The Prevention and Recognition of Ulnar Nerve and Brachial Plexus Injuries

Duffy, Barbara J.; Tubog, Tito D

doi:10.1016/j.jopan.2016.06.005

Cited by 10 publications

(6 citation statements)

References 30 publications

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“…Repositioning the arm(s) or shoulders resulted in nearly an immediate improvement of SSEP amplitude, and all patients awoke without signs of brachial plexopathy 11, 12, 13. Additionally, there are some other studies describing the problem of positioning on brachial plexopathy during spinal surgeries, as well as the general importance of proper patient positioning 14, 15, 16…”

Section: Discussionmentioning

confidence: 95%

Kyphosis – A risk factor for positioning brachial plexopathy during spinal surgeries

Biščević¹,

Sehic²,

Biscevic³

et al. 2019

Acta Orthopaedica et Traumatologica Turcica

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Objective The aim of this study was to evaluate the differences in transcranial electric motor-evoked potentials – TceMEP on upper limbs and the incidences of postoperative brachial plexopathy between patients with kyphotic and scoliotic trunk shapes. Methods In the period of January 2011–January 2017, 61 consecutive patients (mean age: 18.4 years ± 4.4 years (range: 10–32)) with pediatric spinal deformity underwent surgery in our Department. Eight of them had a kyphotic trunk deformity (Scheuermann kyphosis, neurofibromatosis, posterior thoracic hemivertebra), and the rest of the 53 patients had a scoliotic trunk deformity (mostly adolescent idiopathic scoliosis – AIS, lateral hemivertebra). The TceMEP recordings in all four limbs were analyzed every 30 min, or upon the surgeon's command. Upper limb TceMEP recordings were used as a control of systemic and anesthetic related changes, and as the indicator of positioning brachial plexopathy. Results Four out of 8 patients (50.0%) from the kyphotic group experienced noteworthy decreases in TceMEP amplitude (≥65%) in one or both arms, and only 2 out of 53 patients (3.8%) from the scoliotic group, confirming significant statistical difference (Chi-square 16.75, p < 0.05). Two out of 8 patients with decreases in TceMEP amplitude suffered from transitory postoperative brachial plexopathy, and both of them were from the kyphotic group. Conclusion It seems that kyphotic trunks have a higher risk for positioning-related brachial plexopathy, probably due to distribution of trunk's weight onto only four points (two iliac bones and two shoulders), compared to the scoliotic trunks that have wider weight-bearing areas. We emphasize the importance of proper patient positioning and close intraoperative neuro-monitoring of all four limbs in more than one channel per limb. Level of Evidence Level IV Therapeutic Study.

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Section: Discussionmentioning

confidence: 95%

Kyphosis – A risk factor for positioning brachial plexopathy during spinal surgeries

Biščević¹,

Sehic²,

Biscevic³

et al. 2019

Acta Orthopaedica et Traumatologica Turcica

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“…Кроме того, при оперативных доступах на верхней конечности, ввиду вариабельности пространственного расположения элементов плечевого сплетения, часто повреждаются поверхностные нервы плечевого сплетения. В связи с этим, в настоящее время изучение анатомии плечевого сплетения и его отдельных ветвей имеет большое научное и практическое значения для развития современного раздела оперативной хирургии -микрохирургии, а также реконструктивной хирургии, нейрохирургии и травматологии [27,29].…”

Section: Abstract: Medial Cutaneous Nerve Of Arm Anatomy Topography Sensory Innervation Reconstructive Surgeryunclassified

Modern Views on the Clinical Anatomy of the Medial Cutaneous Nerve of Arm and the Prospects for its Use in Reconstructive Surgery

Горбунов

Gorban

Kober

et al. 2021

Žurnal anatomii i gistopatologii

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In the modern aspect, the relevance of damage to the medial cutaneous nerve of the arm during surgical interventions in the axilla and brachial region is displayed. Due to the superficial location in the subcutaneous layer, the nerve is most often subject to accidental damage, including in brachioplasty, axillary lymphodissection, breast cancer surgeries and breast augmentation. The material on variant anatomy, macroscopic structure and topography of the nerve is presented. The medial cutaneous nerve of the arm is formed from the medial cord of the brachial plexus, in some cases - from the posterior cord; isolated cases of the absence of the nerve are described. When exiting the axilla at arm level, the nerve penetrates into the deep brachial fascia, passes in the subcutaneous layer medially from the basilic vein of the arm and provides sensitive innervation to the skin of the medial surface of the arm, the skin of the medial epicondyle and the olecranon of the ulna. The medial cutaneous nerve of the arm has an average of 7-8 cutaneous branches, which are characterized by significant variability in the location under the skin. The significance of the medial cutaneous nerve of the arm in clinical practice, namely, in surgical interventions in the arm region, the development of neuropathic pain syndrome, brachial plexus blockages and the diagnosis of nerve damage, medial cord and inferior trunk of the brachial plexus. This review summarizes recent data, which allow to form a more complete picture of the clinical anatomy of the medial cutaneous nerve of arm and the possibilities of its use in reconstructive surgery. An especially relevant area is the possibility of using a medial skin flap of the arm with directed innervation by the medial cutaneous nerve of the arm for reconstruction and restoration of the sensitivity of the nipple-areola complex.

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“…The use of ultrasonography can be of invaluable help [100]. Some recommendations on patient positioning have also been forwarded [44]. The long-term commitment of every hospital employee is essential to minimize these unwanted mishaps.…”

Section: Future Treatment Possibilitiesmentioning

confidence: 99%

“…These iatrogenic lesions are induced while performing lymph node biopsy [5,31,32], vessel catheterization [33,34], on applying radiotherapy in the treatment of cancer [35,36] repairing upper limb bone fractures [37,38], in programmed orthopedic procedures [39,40], due to inadequate patient positioning [41,42] or when restraining aggressive patients [43]. Preventing these iatrogenic injuries is particularly important, not only because they might lead to ugly medicolegal consequences [28] but because of our motto "primum non nocere" (first do no harm) [44]. Any measure or technical improvement aiming to decrease the chance of these unwanted iatrogenic injuries will always be most welcomed.…”

Section: Introductionmentioning

confidence: 99%