The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform

Kevin C. Chung - One of the best experts on this subject based on the ideXlab platform.

  • quantifying real world upper limb activity via patient initiated movement after nerve reconstruction for upper Brachial Plexus Injury
    Neurosurgery, 2019
    Co-Authors: Brandon W Smith, Kate W C Chang, Lynda J.-s. Yang, Kevin C. Chung, Serena J Saake, Susan H Brown
    Abstract:

    BACKGROUND: A critical concept in Brachial Plexus reconstruction is the accurate assessment of functional outcomes. The current standard for motor outcome assessment is clinician-elicited, outpatient clinic-based, serial evaluation of range of motion and muscle power. However, discrepancies exist between such clinical measurements and actual patient-initiated use. We employed emerging technology in the form of accelerometry-based motion detectors to quantify real-world arm use after Brachial Plexus surgery. OBJECTIVE: To evaluate (1) the ability of accelerometry-based motion detectors to assess functional outcome and (2) the real-world arm use of patients after nerve transfer for Brachial Plexus Injury, through a pilot study. METHODS: Five male patients who underwent nerve transfer after Brachial Plexus Injury wore bilateral motion detectors for 7 d. The patients also underwent range-of-motion evaluation and completed multiple patient-reported outcome surveys. RESULTS: The average age of the recruits was 41 yr (±17 yr), and the average time from operation was 2 yr (±1 yr). The VT (time of use ratio) for the affected side compared to the unaffected side was 0.73 (±0.27), and the VM (magnitude ratio) was 0.63 (±0.59). VT strongly and positively correlated with shoulder flexion and shoulder abduction: 0.97 (P = .008) and 0.99 (P = .002), respectively. CONCLUSION: Accelerometry-based activity monitors can successfully assess real-world functional outcomes after Brachial Plexus reconstruction. This pilot study demonstrates that patients after nerve transfer are utilizing their affected limbs significantly in daily activities and that recovery of shoulder function is critical.

  • a systematic review of outcomes of contralateral c7 transfer for the treatment of traumatic Brachial Plexus Injury part 2 donor site morbidity
    Plastic and Reconstructive Surgery, 2015
    Co-Authors: Guang Yang, Kate W C Chang, Kevin C. Chung
    Abstract:

    Background Although contralateral C7 (CC7) transfer has been widely used for treating traumatic Brachial Plexus Injury, the procedure safety is questionable. We performed a systematic review to investigate the donor-site morbidity including sensory abnormality and motor deficit to guide clinical decision-making.

  • a systematic review of contralateral c7 transfer for the treatment of traumatic Brachial Plexus Injury part 1 overall outcomes
    Plastic and Reconstructive Surgery, 2015
    Co-Authors: Guang Yang, Kate W C Chang, Kevin C. Chung
    Abstract:

    Background Contralateral C7 (CC7) transfer has been used for treating traumatic Brachial Plexus Injury. However, the effectiveness of the procedure remains a subject of debate. The authors performed a systematic review to study the overall outcomes of CC7 transfer to different recipient nerves in traumatic Brachial Plexus injuries. Methods A literature search was conducted using PubMed and EMBASE databases to identify original articles related to CC7 transfer for traumatic Brachial Plexus Injury. The data extracted were study/patient characteristics, and objective outcomes of CC7 transfer to the recipient nerves. The authors normalized outcome measures into a Medical Research Council-based (MRC) outcome scale. Results Thirty-nine studies were identified. The outcomes were categorized based on the major recipient nerves: median, musculocutaneous, and radial/triceps. Regarding overall functional recovery, 11 percent of patients achieved MRC grade M4 wrist flexion and 38 percent achieved MRC grade M3. Grade M4 finger flexion was achieved by 7 percent of patients, whereas 36 percent achieved M3. Finally, 56 percent achieved greater than or equal to S3 sensory recovery in the median nerve territories. In the musculocutaneous nerve group, 38 percent regained to M4 and 37 percent regained to M3. In the radial/triceps nerve group, 25 percent regained elbow or wrist extension strength to a MRC grade M4 and to M3, respectively. Conclusions Outcome measures in the included studies were not consistently reported to uncover true patient-related benefits from the CC7 transfer. Reliable and validated outcome instruments should be applied to critically evaluate patients undergoing CC7 transfer.

  • psychosocial outcomes and coping after complete avulsion traumatic Brachial Plexus Injury
    Disability and Rehabilitation, 2015
    Co-Authors: Lauren E Franzblau, Kevin C. Chung
    Abstract:

    AbstractPurpose: To understand psychosocial outcomes, coping and adjustment after complete avulsion traumatic Brachial Plexus Injury (BPI). Method: We conducted a grounded theory analysis of 12 semi-structured patient interviews exploring psychosocial outcomes, augmented by quantitative evaluation of self-reported mental health and social functioning, body image and coping strategies obtained via three questionnaires (SF-36, Brief COPE and modified SWAP). Results: Subjects’ main sources of psychological stress were chronic pain, unemployment, decreased self-efficacy and social-emotional consequences of poor body image. One third of participants reported depression, half experienced anger and frustration and two-thirds were dissatisfied with the appearance of their affected limbs. Acceptance, active coping, planning and emotional support were the most frequently used coping strategies. Conclusions: Patients encounter high levels of physical and psychological stress after complete avulsion BPI and must find...

  • a systematic review of nerve transfer and nerve repair for the treatment of adult upper Brachial Plexus Injury
    Neurosurgery, 2012
    Co-Authors: Lynda J.-s. Yang, Kate W C Chang, Kevin C. Chung
    Abstract:

    Abstract Nerve reconstruction for upper Brachial Plexus Injury consists of nerve repair and/or transfer. Current literature lacks evidence supporting a preferred surgical treatment for adults with such Injury involving shoulder and elbow function. We systematically reviewed the literature published from January 1990 to February 2011 using multiple databases to search the following: Brachial Plexus and graft, repair, reconstruction, nerve transfer, neurotization. Of 1360 articles initially identified, 33 were included in analysis, with 23 nerve transfer (399 patients), 6 nerve repair (99 patients), and 4 nerve transfer + proximal repair (117 patients) citations (mean preoperative interval, 6 ± 1.9 months). For shoulder abduction, no significant difference was found in the rates ratio (comparative probabilities of event occurrence) among the 3 methods to achieve a Medical Research Council (MRC) scale score of 3 or higher or a score of 4 or higher. For elbow flexion, the rates ratio for nerve transfer vs nerve repair to achieve an MRC scale score of 3 was 1.46 (P = .03); for nerve transfer vs nerve transfer + proximal repair to achieve an MRC scale score of 3 was 1.45 (P = .02) and an MRC scale score of 4 was 1.47 (P = .05). Therefore, for elbow flexion recovery, nerve transfer is somewhat more effective than nerve repair; however, no particular reconstruction strategy was found to be superior to recover shoulder abduction. When considering nerve reconstruction strategies, our findings do not support the sole use of nerve transfer in upper Brachial Plexus Injury without operative exploration to provide a clear understanding of the pathoanatomy. Supraclavicular Brachial Plexus exploration plays an important role in developing individual surgical strategies, and nerve repair (when donor stumps are available) should remain the standard for treatment of upper Brachial Plexus Injury except in isolated cases solely lacking elbow flexion.

Robert J Spinner - One of the best experts on this subject based on the ideXlab platform.

  • role of tacrolimus in return of hand function after Brachial Plexus Injury in a lung transplantation patient
    Case Reports, 2020
    Co-Authors: Tiam M Saffari, Robert J Spinner, Christopher J Arendt, Alexander Y Shin
    Abstract:

    We report a patient who has been on tacrolimus for bilateral lung transplantation and presented with a Brachial Plexus Injury (BPI), with unusual improvement of lower trunk innervated hand function. The lower trunk Injury with resultant left hand paralysis had developed after his sternotomy 18 months ago. He has been treated with tacrolimus as part of his immunosuppression protocol since the surgery, without severe side effects. Physical examination at 18 months demonstrated unusual excellent grip pattern and full opposition of his thumb with slight claw deformity of his ulnar two digits. While the neurotoxic effects of tacrolimus are more emphasised, the neuroregenerative properties have been recently explored. The recovery in this patient is unique and unusual after BPI and is most likely as a result of the low dose tacrolimus treatment.

  • bilateral Brachial Plexus Injury after miradry procedure for axillary hyperhidrosis a case report
    World Neurosurgery, 2019
    Co-Authors: Ross C Puffer, Allen T Bishop, Robert J Spinner, Alexander Y Shin
    Abstract:

    Multiple treatments are available for primary axillary hyperhidrosis, including non-invasive, microwave based thermal treatments designed to destroy sweat glands in the axilla. Often these procedures involve local anesthetic injection to the axilla, followed by placement of the microwave emitter onto the skin and applying the heat treatment to varying depths of the subcutaneous tissues. CASE REPORT: A 49-year old, thin and active woman (BMI 19.6) underwent microwave based treatment to the bilateral axillary regions. She experienced an electric sensation into the ulnar digits of the right hand during anesthetic injection, and then underwent the microwave thermal treatment. She suffered a bilateral Brachial Plexus Injury with imaging evidence of severe, subcutaneous edema surrounding the nerves of the Plexus in the axilla, as well as denervation atrophy of the arm and forearm muscles bilaterally. At the time of evaluation and EMG, 8 months after treatment, she had recovered significant strength in the left upper extremity, but continued to have evidence of a severe radial nerve Injury on the right. EMG demonstrated some recovery and observation was recommended followed by secondary reconstruction if required. It is likely that the patient sustained thermal Injury to the nerves in the axilla bilaterally, given the close proximity to the skin surface in a patient with a low BMI. CONCLUSION: In thin patients undergoing treatment of primary axillary hyperhidrosis, consideration should be given to the distal Brachial Plexus which may be at risk of damage with high powered microwave-based therapy.

  • contralateral trapezius transfer to restore shoulder external rotation following adult Brachial Plexus Injury
    Journal of Hand Surgery (European Volume), 2016
    Co-Authors: Bassem T Elhassan, Allen T Bishop, Robert J Spinner, Eric R Wagner, Alexander Y Shin
    Abstract:

    Purpose To evaluate the outcome of contralateral lower trapezius origin transfer (CLTOT) to restore shoulder external rotation in patients with shoulder paralysis after Brachial Plexus Injury (BPI). Methods We evaluated 12 patients with a history of BPI with persistent shoulder paralysis. All patients had compromised ipsilateral lower trapezius muscle function. All patients underwent CLTOT prolonged with lumbar fascia to the affected infraspinatus tendon either isolated (7 patients) or as part of multiple tendon transfer (5 patients). Standardized patient outcomes measures were obtained. Results At 23 months' follow-up, 10 patients had improved shoulder external rotation from no motion preoperatively to an average external rotation 110° from the abdomen. Five patients had marked improvement of pain, including 2 with isolated CLTOT and 3 with additional tendon transfers. Two patients experienced no change in pain. There were noted improvements in the Constant shoulder scores, simple shoulder value, and Disabilities of the Arm, Shoulder, and Hand scores. One patient sustained a fall resulting in stretch Injury to the transfer, underwent successful revision surgery, and regained 100° active shoulder external rotation away from the abdomen more than a year after revision surgery. Another patient's transfer failed during rehabilitation but the patient elected not to pursue treatment. No patients had changes in contralateral shoulder motion or strength or any pain from the contralateral shoulder. Conclusions This study demonstrated that CLTOT to the infraspinatus tendon was effective in improving shoulder external rotation in patients with BPI. Type of study/level of evidence Therapeutic IV.

  • the role of elective amputation in patients with traumatic Brachial Plexus Injury
    Journal of Plastic Reconstructive and Aesthetic Surgery, 2016
    Co-Authors: Andres A Maldonado, Allen T Bishop, Robert J Spinner, Michelle F Kircher, Alexander Y Shin
    Abstract:

    Summary Background and aim Despite undergoing complex Brachial Plexus, surgical reconstructions, and rehabilitation, some patients request an elective amputation. This study evaluates the role of elective amputation after Brachial Plexus Injury. Methods A retrospective chart review was performed for all the 2140 patients with Brachial Plexus injuries treated with elective amputation between 1999 and 2012 at a single institution. Analysis was conducted on the potential predisposing factors for amputation, amputation level, and postamputation complications. Patients were evaluated using pre- and postamputation Disabilities of the Shoulder, Arm, and hand scores in addition to visual analog pain scores. Results The following three conditions were observed in all nine patients who requested an elective amputation: (1) Pan-Plexus Injury; (2) non-recovery (mid-humeral amputation) or elbow flexion recovery only (forearm amputation) 1 year after all other surgical options were performed; and (3) at least one chronic complication (chronic infection, nonunion fractures, full-thickness burns, chronic neck pain with arm weight, etc.). Pain improvement was found in five patients. Subjective patient assessments and visual analog pain scores before and after amputation did not show a statistically significant improvement in Disabilities of the Shoulder, Arm, and Hand Scores. However, four patients reported that their shoulder pain felt "better" than it did before the amputation, and two patients indicated they were completely cured of chronic pain after surgery. Conclusions Elective amputation after Brachial Plexus Injury should be considered as an option in the above circumstances. When the informed and educated decision is made, patients can have satisfactory outcomes regarding amputation.

  • tendon transfer options about the shoulder in patients with Brachial Plexus Injury
    Journal of Bone and Joint Surgery American Volume, 2012
    Co-Authors: Bassem T Elhassan, Allen T Bishop, Alexander Y Shin, Robert U Hartzler, Robert J Spinner
    Abstract:

    Background: The purpose of this study was to evaluate the early outcome of shoulder tendon transfer in patients with Brachial Plexus Injury and to determine the factors associated with favorable outcomes. Methods: Fifty-two patients with traumatic Brachial Plexus Injury and a paralytic shoulder were included in the study. All patients were evaluated at a mean of nineteen months (range, twelve to twenty-eight months) postoperatively. Twelve patients had a C5-6 Injury, twenty-two had a C5-7 Injury, five had a C5-8 Injury, and thirteen had a C5-T1 Injury. Transfer of the lower portion of the trapezius muscle was performed either in isolation or as part of multiple tendon transfers to improve shoulder function. Additional muscles transferred included the middle and upper portions of the trapezius, levator scapulae, upper portion of the serratus anterior, teres major, latissimus dorsi, and pectoralis major. Results: All patients had a stable shoulder postoperatively. Shoulder external rotation improved substantially in all patients from no external rotation (hand-on-belly position) to a mean of 20° (p = 0.001). Patients who underwent additional transfers had marginal improvement of shoulder flexion, from a mean of 10° preoperatively to 60° postoperatively, and of shoulder abduction, from a mean of 10° to 50° (p = 0.01 for each). Mean pain on a visual analog scale improved from 6 points preoperatively to 2 points postoperatively. The mean Disabilities of the Arm, Shoulder and Hand (DASH) score improved from 59 to 47 points (p = 0.001). The mean Subjective Shoulder Value improved from 5% to 40% (p = 0.001). Greater age, higher body mass index, and more extensive nerve Injury were associated with a poorer DASH score in a multivariate analysis (p = 0.003). Conclusions: Tendon transfers about the shoulder can improve shoulder function in patients with Brachial Plexus Injury resulting in a paralytic shoulder. Significant improvement of shoulder external rotation but only marginal improvements of shoulder abduction and flexion can be achieved. The outcome can be expected to be better in patients with less severe nerve Injury. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Alexander Y Shin - One of the best experts on this subject based on the ideXlab platform.

  • role of tacrolimus in return of hand function after Brachial Plexus Injury in a lung transplantation patient
    Case Reports, 2020
    Co-Authors: Tiam M Saffari, Robert J Spinner, Christopher J Arendt, Alexander Y Shin
    Abstract:

    We report a patient who has been on tacrolimus for bilateral lung transplantation and presented with a Brachial Plexus Injury (BPI), with unusual improvement of lower trunk innervated hand function. The lower trunk Injury with resultant left hand paralysis had developed after his sternotomy 18 months ago. He has been treated with tacrolimus as part of his immunosuppression protocol since the surgery, without severe side effects. Physical examination at 18 months demonstrated unusual excellent grip pattern and full opposition of his thumb with slight claw deformity of his ulnar two digits. While the neurotoxic effects of tacrolimus are more emphasised, the neuroregenerative properties have been recently explored. The recovery in this patient is unique and unusual after BPI and is most likely as a result of the low dose tacrolimus treatment.

  • bilateral Brachial Plexus Injury after miradry procedure for axillary hyperhidrosis a case report
    World Neurosurgery, 2019
    Co-Authors: Ross C Puffer, Allen T Bishop, Robert J Spinner, Alexander Y Shin
    Abstract:

    Multiple treatments are available for primary axillary hyperhidrosis, including non-invasive, microwave based thermal treatments designed to destroy sweat glands in the axilla. Often these procedures involve local anesthetic injection to the axilla, followed by placement of the microwave emitter onto the skin and applying the heat treatment to varying depths of the subcutaneous tissues. CASE REPORT: A 49-year old, thin and active woman (BMI 19.6) underwent microwave based treatment to the bilateral axillary regions. She experienced an electric sensation into the ulnar digits of the right hand during anesthetic injection, and then underwent the microwave thermal treatment. She suffered a bilateral Brachial Plexus Injury with imaging evidence of severe, subcutaneous edema surrounding the nerves of the Plexus in the axilla, as well as denervation atrophy of the arm and forearm muscles bilaterally. At the time of evaluation and EMG, 8 months after treatment, she had recovered significant strength in the left upper extremity, but continued to have evidence of a severe radial nerve Injury on the right. EMG demonstrated some recovery and observation was recommended followed by secondary reconstruction if required. It is likely that the patient sustained thermal Injury to the nerves in the axilla bilaterally, given the close proximity to the skin surface in a patient with a low BMI. CONCLUSION: In thin patients undergoing treatment of primary axillary hyperhidrosis, consideration should be given to the distal Brachial Plexus which may be at risk of damage with high powered microwave-based therapy.

  • contralateral trapezius transfer to restore shoulder external rotation following adult Brachial Plexus Injury
    Journal of Hand Surgery (European Volume), 2016
    Co-Authors: Bassem T Elhassan, Allen T Bishop, Robert J Spinner, Eric R Wagner, Alexander Y Shin
    Abstract:

    Purpose To evaluate the outcome of contralateral lower trapezius origin transfer (CLTOT) to restore shoulder external rotation in patients with shoulder paralysis after Brachial Plexus Injury (BPI). Methods We evaluated 12 patients with a history of BPI with persistent shoulder paralysis. All patients had compromised ipsilateral lower trapezius muscle function. All patients underwent CLTOT prolonged with lumbar fascia to the affected infraspinatus tendon either isolated (7 patients) or as part of multiple tendon transfer (5 patients). Standardized patient outcomes measures were obtained. Results At 23 months' follow-up, 10 patients had improved shoulder external rotation from no motion preoperatively to an average external rotation 110° from the abdomen. Five patients had marked improvement of pain, including 2 with isolated CLTOT and 3 with additional tendon transfers. Two patients experienced no change in pain. There were noted improvements in the Constant shoulder scores, simple shoulder value, and Disabilities of the Arm, Shoulder, and Hand scores. One patient sustained a fall resulting in stretch Injury to the transfer, underwent successful revision surgery, and regained 100° active shoulder external rotation away from the abdomen more than a year after revision surgery. Another patient's transfer failed during rehabilitation but the patient elected not to pursue treatment. No patients had changes in contralateral shoulder motion or strength or any pain from the contralateral shoulder. Conclusions This study demonstrated that CLTOT to the infraspinatus tendon was effective in improving shoulder external rotation in patients with BPI. Type of study/level of evidence Therapeutic IV.

  • the role of elective amputation in patients with traumatic Brachial Plexus Injury
    Journal of Plastic Reconstructive and Aesthetic Surgery, 2016
    Co-Authors: Andres A Maldonado, Allen T Bishop, Robert J Spinner, Michelle F Kircher, Alexander Y Shin
    Abstract:

    Summary Background and aim Despite undergoing complex Brachial Plexus, surgical reconstructions, and rehabilitation, some patients request an elective amputation. This study evaluates the role of elective amputation after Brachial Plexus Injury. Methods A retrospective chart review was performed for all the 2140 patients with Brachial Plexus injuries treated with elective amputation between 1999 and 2012 at a single institution. Analysis was conducted on the potential predisposing factors for amputation, amputation level, and postamputation complications. Patients were evaluated using pre- and postamputation Disabilities of the Shoulder, Arm, and hand scores in addition to visual analog pain scores. Results The following three conditions were observed in all nine patients who requested an elective amputation: (1) Pan-Plexus Injury; (2) non-recovery (mid-humeral amputation) or elbow flexion recovery only (forearm amputation) 1 year after all other surgical options were performed; and (3) at least one chronic complication (chronic infection, nonunion fractures, full-thickness burns, chronic neck pain with arm weight, etc.). Pain improvement was found in five patients. Subjective patient assessments and visual analog pain scores before and after amputation did not show a statistically significant improvement in Disabilities of the Shoulder, Arm, and Hand Scores. However, four patients reported that their shoulder pain felt "better" than it did before the amputation, and two patients indicated they were completely cured of chronic pain after surgery. Conclusions Elective amputation after Brachial Plexus Injury should be considered as an option in the above circumstances. When the informed and educated decision is made, patients can have satisfactory outcomes regarding amputation.

  • tendon transfer options about the shoulder in patients with Brachial Plexus Injury
    Journal of Bone and Joint Surgery American Volume, 2012
    Co-Authors: Bassem T Elhassan, Allen T Bishop, Alexander Y Shin, Robert U Hartzler, Robert J Spinner
    Abstract:

    Background: The purpose of this study was to evaluate the early outcome of shoulder tendon transfer in patients with Brachial Plexus Injury and to determine the factors associated with favorable outcomes. Methods: Fifty-two patients with traumatic Brachial Plexus Injury and a paralytic shoulder were included in the study. All patients were evaluated at a mean of nineteen months (range, twelve to twenty-eight months) postoperatively. Twelve patients had a C5-6 Injury, twenty-two had a C5-7 Injury, five had a C5-8 Injury, and thirteen had a C5-T1 Injury. Transfer of the lower portion of the trapezius muscle was performed either in isolation or as part of multiple tendon transfers to improve shoulder function. Additional muscles transferred included the middle and upper portions of the trapezius, levator scapulae, upper portion of the serratus anterior, teres major, latissimus dorsi, and pectoralis major. Results: All patients had a stable shoulder postoperatively. Shoulder external rotation improved substantially in all patients from no external rotation (hand-on-belly position) to a mean of 20° (p = 0.001). Patients who underwent additional transfers had marginal improvement of shoulder flexion, from a mean of 10° preoperatively to 60° postoperatively, and of shoulder abduction, from a mean of 10° to 50° (p = 0.01 for each). Mean pain on a visual analog scale improved from 6 points preoperatively to 2 points postoperatively. The mean Disabilities of the Arm, Shoulder and Hand (DASH) score improved from 59 to 47 points (p = 0.001). The mean Subjective Shoulder Value improved from 5% to 40% (p = 0.001). Greater age, higher body mass index, and more extensive nerve Injury were associated with a poorer DASH score in a multivariate analysis (p = 0.003). Conclusions: Tendon transfers about the shoulder can improve shoulder function in patients with Brachial Plexus Injury resulting in a paralytic shoulder. Significant improvement of shoulder external rotation but only marginal improvements of shoulder abduction and flexion can be achieved. The outcome can be expected to be better in patients with less severe nerve Injury. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Allen T Bishop - One of the best experts on this subject based on the ideXlab platform.

  • bilateral Brachial Plexus Injury after miradry procedure for axillary hyperhidrosis a case report
    World Neurosurgery, 2019
    Co-Authors: Ross C Puffer, Allen T Bishop, Robert J Spinner, Alexander Y Shin
    Abstract:

    Multiple treatments are available for primary axillary hyperhidrosis, including non-invasive, microwave based thermal treatments designed to destroy sweat glands in the axilla. Often these procedures involve local anesthetic injection to the axilla, followed by placement of the microwave emitter onto the skin and applying the heat treatment to varying depths of the subcutaneous tissues. CASE REPORT: A 49-year old, thin and active woman (BMI 19.6) underwent microwave based treatment to the bilateral axillary regions. She experienced an electric sensation into the ulnar digits of the right hand during anesthetic injection, and then underwent the microwave thermal treatment. She suffered a bilateral Brachial Plexus Injury with imaging evidence of severe, subcutaneous edema surrounding the nerves of the Plexus in the axilla, as well as denervation atrophy of the arm and forearm muscles bilaterally. At the time of evaluation and EMG, 8 months after treatment, she had recovered significant strength in the left upper extremity, but continued to have evidence of a severe radial nerve Injury on the right. EMG demonstrated some recovery and observation was recommended followed by secondary reconstruction if required. It is likely that the patient sustained thermal Injury to the nerves in the axilla bilaterally, given the close proximity to the skin surface in a patient with a low BMI. CONCLUSION: In thin patients undergoing treatment of primary axillary hyperhidrosis, consideration should be given to the distal Brachial Plexus which may be at risk of damage with high powered microwave-based therapy.

  • contralateral trapezius transfer to restore shoulder external rotation following adult Brachial Plexus Injury
    Journal of Hand Surgery (European Volume), 2016
    Co-Authors: Bassem T Elhassan, Allen T Bishop, Robert J Spinner, Eric R Wagner, Alexander Y Shin
    Abstract:

    Purpose To evaluate the outcome of contralateral lower trapezius origin transfer (CLTOT) to restore shoulder external rotation in patients with shoulder paralysis after Brachial Plexus Injury (BPI). Methods We evaluated 12 patients with a history of BPI with persistent shoulder paralysis. All patients had compromised ipsilateral lower trapezius muscle function. All patients underwent CLTOT prolonged with lumbar fascia to the affected infraspinatus tendon either isolated (7 patients) or as part of multiple tendon transfer (5 patients). Standardized patient outcomes measures were obtained. Results At 23 months' follow-up, 10 patients had improved shoulder external rotation from no motion preoperatively to an average external rotation 110° from the abdomen. Five patients had marked improvement of pain, including 2 with isolated CLTOT and 3 with additional tendon transfers. Two patients experienced no change in pain. There were noted improvements in the Constant shoulder scores, simple shoulder value, and Disabilities of the Arm, Shoulder, and Hand scores. One patient sustained a fall resulting in stretch Injury to the transfer, underwent successful revision surgery, and regained 100° active shoulder external rotation away from the abdomen more than a year after revision surgery. Another patient's transfer failed during rehabilitation but the patient elected not to pursue treatment. No patients had changes in contralateral shoulder motion or strength or any pain from the contralateral shoulder. Conclusions This study demonstrated that CLTOT to the infraspinatus tendon was effective in improving shoulder external rotation in patients with BPI. Type of study/level of evidence Therapeutic IV.

  • the role of elective amputation in patients with traumatic Brachial Plexus Injury
    Journal of Plastic Reconstructive and Aesthetic Surgery, 2016
    Co-Authors: Andres A Maldonado, Allen T Bishop, Robert J Spinner, Michelle F Kircher, Alexander Y Shin
    Abstract:

    Summary Background and aim Despite undergoing complex Brachial Plexus, surgical reconstructions, and rehabilitation, some patients request an elective amputation. This study evaluates the role of elective amputation after Brachial Plexus Injury. Methods A retrospective chart review was performed for all the 2140 patients with Brachial Plexus injuries treated with elective amputation between 1999 and 2012 at a single institution. Analysis was conducted on the potential predisposing factors for amputation, amputation level, and postamputation complications. Patients were evaluated using pre- and postamputation Disabilities of the Shoulder, Arm, and hand scores in addition to visual analog pain scores. Results The following three conditions were observed in all nine patients who requested an elective amputation: (1) Pan-Plexus Injury; (2) non-recovery (mid-humeral amputation) or elbow flexion recovery only (forearm amputation) 1 year after all other surgical options were performed; and (3) at least one chronic complication (chronic infection, nonunion fractures, full-thickness burns, chronic neck pain with arm weight, etc.). Pain improvement was found in five patients. Subjective patient assessments and visual analog pain scores before and after amputation did not show a statistically significant improvement in Disabilities of the Shoulder, Arm, and Hand Scores. However, four patients reported that their shoulder pain felt "better" than it did before the amputation, and two patients indicated they were completely cured of chronic pain after surgery. Conclusions Elective amputation after Brachial Plexus Injury should be considered as an option in the above circumstances. When the informed and educated decision is made, patients can have satisfactory outcomes regarding amputation.

  • tendon transfer options about the shoulder in patients with Brachial Plexus Injury
    Journal of Bone and Joint Surgery American Volume, 2012
    Co-Authors: Bassem T Elhassan, Allen T Bishop, Alexander Y Shin, Robert U Hartzler, Robert J Spinner
    Abstract:

    Background: The purpose of this study was to evaluate the early outcome of shoulder tendon transfer in patients with Brachial Plexus Injury and to determine the factors associated with favorable outcomes. Methods: Fifty-two patients with traumatic Brachial Plexus Injury and a paralytic shoulder were included in the study. All patients were evaluated at a mean of nineteen months (range, twelve to twenty-eight months) postoperatively. Twelve patients had a C5-6 Injury, twenty-two had a C5-7 Injury, five had a C5-8 Injury, and thirteen had a C5-T1 Injury. Transfer of the lower portion of the trapezius muscle was performed either in isolation or as part of multiple tendon transfers to improve shoulder function. Additional muscles transferred included the middle and upper portions of the trapezius, levator scapulae, upper portion of the serratus anterior, teres major, latissimus dorsi, and pectoralis major. Results: All patients had a stable shoulder postoperatively. Shoulder external rotation improved substantially in all patients from no external rotation (hand-on-belly position) to a mean of 20° (p = 0.001). Patients who underwent additional transfers had marginal improvement of shoulder flexion, from a mean of 10° preoperatively to 60° postoperatively, and of shoulder abduction, from a mean of 10° to 50° (p = 0.01 for each). Mean pain on a visual analog scale improved from 6 points preoperatively to 2 points postoperatively. The mean Disabilities of the Arm, Shoulder and Hand (DASH) score improved from 59 to 47 points (p = 0.001). The mean Subjective Shoulder Value improved from 5% to 40% (p = 0.001). Greater age, higher body mass index, and more extensive nerve Injury were associated with a poorer DASH score in a multivariate analysis (p = 0.003). Conclusions: Tendon transfers about the shoulder can improve shoulder function in patients with Brachial Plexus Injury resulting in a paralytic shoulder. Significant improvement of shoulder external rotation but only marginal improvements of shoulder abduction and flexion can be achieved. The outcome can be expected to be better in patients with less severe nerve Injury. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  • comparison of single versus double nerve transfers for elbow flexion after Brachial Plexus Injury
    Plastic and Reconstructive Surgery, 2011
    Co-Authors: Brian T Carlsen, Allen T Bishop, Robert J Spinner, Michelle F Kircher, Alexander Y Shin
    Abstract:

    Background:Restoration of elbow flexion is commonly achieved with nerve transfer to the musculocutaneous nerve branches after upper trunk Brachial Plexus Injury. It is unknown if double nerve transfer to the biceps and Brachialis nerve branches results in greater strength than single nerve transfer

Bassem T Elhassan - One of the best experts on this subject based on the ideXlab platform.

  • contralateral trapezius transfer to restore shoulder external rotation following adult Brachial Plexus Injury
    Journal of Hand Surgery (European Volume), 2016
    Co-Authors: Bassem T Elhassan, Allen T Bishop, Robert J Spinner, Eric R Wagner, Alexander Y Shin
    Abstract:

    Purpose To evaluate the outcome of contralateral lower trapezius origin transfer (CLTOT) to restore shoulder external rotation in patients with shoulder paralysis after Brachial Plexus Injury (BPI). Methods We evaluated 12 patients with a history of BPI with persistent shoulder paralysis. All patients had compromised ipsilateral lower trapezius muscle function. All patients underwent CLTOT prolonged with lumbar fascia to the affected infraspinatus tendon either isolated (7 patients) or as part of multiple tendon transfer (5 patients). Standardized patient outcomes measures were obtained. Results At 23 months' follow-up, 10 patients had improved shoulder external rotation from no motion preoperatively to an average external rotation 110° from the abdomen. Five patients had marked improvement of pain, including 2 with isolated CLTOT and 3 with additional tendon transfers. Two patients experienced no change in pain. There were noted improvements in the Constant shoulder scores, simple shoulder value, and Disabilities of the Arm, Shoulder, and Hand scores. One patient sustained a fall resulting in stretch Injury to the transfer, underwent successful revision surgery, and regained 100° active shoulder external rotation away from the abdomen more than a year after revision surgery. Another patient's transfer failed during rehabilitation but the patient elected not to pursue treatment. No patients had changes in contralateral shoulder motion or strength or any pain from the contralateral shoulder. Conclusions This study demonstrated that CLTOT to the infraspinatus tendon was effective in improving shoulder external rotation in patients with BPI. Type of study/level of evidence Therapeutic IV.

  • tendon transfer options about the shoulder in patients with Brachial Plexus Injury
    Journal of Bone and Joint Surgery American Volume, 2012
    Co-Authors: Bassem T Elhassan, Allen T Bishop, Alexander Y Shin, Robert U Hartzler, Robert J Spinner
    Abstract:

    Background: The purpose of this study was to evaluate the early outcome of shoulder tendon transfer in patients with Brachial Plexus Injury and to determine the factors associated with favorable outcomes. Methods: Fifty-two patients with traumatic Brachial Plexus Injury and a paralytic shoulder were included in the study. All patients were evaluated at a mean of nineteen months (range, twelve to twenty-eight months) postoperatively. Twelve patients had a C5-6 Injury, twenty-two had a C5-7 Injury, five had a C5-8 Injury, and thirteen had a C5-T1 Injury. Transfer of the lower portion of the trapezius muscle was performed either in isolation or as part of multiple tendon transfers to improve shoulder function. Additional muscles transferred included the middle and upper portions of the trapezius, levator scapulae, upper portion of the serratus anterior, teres major, latissimus dorsi, and pectoralis major. Results: All patients had a stable shoulder postoperatively. Shoulder external rotation improved substantially in all patients from no external rotation (hand-on-belly position) to a mean of 20° (p = 0.001). Patients who underwent additional transfers had marginal improvement of shoulder flexion, from a mean of 10° preoperatively to 60° postoperatively, and of shoulder abduction, from a mean of 10° to 50° (p = 0.01 for each). Mean pain on a visual analog scale improved from 6 points preoperatively to 2 points postoperatively. The mean Disabilities of the Arm, Shoulder and Hand (DASH) score improved from 59 to 47 points (p = 0.001). The mean Subjective Shoulder Value improved from 5% to 40% (p = 0.001). Greater age, higher body mass index, and more extensive nerve Injury were associated with a poorer DASH score in a multivariate analysis (p = 0.003). Conclusions: Tendon transfers about the shoulder can improve shoulder function in patients with Brachial Plexus Injury resulting in a paralytic shoulder. Significant improvement of shoulder external rotation but only marginal improvements of shoulder abduction and flexion can be achieved. The outcome can be expected to be better in patients with less severe nerve Injury. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  • shoulder tendon transfer options for adult patients with Brachial Plexus Injury
    Journal of Hand Surgery (European Volume), 2010
    Co-Authors: Bassem T Elhassan, Allen T Bishop, Alexander Y Shin, Robert J Spinner
    Abstract:

    Enhancement of upper-extremity function, specifically shoulder function, after Brachial Plexus Injury requires a good understanding of nerve repair and transfer, with their expected outcome, as well as shoulder anatomy and biomechanics enabling the treating surgeon to use available functioning muscles around the shoulder for transfer, to improve shoulder function. Surgical treatment should address painful shoulder subluxation in addition to improvement of function. The literature focuses on improving shoulder abduction, but improving shoulder external rotation should take priority because this function, even if isolated, will allow patients to position their hand in front of their body. With a functional elbow and hand, patients will be able to do most activities of daily living. The lower trapezius has been shown to be a good transfer to restore external rotation of the shoulder. Other parts of the trapezius, levator scapulae, rhomboids, and, when available, the latissimus dorsi, pectoralis major, teres major, biceps, triceps, and serratus anterior muscles can all be used to replace the rotator cuff and deltoid muscle function. To optimize the results, a close working relationship is required between surgeons reconstructing Brachial Plexus Injury and shoulder specialists.