MyMedR

Fulltext A baby with an abnormal upper limb

Keah SH

Malays Fam Physician, 2008;3(2):108.

PMID: 25606130

Matched MeSH terms: Brachial Plexus Neuropathies

Fulltext [Faster onset time of supraclavicular brachial plexus block using local anesthetic diluted with dextrose]

Lim HJ, Hasan MS, Chinna K

Rev Bras Anestesiol, 2016 Jul-Aug;66(4):341-5.

PMID: 27155777 DOI: 10.1016/j.bjan.2016.04.006

A high sodium concentration is known to antagonize local anesthetics when infiltrated around neural tissue. Thus, we hypothesized that the onset time for sensory and motor blockade, in supraclavicular brachial plexus block using ropivacaine diluted with dextrose would be shorter than with saline.

Matched MeSH terms: Brachial Plexus Block

Fulltext Shoulder arthrodesis in brachial plexus injuries--a review of six cases

Wong ELW, Kwan MK, Loh WYC, Ahmad TS

Med J Malaysia, 2005 Jul;60 Suppl C:72-7.

PMID: 16381288

Shoulder arthrodesis is a secondary reconstructive option for patients with brachial plexus injuries requiring a stable shoulder. This study was undertaken to evaluate the clinical and radiological outcomes of shoulder fusion in six patients with flail upper limbs following complete brachial plexus injuries. The shoulder was fused in 30 degrees abduction, 30 degrees internal rotation and 30 degrees flexion via a direct lateral approach by using a 4.5 mm reconstruction plate without bone grafting. The average follow-up was 10.3 months. Radiological union was obtained in all patients. Five patients (83%) had relief of pain after the shoulder fusion. Improvement of function was observed in all patients with a mean improvement of 56.6 degrees (range 30 degrees-75 degrees) and 47.5 degrees (range 30 degrees-60 degrees) active flexion and abduction respectively. One patient developed humeral fracture distal to the plate and the fracture eventually healed with a splint. Successful stable fusion of the shoulder in patients with brachial plexus injuries requires rigid fixation with a single 4.5 mm reconstruction plate, protection of bone healing with a triangular abduction brace for 12 weeks and functional trapezius, levator scapulae, serratus anterior and rhomboid muscles for optimizing the functional result.

Matched MeSH terms: Brachial Plexus/injuries*

Neuromuscular ultrasound standardized scanning techniques and protocols: Expert panel recommendations

Tawfik EA, Cartwright MS, van Alfen N, Axer H, Boon AJ, Crump N, et al.

Muscle Nerve, 2023 Oct;68(4):375-379.

PMID: 37074101 DOI: 10.1002/mus.27830

Neuromuscular ultrasound has become an integral part of the diagnostic workup of neuromuscular disorders at many centers. Despite its growing utility, uniform standard scanning techniques do not currently exist. Scanning approaches for similar diseases vary in the literature creating heterogeneity in the studies as reported in several meta-analysis. Moreover, neuromuscular ultrasound experts including the group in this study have different views with regards to technical aspects, scanning protocols, and the parameters that should be assessed. Establishing standardized neuromuscular scanning protocols is essential for the development of the subspeciality to ensure uniform clinical and research practices. Therefore, we aimed to recommend consensus-based standardized scanning techniques and protocols for common neuromuscular disorders using the Delphi approach. A panel of 17 experts participated in the study, which consisted of three consecutive electronic surveys. The first survey included voting on six scanning protocols addressing the general scanning technique and five common categories of suspected neuromuscular disorders. The subsequent surveys focused on refining the protocols and voting on new steps, rephrased statements, or areas of non-agreement. A high degree of consensus was achieved on the general neuromuscular ultrasound scanning technique and the scanning protocols for focal mononeuropathies, brachial plexopathies, polyneuropathies, amyotophic lateral sclerosis, and muscle diseases. In this study, a group of neuromuscular ultrasound experts developed six consensus-based neuromuscular ultrasound scanning protocols that may serve as references for clinicians and researchers. The standardized protocols could also aid in achieving high-quality uniform neuromuscular ultrasound practices.

Matched MeSH terms: Brachial Plexus Neuropathies*

Photobiomodulation After Neurotization (Oberlin Procedure) in Brachial Plexus Injury: A Randomized Control Trial

Foo YH, Tunku Ahmad Yahaya TS, Chung TY, Silvanathan JP

Photobiomodul Photomed Laser Surg, 2020 Apr;38(4):215-221.

PMID: 32301668 DOI: 10.1089/photob.2019.4757

Objective:
To investigate effect of photobiomodulation (PBM) on nerve regeneration after neurotization with the Oberlin Procedure (ulnar fascicle to motor branch to biceps) to restore elbow flexion in patients with brachial plexus injury.
Materials and methods:
This prospective randomized controlled trial was conducted with 14 patients with high brachial plexus injury who underwent neurotization with the Oberlin Procedure to restore elbow flexion. The patients were randomly allocated to two groups of equal numbers: control group and PBM group. In this study, the PBM used has a wavelength of 808 nm, 50 mW power, continuous mode emission, 4 J/cm2 dosimetry, administered daily for 10 consecutive days, with an interval of 2 days (weekends). The outcome of surgery was assessed after 1, 2, 3, and 6 months. The nonparametric Mann-Whitney U-test and chi-square test were utilized to compare the results between both groups.
Results:
After 3 months postoperatively, more patients in the PBM group had demonstrated signs of reinnervation and the mean muscle power was significantly higher in the PBM group. No adverse effects resulted from the administration of PBM.
Conclusions:
PBM is a treatment modality that can improve nerve regeneration after neurotization with the Oberlin Procedure.

Matched MeSH terms: Brachial Plexus/injuries*; Brachial Plexus Neuropathies/therapy*

Fulltext Complete Brachial Plexus Injury - An Amputation Dilemma. A Case Report

Choong C, Shalimar A, Jamari S

Malays Orthop J, 2015 Nov;9(3):52-54.

PMID: 28611911 MyJurnal DOI: 10.5704/MOJ.1511.017

Brachial plexus injuries with intact yet flail limb presents with problems of persistent neuropathic pain and recurrent shoulder dislocations, that render the flail limb a damn nuisance. As treating surgeons, we are faced with the dilemma of offering treatment options, bearing in mind the patient's functional status and expectations. We present a case of a 55-year old housewife with complete brachial plexus injury begging for surgical amputation of her flail limb, 6 years post-injury. Here we discuss the outcome of transhumeral amputation and the possibility of offering early rather than delayed amputations in this group of patients.

Matched MeSH terms: Brachial Plexus

Ultrasound-Guided Retroclavicular Block (aka Posterior Approach Infraclavicular Block): Anatomical Variation of the Clavicle Limits Block Feasibility

Beh ZY, Hasan MS, Lai HY

Reg Anesth Pain Med, 2016 8 23;41(5):658-9.

PMID: 27547909 DOI: 10.1097/AAP.0000000000000456

Matched MeSH terms: Brachial Plexus

Fulltext End-to-side nerve transfer in neuropathic pain post brachial plexus injury

Nur Dina, A., Shalimar, A.

JUMMEC, 2013;21(2):71-73.

MyJurnal

We report a case of a 59-year-old gentleman with complete left brachial plexus injury. He presented with
chronic pain over the dorsum of his left hand since the injury eight years ago. Medical treatment had been
optimised but the pain still persist. End-to-side nerve transfer was done involving superficial sensory radial
nerve and median nerve to alleviate the pain. The surgery was considered successful as the patient claimed
that the pain score had reduced a few weeks postoperatively. However, there was no sensory recovery and
functionally no improvement was observed.

Matched MeSH terms: Brachial Plexus

Fulltext Unusual variations of the lateral and posterior cords in a female cadaver

Thwin SS, Zaini F, Than M, Lwin S, Myint M

Singapore Med J, 2012 Jun;53(6):e128-30.

PMID: 22711051

The presence of anatomical variations of the peripheral nervous system often accounts for unexpected clinical signs and symptoms. We report unusual variations of the lateral and posterior cords of the brachial plexus in a female cadaver. Such variations are attributed to a faulty union of divisions of the brachial plexus during the embryonic period. The median nerve lay medial to the axillary artery (AA) on both sides. On the right, the lateral root of the median nerve crossing the AA and the median nerve in relation to the medial side of the AA was likely the result of a faulty development of the seventh intersegmental artery. We discuss these variations and compare them with the findings of other researchers. Knowledge of such rare variations is clinically important, aiding radiologists, anaesthesiologists and surgeons to avoid inadvertent damage to nerves and the AA during blocks and surgical interventions.

Matched MeSH terms: Brachial Plexus/abnormalities*; Brachial Plexus/anatomy & histology*

Fulltext A case report of an unusual complication from bee sting: acute brachial plexopathy

Kee HF, Hasan S, Wan Aliaa WS, Basri HB

Pak J Med Sci, 2014 Mar;30(2):455-6.

PMID: 24772163

Brachial plexopathy is usually related to trauma like direct injury to the nerve and stretching injuries. Neurological complications following bee sting are uncommon. Here, we describe a rare case of acute brachial plexopathy as a neurological complication following bee sting. A23-year-old maleinitially presented with angioedema and anaphylactic shock one hour after a bee stung at his neck. Twenty four hours after the incidence, he presented with sudden onset of left upper limb weakness. Nerve conduction study and electromyography had shown evidence of left brachial plexopathy.

Matched MeSH terms: Brachial Plexus Neuropathies

Fulltext Percutaneous t2 and t3 radiofrequency sympathectomy for complex regional pain syndrome secondary to brachial plexus injury: a case series

Chen CK, Phui VE, Nizar AJ, Yeo SN

Korean J Pain, 2013 Oct;26(4):401-5.

PMID: 24156009 DOI: 10.3344/kjp.2013.26.4.401

Complex regional pain syndrome secondary to brachial plexus injury is often severe, debilitating and difficult to manage. Percuteneous radiofrequency sympathectomy is a relatively new technique, which has shown promising results in various chronic pain disorders. We present four consecutive patients with complex regional pain syndrome secondary to brachial plexus injury for more than 6 months duration, who had undergone percutaneous T2 and T3 radiofrequency sympathectomy after a diagnostic block. All four patients experienced minimal pain relief with conservative treatment and stellate ganglion blockade. An acceptable 6 month pain relief was achieved in all 4 patients where pain score remained less than 50% than that of initial score and all oral analgesics were able to be tapered down. There were no complications attributed to this procedure were reported. From this case series, percutaneous T2 and T3 radiofrequency sympathectomy might play a significant role in multi-modal approach of CRPS management.

Matched MeSH terms: Brachial Plexus

Fulltext Modified pectoralis major tendon transfer for reanimation of elbow flexion as a salvage procedure in complete brachial plexus injury: a case report

Taran S, Nawfar S

Malays Orthop J, 2013 Mar;7(1):79-81.

PMID: 25722813 MyJurnal DOI: 10.5704/MOJ.1303.004

Traumatic brachial plexus injuries rarely recover spontaneously and if the window period for neurotisation has elapsed, the only option for restoration of function lies in a salvage procedure. Many such salvage procedures have been described in the literature with variable functional results. We report the case of a 16-year-old boy who presented after unsuccessful treatment for a complete brachial plexus injury; we performed a pectoralis major tendon transfer to attain elbow flexion. Postoperatively, the elbow was splinted with flexion at 100°. After 4 weeks of immobilization the splint was removed and the patient could actively flex his elbow from 30° to 100°.

Matched MeSH terms: Brachial Plexus

Fulltext Risk of Axillary Nerve Injury in Standard Anterolateral Approach of Shoulder: Cadaveric Study

Kongcharoensombat W, Wattananon P

Malays Orthop J, 2018 Nov;12(3):1-5.

PMID: 30555639 DOI: 10.5704/MOJ.1811.001

Introduction: The anterolateral acromion approach of the shoulder is popular for minimally invasive plate osteosynthesis (MIPO) technique. However, there are literatures describing the specific risks of injury of the axillary nerve using this approach. Nevertheless, most of the studies were done with Caucasian cadavers. So, the purpose of this study was to evaluate the risk of iatrogenic axillary nerve injury from using the anterolateral shoulder approach and further investigate the location of the axillary nerve, associated with its location and arm length in the Asian population that have shorter arm length compared to the Caucasian population. Materials and Methods: Seventy-nine shoulders in fourty-two embalmed cadavers were evaluated. The bony landmarks were drawn, and a vertical straight incision was made 5cm from tip of the acromion (anterolateral approach), to the bone. The iatrogenic nerve injury status and the distance between the anterolateral edge of the acromion to the axillary nerve was measured and recorded. Results: In ten of the seventy-nine shoulders, the axillary nerve were iatrogenically injured. The average anterior distance was 6.4cm and the average arm length was 30.2cm. The anterior distance and arm length ratio was 0.2. Conclusion: Our results demonstrated that the recommended safe zone at 5cm from tip of acromion was not suitable with Asian population due to shorter arm length, compared to Caucasian population. The location of axillary nerve could be predicted by 20% of the total arm-length.

Matched MeSH terms: Brachial Plexus

Fulltext Arthroscopic mumford procedure utilizing the anteromedial and neviaser portals – a pilot cadaveric study on neurovascular structures at risk

Nasir Mohd Nizlan, Azfar Rizal Ahmad, Hisham Abdul Rashid, Paisal Hussin, Che Hamzah Fahrudin, Abdullah Arifaizad, et al.

Malaysian Journal of Medicine and Health Sciences, 2016;12(2):16-20.

MyJurnal

Introduction: Degenerative disorder involving the acromioclavicular
joint (ACJ) is quite common especially in the elderly.
One of the surgical modalities of treatment of this disorder is the
Mumford Procedure. Arthroscopic approach is preferred due to
its reduced morbidity and faster post-operative recovery. One
method utilizes the anteromedial and Neviaser portals, which
allow direct and better visualization of the ACJ from the
subacromial space. However, the dangers that may arise from
incision and insertion of instruments through these portals are
not fully understood. This cadaveric study was carried out to
investigate the dangers that can arise from utilization of these
portals and which structures are at risk during this procedure.
Methods: Arthroscopic Mumford procedures were performed
on 5 cadaver shoulders by a single surgeon utilizing the
anteromedial and Neviaser portals. After marking each portals
with methylene blue, dissection of nearby structures were
carried out immediately after each procedure was completed.
Important structures (subclavian artery as well as brachial plexus
and its branches) were identified and the nearest measurements
were made from each portal edges to these structures. Results:
The anteromedial portal was noted to be closest to the
suprascapular nerve (SSN) at 2.91 cm, while the Neviaser portal
was noted to be closest also to the SSN at 1.60 cm. The
suprascapular nerve was the structure most at risk during the
Mumford procedure. The anteromedial portal was noted to be
the most risky portal to utilize compared to the Neviaser portal.
Conclusion: Extra precaution needs to be given to the
anteromedial portal while performing an arthroscopic distal
clavicle resection in view of the risk of injuring the
suprascapular nerve of the affected limb.

Matched MeSH terms: Brachial Plexus

Fulltext Posterior parasagittal in-plane ultrasound-guided infraclavicular brachial plexus block-a case series

Beh ZY, Hasan MS, Lai HY, Kassim NM, Md Zin SR, Chin KF

BMC Anesthesiol, 2015;15:105.

PMID: 26194896 DOI: 10.1186/s12871-015-0090-0

The brachial plexus at the infraclavicular level runs deeper compared to its course proximally, giving rise to impaired needle visualisation due to the steep angle of needle insertion with the current ultrasound-guided approach. A new posterior parasagittal in-plane ultrasound-guided infraclavicular approach was introduced to improve needle visibility. However no further follow up study was done.

Matched MeSH terms: Brachial Plexus Block/methods*

Fulltext Continuous brachial plexus block--regional anaesthesia for reimplantation surgery of the hand: a preliminary study

Sivarajah RS, Keh SA, Ong G, Teo WS, Delilkan AE

Med J Malaysia, 1984 Jun;39(2):112-5.

PMID: 6513849

Continuous brachial plexus block in six patients undergoing reimplantation of severed fingers or hand is described. The technique involved placement of a catheter within the neurovascular sheath enclosing the brachial plexus. This enabled us to give the local anaesthetic as required to last the whole duration of surgery.

Matched MeSH terms: Brachial Plexus/drug effects*

Brachial plexus injuries in Malaysian neonates: incidence and associated risk factors

Boo NY, Lye MS, Kanchanamala M, Ching CL

J Trop Pediatr, 1991 12;37(6):327-30.

PMID: 1791654 DOI: 10.1093/tropej/37.6.327

A prospective study was carried out on 26,176 Malaysian neonates born in the Maternity Hospital, Kuala Lumpur over a 12-month period to determine the incidence and associated risk factors of brachial plexus injuries. This condition was found in 42/26,176 neonates (1.6 per 1000 livebirths). Multiple logistic regression analysis of affected and control neonates from a nested case-control study showed that increasing birth weights and breech deliveries were the significant risk factors. Our study suggests that to reduce the occurrence of this condition, there is a need for: (i) better assessment of fetal size and maternal pelvimetry to enable earlier diagnosis of cephalo-pelvic disproportion, and (ii) review of the indications and techniques of breech delivery.

Matched MeSH terms: Brachial Plexus/injuries*

A Comparative Study of Two Modalities in Pain Management of Patients Presenting with Chronic Brachial Neuralgia

Razak I, Chung TY, Ahmad TS

J Altern Complement Med, 2019 Aug;25(8):861-867.

PMID: 31211607 DOI: 10.1089/acm.2019.0052

Objectives:
The study aims to assess, evaluate, and compare the efficacy of acupressure and hypnotherapy in the management of pain in patients presenting with chronic brachial neuralgia (CBN).
Design:
Randomized controlled trial.
Settings/location:
Department of Orthopaedic Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
Subjects:
Forty patients with CBN following traumatic brachial plexus injury from 2012 to 2017.
Intervention:
Therapy for a duration of 1 month in two groups; subjects in the hypnotherapy group received a weekly session of clinical hypnotherapy (total of four times) using a standardized protocol, while subjects in the acupressure group were guided by an acupuncturist during the initial session, received 2 month take home supply of acupressure patches, and were reviewed fortnightly.
Outcome measures:
The Visual Analog Scale, the Brief Pain Inventory, and the SF-36v2® Health Survey were recorded at different time points; 1 month pretreatment (week 0), pretreatment (week 4), post-treatment (week 8), and 4 months post-treatment (week 20).
Results:
There was a statistically significant improvement in the average pain intensity from pretreatment to post-treatment score in both groups. The pain intensity increased 4 months later; however, the pain intensity was still significantly reduced in comparison with pretreatment scores. The study suggests that both treatment outcomes are effective in terms of alleviating pain and improving quality of life in subjects with CBN, to a different degree.
Conclusion:
Overall, both therapies were able to improve the pain intensity and quality of life significantly during the treatment period. Hypnotherapy was observed to have a better carryover effect compared to acupressure, especially in terms of improving quality of life and the mental component score.

Matched MeSH terms: Brachial Plexus Neuritis/therapy*

Fulltext Axillary Artery Injury with Intact Radial Pulse following Fracture-Dislocation of Shoulder: A Case Report

Rajeev A, Timmons G

Malays Orthop J, 2019 Nov;13(3):66-68.

PMID: 31890113 DOI: 10.5704/MOJ.1911.011

The occurrence of axillary artery injury following proximal humerus fracture dislocation in elderly patient with low velocity fall is uncommon. The patient could have diverse clinical presentations in spite of intact peripheral pulses. We report the case of an 85-year-old lady who presented to our emergency department with greater tuberosity fracture of the humerus with dislocation of the right shoulder. After closed manipulative reduction of the dislocation, it was observed that the patient had brachial plexus palsy with intact radial pulse. An expanding swelling and bruise around the shoulder was noted and a steady drop in haemoglobin level. CT angiogram revealed avulsion of the posterior circumflex artery which was then treated successfully with stenting.

Matched MeSH terms: Brachial Plexus; Brachial Plexus Neuropathies

Ultrasound-guided costoclavicular approach infraclavicular brachial plexus block for vascular access surgery

Beh ZY, Hasan MS

J Vasc Access, 2017 Sep 11;18(5):e57-e61.

PMID: 28478621 DOI: 10.5301/jva.5000720

INTRODUCTION: We report the use of a newly described regional technique, ultrasound-guided costoclavicular approach infraclavicular brachial plexus block for surgical anesthesia in two high-risk patients undergoing 2nd stage transposition of basilic vein fistula.

METHODS: Both patients had features of difficult airway, American Society of Anesthesiologists (ASA) physical status class III and central venous occlusive disease. The common approach, i.e., ultrasound-guided supraclavicular brachial plexus block was technically difficult with inherent risk of vascular puncture due to dilated venous collaterals at the supraclavicular area possibly compromising block quality. The risk of general anesthesia (GA) was significant as patients were morbidly obese with possible risk of obstructive sleep apnea postoperatively. As an alternative, we performed the ultrasound-guided costoclavicular approach infraclavicular brachial plexus block with 20 mL local anesthetic (LA) ropivacaine 0.5% delivered at the identified costoclavicular space using in-plane needling technique. Another 10 mL of LA was infiltrated along the subcutaneous fascia of the proximal medial aspect of arm.

RESULTS: Both surgeries of >2 hours' duration were successful, without the need of further local infiltration at surgical site or conversion to GA.

CONCLUSIONS: Ultrasound-guided costoclavicular approach can be an alternative way of providing effective analgesia and safe anesthesia for vascular access surgery of the upper limb.

Matched MeSH terms: Brachial Plexus/drug effects*; Brachial Plexus Block/adverse effects; Brachial Plexus Block/methods*

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