3D Computerized Model for Measuring Strain and Displacement of the Brachial Plexus Following Placement of Reverse Shoulder Prosthesis

Hoof, Tom Van; Gomes, Germano; Audenaert, Emmanuel; Verstraete, Koenraad; Kerckaert, Ingrid; D’Herde, Katharina

doi:10.1002/ar.20735

Cited by 63 publications

(39 citation statements)

References 47 publications

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“…The fourth lumbar (L4) nerve roots were exposed bilaterally via posterior dissection (laminectomy and facetectomy) from L3 to L5. After dissection and clear visualisation of the L4 root, 0.2 cc of dye solution (2:1 human plasma: 1% Toluidine Blue Stock Solution) 34 was injected into the L4 nerve root just proximal to the dorsal root ganglion expansion. This injection was administered via a syringe (1 cc) and a 0.45 × 23 mm needle at a location just deep to the epineurium.…”

Section: Dissection and Specimensmentioning

confidence: 99%

Effects of lower limb neurodynamic mobilization on intraneural fluid dispersion of the fourth lumbar nerve root: an unembalmed cadaveric investigation

Gilbert

Smith

Sobczak

et al. 2015

Journal of Manual & Manipulative Therapy

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Objectives: Manual and physical therapists incorporate neurodynamic mobilisation (NDM) to improve function and decrease pain. Little is known about the mechanisms by which these interventions affect neural tissue. The objective of this research was to assess the effects of repetitive straight leg raise (SLR) NDM on the fluid dynamics within the fourth lumbar nerve root in unembalmed cadavers. Methods: A biomimetic solution (Toluidine Blue Stock 1% and Plasma) was injected intraneurally, deep to the epineurium, into the L4 nerve roots of seven unembalmed cadavers. The initial dye spread was allowed to stabilise and measured with a digital calliper. Once the initial longitudinal dye spread stabilised, an intervention strategy (repetitive SLR) was applied incorporating NDMs (stretch/relax cycles) at a rate of 30 repetitions per minute for 5 minutes. Post-intervention calliper measurements of the longitudinal dye spread were measured. Results: The mean experimental posttest longitudinal dye spread measurement (1.1 ± 0.9 mm) was significantly greater (P = 0.02) than the initial stabilised pretest longitudinal dye spread measurement. Increases ranged from 0.0 to 2.6 mm and represented an average of 7.9% and up to an 18.1% increase in longitudinal dye spread. Discussion: Passive NDM in the form of repetitive SLR induced a significant increase in longitudinal fluid dispersion in the L4 nerve root of human cadaveric specimen. Lower limb NDM may be beneficial in promoting nerve function by limiting or altering intraneural fluid accumulation within the nerve root, thus preventing the adverse effects of intraneural oedema.

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Section: Dissection and Specimensmentioning

confidence: 99%

Effects of lower limb neurodynamic mobilization on intraneural fluid dispersion of the fourth lumbar nerve root: an unembalmed cadaveric investigation

Gilbert

Smith

Sobczak

et al. 2015

Journal of Manual & Manipulative Therapy

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“…Biomechanically, the Grammont-type reverse total shoulder arthroplasty lengthens the arm by an average of 2 to 3 cm, 4) and therefore can put strain on the brachial plexus. Van Hoof et al 9) reported the degree of strain placed on elements of the brachial plexus using 3-dimensional computer modeling in the reverse total shoulder arthroplasty. Their model calculated direct prosthesis-related strains as up to 19.3% for some components of the brachial plexus.…”

Section: Discussionmentioning

confidence: 99%

Isolated Musculocutaneous Nerve Palsy after the Reverse Total Shoulder Arthroplasty

Kim¹,

Choi²

2016

Clinics in Shoulder and Elbow

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Reverse total shoulder arthroplasty has been performed with promising results in rotator cuff tear arthropathy. However, the global complication of the reverse total shoulder arthroplasty is relatively higher than that of the conventional total shoulder arthroplasty. Neurologic complications after reverse total shoulder arthroplasty are rare but there are sometimes remaining sequelae. The cause of the neurologic complication is multifactorial, including arm traction, position and the design of the implant. Most cases of neurologic palsy following reverse total shoulder arthroplasty occur in the axillary nerve and the radial nerve. The authors report on a case of a 71-year-old man with isolated musculocutaneous nerve palsy after reveres total shoulder arthroplasty with related literature. Reverse total shoulder arthroplasty can produce good results in patients with an arthritic rotator cuff deficient shoulder. However, in a recent systemic review on reverse total shoulder arthroplasty, the global complication rate was reported relatively high as much as 24%.1) Neurologic complications following reverse total shoulder arthroplasty are rare but there are sometimes remaining sequelae. 1,2) Most cases of neurologic palsy after reverse total shoulder arthroplasty occur in the axillary nerve and the radial nerve.1) The author reported a case of a 71-year-old man with isolated musculocutaneous nerve (MCN) palsy after reveres total shoulder arthroplasty for rotator cuff tear arthropathy with related literature. Case ReportA 71-year-old man presented with a chief complaint of the right shoulder pain for 2 years. He reported no antecedent trauma or neurologic symptoms and his previous clinical history was unremarkable. Pain was exacerbated with attempted overhead activities. On physical examination, the active forward elevation of the right shoulder, the passive forward elevation, the internal rotation, and the external rotation at arm at side were 70°, 120°, buttock, and 30°, respectively. Preoperative radiographic demonstrated the cuff arthropathic change of the shoulder with Hamada grade 3, defined as erosion and so-called acetabulization of acromion with narrowing of the subacromial space to ≤5 mm (Fig. 1A).3) The pa tient was diagnosed with rotator cuff tear arthropathy. Despite conservative management for 3 months, the patient complained of sustained symptoms at the right shoulder and underwent re verse total shoulder arthroplasty.The procedure was performed in the beach-chair position under general anesthesia using a standard deltopectoral approach. A chronic and full-thickness subscapularis tear was observed during exposure. A thorough release of the tendon was done to reattach the subscapularis tendon to the lesser tuberosity without tension. Release at the subcoracoid space was done using a finger in order not to damage the brachial plexus.The bone preparation was performed using a routine method. Non-cemented humeral stem type reverse shoulder system (Biomet, Warsaw, IN, USA) was used (Fig. 1B). Final component...

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“…Some studies have estimated an increase in strain between 15 and 20% on the medial and lateral roots of the median nerve with implantation of a reverse prosthesis (Van Hoof et al, 2008). As opposed to plexopathies complicating anatomic replacement, which most likely occur secondary to transient stretching during surgery, the increased tension on the brachial plexus may be more permanent with reverse arthroplasty, although a different rate of spontaneous recovery has not been reported.…”

Section: Complicationsmentioning

confidence: 96%

“…Secure fixation of the glenoid component, the height and orientation of the humeral component, and restoration of an ideal tension on the soft-tissues, and specifically the deltoid, are some of the challenges faced when a reverse shoulder arthroplasty is implanted. Some studies have analyzed the importance of the anatomy of the scapula on fixation of the glenoid component (Humprey et al, 2008;Middernacht et al, 2008), the adverse consequences of central implantation of the glenoid component on notching (Levigne et al, 2008), and the strain on the brachial plexus after implantation of a reverse prosthesis (Van Hoof et al, 2008). However, further research needs to be completed to clarify these and other aspects of the shoulder anatomy as it relates to reverse designs.…”

Section: Introductionmentioning

confidence: 97%

Reverse total shoulder arthroplasty

Sánchez-Sotelo

2008

Clinical Anatomy

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Reverse total shoulder arthroplasty designs have gained popularity over the last few years due to their satisfactory functional results in patients with cuff-tear arthropathy and other difficult reconstructive shoulder problems. These semiconstrained prostheses improve stability and active elevation in the absence of a functional rotator cuff by coupling a spherical glenoid component with a concave humeral component and increasing deltoid tension. Understanding the anatomy of the shoulder is critical in order to ensure secure fixation of the glenoid component, explore uncemented options for humeral component fixation, and determine the ideal soft-tissue tension to provide the best functional outcome without increasing the risk of complications. Key anatomic elements to be considered for the successful implantation of a reverse prosthesis include the orientation and size of the glenoid vault, the scapular regions with better bone stock (coracoid, spine of the scapula), the internal geometry of the humeral medullary canal, and the effects of reverse arthroplasty on the deltoid and brachial plexus.

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3D Computerized Model for Measuring Strain and Displacement of the Brachial Plexus Following Placement of Reverse Shoulder Prosthesis

Cited by 63 publications

References 47 publications

Effects of lower limb neurodynamic mobilization on intraneural fluid dispersion of the fourth lumbar nerve root: an unembalmed cadaveric investigation

Effects of lower limb neurodynamic mobilization on intraneural fluid dispersion of the fourth lumbar nerve root: an unembalmed cadaveric investigation

Isolated Musculocutaneous Nerve Palsy after the Reverse Total Shoulder Arthroplasty

Reverse total shoulder arthroplasty

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