Upper extremity neuropathies after cardiac surgery

Seyfer, Alan E.; Grammer, Nadja Y.; Bogumill, George P.; Provost, John M.; Chandry, Usha

doi:10.1016/s0363-5023(85)80241-0

Cited by 58 publications

(23 citation statements)

References 3 publications

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“…Other studies found a higher correlation of upper-extremity neurapraxia after cardiac surgery, but the highest risk is still related to orthopedic surgeries. 26 In the case of lateral interbody fusion procedures, the L4-5 intervertebral disc is the most challenging when using a transpsoas approach. This is due to the iliac crest and the course and size of the obturator and femoral nerves.…”

Section: Discussionmentioning

confidence: 99%

Is the lateral jack-knife position responsible for cases of transient neurapraxia?

Molinares

Davis

Fung

et al. 2016

SPI

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OBJECT The lateral jack-knife position is often used during transpsoas surgery to improve access to the spine. Postoperative neurological signs and symptoms are very common after such procedures, and the mechanism is not adequately understood. The objective of this study is to assess if the lateral jack-knife position alone can cause neurapraxia. This study compares neurological status at baseline and after positioning in the 25° right lateral jack-knife (RLJK) and the right lateral decubitus (RLD) position. METHODS Fifty healthy volunteers, ages 21 to 35, were randomly assigned to one of 2 groups: Group A (RLD) and Group B (RLJK). Motor and sensory testing was performed prior to positioning. Subjects were placed in the RLD or RLJK position, according to group assignment, for 60 minutes. Motor testing was performed immediately after this 60-minute period and again 60 minutes thereafter. Sensory testing was performed immediately after the 60-minute period and every 15 minutes thereafter, for a total of 5 times. Motor testing was performed by a physical therapist who was blinded to group assignment. A follow-up call was made 7 days after the positioning sessions. RESULTS Motor deficits were observed in the nondependent lower limb in 100% of the subjects in Group B, and no motor deficits were seen in Group A. Statistically significant differences (p < 0.05) were found between the 2 groups with respect to the performance on the 10-repetition maximum test immediately immediately and 60 minutes after positioning. Subjects in Group B had a 10%–70% (average 34.8%) decrease in knee extension strength and 20%–80% (average 43%) decrease in hip flexion strength in the nondependent limb. Sensory abnormalities were observed in the nondependent lower limb in 98% of the subjects in Group B. Thirty-six percent of the Group B subjects still exhibited sensory deficits after the 60-minute recovery period. No symptoms were reported by any subject during the follow-up calls 7 days after positioning. CONCLUSIONS Twenty-five degrees of right lateral jack-knife positioning for 60 minutes results in neurapraxia of the nondependent lower extremity. Our results support the hypothesis that jack-knife positioning alone can cause postoperative neurological symptoms.

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Section: Discussionmentioning

confidence: 99%

Is the lateral jack-knife position responsible for cases of transient neurapraxia?

Molinares

Davis

Fung

et al. 2016

SPI

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“…Although BPI may cause substantial morbidity in the perioperative period, most lesions last on average 2e3 months and are usually resolved within a year with no surgical intervention necessary. 1,2 As the brachial plexus trunks pass superficially over the first rib and deep to the clavicle, the brachial plexus is vulnerable to direct local trauma from surgical manipulation of the chest wall necessary during openheart surgery. In addition, as its roots are tethered proximally at their site of exit from the intervertebral foramen and distally at its terminal branch insertions, the brachial plexus is susceptible to stretch injury from positioning and retraction often encountered in openheart surgery.…”

Section: Brachial Plexus Injuriesmentioning

confidence: 99%

“…Larger width of retraction has been found to increase the risk of BPI. 2 Also, use of the internal mammary artery as a graft requires placement of deeper retractors for adequate visualization to dissect the artery off the chest wall. A prospective study of patients undergoing CABG found the rate of brachial plexopathy to be 11% in patients receiving internal mammary artery grafts compared with a rate of 1% in those without internal mammary artery harvest.…”

Section: Brachial Plexus Injuriesmentioning

confidence: 99%

Section: Cardiopulmonary Bypassmentioning

confidence: 99%

“…2 The ulnar nerve is particularly sensitive to ischemia with extended durations of cardiopulmonary bypass, and weakness in ulnar-innervated musculature is also common as the duration of bypass increases. 2 Patient positioning during cardiac surgery Proper elbow padding and arm positioning are essential in preventing ulnar neuropathy in patients lying supine. Clinical studies have shown some correlation between arm position and the rate of postoperative ulnar neuropathy, with the incidence of ulnar neuropathy being greater with the arms adducted (24%) compared with an abducted (15%) positioning of the arms.…”

Section: Cardiopulmonary Bypassmentioning

confidence: 99%

See 2 more Smart Citations

Upper Extremity Complications and Concerns in Patients With Cardiac Disease

Dineen

Gentry

Draeger

2016

The Journal of Hand Surgery

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Accessory neuropathy after sternotomy: Clinico‐anatomical correlation supporting an inflammatory cause

et al. 2017

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Inflammatory etiologies are becoming increasingly recognized as explanations of some neuropathies, especially those occurring in the perioperative period. Although "brachial neuritis" is known to affect extraplexal nerves, accessory nerve palsy following median sternotomy has been attributed to stretch on the nerve. To better elucidate stretch as a potential cause, a cadaveric study was performed. Two patients who developed accessory nerve palsy following median sternotomy are presented to illustrate features consistent with the diagnosis of a perioperative inflammatory neuropathy. Five adult unembalmed cadavers underwent exposure of the bilateral accessory nerves in the posterior cervical triangle. A median sternotomy was performed and self-retaining retractors positioned. With the head in neutral, left rotation and right rotation, retractors were opened as during surgery while observing and recording any accessory nerve movements. The self-retaining sternal retractors were fully opened to a mean inter-blade distance of 13 cm. Regardless of head position, from the initial retractor click to maximal opening there was no gross movement of the accessory nerve on the left or right sides. Opening self-retaining sternal retractors does not appear to stretch the accessory nerve in the posterior cervical triangle. Based on our clinical experience and cadaveric results, we believe that inflammatory conditions, (i.e., idiopathic brachial plexitis) can involve the accessory nerve, and might be triggered by surgical procedures. Clin. Anat. 31:417-421, 2018. © 2017 Wiley Periodicals, Inc.

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Upper extremity neuropathies after cardiac surgery

Cited by 58 publications

References 3 publications

Is the lateral jack-knife position responsible for cases of transient neurapraxia?

Is the lateral jack-knife position responsible for cases of transient neurapraxia?

Upper Extremity Complications and Concerns in Patients With Cardiac Disease

Accessory neuropathy after sternotomy: Clinico‐anatomical correlation supporting an inflammatory cause

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