Ultrasound imaging of brachial plexus trauma in gunshot injury

Nwawka, O. Kenechi; Casaletto, Emily; Wolfe, Scott W.; Feinberg, Joseph H.

doi:10.1002/mus.26461

Cited by 11 publications

(19 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Studies about the patterns and origins of the axillary artery branches and their correlation are important for 5 BioMed Research International clinicians [4][5][6]. Patients with severe trauma to the shoulder and upper chest should be clinically assessed for vascular damage and musculoskeletal evaluation [12][13][14][15][16][17]. In addition, it will be helpful to recognize and understand such a variation, even in radiographic procedures, to increase the accuracy of the technique and to reduce unnecessary complications [26,27].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, injuries of the brachial plexus are quite common and require exploration and repair. The axillary artery variation is a concern during these procedures [12][13][14]. For better clinical procedures, detailed knowledge of anatomical relationships of the axillary artery and distribution of its branches is crucial [15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Topography and Anatomical Variations of the Axillary Artery

Yang

Lee

Choi

et al. 2021

BioMed Research International

View full text Add to dashboard Cite

Knowledge of anatomical variations of the limb’s main arteries is significant for the clinicians. Thus, this study is aimed at examining the branching pattern and anatomical variations of the axillary artery. We conducted research on 59 upper limbs of adult human donated cadavers. All axillary artery branches’ origins were assessed, and the correlations between points of origins and variations of specific branches were evaluated. The average length of the axillary artery was found to be 11.22 cm, and this length was defined as reference line. Based on this reference line, the first, second, and third parts were 37.56%, 39%, and 30.05%, respectively. The STA was originated from 25.11%. The TAA and LTA were 42.67% and 54.82%, respectively. The SSA, ACHA, and PCHA were 64.72%, 83.89%, and 84.53%, respectively. The origin of LTA was correlated with that of SSA ( R = 0.473 , P < 0.05 ) and AHCA ( R = 0.307 , P < 0.05 ), respectively. And there was a positive correlation between AHCA and PHCA ( R = 0.705 , P < 0.05 ). The number of branches ranged from 3~6, and 9 types were shown. The most frequent branching pattern was common origin of the LTA and SSA (22/59). And AHCA and PHCA were originated together in 19 cases, and both patterns were combined in 12 cases. TTA and LTA branched together in 9 cases, and common trunk for the SSA, PHCA, and AHCA was found in 2 cases. According to this pattern, the origin of LTA and PCHA was significantly different. This information is particularly useful for surgeons and clinicians.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Topography and Anatomical Variations of the Axillary Artery

Yang

Lee

Choi

et al. 2021

BioMed Research International

View full text Add to dashboard Cite

show abstract

“…Furthermore, the evaluation of MEP persistence may provide additional context for imaging modalities and EMG studies. Magnetic resonance imaging and ultrasound can be useful for identifying damaged nerves or muscle preoperatively, but they cannot predict regeneration potential, [39][40][41] which depends on the viability of the MEP within targeted muscle fibers. 42 Clinicians also routinely use EMG studies to gather objective data about the status of muscle innervation, with fibrillation potentials and positive sharp waves as the hallmarks of a denervated muscle.…”

Section: Unexpected Persistence Of Meps In Denervated Human Musclementioning

confidence: 99%

Human motor endplate remodeling after traumatic nerve injury

Gupta

Chan

Uong

et al. 2020

Journal of Neurosurgery

View full text Add to dashboard Cite

OBJECTIVECurrent management of traumatic peripheral nerve injuries is variable with operative decisions based on assumptions that irreversible degeneration of the human motor endplate (MEP) follows prolonged denervation and precludes reinnervation. However, the mechanism and time course of MEP changes after human peripheral nerve injury have not been investigated. Consequently, there are no objective measures by which to determine the probability of spontaneous recovery and the optimal timing of surgical intervention. To improve guidance for such decisions, the aim of this study was to characterize morphological changes at the human MEP following traumatic nerve injury.METHODSA prospective cohort (here analyzed retrospectively) of 18 patients with traumatic brachial plexus and axillary nerve injuries underwent biopsy of denervated muscles from the upper extremity from 3 days to 6 years after injury. Muscle specimens were processed for H & E staining and immunohistochemistry, with visualization via confocal and two-photon excitation microscopy.RESULTSImmunohistochemical analysis demonstrated varying degrees of fragmentation and acetylcholine receptor dispersion in denervated muscles. Comparison of denervated muscles at different times postinjury revealed progressively increasing degeneration. Linear regression analysis of 3D reconstructions revealed significant linear decreases in MEP volume (R = −0.92, R2 = 0.85, p = 0.001) and surface area (R = −0.75, R2 = 0.56, p = 0.032) as deltoid muscle denervation time increased. Surprisingly, innervated and structurally intact MEPs persisted in denervated muscle specimens from multiple patients 6 or more months after nerve injury, including 2 patients who had presented > 3 years after nerve injury.CONCLUSIONSThis study details novel and critically important data about the morphology and temporal sequence of events involved in human MEP degradation after traumatic nerve injuries. Surprisingly, human MEPs not only persisted, but also retained their structures beyond the assumed 6-month window for therapeutic surgical intervention based on previous clinical studies. Preoperative muscle biopsy in patients being considered for nerve transfer may be a useful prognostic tool to determine MEP viability in denervated muscle, with surviving MEPs also being targets for adjuvant therapy.

show abstract

“…5,11 It should be noted, however, that although sonographic findings show high positive predictive values in characterizing peripheral nerve trauma, surgical inspection is still considered the gold standard. 20 This case study illustrates the evolving role of high-resolution sonography in musculoskeletal ultrasound and peripheral nerve evaluation.…”

Section: Discussionmentioning

confidence: 93%

Sonographic Evaluation of Peripheral Sciatic Nerve Injury: A Case Study

Franceschina

2021

Journal of Diagnostic Medical Sonography

View full text Add to dashboard Cite

Traumatic peripheral nerve injury is not a common finding in the general population but is increasingly being recognized and diagnosed in trauma and emergency medicine settings. Peripheral nerve injury can cause temporary or long-term motor and sensory loss, as well as intense pain and disability, if left untreated. The cause of peripheral nerve injury is diverse and often involves soft tissue damage, fractures, and hemorrhage in cases of traumatic injury. Peripheral nerve injury does not always heal spontaneously and, depending on severity, may warrant surgical intervention and repair. Although electrodiagnosic testing and surgical exploration are considered gold standards for peripheral nerve injury, high-resolution sonographic examination supplemented by clinical findings may be of value. The use of sonography demonstrated utility in determining a strategic management timeline and the efficacy of a surgical intervention.

show abstract

Ultrasound imaging of brachial plexus trauma in gunshot injury

Cited by 11 publications

References 29 publications

Topography and Anatomical Variations of the Axillary Artery

Topography and Anatomical Variations of the Axillary Artery

Human motor endplate remodeling after traumatic nerve injury

Sonographic Evaluation of Peripheral Sciatic Nerve Injury: A Case Study

Contact Info

Product

Resources

About