Brachial Plexus Injuries in the Adult

Table of contents :
Brachial plexus injuries in adults……Page 1
General overview of the brachial plexus……Page 3
Common variations of the brachial plexus……Page 4
Pathoanatomy……Page 6
Anatomic considerations of postganglionic injuries……Page 7
Supraclavicular brachial plexus……Page 8
Infraclavicular brachial plexus……Page 10
Posterior approach to the suprascapular nerve……Page 11
References……Page 12
Classification of nerve injury……Page 14
Mechanism and pathoanatomy……Page 15
Root avulsions……Page 16
Injury patterns……Page 18
Other mechanisms……Page 19
Physical examination……Page 20
Electrodiagnostic studies……Page 22
References……Page 24
Overview……Page 26
CT myelography……Page 27
MRI “myelography”……Page 29
Nonmyelographic MRI……Page 30
Breast and lung cancer……Page 34
Neurogenic tumors……Page 36
References……Page 37
Preoperative electrodiagnosis……Page 39
Stimulation……Page 41
Motor evoked potentials……Page 42
Nerve root integrity……Page 44
Assessment of partial and complete plexus lesions……Page 45
References……Page 46
Injury classification……Page 47
Timing of surgical intervention……Page 48
Imaging studies……Page 49
Surgical options……Page 50
References……Page 52
Methods……Page 55
Lacerations……Page 56
Gunshot wounds……Page 57
Stretch/contusion injuries……Page 58
Open injuries……Page 62
Lacerations……Page 63
Elbow flexion……Page 65
Direct repair supplemented by transfers……Page 66
References……Page 67
End-to-side neurorrhaphy……Page 70
General principles for nerve transfers……Page 72
Shoulder elevation (or abduction)……Page 76
Finger flexion (or extension)……Page 78
C6 through T1 four-root avulsion……Page 79
References……Page 80
Plan of surgical treatment……Page 82
The fifth to sixth cervical nerve stump……Page 83
Phrenic nerve……Page 84
Intercostal nerve……Page 85
Other nerves (eg, long thoracic, hypoglossal, medial pectoral, thoracodorsal, triceps, ipsilateral C7)……Page 86
References……Page 87
Muscle changes with denervation……Page 89
Selection of donor muscle……Page 90
Patient requirements for functioning free-muscle transfer……Page 91
Double gracilis transfer……Page 92
Gracilis harvest……Page 93
Single gracilis transfer method……Page 94
Double gracilis transfer method……Page 96
Results: double free-muscle transfer……Page 97
References……Page 98
Preoperative care……Page 101
Immediate postoperative care……Page 102
Re-education of muscle……Page 103
Gravity-eliminated exercise……Page 104
References……Page 105
Repair of Avulsed Ventral Nerve Roots by Direct Ventral Intraspinal Implantation after Brachial Plexus Injury……Page 107
Prior research……Page 108
Anatomic basis of the posterior approach to the brachial plexus for repairing avulsed spinal nerve roots……Page 109
Ideal intraspinal implantation site for repairing ventral root avulsion……Page 110
Surgical anatomy of the lateral interscalenic, multilevel, oblique corpectomies……Page 111
Reimplantation surgery of the brachial plexus:the place of neurotrophic factors……Page 113
References……Page 114