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Gerbrand J. Groen - One of the best experts on this subject based on the ideXlab platform.
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Vertical infraclavicular brachial plexus block: needle redirection after elicitation of elbow flexion.
Regional anesthesia and pain medicine, 2009Co-Authors: Nizar Moayeri, Steven H. Renes, Geert J. Van Geffen, Gerbrand J. GroenAbstract:BACKGROUND: In vertical infraclavicular brachial plexus block, success depends on distal flexion or extension response. Initially, elbow flexion (Lateral Cord) is generally observed. However, specific knowledge about how to reach the medial or posterior Cord is lacking. We investigated the mid-infraclavicular area in undisturbed anatomy and tested the findings in a clinical setting. METHODS: Along a length of 35 mm around the mid-infraclavicular point, cryomicrotomy sections of 5 shoulders from cadavers were used to determine the topography of the Cords in relation to one another and the axillary artery. Based on the findings, the anesthesiologists were instructed on how to elicit a distal motor response after an initial elbow flexion response in single-shot, Doppler-aided, vertical infraclavicular block in a series of 50 consecutive patients. RESULTS: In the mid-infraclavicular area, the Lateral Cord always lies anterior to either the posterior or the medial Cord and cranial to the axillary artery; the posterior Cord was always cranial to the medial Cord; and both Cords were always located dorsal to the artery. In the clinical study, in 98% of the included patients, finger flexion or finger and/or wrist extension was elicited as predicted. The overall success rate was 92%. No vascular or lung puncture occurred. CONCLUSIONS: In the clinical study, in 98% of cases, the final stimulation response of posterior or medial Cord was found as predicted by the findings of the anatomic study. Once elbow flexion is elicited, a further (ie, deeper) advancement of the needle will result in the proper distal motor response.
Paul A Grabb - One of the best experts on this subject based on the ideXlab platform.
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surgical relationship of the medial pectoral nerve to the musculocutaneous nerve a cadaveric study
Neurosurgery, 2001Co-Authors: A Hansasuta, Rs Tubbs, Paul A GrabbAbstract:OBJECTIVE: For purposes of neurotization of the musculocutaneous nerve (MCN) with the medial pectoral nerve (MPN) after upper trunk brachial plexus injuries, the anatomic relationship between these two nerves was defined in a cadaveric model. METHODS: Thirty-five brachial plexuses in 18 adult cadavers were dissected. The distance between the origin of the MPN from the medial Cord to the origin of the MCN from the Lateral Cord was measured. The length, diameter, branching, and location of the MPN were reCorded. The diameter of the proximal MCN was reCorded. RESULTS: Thirty-seven percent of the MPNs, when detached from the pectoralis muscles, were too short to reach the proximal MCN by a mean distance of 15 mm. The MPN pierced the pectoralis minor muscle in 80% of the dissections. The cross sectional area of the MCN was always larger than the cross sectional area of the MPN by an average factor of 2.5. CONCLUSION: When planning to use the MPN for neurotization of the MCN, one should be prepared to harvest an interposition graft, because over one-third of MPNs may not have enough length to reach the MCN in a tension-free manner. Diameter mismatch occurs predictably between the distal MPN and the proximal MCN.
Shigeki Mizukami - One of the best experts on this subject based on the ideXlab platform.
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absence of the musculocutaneous nerve with innervation of coracobrachialis biceps brachii brachialis and the Lateral border of the forearm by branches from the Lateral Cord of the brachial plexus
Journal of Anatomy, 1997Co-Authors: Toshio Nakatani, Shigenori Tanaka, Shigeki MizukamiAbstract:Anomalies of the brachial plexus and its terminal branches are not uncommon. Variations in the course and branches of the musculocutaneous nerve have been noted (Clemente, 1985; Bergman et al. 1988) and its absence was reported by Le Minor (1990). Several anomalies were present in the left plexus of a 59-y-old Japanese man (Fig.). There were no anterior and posterior divisions of the middle trunk, although there were communications between the posterior, medial and Lateral Cords. The musculocutaneous nerve was absent (Le Minor, 1990) and the medial and Lateral roots of the median nerve did not unite in the axillary fossa but in the upper arm about 5 cm distal to the lower border of latissimus dorsi (Adachi, 1928; Buch-Hansen, 1955). The hitherto unreported findings were branches arising directly from the Lateral Cord to supply coracobrachialis, both heads of biceps brachii and brachialis. The Lateral cutaneous nerve of the forearm was derived from the Lateral Cord with a small contribution from the medial root of the median nerve. Since there were communications between the posterior Cord (a continuation of the middle trunk) and the medial and Lateral Cords, it is theoretically possibly, but not proven, that the root values of branches innervating the flexor muscles of the arm and forearm and the skin of Lateral border of the forearm were normal.
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Three cases of the musculocutaneous nerve not perforating the coracobrachialis muscle.
Kaibogaku zasshi. Journal of anatomy, 1997Co-Authors: Toshio Nakatani, Shigeki Mizukami, Shigenori TanakaAbstract:We encountered three anomalies in which the musculocutaneous nerve did not penetrate the coracobrachialis during a gross anatomy course in 1996. Two of the anomalies were present in the biLateral arms of the cadaver of an 89-year-old woman, and the other in the right arm of the cadaver of a 64-year-old man. In all of the anomlies the musculocutaneous nerve, the Lateral Cord of the brachial plexus, and the median nerve were contained in a common sheath of connective tissue. Thus, muscular branches to the flexor muscles of the upper arm and the Lateral antebrachial cutaneous nerve seemed to arise from the Cord and the median nerve. After the common sheath was removed, the musculocutaneous and median nerves were completely separated, or the fusion between the musculocutaneous and median nerves only remained partially. These variations are apparently not rare, and it is possible that the combined paralysis of the musculocutaneous and median nerves would occur. The present variation may be important to clinicians.
Utku Senol - One of the best experts on this subject based on the ideXlab platform.
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mr imaging findings in brachial plexopathy with thoracic outlet syndrome
American Journal of Neuroradiology, 2010Co-Authors: Ayse Aralasmak, Kamil Karaali, Can Cevikol, H Uysal, Utku SenolAbstract:SUMMARY: The BPL is a part of the peripheral nervous system. Many disease processes affect the BPL. In this article, on the basis of 60 patients, we reviewed MR imaging findings of subjects with brachial plexopathy. Different varieties of BPL lesions are discussed. AA : axillary artery ABD : abduction ADs : anterior divisions AS : anterior scalene muscle AV : axillary vein BPL : brachial plexus CC : costoclavicular space CL : clavicula EMG : electromyelography I : inferior trunk IS : interscalene triangular space LC : Lateral Cord M : middle trunk MC : medial Cord MRA : MR angiography MRV : MR venography MS : middle scalene NEU : neutral PC : posterior Cord PDs : posterior divisions PET : positron-emission tomography PMA : pectoralis major muscle PMI : pectoralis minor muscle RP : retropectoralis minor space S : superior trunk SA : subclavian artery STIR : short tau inversion recovery SV : subclavian vein T1WI : T1-weighted imaging T2WI : T2-weighted imaging TOS : thoracic outlet syndrome TSE : turbo spin-echo
Devi K Sankar - One of the best experts on this subject based on the ideXlab platform.
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biLateral absence of musculocutaneous nerve with unusual branching pattern of Lateral Cord and median nerve of brachial plexus
Anatomy & Cell Biology, 2012Co-Authors: Sharmila P Bhanu, Devi K SankarAbstract:A 43-year-old female cadaver showed a complete biLateral absence of the musculocutaneous nerve. The anterior compartment muscles of both arms were supplied by median nerve excepting the coracobrachialis which was innervated by a direct branch from the Lateral Cord of brachial plexus. The median nerve, after supplying the biceps and brachialis muscles, gave onto the Lateral cutaneous nerve of the forearm. The median nerve also showed variation on the left side where it was formed by two Lateral roots and one medial root. Variations of the brachial plexus are of great interest to anatomists, clinicians and surgeons, in that they may be incorporated in their day to day practice. Our present case may be noted for its clinical and surgical significance in the variations of brachial plexus which can be useful for diagnostic purposes.
