JournalTOCs

Journal of Brachial Plexus and Peripheral Nerve Injury
Journal Prestige (SJR): 0.136

Citation Impact (citeScore): 1
Number of Followers: 5

This is an Open Access Journal

Open Access journal
ISSN (Print) 1749-7221
Published by Thieme Publishing Group

[233 journals]

Fusion of the Median and Musculocutaneous Nerves Masquerading as Biceps'
Innervation from the Median Nerve
- Authors: Antonopoulos; Ioannis, Ampadiotaki, Margarita- Michaela, Tsikouris, George, Chiotis, Ioannis, Tsakotos, Georgios, Pathiakis, Ioannis, Troupis, Theodore G.
  Pages: e42 - e45
  Abstract: Embryologically, the musculocutaneous nerve (MCN) comes from the lateral root of the median nerve, and thus numerous anatomical variations concerning the formation and branching pattern of these two nerves of the brachial plexus have been described. In this case study, we describe a relatively uncommon case of fusion of the median and MCNs that was identified during routine teaching dissection of a male human cadaver. The identification of this anatomical variation requires awareness of the embryological background, as it may be confused with biceps innervation from the median nerve or the existence of a communicating branch between the two nerves. In addition, awareness of such anatomical variations is of undisputable significance for the safety of surgical operations in the brachial plexus and the arm in general.
  Citation: J Brachial Plex Peripher Nerve Inj 2023; 18: e42-e45
  PubDate: 2023-11-15T11:55:32+0100
  DOI: 10.1055/s-0043-1767674
  Issue No: Vol. 18, No. 01 (2023)
Redefining the Inclusion Criteria for Successful Steindler Flexorplasty
Based on the Outcomes of a Case Series in Eight Patients
- Authors: Gatskiy; Alexander A., Tretyak, Ihor B., Bahm, Jörg, Tsymbaliuk, Vitaliy I., Tsymbaliuk, Yaroslav V.
  Pages: e32 - e41
  Abstract: Background (rationale) Steindler flexorplasty (SF) is aimed at restoring independent elbow flexion in the late stages of dysfunction of the primary elbow flexors. Selection criteria for successful SF have been defined. Objectives The purpose of this study was to redefine the inclusion criteria for successful SF based on functional outcomes. Methods Eight patients received SF after an average of 50.8 months after injury or dysfunction. Three patients (37.5%) met all five Al-Qattan inclusion criteria (AQIC), and another five patients (62.5%) met four or less AQIC. Patients were followed up for at least 9 months, and the maximum range of active elbow flexion (REF) was measured. Functional results of SF were assessed using the Al-Qattan scale (in accordance with Al-Qattan's scale). Results The mean maximum REF was 100 degrees (70 to 140 degrees). Five patients reached REF greater than 100 degrees. One patient had a poor outcome, two patients (25%) had a fair outcome, three patients (37.5%) had a good outcome, and two patients (25%) had an excellent outcome of SF on the Al-Qattan scale. The impact of each AQIC on functional outcome has been critically reviewed from a biomechanical point of view. Conclusions The sufficient number of inclusion criteria required for successful SF can be reduced from five (according to AQIC) to two; Normal or near-normal function (M4 or greater on the MRC scale) of the muscles of the flexor-pronator mass should be considered an obligatory inclusion criterion, while primary wrist extensors may be considered an optional inclusion criterion.
  Citation: J Brachial Plex Peripher Nerve Inj 2023; 18: e32-e41
  PubDate: 2023-10-11T13:26:21+01:00
  DOI: 10.1055/s-0043-1767672
  Issue No: Vol. 18, No. 01 (2023)
Impact of Preoperative Neuropraxia on Surgical Duration Following
Pediatric Supracondylar Fracture of the Humerus: A Retrospective Cohort
Study
- Authors: Alayed; Yazeed, Alrashedan, Bander S., Almisfer, Sultan K., Aldossari, Ali M.
  Pages: e27 - e31
  Abstract: Background Supracondylar fractures of the humerus (SCFHs) are the most common type of elbow fracture in children. Because of the influence on functional outcome, neuropraxia is one of the most common concerns at presentation. The impact of preoperative neuropraxia on surgery duration is not extensively probed. The clinical implications of several other risk factors associated with preoperative neuropraxia at presentation may contribute to longer surgical duration of SCFH. Hypothesis Preoperative neuropraxia is likely to increase surgery duration in patients who sustained SCFH. Patients and Methods This is a retrospective cohort analysis. Sixty-six patients who sustained surgical pediatric supracondylar humerus fracture were included in the study. Baseline characteristics including age, gender, the type of fracture according to Gartland classification, mechanism of injury, patient weight, side of injury, and associated nerve injury were included in the study. Logistic regression analysis was performed using mean surgery duration as the main dependent variable and age, gender, fracture type according to the mechanism of injury, Gartland classification, injured arm, vascular status, time from presentation to surgery, weight, type of surgery, medial K-wire use, and afterhours surgery as the independent variables. A follow-up of 1 year was implemented. Result The overall preoperative neuropraxia rate was 9.1%. The mean surgery duration was 57.6 ± 5.6 minutes. The mean duration of closed reduction and percutaneous pinning surgeries was 48.5 ± 5.3 minutes, whereas the mean duration of open reduction and internal fixation (ORIF) surgeries was 129.3 ± 15.1 minutes. Preoperative neuropraxia was associated with an overall increase in the surgery duration (p
  Citation: J Brachial Plex Peripher Nerve Inj 2023; 18: e27-e31
  PubDate: 2023-07-03T14:40:27+01:00
  DOI: 10.1055/s-0043-1771012
  Issue No: Vol. 18, No. 01 (2023)
Peroneal Nerve Repair with Cross-Bridge Ladder Technique: Parallel
End-to-Side Neurorrhaphies
- Authors: Ammanuel; Simon, Burkett, Daniel, Kim, Jason J., Bond, Evalina S., Hanna, Amgad S.
  Pages: e21 - e26
  Abstract: Background Multiple nerve transfer techniques are used to treat patients with nerve injuries when a primary repair is not possible. These techniques are categorized to end-to-end, end-to-side, and side-to-side neurorrhaphy. Our study aims to explore the utility of the cross-bridge ladder technique (H-shaped), which has shown promising results in animal models and probably underutilized clinically. Methods Four patients with significant loss of ankle dorsiflexion were seen in the clinic and underwent evaluation, including electrodiagnostic studies. A cross-bridge ladder repair technique was used between the tibial nerve as the donor and the common peroneal nerve as the recipient via one or two nerve grafts coapted in parallel with end-to-side neurorrhaphies. Dorsiflexion strength was measured preoperatively using the Medical Research Council (MRC) grading system and at each postoperative follow-up appointment. Results All four patients had suffered persistent and severe foot drop (MRC of 0) following trauma that had occurred between 6 and 15 months preoperatively. Three of the four patients improved to an MRC of 2 several months postoperatively. The last patient had an immediate improvement to an MRC of 2 by his first month and had a complete recovery of ankle dorsiflexion within 4 months from surgery. Conclusion We demonstrate the utility and clinical outcomes of the cross-bridge ladder technique in patients with persistent and prolonged foot drop following trauma. Both early and late recovery were seen while all patients regained motor function, with some patients continuing to improve up to the most recent follow-up.IRB Approval: Obtained 2013–1411-CP005
  Citation: J Brachial Plex Peripher Nerve Inj 2023; 18: e21-e26
  PubDate: 2023-05-23T15:26:28+01:00
  DOI: 10.1055/s-0043-1768996
  Issue No: Vol. 18, No. 01 (2023)
Patient-Reported Outcomes and Provocative Testing in Peripheral Nerve
Injury and Recovery
- Authors: John; Albin, Rossettie, Stephen, Rafael, John, Cox, Cameron T., Ducic, Ivica, Mackay, Brendan J.
  Pages: e10 - e20
  Abstract: Background Peripheral nerve function is often difficult to assess given the highly variable presentation and subjective patient experience of nerve injury. If nerve assessment is incomplete or inaccurate, inappropriate diagnosis and subsequent treatment may result in permanent dysfunction. Objective As our understanding of nerve repair and generation evolves, so have tools for evaluating peripheral nerve function, recovery, and nerve-related impact on the quality of life. Provocative testing is often used in the clinic to identify peripheral nerve dysfunction. Patient-reported outcome forms provide insights regarding the effect of nerve dysfunction on daily activities and quality of life. Methods We performed a review of the literature using a comprehensive combination of keywords and search algorithms to determine the clinical utility of different provocative tests and patient-reported outcomes measures in a variety of contexts, both pre- and postoperatively. Results This review may serve as a valuable resource for surgeons determining the appropriate provocative testing tools and patient-reported outcomes forms to monitor nerve function both pre- and postoperatively. Conclusion As treatments for peripheral nerve injury and dysfunction continue to improve, identifying the most appropriate measures of success may ultimately lead to improved patient outcomes.
  Citation: J Brachial Plex Peripher Nerve Inj 2023; 18: e10-e20
  PubDate: 2023-04-21T10:25:30+01:00
  DOI: 10.1055/s-0043-1764352
  Issue No: Vol. 18, No. 01 (2023)
Outcomes of Surgical Treatment of Peripheral Neuromas of the Hand and
Forearm
- Authors: El-Gammal; Yousif Tarek, Cardenas-Mateus, Laura, Tsai, Tsu Min
  Pages: e6 - e9
  Abstract: The choice of a specific technique for surgical treatment of neuromas remains a problem. The purpose of this study is to determine the overall effectiveness of surgery as well as to find out whether certain surgical procedures are more effective than others. Twenty-nine patients operated between 1998 and 2018 and followed for at least 12 months were reviewed. Clinical assessment included the identification of a pre- and postoperative Tinel sign, pain visual analog score, two-point discrimination (2PD), and grip strength. Mechanisms of injury included clean lacerations (11), crush injuries (11), and other trauma or surgery (7). Mean time from presentation to surgery was 9 months. Seven surgical procedures involving excision in 10 patients and excision and nerve repair in 19 patients were performed. Pain score improved from an average of 7.1 ± 2.3 to 1.8 ± 1.7 with 27 patients (93%) reporting mild or no postoperative pain. Nine patients complained of residual scar hypersensitivity and six patients had residual positive Tinel. No patient required an additional surgical procedure. 2PD improved from an average of 9.6 ± 4.0 to 6.8 ± 1.0. The improvement of pain score and 2PD was statistically significant. Nerve repair resulted in marginally better outcomes, in terms of 2PD and grip strength recovery, than excision alone. The mechanism of injury, zone of involvement, time to intervention, or length of follow-up did not have an impact on the outcomes. Although patient numbers in this study are large in comparison to previous studies, larger patient numbers will allow for a multivariate analysis, which can be possible with a prospective multicenter trial.
  Citation: J Brachial Plex Peripher Nerve Inj 2023; 18: e6-e9
  PubDate: 2023-04-05T12:58:03+01:00
  DOI: 10.1055/s-0043-1767673
  Issue No: Vol. 18, No. 01 (2023)
Outcomes after Anterior Interosseous Nerve to Ulnar Motor Nerve Transfer
- Authors: Gross; Jeffrey N., Dawson, Steven E., Wu, Gerald J., Loewenstein, Scott, Borschel, Gregory H., Adkinson, Joshua M.
  Pages: e1 - e5
  Abstract: Background Ulnar nerve lesions proximal to the elbow can result in loss of intrinsic muscle function of the hand. The anterior interosseous nerve (AIN) to deep motor branch of the ulnar nerve (DBUN) transfer has been demonstrated to provide intrinsic muscle reinnervation, thereby preventing clawing and improving pinch and grip strength. The purpose of this study was to evaluate the efficacy of the AIN to DBUN transfer in restoring intrinsic muscle function for patients with traumatic ulnar nerve lesions. Methods We performed a prospective, multi-institutional study of outcomes following AIN to DBUN transfer for high ulnar nerve injuries. Twelve patients were identified, nine of which were enrolled in the study. The mean time from injury to surgery was 15 weeks. Results At final follow-up (mean postoperative follow-up 18 months + 15.5), clawing was observed in all nine patients with metacarpophalangeal joint hyperextension of the ring finger averaging 8.9 degrees (+ 10.8) and small finger averaging 14.6 degrees (+ 12.5). Grip strength of the affected hand was 27% of the unaffected extremity. Pinch strength of the affected hand was 29% of the unaffected extremity. None of our patients experienced claw prevention after either end-to-end (n = 4) or end-to-side (n = 5) AIN to DBUN transfer. Conclusion We conclude that, in traumatic high ulnar nerve injuries, the AIN to DBUN transfer does not provide adequate intrinsic muscle reinnervation to prevent clawing and normalize grip and pinch strength.
  Citation: J Brachial Plex Peripher Nerve Inj 2023; 18: e1-e5
  PubDate: 2023-01-11T13:20:30+0100
  DOI: 10.1055/s-0042-1760097
  Issue No: Vol. 18, No. 01 (2023)
Bilateral Thoracic Outlet Syndrome from Anomalous 8th Cervical Vertebrae
Ribs
- Authors: Ferris; Scott, Lonie, Sarah
  Pages: e30 - e32
  Abstract: Thoracic outlet syndrome (TOS) is a group of diverse disorders resulting from compression of neurovascular structures as they pass from the lower neck to upper limb. Neurological symptoms, such as pain, weakness, or paraesthesia, are much more common than vascular symptoms such as pallor or venous congestion. Anatomical abnormalities can contribute to this condition. Thirty percent of patients with TOS can have a cervical rib, arising from the transverse process of the 7th cervical vertebra, compared with 1% of the general population. We report the first case in the literature of neurogenic TOS from a cervical rib arising from a supernumerary 8th cervical vertebra. This patient had immediate improvement in TOS symptoms following scalene muscle surgery and resection of cervical and first thoracic ribs.
  Citation: J Brachial Plex Peripher Nerve Inj 2022; 17: e30-e32
  PubDate: 2022-07-18T09:09:14+01:00
  DOI: 10.1055/s-0042-1753541
  Issue No: Vol. 17, No. 01 (2022)
A Rabbit Model for Peripheral Nerve Reconstruction Studies Avoiding
Automutilation Behavior
- Authors: Sorkin; Jonathan A., Rechany, Ziv, Almog, Mara, Dietzmeyer, Nina, Shapira, Yuval, Haastert-Talini, Kirsten, Rochkind, Shimon
  Pages: e22 - e29
  Abstract: Background The rabbit sciatic nerve injury model may represent a valuable alternative for critical gap distance seen in humans but often leads to automutilation. In this study, we modified the complete sciatic nerve injury model for avoiding autophagy. Materials and Methods In 20 adult female New Zealand White rabbits, instead of transecting the complete sciatic nerve, we unilaterally transected the tibial portion and preserved the peroneal portion. Thereby loss of sensation in the dorsal aspect of the paw was avoided. The tibial portion was repaired in a reversed autograft approach in a length of 2.6 cm. In an alternative repair approach, a gap of 2.6 cm in length was repaired with a chitosan-based nerve guide. Results During the 6-month follow-up period, there were no incidents of autotomy. Nerve regeneration of the tibial portion of the sciatic nerve was evaluated histologically and morphometrically. A clear difference between the distal segments of the healthy contralateral and the repaired tibial portion of the sciatic nerve was detectable, validating the model. Conclusion By transecting the isolated tibial portion of the rabbit sciatic nerve and leaving the peroneal portion intact, it was possible to eliminate automutilation behavior.
  Citation: J Brachial Plex Peripher Nerve Inj 2022; 17: e22-e29
  PubDate: 2022-06-21T08:03:04+01:00
  DOI: 10.1055/s-0042-1747959
  Issue No: Vol. 17, No. 01 (2022)
Follistatin Protein Enhances Satellite Cell Counts in Reinnervated Muscle
- Authors: Feger; Mark A., Isaacs, Jonathan, Mallu, Satya, Yager, Dorne, Shall, Mary, Patel, Gaurangkumar, Protzuk, Omar, Bokkisam, Akhil S.
  Pages: e12 - e21
  Abstract: Background Muscle recovery following peripheral nerve repair is sup-optimal. Follistatin (FST), a potent muscle stimulant, enhances muscle size and satellite cell counts following reinnervation when administered as recombinant FST DNA via viral vectors. Local administration of recombinant FST protein, if effective, would be more clinically translatable but has yet to be investigated following muscle reinnervation. Objective The aim of this study is to assess the effect of direct delivery of recombinant FST protein on muscle recovery following muscle reinnervation. Materials and Methods In total, 72 Sprague-Dawley rats underwent temporary (3 or 6 months) denervation or sham denervation. After reinnervation, rats received FST protein (isoform FS-288) or sham treatment via a subcutaneous osmotic pump delivery system. Outcome measures included muscle force, muscle histomorphology, and FST protein quantification. Results Follistatin treatment resulted in smaller muscles after 3 months denervation (p = 0.019) and reduced force after 3 months sham denervation (p
  Citation: J Brachial Plex Peripher Nerve Inj 2022; 17: e12-e21
  PubDate: 2022-06-21T08:00:05+01:00
  DOI: 10.1055/s-0042-1748535
  Issue No: Vol. 17, No. 01 (2022)
Commentary to “Morphometry and Contents of the Suprascapular Notch with
Potential Clinical Implications: A Cadaveric Study”
- J Brachial Plex Peripher Nerve Inj 2022; 17: e10-e11
  DOI: 10.1055/s-0042-1747960
  
  Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
  
  Artikel in Thieme eJournals:
  Inhaltsverzeichnis open access Volltext
  J Brachial Plex Peripher Nerve Inj 2022; 17: e10-e112022-06-20T06:00:14+01:00
  Issue No: Vol. 17, No. 01 (2022)
Effects of Prestretch on Neonatal Peripheral Nerve: An In Vitro Study
- Authors: Singh; Anita, Majmudar, Tanmay, Magee, Rachel, Gonik, Bernard, Balasubramanian, Sriram
  Pages: e1 - e9
  Abstract: Background Characterizing the biomechanical failure responses of neonatal peripheral nerves is critical in understanding stretch-related peripheral nerve injury mechanisms in neonates. Objective This in vitro study investigated the effects of prestretch magnitude and duration on the biomechanical failure behavior of neonatal piglet brachial plexus (BP) and tibial nerves. Methods BP and tibial nerves from 32 neonatal piglets were harvested and prestretched to 0, 10, or 20% strain for 90 or 300 seconds. These prestretched samples were then subjected to tensile loading until failure. Failure stress and strain were calculated from the obtained load-displacement data. Results Prestretch magnitude significantly affected failure stress but not the failure strain. BP nerves prestretched to 10 or 20% strain, exhibiting significantly lower failure stress than those prestretched to 0% strain for both prestretch durations (90 and 300 seconds). Likewise, tibial nerves prestretched to 10 or 20% strain for 300 seconds, exhibiting significantly lower failure stress than the 0% prestretch group. An effect of prestretch duration on failure stress was also observed in the BP nerves when subjected to 20% prestretch strain such that the failure stress was significantly lower for 300 seconds group than 90 seconds group. No significant differences in the failure strains were observed. When comparing BP and tibial nerve failure responses, significantly higher failure stress was reported in tibial nerve prestretched to 20% strain for 300 seconds than BP nerve. Conclusion These data suggest that neonatal peripheral nerves exhibit lower injury thresholds with increasing prestretch magnitude and duration while exhibiting regional differences.
  Citation: J Brachial Plex Peripher Nerve Inj 2022; 17: e1-e9
  PubDate: 2022-04-08T00:00:00+01:00
  DOI: 10.1055/s-0042-1743132
  Issue No: Vol. 17, No. 01 (2022)