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Manoel Jacobsen Teixeira - One of the best experts on this subject based on the ideXlab platform.
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Transfer of a fascicle from the Posterior Cord to the suprascapular nerve after injury of the upper roots of the brachial plexus: technical case report.
Neurosurgery, 2009Co-Authors: Roberto Sergio Martins, Mario Gilberto Siqueira, Carlos Otto Heise, Manoel Jacobsen TeixeiraAbstract:A new nerve transfer technique using a healthy fascicle of the Posterior Cord for suprascapular nerve reconstruction is presented. This technique was used in a patient with posttraumatic brachial plexopathy resulting in upper trunk injury with proximal root stumps that were unavailable for grafting associated with multiple nerve dysfunction. A 45-year-old man sustained a right brachial plexus injury after a bicycle accident. Clinical evaluation and electromyography indicated upper trunk involvement. Trapezius muscle function and triceps strength were normal on physical examination. The patient underwent a combined supra- and infraclavicular approach to the brachial plexus. A neuroma-in-continuity of the upper trunk and fibrotic C5 and C6 roots were identified. Electrical stimulation of the phrenic and spinal accessory nerves produced no response. The suprascapular nerve was dissected from the upper trunk, transected, and rerouted to the infraclavicular fossa. A healthy fascicle of the Posterior Cord to the triceps muscle was transferred to the suprascapular nerve. At the time of the 1-year follow-up evaluation, arm abduction against gravity and external rotation reached 40 and 34 degrees, respectively. The Posterior Cord can be used as a source of donor fascicle to the suprascapular nerve after its infraclavicular relocation. This new intraplexal nerve transfer could be applied in patients with isolated injury of the upper trunk and concomitant lesion of the extraplexal nerve donors usually used for reinnervation of the suprascapular nerve.
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Transfer of a fascicle from the Posterior Cord to the suprascapular nerve after injury of the upper roots of the brachial plexus: technical case report.
Neurosurgery, 2009Co-Authors: Roberto Sergio Martins, Mario Gilberto Siqueira, Carlos Otto Heise, Manoel Jacobsen TeixeiraAbstract:OBJECTIVE: A new nerve transfer technique using a healthy fascicle of the Posterior Cord for suprascapular nerve reconstruction is presented. This technique was used in a patient with posttraumatic brachial plexopathy resulting in upper trunk injury with proximal root stumps that were unavailable for grafting associated with multiple nerve dysfunction. CLINICAL PRESENTATION: A 45-year-old man sustained a right brachial plexus injury after a bicycle accident. Clinical evaluation and electromyography indicated upper trunk involvement. Trapezius muscle function and triceps strength were normal on physical examination. INTERVENTION: The patient underwent a combined supra- and infraclavicular approach to the brachial plexus. A neuroma-in-continuity of the upper trunk and fibrotic C5 and C6 roots were identified. Electrical stimulation of the phrenic and spinal accessory nerves produced no response. The suprascapular nerve was dissected from the upper trunk, transected, and rerouted to the infraclavicular fossa. A healthy fascicle of the Posterior Cord to the triceps mus-cle was transferred to the suprascapular nerve. At the time of the 1-yearfollow-up evaluation, arm abduction against gravity and external rotation reached 40 and 34 degrees, respectively. CONCLUSION: The Posterior Cord can be used as a source of donor fascicle to the suprascapular nerve after its infraclavicular relocation. This new intraplexal nerve transfer could be applied in patients with isolated injury of the upper trunk and concomitant lesion of the extraplexal nerve donors usually used for reinnervation of the suprascapular nerve.
Roberto Sergio Martins - One of the best experts on this subject based on the ideXlab platform.
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Transfer of a fascicle from the Posterior Cord to the suprascapular nerve after injury of the upper roots of the brachial plexus: technical case report.
Neurosurgery, 2009Co-Authors: Roberto Sergio Martins, Mario Gilberto Siqueira, Carlos Otto Heise, Manoel Jacobsen TeixeiraAbstract:A new nerve transfer technique using a healthy fascicle of the Posterior Cord for suprascapular nerve reconstruction is presented. This technique was used in a patient with posttraumatic brachial plexopathy resulting in upper trunk injury with proximal root stumps that were unavailable for grafting associated with multiple nerve dysfunction. A 45-year-old man sustained a right brachial plexus injury after a bicycle accident. Clinical evaluation and electromyography indicated upper trunk involvement. Trapezius muscle function and triceps strength were normal on physical examination. The patient underwent a combined supra- and infraclavicular approach to the brachial plexus. A neuroma-in-continuity of the upper trunk and fibrotic C5 and C6 roots were identified. Electrical stimulation of the phrenic and spinal accessory nerves produced no response. The suprascapular nerve was dissected from the upper trunk, transected, and rerouted to the infraclavicular fossa. A healthy fascicle of the Posterior Cord to the triceps muscle was transferred to the suprascapular nerve. At the time of the 1-year follow-up evaluation, arm abduction against gravity and external rotation reached 40 and 34 degrees, respectively. The Posterior Cord can be used as a source of donor fascicle to the suprascapular nerve after its infraclavicular relocation. This new intraplexal nerve transfer could be applied in patients with isolated injury of the upper trunk and concomitant lesion of the extraplexal nerve donors usually used for reinnervation of the suprascapular nerve.
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Transfer of a fascicle from the Posterior Cord to the suprascapular nerve after injury of the upper roots of the brachial plexus: technical case report.
Neurosurgery, 2009Co-Authors: Roberto Sergio Martins, Mario Gilberto Siqueira, Carlos Otto Heise, Manoel Jacobsen TeixeiraAbstract:OBJECTIVE: A new nerve transfer technique using a healthy fascicle of the Posterior Cord for suprascapular nerve reconstruction is presented. This technique was used in a patient with posttraumatic brachial plexopathy resulting in upper trunk injury with proximal root stumps that were unavailable for grafting associated with multiple nerve dysfunction. CLINICAL PRESENTATION: A 45-year-old man sustained a right brachial plexus injury after a bicycle accident. Clinical evaluation and electromyography indicated upper trunk involvement. Trapezius muscle function and triceps strength were normal on physical examination. INTERVENTION: The patient underwent a combined supra- and infraclavicular approach to the brachial plexus. A neuroma-in-continuity of the upper trunk and fibrotic C5 and C6 roots were identified. Electrical stimulation of the phrenic and spinal accessory nerves produced no response. The suprascapular nerve was dissected from the upper trunk, transected, and rerouted to the infraclavicular fossa. A healthy fascicle of the Posterior Cord to the triceps mus-cle was transferred to the suprascapular nerve. At the time of the 1-yearfollow-up evaluation, arm abduction against gravity and external rotation reached 40 and 34 degrees, respectively. CONCLUSION: The Posterior Cord can be used as a source of donor fascicle to the suprascapular nerve after its infraclavicular relocation. This new intraplexal nerve transfer could be applied in patients with isolated injury of the upper trunk and concomitant lesion of the extraplexal nerve donors usually used for reinnervation of the suprascapular nerve.
Steven H. Renes - 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.
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A simplified approach to vertical infraclavicular brachial plexus blockade using hand-held Doppler.
Anesthesia and analgesia, 2008Co-Authors: Steven H. Renes, Laura Clark, Mathieu J. M. Gielen, Huub Spoormans, Janneke Giele, Anupama WadhwaAbstract:In this observational study, we used Doppler ultrasound during the performance of vertical infraclavicular brachial plexus blockade. The success rate at inserting the needle at the point where the sound of the subclavian artery via Doppler reached its maximum audibility was compared with that of the classical insertion point. In 89 of the 100 patients, the medial or Posterior Cord was found at first needle pass. Using the Doppler point for insertion resulted in a significantly more lateral entry point compared with the classical point (P < 0.001) and was associated with a high success rate of infraclavicular block.
Marcos Flávio Ghizoni - One of the best experts on this subject based on the ideXlab platform.
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Transfer of the musculocutaneous nerve branch to the brachialis muscle to the triceps for elbow extension: anatomical study and report of five cases.
The Journal of hand surgery European volume, 2017Co-Authors: Jayme Augusto Bertelli, Marcos Flávio Ghizoni, Francisco Soldado, Alfonso Rodríguez-baezaAbstract:We report the study of the anatomical feasibility of transferring the nerve to the brachialis muscle to the upper medial head motor branch that innervate the triceps, and outcomes of such transfers in restoring elbow extension in five patients with Posterior Cord lesion of the brachial plexus. The length of the branches to the brachialis muscle measured 7.6 cm and the triceps upper medial head motor branch was 5 cm in 10 adult cadavers. Five male patients were treated with this transfer 5 months after the injury (range 4 to 6 months) after Posterior Cord injury of the brachial plexus with a mean follow-up of 31 months (range 28 to 36 months). Elbow extension scored M4 in all cases. No complications occurred. These preliminary results suggest that transferring the nerve to the brachialis muscle is an effective technique for the reconstruction of elbow extension after Posterior Cord brachial plexus injuries. Level of evidence IV.
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Results of nerve grafting in radial nerve injuries occurring proximal to the humerus, including those within the Posterior Cord.
Journal of neurosurgery, 2016Co-Authors: Jayme Augusto Bertelli, Marcos Flávio GhizoniAbstract:OBJECTIVE Results of radial nerve grafting are largely unknown for lesions of the radial nerve that occur proximal to the humerus, including those within the Posterior Cord. METHODS The authors describe 13 patients with proximal radial nerve injuries who were surgically treated and then followed for at least 24 months. The patients' average age was 26 years and the average time between accident and surgery was 6 months. Sural nerve graft length averaged 12 cm. Recovery was scored acCording to the British Medical Research Council (BMRC) scale, which ranges from M0 to M5 (normal muscle strength). RESULTS After grafting, all 7 patients with an elbow extension palsy recovered elbow extension, scoring M4. Six of the 13 recovered M4 wrist extension, 6 had M3, and 1 had M2. Thumb and finger extension was scored M4 in 3 patients, M3 in 2, M2 in 2, and M0 in 6. CONCLUSIONS The authors consider levels of strength of M4 for elbow and wrist extension and M3 for thumb and finger extension to be good results. Based on these criteria, overall good results were obtained in only 5 of the 13 patients. In proximal radial nerve lesions, the authors now advocate combining nerve grafts with nerve or tendon transfers to reconstruct wrist, thumb, and finger extension.
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Results of nerve grafting in radial nerve injuries occurring proximal to the humerus, including those within the Posterior Cord
Journal of neurosurgery, 2015Co-Authors: Jayme Augusto Bertelli, Marcos Flávio GhizoniAbstract:OBJECT Results of radial nerve grafting are largely unknown for lesions of the radial nerve that occur proximal to the humerus, including those within the Posterior Cord. METHODS The authors describe 13 patients with proximal radial nerve injuries who were surgically treated and then followed for at least 24 months. The patients' average age was 26 years and the average time between accident and surgery was 6 months. Sural nerve graft length averaged 12 cm. Recovery was scored acCording to the British Medical Research Council (BMRC) scale, which ranges from M0 to M5 (normal muscle strength). RESULTS After grafting, all 7 patients with an elbow extension palsy recovered elbow extension, scoring M4. Six of the 13 recovered M4 wrist extension, 6 had M3, and 1 had M2. Thumb and finger extension was scored M4 in 3 patients, M3 in 2, M2 in 2, and M0 in 6. CONCLUSIONS The authors consider levels of strength of M4 for elbow and wrist extension and M3 for thumb and finger extension to be good results. Based on these criteria, overall good results were obtained in only 5 of the 13 patients. In proximal radial nerve lesions, the authors now advocate combining nerve grafts with nerve or tendon transfers to reconstruct wrist, thumb, and finger extension.
Mario Gilberto Siqueira - One of the best experts on this subject based on the ideXlab platform.
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Transfer of a fascicle from the Posterior Cord to the suprascapular nerve after injury of the upper roots of the brachial plexus: technical case report.
Neurosurgery, 2009Co-Authors: Roberto Sergio Martins, Mario Gilberto Siqueira, Carlos Otto Heise, Manoel Jacobsen TeixeiraAbstract:A new nerve transfer technique using a healthy fascicle of the Posterior Cord for suprascapular nerve reconstruction is presented. This technique was used in a patient with posttraumatic brachial plexopathy resulting in upper trunk injury with proximal root stumps that were unavailable for grafting associated with multiple nerve dysfunction. A 45-year-old man sustained a right brachial plexus injury after a bicycle accident. Clinical evaluation and electromyography indicated upper trunk involvement. Trapezius muscle function and triceps strength were normal on physical examination. The patient underwent a combined supra- and infraclavicular approach to the brachial plexus. A neuroma-in-continuity of the upper trunk and fibrotic C5 and C6 roots were identified. Electrical stimulation of the phrenic and spinal accessory nerves produced no response. The suprascapular nerve was dissected from the upper trunk, transected, and rerouted to the infraclavicular fossa. A healthy fascicle of the Posterior Cord to the triceps muscle was transferred to the suprascapular nerve. At the time of the 1-year follow-up evaluation, arm abduction against gravity and external rotation reached 40 and 34 degrees, respectively. The Posterior Cord can be used as a source of donor fascicle to the suprascapular nerve after its infraclavicular relocation. This new intraplexal nerve transfer could be applied in patients with isolated injury of the upper trunk and concomitant lesion of the extraplexal nerve donors usually used for reinnervation of the suprascapular nerve.
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Transfer of a fascicle from the Posterior Cord to the suprascapular nerve after injury of the upper roots of the brachial plexus: technical case report.
Neurosurgery, 2009Co-Authors: Roberto Sergio Martins, Mario Gilberto Siqueira, Carlos Otto Heise, Manoel Jacobsen TeixeiraAbstract:OBJECTIVE: A new nerve transfer technique using a healthy fascicle of the Posterior Cord for suprascapular nerve reconstruction is presented. This technique was used in a patient with posttraumatic brachial plexopathy resulting in upper trunk injury with proximal root stumps that were unavailable for grafting associated with multiple nerve dysfunction. CLINICAL PRESENTATION: A 45-year-old man sustained a right brachial plexus injury after a bicycle accident. Clinical evaluation and electromyography indicated upper trunk involvement. Trapezius muscle function and triceps strength were normal on physical examination. INTERVENTION: The patient underwent a combined supra- and infraclavicular approach to the brachial plexus. A neuroma-in-continuity of the upper trunk and fibrotic C5 and C6 roots were identified. Electrical stimulation of the phrenic and spinal accessory nerves produced no response. The suprascapular nerve was dissected from the upper trunk, transected, and rerouted to the infraclavicular fossa. A healthy fascicle of the Posterior Cord to the triceps mus-cle was transferred to the suprascapular nerve. At the time of the 1-yearfollow-up evaluation, arm abduction against gravity and external rotation reached 40 and 34 degrees, respectively. CONCLUSION: The Posterior Cord can be used as a source of donor fascicle to the suprascapular nerve after its infraclavicular relocation. This new intraplexal nerve transfer could be applied in patients with isolated injury of the upper trunk and concomitant lesion of the extraplexal nerve donors usually used for reinnervation of the suprascapular nerve.