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2.1
Brachial Plexus Injury
Injury to Brachial Plexus

Presentation

We present the case of a cervicothoracic epidural pseudomeningocele with spinal cord compression 18 years after a brachial plexus injury. PURPOSE: To present a case report of a patient and literature review on cases with epidural pseudomeningoceles. [ncbi.nlm.nih.gov]

Entire Body System

  • Falling

    One patient sustained a fall resulting in stretch injury to the transfer, underwent successful revision surgery, and regained 100° active shoulder external rotation away from the abdomen more than a year after revision surgery. [ncbi.nlm.nih.gov]

    This is typically seen in rugby injuries, falls from horses and falls from motorcycles. In these cases the upper roots are more vulnerable to injury (ie C4/C5), as shown. [rcemlearning.co.uk]

    But older children sometimes incur brachial plexus injuries, as well, from traumatic events such as falling off of a jungle gym or a car accident. Most brachial plexus injuries result from the bruising or stretching of the nerves. [stanfordchildrens.org]

    Most brachial plexus injuries are caused by trauma such as motor vehicle accidents, sports injuries or falls, but they can also result from cancer and radiation therapy. Brachial plexus injury can also occur during birth. [hopkinsmedicine.org]

    Traumatic Brachial Plexus Injuries These can occur as the result of a number of reasons, including: high falls where the body lands on its side and shoulder violence or gunshot wounds traction on the arm motor vehicle accidents attempts to reduce shoulder [beaumont.org]

  • Arm Pain

    The syndrome can begin with severe shoulder or arm pain followed by weakness and numbness. Brachial plexus injuries can happen during birth if the baby's shoulder is stretched as the baby passes through the birth canal. [ohsu.edu]

    This syndrome can begin with severe shoulder or arm pain followed by weakness and numbness. [brainfacts.org]

  • Unable to Bend

    The ability to bend the elbow (biceps function) by the third month of life is an indicator of probable recovery. [cincinnatichildrens.org]

    Patients with upper-trunk palsies are unable to use the shoulder to raise the arm away from the body, have weakness in the arm, and may be unable to bend the arm at the elbow. [orthoinfo.aaos.org]

Musculoskeletal

  • Unilateral Arm Weakness

    RESULTS: Five patients had unilateral arm weakness after the initiation of ECMO therapy. There was no neurological examination or electrophysiological testing data available for 3 patients. [ncbi.nlm.nih.gov]

Skin

  • Anhidrosis

    […] comprised of fibers from C3 through C5, and the sympathetic fibers of T1 are affected commonly in brachial plexus injuries, resulting, respectively, in ipsilateral diaphragmatic paralysis and Horner syndrome (miosis, partial ptosis, slight enophthalmos and anhidrosis [pedsinreview.aappublications.org]

    Review Topic QID: 4750 1 The injury has likely resulted in the avulsion of several nerve roots 2 Physical exam would likely reveal drooping of his left eyelid and anhidrosis 3 Intact paraspinal musculature on EMG is suggestive of a post-ganglionic lesion [orthobullets.com]

    Avulsion or damage of the C8 and T1 nerve roots from which the cervical sympathetic chain arises cause Horner syndrome, which is characterized by ptosis, meiosis, anhidrosis of the cheek and enophthalmos. [thenerve.net]

Neurologic

  • Stroke

    Neurological Disorders and Stroke » [brainfacts.org]

    NIH: National Institute of Neurological Disorders and Stroke [medlineplus.gov]

    Kingery, WS, Date, ES, Bocobo, C 1993, ‘The absence of brachial plexus injury in stroke’, American Journal of Physical Medicine and Rehabilitation, vol. 72, no. 3. [ausmed.com]

    Sources: United Brachial Plexus Network, Brachial Plexus Palsy Foundation, National Institute of Neurological Disorders and Stroke. [christopherreeve.org]

    Minor Injuries Per the National Institute of Neurological Disorders and Stroke (NINDS), the location and severity of a baby’s brachial plexus injury ultimately determines the prognosis. [birthinjuryguide.org]

  • Areflexia

    Neurological examination showed a brachial diplegia, distal vibratory, thermic and algic hypoesthesia, deep tendon areflexia in upper limbs. There was no sensory or motor deficit in lower extremities. No cognitive disturbances were detected. [ncbi.nlm.nih.gov]

Treatment

The authors present the first cost-effectiveness model to directly compare the different treatment strategies available to a patient with PBPI. [ncbi.nlm.nih.gov]

Prognosis

[…] recovery of reconstructed plexus can take up to 3 years nerve regeneration occurs at speed of 1mm/day infraclavicular plexus injuries have better prognosis than supraclavicular injuries upper plexus injuries have improved prognosis preservation of hand [orthobullets.com]

This makes predicting a prognosis of brachial plexus injuries difficult. Early Intervention Early detection and timely treatment of brachial plexus injuries are the most important factors that lead to a positive prognosis. [birthinjuryguide.org]

Etiology

When considering the etiology and treatment of such injuries, it is important to make a distinction between adult versus obstetric brachial plexus injury. [ncbi.nlm.nih.gov]

Although trauma remains the probable etiology for many brachial plexus injuries, other, nontraumatic etiologies need to be considered. [jaoa.org]

Epidemiology

Design: Observational epidemiological study. Setting: Hospital-based multicenter study. Subjects: One hundred seven prospectively enrolled patients with brachial plexus injury. [ncbi.nlm.nih.gov]

Although the ability to predict brachial plexus injury antenatally remains elusive, knowledge of its epidemiology, risk factors, variations in presentation, prognosis, and management can guide therapeutic decisions and potentially avoid lifelong disability [pedsinreview.aappublications.org]

Epidemiology Frequency United States Brachial plexus injuries are the most common peripheral nerve injuries seen in athletes. True rate of brachial plexus injuries is difficult to determine due to significant underreporting. [emedicine.medscape.com]

"Epidemiology of Brachial Plexus Injuries in a Multitrauma Population". Neurosurgery. 40 (6): 1182–8, discussion 1188–9. doi : 10.1097/00006123-199706000-00014. PMID 9179891. External links [ edit ] [en.wikipedia.org]

Pathophysiology

BACKGROUND: Assessment of muscle atrophy and fatty degeneration in brachial plexus injury (BPI) could yield valuable insight into pathophysiology and could be used to predict clinical outcome. [ncbi.nlm.nih.gov]

The pathomechanics, pathophysiology and prevention of cervical spinal cord and brachial plexus injuries in athletics. Sports Med. 2010. 40(1):59-75. [Medline]. Terzis JK, Kokkalis ZT. [emedicine.medscape.com]

Pathophysiology of the BPI Root injury is defined as root avulsion from the spinal cord and rupture in the preganglionic root zone or dorsal ganglion at the vertebral foramen. [thenerve.net]

Prevention

This article will also discuss the etiology and pathogenesis of nerve injury after MVD and the means to prevent them. METHODS: Intraoperative SSEP monitorings for 485 patients who underwent MVD surgery were reviewed. [ncbi.nlm.nih.gov]

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