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Inmaculada Royo - One of the best experts on this subject based on the ideXlab platform.
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Long Thoracic Nerve injury in breast cancer patients treated with axillary lymph node dissection
Supportive Care in Cancer, 2015Co-Authors: R Belmonte, Sandra Monleon, Neus Bofill, Martha Ligia Alvarado, Josep Espadaler, Inmaculada RoyoAbstract:Purpose The objectives of this study were to electromyographically (EMG) describe and analyze factors associated with Long Thoracic Nerve injuries in breast cancer patients after axillary lymph node dissection.
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Long Thoracic Nerve injury in breast cancer patients treated with axillary lymph node dissection
Supportive Care in Cancer, 2015Co-Authors: R Belmonte, Sandra Monleon, Neus Bofill, Martha Ligia Alvarado, Josep Espadaler, Inmaculada RoyoAbstract:The objectives of this study were to electromyographically (EMG) describe and analyze factors associated with Long Thoracic Nerve injuries in breast cancer patients after axillary lymph node dissection. This was a prospective Longitudinal observational study. Two hundred sixty-four women with primary invasive breast cancer were included between 2008 and 2011. All of them were treated by axillary lymph node dissection. Patients were evaluated at 1, 6, and 12 months following surgery. The presence of winged scapula was systematically tested at each follow-up and an EMG performed whenever it was observed. Affected and unaffected groups were compared for demographic, tumour, and treatment variables. Student t test, Mann–Whitney U test, chi-squared or Fisher test were computed as appropriate. Among the 36 (13.6 %) winged scapula observed, the EMG confirmed Long Thoracic Nerve injury in 30 (11.3 %) of them, 27 were partial axonotmesis and three were severe axonotmesis. At 12 months, the EMG showed that injury persisted in six (2.27 %) patients. Patients with Long Thoracic Nerve injury had a lower body mass index than unaffected patients (26.2 vs. 28.2, p = 0.045). Age, tumour stage, type of breast surgery, nodes excised, surgical complications, previous chemotherapy and previous hormonotherapy were not factors associated with winged scapula. A lower body mass index was the only factor associated to Long Thoracic Nerve injury. In most of the patients, the EMG showed partial axonotmesis. At 12 months, 2.27 % of studied patients remained with an unsolved Long Thoracic Nerve injury.
Jon J P Warner - One of the best experts on this subject based on the ideXlab platform.
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dynamic stabilization of the scapula for serratus anterior dysfunction a retrospective study of functional outcome and results
Computational Intelligence, 2015Co-Authors: Soo Tai Chung, Jon J P WarnerAbstract:Background: Twenty-six patients (12 male and 14 female) with symptomatic scapular winging caused by serratus anterior dysfunction were managed by split pectoralis major tendon transfer (sternal head) with autogenous hamstring tendon augmentation from 1998 to 2006. Methods: Twenty-five patients showed positive results upon Long Thoracic Nerve palsy on electromyography. The mean duration of symptoms until surgery was 48 months (range, 12–120 months). Four patients had non-traumatic etiologies and 22 patients had traumatic etiologies. On follow-up assessment for functional improvement, a Constant-Murley score was used. Twenty-one patients were completely evaluated, while five patients who had less than 12 months of follow-up were excluded. Results: Pain relief was achieved in 19 of the 21 patients, with 20 patients showing functional improvement. The pain scores improved from 6.0 preoperatively to 1.8 postoperatively. The mean active forward elevation improved from 108o (range, 20°–165°) preoperatively to 151° (range, 125°–170°) postoperatively. The mean Constant-Murley score improved from 57.7 (range, 21–86) preoperatively to 86.9 (range, 42–98) postoperatively. A recurrence developed in one patient. Of the 21 patients, ten had excellent results, six had good results, four had fair results, and one had poor results. Conclusions: Most patients with severe symptomatic scapular winging showed functional improvement and pain relief with resolution of scapular winging.
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pectoralis major tendon transfer for the treatment of scapular winging due to Long Thoracic Nerve palsy
Journal of Shoulder and Elbow Surgery, 2012Co-Authors: Jonathan J Streit, Christopher J Lenarz, Yousef Shishani, Christopher L Mccrum, John Paul Wanner, Robert J Nowinski, Jon J P Warner, Reuben GobezieAbstract:Background: Painful scapular winging due to chronic Long Thoracic Nerve (LTN) palsy is a relatively rare disorder that can be difficult to treat. Pectoralis major tendon (PMT) transfer has been shown to be effective in relieving pain, improving cosmesis, and restoring function. However, the available body of literature consists of few, small-cohort studies, and more outcomes data are needed. Materials and methods: Outcomes of 26 consecutive patients with electromyelogram-confirmed LTN palsy who underwent direct (n ! 4) or indirect transfer (n ! 22) of the PMT for dynamic stabilization of the scapula were reviewed. All patients were followed up clinically for an average of 21.8 months (range, 3-62 months) with evaluations of active forward flexion, active external rotation, American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) pain score, and observation of scapular winging. Results: Preoperative to postoperative results included increases in the mean active forward flexion from 112 " to 149 " (P <.001) an in mean active external rotation from 53.8 " to 62.8 " (P ! .045), an improvement in the mean ASES score from 28 to 67.0 (P <.001), and an improvement in the mean VAS pain score from 7.7 to 3.0 (P < .001). Recurrent scapular winging occurred in 5 patients. There was no difference in outcome by length of follow-up. Conclusions: PMT transfer is an effective treatment for painful scapular winging resulting from LTN palsy. This is the largest reported series of consecutive patients treated with PMT transfer for the correction of scapular winging. Level of evidence: Level IV, Case Series, Treatment Study. ! 2011 Journal of Shoulder and Elbow Surgery Board of Trustees.
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serratus anterior dysfunction recognition and treatment
Clinical Orthopaedics and Related Research, 1998Co-Authors: Jon J P Warner, Ronald A NavarroAbstract:Recognition of scapular winging may be difficult, and potential errors in treatment can result. Such treatment errors may cause morbidity for the patient. In addition, electrical evidence of Long Thoracic Nerve injury usually is required to confirm the etiology of scapular winging as being caused by serratus anterior dysfunction. Although various conditions may result in scapular winging, primary serratus anterior dysfunction can be treated effectively by transfer of the pectoralis major tendon; however, this surgical approach sometimes may given an unacceptable cosmesis, and there may be local morbidity to the donor site of the iliotibial band graft that is used to augment the tendon transfer. The authors report eight patients with primary chronic scapuloThoracic winging refractory to conservative treatment. Five of these patients had an incorrect diagnosis, and this resulted in 17 surgical procedures without resolution of their pain or improvement of function. Of the eight patients who required additional surgery to stabilize the scapula, only five patients had an electromyographic study that showed Long Thoracic Nerve palsy, although all patients had profound scapuloThoracic winging. All patients underwent a modified pectoralis major transfer with autogenous semitendinosus and gracilis tendon augmentation using two small incisions. Although one patient had a postoperative infection develop, the remaining seven patients had resolution of their winging, improved function, and satisfactory cosmesis.
R Belmonte - One of the best experts on this subject based on the ideXlab platform.
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Long Thoracic Nerve injury in breast cancer patients treated with axillary lymph node dissection
Supportive Care in Cancer, 2015Co-Authors: R Belmonte, Sandra Monleon, Neus Bofill, Martha Ligia Alvarado, Josep Espadaler, Inmaculada RoyoAbstract:Purpose The objectives of this study were to electromyographically (EMG) describe and analyze factors associated with Long Thoracic Nerve injuries in breast cancer patients after axillary lymph node dissection.
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Long Thoracic Nerve injury in breast cancer patients treated with axillary lymph node dissection
Supportive Care in Cancer, 2015Co-Authors: R Belmonte, Sandra Monleon, Neus Bofill, Martha Ligia Alvarado, Josep Espadaler, Inmaculada RoyoAbstract:The objectives of this study were to electromyographically (EMG) describe and analyze factors associated with Long Thoracic Nerve injuries in breast cancer patients after axillary lymph node dissection. This was a prospective Longitudinal observational study. Two hundred sixty-four women with primary invasive breast cancer were included between 2008 and 2011. All of them were treated by axillary lymph node dissection. Patients were evaluated at 1, 6, and 12 months following surgery. The presence of winged scapula was systematically tested at each follow-up and an EMG performed whenever it was observed. Affected and unaffected groups were compared for demographic, tumour, and treatment variables. Student t test, Mann–Whitney U test, chi-squared or Fisher test were computed as appropriate. Among the 36 (13.6 %) winged scapula observed, the EMG confirmed Long Thoracic Nerve injury in 30 (11.3 %) of them, 27 were partial axonotmesis and three were severe axonotmesis. At 12 months, the EMG showed that injury persisted in six (2.27 %) patients. Patients with Long Thoracic Nerve injury had a lower body mass index than unaffected patients (26.2 vs. 28.2, p = 0.045). Age, tumour stage, type of breast surgery, nodes excised, surgical complications, previous chemotherapy and previous hormonotherapy were not factors associated with winged scapula. A lower body mass index was the only factor associated to Long Thoracic Nerve injury. In most of the patients, the EMG showed partial axonotmesis. At 12 months, 2.27 % of studied patients remained with an unsolved Long Thoracic Nerve injury.
Josep Espadaler - One of the best experts on this subject based on the ideXlab platform.
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Long Thoracic Nerve injury in breast cancer patients treated with axillary lymph node dissection
Supportive Care in Cancer, 2015Co-Authors: R Belmonte, Sandra Monleon, Neus Bofill, Martha Ligia Alvarado, Josep Espadaler, Inmaculada RoyoAbstract:Purpose The objectives of this study were to electromyographically (EMG) describe and analyze factors associated with Long Thoracic Nerve injuries in breast cancer patients after axillary lymph node dissection.
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Long Thoracic Nerve injury in breast cancer patients treated with axillary lymph node dissection
Supportive Care in Cancer, 2015Co-Authors: R Belmonte, Sandra Monleon, Neus Bofill, Martha Ligia Alvarado, Josep Espadaler, Inmaculada RoyoAbstract:The objectives of this study were to electromyographically (EMG) describe and analyze factors associated with Long Thoracic Nerve injuries in breast cancer patients after axillary lymph node dissection. This was a prospective Longitudinal observational study. Two hundred sixty-four women with primary invasive breast cancer were included between 2008 and 2011. All of them were treated by axillary lymph node dissection. Patients were evaluated at 1, 6, and 12 months following surgery. The presence of winged scapula was systematically tested at each follow-up and an EMG performed whenever it was observed. Affected and unaffected groups were compared for demographic, tumour, and treatment variables. Student t test, Mann–Whitney U test, chi-squared or Fisher test were computed as appropriate. Among the 36 (13.6 %) winged scapula observed, the EMG confirmed Long Thoracic Nerve injury in 30 (11.3 %) of them, 27 were partial axonotmesis and three were severe axonotmesis. At 12 months, the EMG showed that injury persisted in six (2.27 %) patients. Patients with Long Thoracic Nerve injury had a lower body mass index than unaffected patients (26.2 vs. 28.2, p = 0.045). Age, tumour stage, type of breast surgery, nodes excised, surgical complications, previous chemotherapy and previous hormonotherapy were not factors associated with winged scapula. A lower body mass index was the only factor associated to Long Thoracic Nerve injury. In most of the patients, the EMG showed partial axonotmesis. At 12 months, 2.27 % of studied patients remained with an unsolved Long Thoracic Nerve injury.
Sandra Monleon - One of the best experts on this subject based on the ideXlab platform.
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Long Thoracic Nerve injury in breast cancer patients treated with axillary lymph node dissection
Supportive Care in Cancer, 2015Co-Authors: R Belmonte, Sandra Monleon, Neus Bofill, Martha Ligia Alvarado, Josep Espadaler, Inmaculada RoyoAbstract:Purpose The objectives of this study were to electromyographically (EMG) describe and analyze factors associated with Long Thoracic Nerve injuries in breast cancer patients after axillary lymph node dissection.
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Long Thoracic Nerve injury in breast cancer patients treated with axillary lymph node dissection
Supportive Care in Cancer, 2015Co-Authors: R Belmonte, Sandra Monleon, Neus Bofill, Martha Ligia Alvarado, Josep Espadaler, Inmaculada RoyoAbstract:The objectives of this study were to electromyographically (EMG) describe and analyze factors associated with Long Thoracic Nerve injuries in breast cancer patients after axillary lymph node dissection. This was a prospective Longitudinal observational study. Two hundred sixty-four women with primary invasive breast cancer were included between 2008 and 2011. All of them were treated by axillary lymph node dissection. Patients were evaluated at 1, 6, and 12 months following surgery. The presence of winged scapula was systematically tested at each follow-up and an EMG performed whenever it was observed. Affected and unaffected groups were compared for demographic, tumour, and treatment variables. Student t test, Mann–Whitney U test, chi-squared or Fisher test were computed as appropriate. Among the 36 (13.6 %) winged scapula observed, the EMG confirmed Long Thoracic Nerve injury in 30 (11.3 %) of them, 27 were partial axonotmesis and three were severe axonotmesis. At 12 months, the EMG showed that injury persisted in six (2.27 %) patients. Patients with Long Thoracic Nerve injury had a lower body mass index than unaffected patients (26.2 vs. 28.2, p = 0.045). Age, tumour stage, type of breast surgery, nodes excised, surgical complications, previous chemotherapy and previous hormonotherapy were not factors associated with winged scapula. A lower body mass index was the only factor associated to Long Thoracic Nerve injury. In most of the patients, the EMG showed partial axonotmesis. At 12 months, 2.27 % of studied patients remained with an unsolved Long Thoracic Nerve injury.
