11/17. Indications and results of brachial plexus surgery in obstetrical palsy.This article presents the first series with long-term results of a large number of patients. As a result, it is difficult to compare these results with anything but spontaneous recovery. In most cases, the end result after surgical treatment will be better than spontaneous recovery.- - - - - - - - - - ranking = 1keywords = plexus (Clic here for more details about this article) |
12/17. Early microsurgical reconstruction in birth palsy.Most patients with birth palsy can be expected to recover spontaneously. But in some patients the recovery is unsatisfactory and the functional results are disappointing. One possible way to improve the prognosis for such patients is early surgical nerve reconstruction. In six infants, exploration of the brachial plexus was carried out at about six months after delivery, when there were no signs of recovery in shoulder and elbow joint movements. Preoperative metrizamide myelography, computerized tomography with intrathecal metrizamide (CT myelography), and axon reflex test (histamine test) were followed by intraoperative electrophysiologic examinations of root sensory evoked potential (SEP), nerve action potential (NAP), and evoked muscle response (M-response). Microsurgical nerve repair was performed on the basis of intraoperative diagnosis. metrizamide myelography showed 13% false-positive root avulsion. Reliability of the histamine test was 80%. The intraoperative electro-diagnosis is essential for understanding the actual condition of the brachial plexus lesion and obtaining better results from microsurgical reconstruction in birth palsy. The surgical results, with an average follow-up evaluation of two years and four months, have been encouraging enough to continue this diagnostic and therapeutic program, though its superiority to natural recovery has not yet been clarified.- - - - - - - - - - ranking = 0.5keywords = plexus (Clic here for more details about this article) |
13/17. The unusual features of traumatic neurogenic muscular atrophy in the infant: an anatomic study.A biopsy from the deltoid muscle of an 8-week old girl who had sustained a bilateral traumatic Erb's brachial plexus paresis at birth revealed the neurogenic atrophy to be different from that of adult muscle in that small, round fibers, similar to those observed in Werdnig-Hoffmann disease, were found. Detailed histochemistry of the fibers is submitted. On electron microscopy, there was focal degeneration of sarcomeres; a loss of myofibrils and myofilaments accompanied by increased autophagocytosis and increased amounts of glycogen; occasionally, preferential drop out of thick myofilaments and a peculiar displacement and deformation of the T-system, triads. In spite of the fact that the injury was sustained at one well defined point of time, the degree to which the muscle fibers were affected was quite variable from area to area. It is proposed that denervation in infantile muscle results in typical small rounded fibers and that this process, so different from that of adult neurogenic atrophy, is age-dependent.- - - - - - - - - - ranking = 0.25keywords = plexus (Clic here for more details about this article) |
14/17. Isolated radial nerve lesion in the newborn.Two newborn infants had isolated radial nerve lesion documented on electromygraphy. Fibrillation potentials present in one child at age 6 days suggest the possibility of an in utero onset. skin necrosis present above the triceps muscle and radial nerve favors an entrapment mechanism, possibly from the umbilical cord. Because both patients had complete resolution in 4 months, it is important to differentiate this lesion form the more common but more serious medial brachial plexus lesion.- - - - - - - - - - ranking = 0.25keywords = plexus (Clic here for more details about this article) |
15/17. brachial plexus palsy: an old problem revisited again. II. Cases in point.OBJECTIVES: In spite of mounting evidence to the contrary, plaintiffs' expert witnesses continue to maintain that brachial plexus impairment is almost always the result of excessive lateral traction on the head during the last phase of delivery. Case studies are presented to challenge this concept. STUDY DESIGN: Examples encountered in medicolegal consultations were analyzed with this purpose as our focus. RESULTS: Cases of brachial plexus impairment were encountered in which there was no evidence of shoulder dystocia or extreme lateral traction on the fetal head. In one in which shoulder dystocia was recorded, there was also incontrovertible evidence of intrauterine maladaptation. In another, the posterior shoulder was involved. CONCLUSION: To propose that shoulder dystocia with extreme lateral traction on the fetal head after its delivery is not a factor in some cases of brachial plexus impairment would be insupportable. Conversely, to maintain a posteriori that brachial plexus impairment in itself is evidence that such pressure must have been used is untenable.- - - - - - - - - - ranking = 2keywords = plexus (Clic here for more details about this article) |
16/17. Closed reduction and tendon transfer for treatment of dislocation of the glenohumeral joint secondary to brachial plexus birth palsy.Dislocation of the glenohumeral joint developed, in the first few years of life, in eight children who had brachial plexus birth palsy. The palsy involved the fifth and sixth cervical nerve roots in six children and the fifth, sixth, and seventh cervical nerve roots in two. All of the children had a release of the insertions of the pectoralis major, latissimus dorsi, and teres major followed by a closed reduction of the glenohumeral joint. The latissimus dorsi and the teres major were then transferred to the rotator cuff. All of the children had a well located glenohumeral joint with at least 25 degrees (mean, 51 degrees) of external rotation and at least 135 degrees (mean, 164 degrees) of abduction at the latest follow-up examination, at least two years postoperatively. Strength in abduction increased at least one grade, and strength in external rotation increased at least two grades. The improved motion and strength allowed the children to place the hands more effectively above the head and helped them to perform activities of daily living easily.- - - - - - - - - - ranking = 1.25keywords = plexus (Clic here for more details about this article) |
17/17. Lower thoracic spinal cord injury--a severe complication of shoulder dystocia.Fundal pressure as a maneuver for the relief of shoulder dystocia is associated with up to a 77% fetal injury rate. The usual injuries involve the brachial plexus or orthopedic injuries. We now report a severe lower thoracic spinal cord injury with permanent neurological injury when fundal pressure was applied in an attempt to relieve shoulder dystocia. shoulder dystocia occurred in a 28-year-old nulliparous woman. A series of manual maneuvers to include episiotomy extension, McRoberts, suprapubic pressure, Woods screw, and extraction of the posterior arm all failed to achieve delivery. During these maneuvers, but not coordinated with them, fundal pressure was applied by multiple individuals. The Zavanelli maneuver and cesarean delivery ultimately allowed delivery. On Day 2 of life marked decrease in lower extremity motor function, over-flow urinary incontinence, and rectal incontinence led to imaging studies that revealed focal spinal cord injury at T-9 through T-12. Compressive forces applied to the fetal spine during fundal pressure is the likely cause of the lower thoracic spinal cord injury manifest by this newborn.- - - - - - - - - - ranking = 0.25keywords = plexus (Clic here for more details about this article) |
| <- Previous | |