The utility of selective partial neurectomy of the musculocutaneous nerve in children with bilateral spastic elbow

Heredia-Gutiérrez, Antonio; Carbarín-Carbarín, María E; Torres-García, Samuel; González-Carranza, Vicente; León, Fernando Chico-Ponce de

doi:10.1007/s00381-023-06009-9

Cited by 2 publications

(2 citation statements)

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“…While most evidence supported its use in lower limbs [17][18][19][20][21] and a recently developed recommendation included selective neurectomies among treatments for post-stroke equinovarus foot deformities [22], no recommendations exist for upper limbs. However the effectiveness of selective peripheral neurectomies to treat ULS has been reported [13,14,18,[23][24][25][26][27]. In our proposed technique, 50-75% of nerve fascicles are excised during the selective peripheral neurectomy.…”

Section: Discussionmentioning

confidence: 99%

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Lateral Pectoral Nerve Identification through Ultrasound-Guided Methylene Blue Injection during Selective Peripheral Neurectomy for Shoulder Spasticity: Proposal for a New Procedure

Zerbinati,

Bemporad,

Massimiani

et al. 2024

JPM

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Internally rotated and adducted shoulder is a common posture in upper limb spasticity. Selective peripheral neurectomy is a useful and viable surgical technique to ameliorate spasticity, and the lateral pectoral nerve (LPN) could be a potential good target to manage shoulder spasticity presenting with internal rotation. However, there are some limitations related to this procedure, such as potential anatomical variability and the necessity of intraoperative surgical exploration to identify the target nerve requiring wide surgical incisions. This could result in higher post-surgical discomfort for the patient. Therefore, the aim of our study was to describe a modification of the traditional selective peripheral neurectomy procedure of the LPN through the perioperative ultrasound-guided marking of the target nerve with methylene blue. The details of the localization and marking procedure are described, as well as the surgical technique of peripheral selective neurectomy and the potential advantages in terms of nerve localization, surgical precision and patients’ post-surgical discomfort. We suggest that the proposed modified procedure could be a valid technique to address some current limitations and move the surgical treatment of spasticity toward increasingly tailored management due to the ease of nerve identification, the possibility of handling potential anatomical variability and the resulting smaller surgical incisions.

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Section: Discussionmentioning

confidence: 99%

“…Although no recommendations exist for upper limbs, several studies demonstrated the effectiveness of selective peripheral neurectomy in ULS as well [13,14,18,[23][24][25][26][27]. Regarding shoulder spasticity, only very few papers exist.…”

Section: Introductionmentioning

confidence: 99%