogram improvement in the group A was 90.0% (18/20), which was better than 45.0% (9/20) in the group B (P < 0. 05), and the symptom scores in the group A were lower than those in the group B (P < 0.01).

CONCLUSIONAcupuncture combined with Tuina can improve the recovery of nerve and upper extremity function and its therapeutic effect is superior to that of intramuscular injection with Nobex.

Acupuncture Therapy ; Birth Injuries ; physiopathology ; therapy ; Brachial Plexus ; injuries ; physiopathology ; Combined Modality Therapy ; Female ; Humans ; Infant ; Male ; Massage

OBJECTIVETo observe the anesthetic efficacy and safety of bilateral ultrasound-guided supraclavicular brachial plexus block in patients undergoing arthrolysis for shoulder periarthritis.

METHODSTwenty-seven patients (ASA class I-II) undergoing bilateral shoulder joint release surgery and 24 ml received bilateral ultrasound-guided supraclavicular brachial plexus block anesthesia with 0.4% ropivacaine and 0.8% lidocaine. The visual analogue scale (VAS) scores for shoulder joint pain were recorded before and after anesthesia. The efficacy of axillary nerve, dorsal scapular nerve and suprascapular nerve block was evaluated, and the anesthetic effect and complications was assessed during surgery. Before and after anesthesia, the range of left and right diaphragmatic muscle movement was measured when the patient took a quiet breath and a deep breath.

RESULTSThe patients showed no significant variations in MAP, HR, or SpO₂after anesthesia. The VAS scores of shoulder joint pain during anteflexion, abduction, posterior extension, rotation, posterior extension and medial rotation were significantly lowered after anesthesia (P<0.05), but the left and the right diaphragm movement range showed no significant difference between quiet breath and deep breath (P>0.05). The rates of complete block of the axillary nerve and dorsal scapular nerve was 100%, and that of suprascapular nerve was 92.6%. Partial phrenic nerve block occurred in 1 case with mild local anesthetic toxicity in another.

CONCLUSIONSBilateral ultrasound-guided supraclavicular brachial plexus block in patients has excellent analgesic effect in should joint release surgery with good safely.

Amides ; Anesthetics, Local ; Brachial Plexus Block ; Diaphragm ; Humans ; Lidocaine ; Orthopedic Procedures ; Pain Measurement ; Periarthritis ; diagnostic imaging ; surgery ; Shoulder Joint ; diagnostic imaging ; physiopathology ; Ultrasonography

OBJECTIVETo identify the risk factors and related degrees associated to obstetric brachial plexus palsy(OBPP).

METHODSA case-control study was performed. Neonatal records of thirty-one cases with OBPP and their corresponding maternal records from the Department of Gynecology and Obstetrics of eight hospitals in Shanghai city from 1988 to 2002 were reviewed. Four controls, all living in Shanghai were selected to match each case and were born within the same year at the same hospital. The control group also included 124 cases without OBPP. According to the uniformed data and tables used were from medical records and from pregnant women. Epidemiological study was carried out on both case group and control group. Variables for analyses would include: (1) race, age, height, family history, pre-pregnancy weight, body mass index at the pre-pregnancy (weight/height2) on those pregnant women as well as on parity of their mothers; (2) the process of delivery which includeing clinic pelvis evaluation, height of uterus, abdomen circumference,antepartum weight,body mass index before delivery, mode of delivery,the duration of active phase and 2nd stage of labor, shoulder dystocia; (3) on neonates: sex, gestational age, birth weight,affected limb, Apgar scores of 1 and 5 minutes, other birth trauma and resuscitation of infant. Statistical tests applied to these data would include Student's T test for continuous variables and chi2 analysis for discrete data. Risk calculation of OBPP was performed by univariable and multivariable conditional logistic regression analysis.

RESULTS12 factors related to expsure were identified for OBPP through univariable conditional logistic regression analysis. When multivariable conditional logistic regression model at P = 0.1 was applied, four factors such as cesarean (OR = 0.060), forceps (OR = 65.237), birth weight (OR = 35.468), and pre-pregnancy body mass index (OR = 23.901) were selected.

CONCLUSIONForceps delivery,macrosomia, and increase of pre-pregnancy body mass index (> or = 21) were risk factors of OBPP in the order of degrees to risk while cesarean seemed to serve as a protective factor.

Adult ; Brachial Plexus ; pathology ; Case-Control Studies ; Female ; Health Surveys ; Humans ; Infant, Newborn ; Logistic Models ; Male ; Multivariate Analysis ; Paralysis, Obstetric ; epidemiology ; pathology ; physiopathology ; Pregnancy ; Risk Factors

Acute brachial neuropathy (ABN) is a rare disease, characterized by an acute or subacute onset of pain followed by weakness of shoulder or arm muscles without trauma or traction injury. So the diagnosis of this clinical entity is not easy. The purpose of this study was to analyze retrospectively the ABN in 14 cases focusing on the clinical profile and to evaluate the effectiveness of electrophysiologic study in diagnosis of ABN with a new result helpful in localizing a brachial plexus disorder. The most helpful electrophysiologic data of ABN in my patients seemed to be abnormalities of low amplitude, abnormal right to left difference of compound motor action potentials (CMAPs) and sensory nerve action potentials (SNAPs) in axillary nerve, ulnar or median nerves. Results of nerve conduction velocity, terminal and F-wave latency were not as useful. But the electromyogram was most helpful in localization of upper or lower plexus lesions and cervical radiculopathy. The most striking clinical feature of ABN was the rapid onset of pain followed by the development of muscle weakness of shoulder girdle after a variable period or within four days. In contrast to other reports, intrinsic hand muscle weakness was observed in 3 cases with sensory changes in ulnar nerve distribution. The cervical radiculopathies (C5-C7 roots) were simultaneously combined with ipsilateral axillary neuropathy in 3 cases. In this study, decreased amplitude, abnormal right to left difference of SNAPs and CMAPs, and neurogenic EMG findings with normal data of NCV, terminal and F-wave latencies suggest that the pathology of ABN might not be a demyelinating process, but axonopathy.
Adult ; Aged ; Brachial Plexus Neuritis/complications/diagnosis/*physiopathology ; Electromyography ; Electrophysiology ; Evoked Potentials ; Female ; Human ; Male ; Middle Age ; Muscle Weakness/etiology ; *Neural Conduction ; Prognosis ; Retrospective Studies ; Sensation Disorders/etiology ; Skin Temperature ; Ulnar Nerve/physiopathology

BACKGROUNDPrevious brain imaging studies suggested that the brain activity underlying the perception of chronic pain may differ from that underlying acute pain. To investigate the brain regions involved in chronic spontaneous pain due to brachial plexus avulsion (BPA), fluorine-(18)fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) scanning was applied to determine the glucose metabolic changes in patients with pain due to BPA.

METHODSSix right-handed patients with chronic spontaneous pain due to left-BPA and twelve right-handed age- and sex-matched healthy control subjects participated in the (18)F-FDG PET study. The patients were rated by visual analog scale (VAS) during scanning and Hamilton depression scale and Hamilton anxiety scale after scanning. Statistical parametric mapping 2 (SPM2) was applied for data analysis.

RESULTSCompared with healthy subjects, the patients had significant glucose metabolism decreases in the right thalamus and SI (P < 0.001, uncorrected), and significant glucose metabolism increases in the right orbitofrontal cortex (OFC) (BA11), left rostral insula cortex and left dorsolateral prefrontal cortex (DLPFC) (BA10/46) (P < 0.001, uncorrected).

CONCLUSIONThese findings suggest that the brain areas involved in emotion, attention and internal modulation of pain may be related to the chronic spontaneous pain due to BPA.

Adult ; Brachial Plexus ; injuries ; Brain ; metabolism ; Chronic Disease ; Female ; Glucose ; metabolism ; Humans ; Male ; Middle Aged ; Pain ; etiology ; physiopathology ; Pain Measurement ; Positron-Emission Tomography ; methods ; Prefrontal Cortex ; metabolism ; Thalamus ; metabolism

Adult ; Aged ; Axilla ; innervation ; surgery ; Brachial Plexus ; surgery ; Breast Neoplasms ; physiopathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Lymph Node Excision ; methods ; Mastectomy, Radical ; adverse effects ; methods ; Middle Aged ; Pain, Postoperative ; etiology ; Somatosensory Disorders ; etiology