Prognosis in Traction Lesions of the Brachial Plexus

Bonney, George

doi:10.1302/0301-620x.41b1.4

Cited by 100 publications

(32 citation statements)

References 4 publications

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“…The finding of preserved peripheral sensory conduction in root avulsions of the brachial plexus was first described by Bonney and Gilliatt (1958) and has been confirmed by others (Warren et al, 1969;Buchthal et al, 1975).…”

Section: Methodsmentioning

confidence: 56%

Motor and sensory conduction in the musculocutaneous nerve.

Trojaborg¹

1976

Journal of Neurology, Neurosurgery & Psychiatry

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SYNOPSIS Motor and sensory conductionvelocity in the musculocutaneous nerve were determined in 51 normal subjects. The maximal velocity from the anterior cervical triangle to the axilla was the same in motor and sensory fibres. The musculocutaneous nerve originates from the lateral cord of the brachial plexus at or about the lower border of the pectoralis minor muscle and its fibres derive chiefly from the fifth and sixth cervical nerve roots (Sunderland, 1968). Conduction along motor fibres from the axilla to the brachial biceps muscle has been described by Redford (1958) and from Erb's point to the brachial biceps by Gassel (1964) and Kraft (1972). Nelson and Currier (1969) stimulated the nerve at two sites in seven normal subjects and determined the motor conduction velocity along the fibres to the brachial biceps in the nerve segment between the anterior cervical triangle and the axilla.The study presented in this report deals with conduction velocity along the musculocutaneous nerve in normal subjects in proximal (fossa supraclavicularis-axilla) and distal segments of motor fibres and in proximal (fossa supraclavicularis-axilla) and intermediate (elbowaxilla)

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Section: Methodsmentioning

confidence: 56%

Motor and sensory conduction in the musculocutaneous nerve.

Trojaborg¹

1976

Journal of Neurology, Neurosurgery & Psychiatry

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“…Following publication of this report, surgical repair of brachial plexus injuries was performed on a few occasions in the early 20 th century 3,4 with apparently good results, but the initial enthusiasm was replaced with pessimism because of the poor subsequent results 5,6 . In the early 1960s, the skepticism about the results from the surgical treatment was so intense that the treatment advocated for complete root avulsions was above-elbow amputation, combined with shoulder fusion in slight abduction and flexion, and complemented by a forearmhand prosthesis.…”

Section: Historymentioning

confidence: 99%

“…[5] Wrist and finger extension. [6] Wrist and finger flexion. [7] The ulnar innervated structures are the last priority because of the poor prognosis for recovery.…”

Section: Repair Prioritiesmentioning

confidence: 99%

Surgical treatment of adult traumatic brachial plexus injuries: an overview

Siqueira

Martins

2011

Arq. Neuro-Psiquiatr.

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Traumatic injuries to the brachial plexus in adults are severely debilitating. They generally affect young individuals. A thorough understanding of the anatomy, clinical evaluation, imaging and electrodiagnostic assessments, treatment options and proper timing of surgical interventions will enable nerve surgeons to offer optimal care to patients. Advances in microsurgical technique have improved the outcome for many of these patients. The treatment options offer patients with brachial plexus injuries the possibility of achieving elbow flexion, shoulder stability with limited abduction and the hope of limited but potentially useful hand function. Key words: brachial plexus injury, surgical treatment, nerve repair.Tratamento cirúrgico das lesões traumáticas do plexo braquial em adultos: uma visão geral RESUMO As lesões traumáticas do plexo braquial em adultos são severamente debilitantes e, em geral, afetam indivíduos jovens. Uma ampla compreensão da anatomia, da avaliação clínica, dos estudos eletrodiagnósticos e por imagem, das opções de tratamento e do momento apropriado para o tratamento cirúrgico irá permitir que o cirurgião de nervos ofereça o tratamento ideal ao paciente. Os avanços na técnica microcirúrgica melhoraram os resultados para muitos desses pacientes. As opções de tratamento oferecem aos pacientes com lesões do plexo braquial a possibilidade de obter flexão do cotovelo, estabilidade do ombro com abdução limitada e a esperança de função limitada mas potencialmente útil da mão. Palavras-chave: lesão do plexo braquial, tratamento cirúrgico, reparo de nervos. Traumatic brachial plexus lesions in adults are devastating injuries. The typical patient is a young man who was injured in a motorcycle accident. These lesions are of great social significance since most of the patients have to face severe residual morbidity after their injuries. The exact number of lesions occurring each year is difficult to ascertain, but it is certainly growing, in parallel with the increasing number of high-speed motor vehicle accidents, especially involving motorcycles.Based on experience with 1,068 patients with brachial plexus injuries, Narakas 1 developed a rule of "seven seventies" that gives an approximate idea of the statistics involved in brachial plexus lesions: approximately 70% of traumatic brachial plexus injuries are secondary to motor vehicle accidents; of these, approximately 70% involve motorcycles or bicycles. Of the cycle riders, approximately 70% have multiple injuries. Overall, 70% have supraclavicular lesions; of these, 70% have at least one root avulsion. At least 70% of patients with a root avulsion also have avulsions of the lower roots (C7, C8 or T1). Finally, of patients with lower root avulsion, nearly 70% will experience persistent pain.

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“…Bonney (1959) followed 25 patients for a minimum of two years and found that the pain was worse in those who showed no functional recovery. Yeoman (1975) observed that severe pain persisted in 32 of his 46 patients with complete paralysis.…”

mentioning

confidence: 99%