http://www.jbppni.com The most accessed research articles published by Journal of Brachial Plexus and Peripheral Nerve Injury 2012-04-30T00:00:00Z Currently, notalgia paresthetica (NP) is a poorly-understood condition diagnosed on the basis of pruritus, pain, or both, in the area medial to the scapula and lateral to the thoracic spine. It has been proposed that NP is caused by degenerative changes to the T2-T6 vertebrae, genetic disposition, or nerve entrapment of the posterior rami of spinal nerves arising at T2-T6. Despite considerable research, the etiology of NP remains unclear, and a multitude of different treatment modalities have correspondingly met with varying degrees of success. Here we demonstrate that NP can be caused by long thoracic nerve injury leading to serratus anterior dysfunction, and that electrical muscle stimulation (EMS) of the serratus anterior can successfully and conservatively treat NP. In four cases of NP with known injury to the long thoracic nerve we performed transcutaneous EMS to the serratus anterior in an area far lateral to the site of pain and pruritus, resulting in significant and rapid pain relief. These findings are the first to identify long thoracic nerve injury as a cause for notalgia paresthetica and electrical muscle stimulation of the serratus anterior as a possible treatment, and we discuss the implications of these findings on better diagnosing and treating notalgia paresthetica. http://www.jbppni.com/content/4/1/17 Charlie Wang Alpana Gowda Meredith Barad Sean Mackey Ian Carroll Journal of Brachial Plexus and Peripheral Nerve Injury 2009, null:17 2009-09-22T00:00:00Z doi:10.1186/1749-7221-4-17 /content/figures/1749-7221-4-17-toc.gif Journal of Brachial Plexus and Peripheral Nerve Injury 1749-7221 ${item.volume} 17 2009-09-22T00:00:00Z XML Background: Phlebotomy is one of the routine procedures done in medical labs daily.Case presentationA 52 yr woman noted shooting pain and dysesthesia over her right side anterolateral aspect of forearm, clinical examination and electrodiagnostic studies showed severe involvement of right side lateral antebrachial cutaneous nerve. Conclusion: Phlebotomy around lateral aspect of antecubital fossa may cause lateral antebrachial cutaneous nerve injury, electrodiagnostic studies are needed for definite diagnosis. http://www.JBPPNI.com/content/2/1/6 S Mansoor Rayegani Arezoo Azadi Journal of Brachial Plexus and Peripheral Nerve Injury 2007, null:6 2007-03-14T00:00:00Z doi:10.1186/1749-7221-2-6 /content/figures/1749-7221-2-6-toc.gif Journal of Brachial Plexus and Peripheral Nerve Injury 1749-7221 ${item.volume} 6 2007-03-14T00:00:00Z XML Background: Diabetic neuropathy is a family of nerve disorders with progressive loss of nerve function in 15% of diabetes mellitus (DM) subjects. Two-point discrimination (TPD) is one method of quantitatively testing for loss of nerve function. The law of mobility for TPD is known for normal subjects in earlier studies but has not been studied for diabetic subjects. This is a pilot study to evaluate and plot the law of mobility for TPD among DM subjects. Methods: The Semmes Weinstein monofilament (SWMF) was used to measure the loss of protective sensation. An Aesthesiometer was used to find the TPD of several areas in upper and lower extremities for normal and diabetic subjects. All the subjects were screened for peripheral artery occlusive disease with ankle brachial pressure index (0.9 or above). Results: TPD of normal and diabetic subjects for different areas of hands and legs from proximal to distal is evaluated for 18 subjects. TPD values decrease from proximal to distal areas. Vierodt's law of mobility for TPD holds good for normal subjects in the hand and foot areas. The law of mobility for TPD in DM subjects holds well in the hand but doesn't hold well in foot areas with or without sensation. Conclusion: TPD is a quantitative and direct measure of sensory loss. The TPD value of diabetic subjects reveals that the law of mobility do not hold well for Diabetic subjects in foot areas. The significance of this result is that the TPD of the diabetic subjects could provide direct, cost effective and quantitative measure of neuropathy. http://www.jbppni.com/content/3/1/3 Periyasamy R Manivannan M Vengesana Balakrishna Raja Narayanamurthy Journal of Brachial Plexus and Peripheral Nerve Injury 2008, null:3 2008-01-29T00:00:00Z doi:10.1186/1749-7221-3-3 /content/figures/1749-7221-3-3-toc.gif Journal of Brachial Plexus and Peripheral Nerve Injury 1749-7221 ${item.volume} 3 2008-01-29T00:00:00Z XML Background: The current method of treatment for persistent internal rotation due to the medial rotation contracture in patients with obstetric brachial plexus injury is humeral derotational osteotomy. While this procedure places the arm in a more functional position, it does not attend to the abnormal glenohumeral joint. Poor positioning of the humeral head secondary to elevation and rotation of the scapula and elongated acromion impingement causes functional limitations which are not addressed by derotation of the humerus. Progressive dislocation, caused by the abnormal positioning and shape of the scapula and clavicle, needs to be treated more directly. Methods: Four patients with Scapular Hypoplasia, Elevation And Rotation (SHEAR) deformity who had undergone unsuccessful humeral osteotomies to treat internal rotation underwent acromion and clavicular osteotomy, ostectomy of the superomedial border of the scapula and posterior capsulorrhaphy in order to relieve the torsion developed in the acromio-clavicular triangle by persistent asymmetric muscle action and medial rotation contracture. Results: Clinical examination shows significant improvement in the functional movement possible for these four children as assessed by the modified Mallet scoring, definitely improving on what was achieved by humeral osteotomy. Conclusion: These results reveal the importance of recognizing the presence of scapular hypoplasia, elevation and rotation deformity before deciding on a treatment plan. The Triangle Tilt procedure aims to relieve the forces acting on the shoulder joint and improve the situation of the humeral head in the glenoid. Improvement in glenohumeral positioning should allow for better functional movements of the shoulder, which was seen in all four patients. These dramatic improvements were only possible once the glenohumeral deformity was directly addressed surgically. http://www.JBPPNI.com/content/1/1/9 Rahul Nath Sonya Melcher Melia Paizi Journal of Brachial Plexus and Peripheral Nerve Injury 2006, null:9 2006-12-27T00:00:00Z doi:10.1186/1749-7221-1-9 /content/figures/1749-7221-1-9-toc.gif Journal of Brachial Plexus and Peripheral Nerve Injury 1749-7221 ${item.volume} 9 2006-12-27T00:00:00Z XML N/A http://www.jbppni.com/content/7/1/3 Gerhard Blaauw Journal of Brachial Plexus and Peripheral Nerve Injury 2012, null:3 2012-04-13T00:00:00Z doi:10.1186/1749-7221-7-3 /content/figures/1749-7221-7-3-toc.gif Journal of Brachial Plexus and Peripheral Nerve Injury 1749-7221 ${item.volume} 3 2012-04-13T00:00:00Z XML Evaluation of functional and structural recovery after peripheral nerve injury is crucial to determine the therapeutic effect of a nerve repair strategy. In the present study, we examined the relationship between the structural evaluation of regeneration by means of retrograde tracing and the functional evaluation analysis of toe spreading. Two standardized rat sciatic nerve injury models were used to address this relationship. As such, animals received either a 2 cm sciatic nerve defect (neurotmesis) followed by autologous nerve transplantation (ANT animals) or a crush injury with spontaneous recovery (axonotmesis; CI animals). Functional recovery of toe spreading was observed over an observation period of 84 days. In contrast to CI animals, ANT animals did not reach pre-surgical levels of toe spreading. After the observation period, the lipophilic dye DiI was applied to label sensory and motor neurons in dorsal root ganglia (DRG; sensory neurons) and spinal cord (motor neurons), respectively. No statistical difference in motor or sensory neuron counts could be detected between ANT and CI animals.In the present study we could indicate that there was no direct relationship between functional recovery (toe spreading) measured by SSI and the number of labelled (motor and sensory) neurons evaluated by retrograde tracing. The present findings demonstrate that a multimodal approach with a variety of independent evaluation tools is essential to understand and estimate the therapeutic benefit of a nerve repair strategy. http://www.jbppni.com/content/7/1/5 Sabien van Neerven Ahmet Bozkurt Dan O'Dey Juliane Scheffel Arne Boecker Jan-Philipp Stromps Sebastian Dunda Gary Brook Norbert Pallua Journal of Brachial Plexus and Peripheral Nerve Injury 2012, null:5 2012-04-30T00:00:00Z doi:10.1186/1749-7221-7-5 /content/figures/1749-7221-7-5-toc.gif Journal of Brachial Plexus and Peripheral Nerve Injury 1749-7221 ${item.volume} 5 2012-04-30T00:00:00Z PDF Background: The superiority of a single stage combined anterior (first) posterior (second) approach and end-to-side side-to-side grafting neurorrhaphy in direct cord implantation was investigated as to providing adequate exposure to both the cervical cord and the brachial plexus, as to causing less tissue damage and as to being more extensible than current surgical approaches. Methods: The front and back of the neck, the front and back of the chest up to the midline and the whole affected upper limb were sterilized while the patient was in the lateral position; the patient was next turned into the supine position, the plexus explored anteriorly and the grafts were placed; the patient was then turned again into the lateral position, and a posterior cervical laminectomy was done. The grafts were retrieved posteriorly and side grafted to the anterior cord. Using this approach, 5 patients suffering from complete traumatic brachial plexus palsy, 4 adults and 1 obstetric case were operated upon and followed up for 2 years. 2 were C5,6 ruptures and C7,8T1 avulsions. 3 were C5,6,7,8T1 avulsions. C5,6 ruptures were grafted and all avulsions were cord implanted. Results: Surgery in complete avulsions led to Grade 4 improvement in shoulder abduction/flexion and elbow flexion. Cocontractions occurred between the lateral deltoid and biceps on active shoulder abduction. No cocontractions occurred after surgery in C5,6 ruptures and C7,8T1 avulsions, muscle power improvement extended into the forearm and hand; pain disappeared.Limitations includespontaneous recovery despite MRI appearance of avulsions, fallacies in determining intraoperative avulsions (wrong diagnosis, wrong level); small sample size; no controls rule out superiority of this technique versus other direct cord reimplantation techniques or other neurotization procedures; intra- and interobserver variability in testing muscle power and cocontractions. Conclusion: Through providing proper exposure to the brachial plexus and to the cervical cord, the single stage combined anterior (first) and posterior (second) approach might stimulate brachial plexus surgeons to go more for direct cord implantation. In this study, it allowed for placing side grafts along an extensive donor recipient area by end-to-side, side-to-side grafting neurorrhaphy and thus improved results.Level of evidenceLevel IV, prospective case series. http://www.jbppni.com/content/4/1/8 Sherif Amr Ahmad Essam Amr Abdel-Meguid Ahmad Kholeif Ashraf Moharram Rashed El-Sadek Journal of Brachial Plexus and Peripheral Nerve Injury 2009, null:8 2009-06-19T00:00:00Z doi:10.1186/1749-7221-4-8 /content/figures/1749-7221-4-8-toc.gif Journal of Brachial Plexus and Peripheral Nerve Injury 1749-7221 ${item.volume} 8 2009-06-19T00:00:00Z XML We review our experience treating 335 adult patients with supraclavicular brachial plexus injuries over a 7-year period at the University of Southern Santa Catarina, in Brazil. Patients were categorized into 8 groups, according to functional deficits and roots injured: C5-C6, C5-C7, C5-C8 (T1 Hand), C5-T1 (T2 Hand), C8-T1, C7-T1, C6-T1, and total palsy. To restore function, nerve grafts, nerve transfers, and tendon and muscle transfers were employed. Patients with either upper- or lower-type partial injuries experienced considerable functional return. In total palsies, if a root was available for grafting, 90% of patients had elbow flexion restored, whereas this rate dropped to 50% if no roots were grafted and only nerve transfers performed. Pain resolution should be the first priority, and root exploration and grafting helped to decrease or eliminate pain complaints within a short time of surgery. http://www.jbppni.com/content/6/1/2 Jayme Bertelli Marcos Ghizoni Journal of Brachial Plexus and Peripheral Nerve Injury 2011, null:2 2011-06-16T00:00:00Z doi:10.1186/1749-7221-6-2 /content/figures/1749-7221-6-2-toc.gif Journal of Brachial Plexus and Peripheral Nerve Injury 1749-7221 ${item.volume} 2 2011-06-16T00:00:00Z XML Clavicle fractures are frequent injuries in athletes and midshaft clavicle fractures in particular are well-known injuries in Ironman triathletes. In 2000, Auzou et al. described the mechanism leading to an isolated truncular paralysis of the musculocutaneous nerve after a shoulder trauma. It is well-known that nerve palsies can lead to an atrophy of the associated muscle if they persist for months or even longer. In this case report we describe a new case of an Ironman triathlete suffering from a persistent isolated atrophy of the brachialis muscle. The atrophy occurred following a displaced midshaft clavicle fracture acquiring while falling off his bike after hitting a duck during a competition. http://www.jbppni.com/content/6/1/7 Rust Christoph Alexander Knechtle Beat Knechtle Patrizia Rosemann Thomas Journal of Brachial Plexus and Peripheral Nerve Injury 2011, null:7 2011-10-02T00:00:00Z doi:10.1186/1749-7221-6-7 /content/figures/1749-7221-6-7-toc.gif Journal of Brachial Plexus and Peripheral Nerve Injury 1749-7221 ${item.volume} 7 2011-10-02T00:00:00Z XML Patients with complex regional pain syndrome (CRPS) often suffer from an array of associated movement disorders, including dystonia of an affected limb. We present a case of a patient with long standing CRPS after a brachial plexus injury, who after displaying several features of the movement disorder previously, developed painful dystonia of chest wall musculature. Detailed neurologic examination found palpable sustained contractions of the pectoral and intercostal muscles in addition to surface allodynia. Needle electromyography of the intercostal and paraspinal muscles supported the diagnosis of dystonia. In addition, pulmonary function testing showed both restrictive and obstructive features in the absence of a clear cardiopulmonary etiology. Treatment was initiated with intrathecal baclofen and the patient had symptomatic relief and improvement of dystonia. This case illustrates a novel form of the movement disorder associated with CRPS with response to intrathecal baclofen treatment. http://www.jbppni.com/content/6/1/6 David Irwin Robert Schwartzman Journal of Brachial Plexus and Peripheral Nerve Injury 2011, null:6 2011-09-26T00:00:00Z doi:10.1186/1749-7221-6-6 /content/figures/1749-7221-6-6-toc.gif Journal of Brachial Plexus and Peripheral Nerve Injury 1749-7221 ${item.volume} 6 2011-09-26T00:00:00Z XML