Direct nerve crossing with the intercostal nerve to treat avulsion injuries of the brachial plexus

Nagano, Akira; Tsuyama, Naoichi; Ochiai, Naoyuki; Hara, Tetsuya; Takahashi, Masataru

doi:10.1016/s0363-5023(89)80047-4

Cited by 186 publications

(85 citation statements)

References 5 publications

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“…Major factors recognized as influencing the outcome of peripheral nerve repair are the degree of injury, the age of the patient, type of nerve, level of injury, and the timing of repair, the last of which is particularly related to our findings. Proximal injuries, such as brachial plexus injuries, show only very limited motor recovery for wrist and finger flexors and none for intrinsic muscles (5,49). Delay in surgery of over 6 months significantly reduces the extent of motor recovery, and it is considered clinically fruitless to expect motor recovery if an operation is delayed for more than a year (50).…”

Section: Discussionmentioning

confidence: 99%

“…However, sensation commonly recovers even though the quality may be defective, pointing to a clear difference in functional sensory and motor recovery. Ninety percent of patients with brachial plexus injury, for example, recover protective sensation in their fingers in the absence of any meaningful recovery in thenar muscles (49). This agrees well with our data, showing substantial sensory but only minimal motor recovery after a SNT injury.…”

Section: Discussionmentioning

confidence: 99%

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Accelerating axonal growth promotes motor recovery after peripheral nerve injury in mice

Eddie¹,

Ômura²,

Cobos³

et al. 2011

J. Clin. Invest.

214

239

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Although peripheral nerves can regenerate after injury, proximal nerve injury in humans results in minimal restoration of motor function. One possible explanation for this is that injury-induced axonal growth is too slow. Heat shock protein 27 (Hsp27) is a regeneration-associated protein that accelerates axonal growth in vitro. Here, we have shown that it can also do this in mice after peripheral nerve injury. While rapid motor and sensory recovery occurred in mice after a sciatic nerve crush injury, there was little return of motor function after sciatic nerve transection, because of the delay in motor axons reaching their target. This was not due to a failure of axonal growth, because injured motor axons eventually fully re-extended into muscles and sensory function returned; rather, it resulted from a lack of motor end plate reinnervation. Tg mice expressing high levels of Hsp27 demonstrated enhanced restoration of motor function after nerve transection/resuture by enabling motor synapse reinnervation, but only within 5 weeks of injury. In humans with peripheral nerve injuries, shorter wait times to decompression surgery led to improved functional recovery, and, while a return of sensation occurred in all patients, motor recovery was limited. Thus, absence of motor recovery after nerve damage may result from a failure of synapse reformation after prolonged denervation rather than a failure of axonal growth.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Accelerating axonal growth promotes motor recovery after peripheral nerve injury in mice

Eddie¹,

Ômura²,

Cobos³

et al. 2011

J. Clin. Invest.

214

239

View full text Add to dashboard Cite

show abstract

“…Such injuries are associated with significant morbidity and psychological stress, all of which result in reduced quality of life. 24 Despite improvements in our understanding of the pathophysiology of nerve injury, repair, and regeneration and improvements in microsurgical techniques, the results of surgery to treat this injury have been far from satisfactory. 16 Gaining insight into the changes in the brain that take place after these events might help us to develop new strategies for improving outcome after management of such injuries.…”

Section: Neurosurg Focus 42 (3):e14 2017mentioning

confidence: 99%

Cortical plasticity after brachial plexus injury and repair: a resting-state functional MRI study

Bhat¹,

Devi²,

Bharti³

et al. 2017

FOC

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OBJECTIVE The authors aimed to understand the alterations of brain resting-state networks (RSNs) in patients with pan–brachial plexus injury (BPI) before and after surgery, which might provide insight into cortical plasticity after peripheral nerve injury and regeneration. METHODS Thirty-five patients with left pan-BPI before surgery, 30 patients after surgery, and 25 healthy controls underwent resting-state functional MRI (rs-fMRI). The 30 postoperative patients were subdivided into 2 groups: 14 patients with improvement in muscle power and 16 patients with no improvement in muscle power after surgery. RSNs were extracted using independent component analysis to evaluate connectivity at a significance level of p < 0.05 (familywise error corrected). RESULTS The patients with BPI had lower connectivity in their sensorimotor network (SMN) and salience network (SN) and greater connectivity in their default mode network (DMN) before surgery than the controls. Connectivity of the left supplementary motor cortex in the SMN and medial frontal gyrus and in the anterior cingulate cortex in the SN increased in patients whose muscle power had improved after surgery, whereas no significant changes were noted in the unimproved patients. There was a trend toward reduction in DMN connectivity in all the patients after surgery compared with that in the preoperative patients; however, this result was not statistically significant. CONCLUSIONS The results of this study highlight the fact that peripheral nerve injury, its management, and successful treatment cause dynamic changes within the brain's RSNs, which includes not only the obvious SMN but also the higher cognitive networks such as the SN and DMN, which indicates brain plasticity and compensatory mechanisms at work.

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“…This experience prompted us to use the operation for the treatment of intractable pain. Intercostal nerve transfers are valuable in restoring deltoid function and elbow flexion and may allow some sensory recovery in the hand, but useful motor recovery cannot be expected when the operation is performed more than one year after injury (Nagano et al 1989). We have performed these transfers at over one year after injury in 19 patients with the sole purpose of the relief of pain.…”

mentioning

confidence: 99%

Pain Relief From Preganglionic Injury to the Brachial Plexus by Late Intercostal Nerve Transfer

Berman

Chen

Taggart

et al. 1996

The Journal of Bone and Joint Surgery. British volume

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Direct nerve crossing with the intercostal nerve to treat avulsion injuries of the brachial plexus

Cited by 186 publications

References 5 publications

Accelerating axonal growth promotes motor recovery after peripheral nerve injury in mice

Accelerating axonal growth promotes motor recovery after peripheral nerve injury in mice

Cortical plasticity after brachial plexus injury and repair: a resting-state functional MRI study

Pain Relief From Preganglionic Injury to the Brachial Plexus by Late Intercostal Nerve Transfer

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