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Bertelli JA, Goklani MS, Patel N, Duarte ECW. Triceps and cutaneous radial nerve branches investigated via an axillary anterior arm approach: new findings in a fresh-cadaver anatomical study. J Neurosurg 2022; 136:1424-1433. [PMID: 34624848 DOI: 10.3171/2021.4.jns2169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors sought to describe the anatomy of the radial nerve and its branches when exposed through an axillary anterior arm approach. METHODS Bilateral upper limbs of 10 fresh cadavers were dissected after dyed latex was injected into the axillary artery. RESULTS Via the anterior arm approach, all triceps muscle heads could be dissected and individualized. The radial nerve overlaid the latissimus dorsi tendon, bounded by the axillar artery on its superior surface, then passed around the humerus, together with the lower lateral arm and posterior antebrachial cutaneous nerve, between the lateral and medial heads of the triceps. No triceps motor branch accompanied the radial nerve's trajectory. Over the latissimus dorsi tendon, an antero-inferior bundle, containing all radial nerve branches to the triceps, was consistently observed. In the majority of the dissections, a single branch to the long head and dual innervations for the lateral and medial heads were observed. The triceps long and proximal lateral head branches entered the triceps muscle close to the latissimus dorsi tendon. The second branch to the lateral head stemmed from the triceps lower head motor branch. The triceps medial head was innervated by the upper medial head motor branch, which followed the ulnar nerve to enter the medial head on its anterior surface. The distal branch to the triceps medial head also originated near the distal border of the latissimus dorsi tendon. After a short trajectory, a branch went out that penetrated the medial head on its posterior surface. The triceps lower medial head motor branch ended in the anconeus muscle, after traveling inside the triceps medial head. The lower lateral arm and posterior antebrachial cutaneous nerve followed the radial nerve within the torsion canal. The lower lateral brachial cutaneous nerve innervated the skin over the biceps, while the posterior antebrachial cutaneous nerve innervated the skin over the lateral epicondyle and posterior surface of the forearm. The average numbers of myelinated fibers were 926 in the long and 439 in the upper lateral head and 658 in the upper and 1137 in the lower medial head motor branches. CONCLUSIONS The new understanding of radial nerve anatomy delineated in this study should aid surgeons during reconstructive surgery to treat upper-limb paralysis.
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Affiliation(s)
- Jayme A Bertelli
- 1Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina, Brazil
| | - Mayur Sureshlal Goklani
- 2Department of Plastic Surgery, Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai, Maharashtra, India
| | - Neehar Patel
- 3Department of Plastic Surgery, Wockhardt Hospital, The Umrao IMSR, Mumbai, Maharashtra, India; and
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Ellabban MA, Sadek AF, Galhom A, Hafez AE, Ramadan A. Comparison between long and lower medial head triceps branches in dual neurotization for shoulder function restoration in upper brachial plexus palsy. Microsurgery 2020; 41:124-132. [PMID: 33296099 DOI: 10.1002/micr.30690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 07/28/2020] [Accepted: 11/20/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE In upper brachial plexus injury (UBPI), restoring shoulder function is crucial. This study compares the transfer of long and lower medial heads of triceps branches to the axillary nerve to achieve proper restoration of function. PATIENTS AND METHODS A retrospective comparative study was conducted between two groups of patients with (UBPI). Group I patients (10) [mean age: 19 ± 10.6 years] were managed by transferring triceps long head branch to axillary nerve while group II patients (8) [mean age: 26 ± 9.6 years] were managed by triceps lower medial head branch transfer. The mean time from injury to surgery was 6 ± 1.3 and 5 ± 1.7 months respectively. All patients were followed up for a minimum of 12 months with the assessment of VAS, DASH score, active range of motion (AROM) and strength of shoulder abduction and external rotation; in addition to shoulder endurance and strengths of donors. Postoperative, three-monthly, electrodiagnostic assessments were performed. RESULTS Postoperatively, the mean VAS and DASH scores; in addition to endurance time, showed significant enhancement in both groups. Patients in both groups have accomplished a mean abduction (AROM) of 98° ± 27.9 and 97° ± 11.9 respectively. The mean external rotation (AROM) was 48° ± 18.4 and 47° ± 9.2 respectively. Furthermore, group II patients had less triceps morbidity in addition to earlier and enhanced electrophysiological recovery. CONCLUSIONS Dual neurotization for shoulder function restoration in (UBPI) is capable of providing proper functional results with minimal donor morbidity. The triceps lower medial branch provides an excelling donor due to less triceps morbidity, extra length; yet, earlier and enhanced electrophysiological recovery.
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Affiliation(s)
- Mohamed A Ellabban
- Plastic and Reconstructive Surgery Unit, Suez Canal University Hospitals and Medical School, Ismailia, Egypt
| | - Ahmed Fathy Sadek
- Department of Orthopaedic Surgery, Hand and Microsurgery Unit, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ayman Galhom
- Department of Neurosurgery, Faculty of Medicine, Port Said University, Port Said, Egypt
| | - Ahmed E Hafez
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ahmed Ramadan
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Port Said University, Port Said, Egypt
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Singh S, Das KK, Deora H, Jaiswal AK, Behari S. Traumatic Partial Posterior Cord Brachial Plexus Injury in a Patient with Aberrant Innervation of the Long Head of the Triceps by the Axillary Nerve: Implications in Nerve Transfer Surgery. Asian J Neurosurg 2020; 15:391-393. [PMID: 32656138 PMCID: PMC7335135 DOI: 10.4103/ajns.ajns_160_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 01/21/2020] [Indexed: 11/10/2022] Open
Abstract
Brachial plexus repair forms an unmet need in terms of posttraumatic rehabilitation, especially the young population, wherein the incidence of accidents is high. This leads to decrease in the number of functionally active years after the accident. We encountered an interesting case of posttraumatic posterior cord injury predominantly affecting the shoulder abduction beyond 15°. An electrodiagnostic study showed a complete lack of conduction within the axillary nerve with reduced conduction velocity in the radial nerve. We took the patient up for the long head of the triceps transfer to the anterior division of the axillary nerve transfer. Intraoperatively, we found that the long head branch was originating from the axillary nerve at the point of division. As it could not be used for neurotization, we transferred the medial head branch of the radial nerve to the axillary nerve. The patient started to show electroclinical improvement after 3 months of the surgery. A few similar cases have been published, as a cadaveric finding. We report this case to highlight the possibility and need for a high clinical suspicion and also to provide a possible treatment option, in such aberrant anatomy.
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Affiliation(s)
- Suyash Singh
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Harsh Deora
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Awadhesh Kumar Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Jain DKA, Kumar ST, Shetty N. Ulnar Nerve Innervation to Triceps: A Cadaveric Study and a Technical Note on Partial Triceps to Biceps Transfer. Indian J Orthop 2019; 53:353-356. [PMID: 30967708 PMCID: PMC6415570 DOI: 10.4103/ortho.ijortho_440_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The loss of elbow flexion is a routinely encountered problem in clinical practice. There is no literature on ulnar nerve innervation to triceps in addition to the radial nerve which is dual nerve innervation to triceps in the Indian population. We intend to study the incidence of ulnar nerve innervation to the medial head of triceps in Indian population and also the clinical feasibility of transfer of long and medial head of triceps tendon to biceps around the medial aspect of humerus. MATERIALS AND METHODS A cross-sectional study was conducted using 32 fresh-frozen skeletally mature cadavers of Indian origin. The possible contribution of the ulnar nerve to medial head of triceps in addition to the radial nerve was recorded. The arm length, the distance where the ulnar nerve pierces the medial intermuscular septum from medial epicondyle; the distance of the ulnar nerve fascicle from the medial epicondyle was also measured. RESULTS The incidence of ulnar nerve innervation to the medial head of triceps was 43.8%. Mean arm length was 29.13 cm. Mean distance where the ulnar nerve pierced the medial intermuscular septum from medial epicondyle was 9.93 cm. Mean distance of the ulnar nerve branch to the triceps from medial epicondyle was 8.01 cm. CONCLUSION This study reveals the presence of dual nerve innervation to triceps in 43.8% of the Indian population. The clinical implication would be to look for the possible contribution of the ulnar nerve fascicle to the medial head of triceps, which will help us to include the medial head along with the long head of triceps while performing partial triceps-to-biceps tendon transfer, and the other use would be as a donor fascicle when performing a nerve transfer.
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Affiliation(s)
- Darshan Kumar A Jain
- Department of Orthopaedics, Ramaiah Medical College, Bengaluru, Karnataka, India,Address for correspondence: Dr. Darshan Kumar A Jain, Department of Orthopaedics, Ramaiah Medical College, Bengaluru, Karnataka, India. E-mail:
| | - Sathish T Kumar
- Department of Orthopaedics, Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Naresh Shetty
- Department of Orthopaedics, Ramaiah Medical College, Bengaluru, Karnataka, India
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Cho SH, Chung IH, Lee UY. Relationship between the ulnar nerve and the branches of the radial nerve to the medial head of the triceps brachii muscle. Clin Anat 2018; 32:137-142. [PMID: 29770497 DOI: 10.1002/ca.23207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/14/2018] [Accepted: 05/08/2018] [Indexed: 11/06/2022]
Abstract
One branch of the radial nerve to the medial head of the triceps brachii muscle (MHN) has been described as accompanying or joining the ulnar nerve. Mostly two MHN branches have been reported, with some reports of one; however, the topographical anatomy is not well documented. We dissected 52 upper limbs from adult cadavers and found one, two, and three MHN branches in 9.6%, 80.8%, and 9.6% of cases, respectively. The MHN accompanying the ulnar nerve was always the superior MHN. The relationship between the ulnar nerve and the MHN was classified into four types according to whether the MHN was enveloped along with the ulnar nerve in the connective tissue sheath and whether it was in contact with the ulnar nerve. It contacted the ulnar nerve in 75.0% of cases and accompanied it over a mean distance of 73.6 mm (range 36-116 mm). In all cases in which the connective tissue sheath enveloped the branch of the MHN and the ulnar nerve, removing the sheath confirmed that the MHN branch originated from the radial nerve. The detailed findings and anatomical measurements of the MHN in this study will help in identifying its branches during surgical procedures. Clin. Anat. 00:1-16, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Sung Hun Cho
- Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In-Hyuk Chung
- Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - U-Young Lee
- Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Chaware PN, Santoshi JA, Patel M, Ahmad M, Rathinam BAD. Surgical Implications of Innervation Pattern of the Triceps Muscle: A Cadaveric Study. J Hand Microsurg 2018; 10:139-142. [PMID: 30483020 DOI: 10.1055/s-0038-1660771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/01/2018] [Indexed: 10/28/2022] Open
Abstract
The innervation pattern of triceps is complex and not fully comprehended. Anomalous innervations of triceps have been described by various authors. We have attempted to delineate the nerve supply of the triceps and documented the anomalous innervations of its different heads. The brachial plexus and its major branches (in the region of the axilla and arm) and triceps were dissected in 36 embalmed cadaver upper limbs. Long head received one branch from radial nerve in 31 (86%) specimens. Four (11%) specimens received two branches including one that had dual innervation from the radial and axillary nerves, and one (3%) specimen had exclusive innervation from a branch of the axillary nerve. Medial head received two branches arising from the radial nerve in 34 (94%) specimens. One (3%) specimen received three branches from the radial nerve whereas one (3%) had dual supply from the radial and ulnar nerves. Lateral head received multiple branches exclusively from the radial nerve, ranging from 2 to 5, in all (100%) specimens. Knowledge of the variations in innervation of the triceps would not only help the surgeon to avoid inadvertent injury to any of the nerve branches but also offers new options for nerve and free functional muscle transfers.
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Affiliation(s)
| | - John Ashutosh Santoshi
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Manmohan Patel
- Department of Anatomy, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Mohtashim Ahmad
- Department of Anatomy, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Bertha A D Rathinam
- Department of Anatomy, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Connections between radial and ulnar nerve at high humeral level in cadavers: incidence, topography, and literature review. Surg Radiol Anat 2017; 40:313-322. [PMID: 29124342 DOI: 10.1007/s00276-017-1939-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Although communications between branches and cords of the brachial plexus have been extensively published, there is a scarcity of reports concerning radial and ulnar nerve (RN-UN) communication in the arm. The current study aims to demonstrate the incidence, topography, and length of communicating branches between RN and UN. Any additional coexisted variations were also recorded. MATERIALS AND METHODS Two hundred and sixty-six upper limbs collected from one hundred and thirty-three (81 males and 52 females) Greek cadavers were dissected. RESULTS Three out of one hundred and thirty-three cadavers, accounting for an incidence of up to 2.3%, were found to have an atypical communicating branch originating at a high humeral level from RN towards UN. In two cadavers, communicating branches were detected on the left side and in one cadaver bilaterally. CONCLUSIONS The study of atypical communications between RN and UN attracts great attention for its clinical importance, mainly in cases of peripheral neuropathies with diagnostic dilemma or upper limb nerve injury producing an otherwise unexpected symptomatology due to the aberrant nerve supply. Familiarity with these variations is crucial in avoiding misdiagnosis and preserving valuable communicating branches, thus achieving an uneventful outcome in cases of upper limb nerve injury repair.
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Varshney R, Sharma N, Malik S, Malik S. A cadaveric study comparing the three approaches for ulnar nerve block at wrist. Saudi J Anaesth 2014; 8:S25-8. [PMID: 25538516 PMCID: PMC4268523 DOI: 10.4103/1658-354x.144064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Ulnar nerve blockade as a component of wrist block is a promising technique for adequate anesthesia and analgesia for different surgeries of the hand. Due to anatomical variations in the location of ulnar nerve under the flexor carpi ulnaris (FCU) a technique with good results and minimal complications are required. Aim: The aim of the following study is to compare the three techniques (volar, transtendinous volar [TTV] and ulnar) for ulnar nerve block at the wrist in human cadaveric wrists. Materials and Methods: Our study was conducted using 40 cadaver wrists. After inserting standard hypodermic needles by three techniques for ulnar nerve blockade at the wrist, a detailed dissection of FCU was done. The mean distance from the tip of the needle to ulnar artery/nerve and number of instances in which the ulnar artery/nerve pierced were observed. Results: Inter-group statistical significance was observed in measurement of the mean distance (mm) from the tip of the needle to the ulnar artery (volar [0.92 ± 0.11], TTV [3.96 ± 0.14] and ulnar [7.14 ± 0.08] approaches) and ulnar nerve (volar/TTV/ulnar approaches were 0.71 ± 0.12/3.61 ± 0.10/6.31 ± 0.49, respectively) (P = 0.001). Inadvertent intra-arterial/intraneural injections was seen with volar approach in 14 (35%) and 16 (40%) of the cadaveric wrists respectively, statistically significant with transtendinous and ulnar techniques of ulnar nerve block. Conclusion: TTV approach could be a better technique of choice for ulnar nerve blockade at the wrist because of its ease to practice, safer profile and minimum chances of inadvertent intra-arterial/intraneural injection with adequate anesthesia/analgesia.
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Affiliation(s)
- Rohit Varshney
- Department of Anesthesia, Teerthanker Mahaveer Medical College, Moradabad, Uttar Pradesh, India
| | - Nidhi Sharma
- Department of Anatomy, Teerthanker Mahaveer Medical College, Moradabad, Uttar Pradesh, India
| | - Shraddha Malik
- Department of Anesthesia, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Sunny Malik
- Department of Anesthesia, Rajiv Gandhi Cancer Hospital Institute and Research Centre, Rohini, New Delhi, India
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Pascual-Font A, Vazquez T, Marco F, Sañudo JR, Rodriguez-Niedenführ M. Ulnar nerve innervation of the triceps muscle: real or apparent? An anatomic study. Clin Orthop Relat Res 2013; 471:1887-93. [PMID: 23283677 PMCID: PMC3706638 DOI: 10.1007/s11999-012-2768-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 12/14/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Since the 18th century, the existence of ulnar nerve innervation of the medial head of the triceps brachii muscle has been controversial. The evidence for or against such innervation has been based on macroscopic dissection, an unsuitable method for studying intraneural topography or intramuscular branching. The study of smaller specimens (embryos or fetuses) by means of serial histologic sections may resolve the controversy. QUESTIONS/PURPOSES Using fetal specimens and histology we determined the contributions of the ulnar and radial nerves to innervation of the triceps brachii muscle. METHODS We histologically examined 15 embryonic and fetal arms. Radial nerve branches obtained from six adult arms were analyzed immunohistochemically to determine motor fiber content. RESULTS The medial head of the triceps brachii muscle was always innervated by the radial nerve (ulnar collateral branch). The branches seeming to leave the ulnar nerve at elbow level were the continuation of the radial nerve that had joined the ulnar nerve sheath via a connection in the axillary region. Immunohistochemistry revealed motor and nonmotor fibers in this radial nerve branch. CONCLUSIONS A connection between the radial and ulnar nerves sometimes may exist, resulting in an apparent ulnar nerve origin of muscular branches to the medial head of the triceps, even though in all our specimens the fibers could be traced back to the radial nerve. CLINICAL RELEVANCE Before performing or suggesting new muscle and nerve transpositions using this apparent ulnar innervation, the real origin should be confirmed to avoid failure.
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Affiliation(s)
- Aran Pascual-Font
- Department of Human Anatomy and Embryology I, School of Medicine, Complutense University of Madrid, Ciudad Universitaria s/n, 28040 Madrid, Spain
| | - Teresa Vazquez
- Department of Human Anatomy and Embryology I, School of Medicine, Complutense University of Madrid, Ciudad Universitaria s/n, 28040 Madrid, Spain
| | - Fernando Marco
- Shoulder and Elbow Unit, Department of Orthopedics, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - Jose R. Sañudo
- Department of Human Anatomy and Embryology I, School of Medicine, Complutense University of Madrid, Ciudad Universitaria s/n, 28040 Madrid, Spain
| | - Marc Rodriguez-Niedenführ
- Department of Human Anatomy and Embryology I, School of Medicine, Complutense University of Madrid, Ciudad Universitaria s/n, 28040 Madrid, Spain
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Loukas M, Bellary SS, Yüzbaşioğlu N, Shoja MM, Tubbs RS, Spinner RJ. Ulnar nerve innervation of the medial head of the triceps brachii muscle: A cadaveric study. Clin Anat 2013; 26:1028-30. [PMID: 23716143 DOI: 10.1002/ca.22270] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 03/20/2013] [Accepted: 04/22/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Marios Loukas
- Department of Anatomical Sciences; School of Medicine; St George's University; Grenada West Indies
- Department of Anatomy; Medical School Varmia and Mazuria; Olsztyn Poland
| | - Sharath S. Bellary
- Department of Anatomical Sciences; School of Medicine; St George's University; Grenada West Indies
| | - Neslihan Yüzbaşioğlu
- Department of Anatomy; Istanbul Medipol University School of Medicine; Istanbul Turkey
| | - Mohammadali M. Shoja
- Neuroscience Research Center; Tabriz University of Medical Sciences; Tabriz Iran
| | - R. Shane Tubbs
- Children's Hospital, Pediatric Neurosurgery; Birmingham, Alabama
| | - Robert J. Spinner
- Departments of Neurologic Surgery; Orthopedics, and Anatomy, Mayo Clinic; Rochester Minnesota
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Flores LP. Triceps brachii reinnervation in primary reconstruction of the adult brachial plexus: experience in 25 cases. Acta Neurochir (Wien) 2011; 153:1999-2007. [PMID: 21766190 DOI: 10.1007/s00701-011-1080-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 06/22/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Elbow flexion and shoulder abduction are the primary goals in brachial plexus surgery; however, reinnervation of the triceps is also an objective to be considered, as restoration of elbow extension improves the stabilization of the elbow and can provide a more powerful grasp. This study aims to demonstrate the author's experience with restoration of elbow extension function in cases of brachial plexus surgery in adults. METHODS Records of 25 patients sustaining traumatic brachial plexus injuries who were treated surgically with reinnervation of the triceps were reviewed. Nine techniques were employed, including posterior cord reconstruction and nerve transfers using donors such as the ipsilateral C7 root, phrenic nerve, medial pectoral nerve, intercostal nerves, the spinal accessory nerve, and a motor fascicle of the ulnar nerve. The targeted structure was the radial nerve or the branch to the long head of the triceps. FINDINGS Twenty-one subjects (83%) obtained triceps reinnervation, and good results (M3 or better) were observed in 19 cases (76%). M4 grade was noted in 36% of the cases, M3 grade in 40%, M2 grade in 8%, M1 grade in 8%, and M0 grade in 8% of the patients. The best outcomes were observed in the cases presenting a C5 to C7 palsy and those in which the nerve to the triceps was chosen as the transfer target. CONCLUSIONS Reinnervation of the triceps can be achieved in most patients if adequate donor and recipient nerves are carefully selected based on an individual case-specific decision.
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Affiliation(s)
- Leandro Pretto Flores
- Unit of Neurosurgery, Hospital de Base do Distrito Federal, Post-Graduate Program in Medical Science, University of Brasília, SQN 208 Bloco F Apartamento 604, Asa Norte Brasília Distrito Federal, 70853-060, Brazil.
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