RESUMEN
PURPOSE: Self-biting behavior in patients with neonatal brachial plexus palsy (NBPP) has been associated with finger amputation. Our objective is to describe the incidence of this complication, risk factors, and clinical management. METHODS: We retrospectively analyzed 612 patients with NBPP. There were 303 males and 309 females. 51.8% of patients had C5-C6 lesions, 28.9% had C5-C7, 18.9% had C5-T1, and 0.3 had C7-T1 involvement. RESULTS: We identified 15 patients with self-biting behavior (2.5%). Ten patients had C5-T1 lesions, and five had C5-C7 lesions. Eight patents were submitted to brachial plexus surgery and seven were not. This behavior appeared between 8 and 46 months of life (mean 23.5), and it was always temporary. There was no difference between operated and non-operated patients (p > 0.05), and no correlation between age at surgery and age of appearance of self-biting behavior (p > 0.05). Physical restriction was effective in treating this complication and we had no case of finger amputation. CONCLUSION: Self-biting behavior is a rare complication of NBPP, and it is usually associated with severe motor involvement. The behavior duration is limited to a few months. This condition can be effectively treated with physical restriction to prevent hand biting.
Asunto(s)
Neuropatías del Plexo Braquial , Plexo Braquial , Parálisis Neonatal del Plexo Braquial , Plexo Braquial/cirugía , Neuropatías del Plexo Braquial/etiología , Neuropatías del Plexo Braquial/cirugía , Femenino , Humanos , Recién Nacido , Masculino , Estudios RetrospectivosRESUMEN
BACKGROUND: There is no consensus about which type of imaging study, computed tomography myelography (CTM) or magnetic resonance imaging (MRI), provides better information concerning root avulsion in adult brachial plexus injuries. METHODS: Patients with upper brachial plexus traumatic injuries underwent both CTM and MRI and surgical exploration. The imaging studies were analyzed by two independent radiologists and the data were compared with the intraoperative findings. The statistical analysis was based on dichotomous classification of the nerve roots (normal or altered). The interobserver agreement was assessed using Cohen's Kappa. The accuracy of CTM and MRI in comparison with the intraoperative findings was evaluated using the same methodology. RESULTS: Fifty-two adult patients were included. CTM tended to yield slightly higher percentages of alterations than MRI The interobserver agreement was better on CTM than on MRI for all nerve roots: C5, 0.9960 (strong) vs. 0.145 (poor); C6, 0.970 (strong) vs. 0.788 (substantial); C7, 0.969 (strong) vs. 0.848 (strong). The accuracy regarding the intraoperative findings was also higher on CTM (moderate, kappa 0.40-0.59) than on MRI (minimal, kappa 0.20-0.39) for all nerve roots. Accordingly, the overall percentage concordance (both normal or both altered) was superior in the CTM evaluation (approx. 70-75% vs. 60-65%). CTM was superior for both sensitivity and specificity at all nerve roots. CONCLUSION: CTM had greater interobserver agreement and higher diagnostic accuracy than MRI in adult patients with root avulsions due to brachial plexus injury.
Asunto(s)
Plexo Braquial/diagnóstico por imagen , Plexo Braquial/lesiones , Radiculopatía/diagnóstico por imagen , Adolescente , Adulto , Plexo Braquial/cirugía , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Mielografía , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
PURPOSE: Long-term evaluation of hand function in children who underwent transfer procedures to reinnervate the biceps muscle, using fascicles from the ulnar and median nerves as donors. METHODS: In the last follow-up evaluation, the children underwent a neurological examination, and their hand status was classified according to the Raimondi grading system for hand function. Two physical measurements, the child health assessment questionnaire (CHAQ) and the Sollerman hand function test, were applied to assess upper extremity function. RESULTS: Eight children were re-evaluated. In four the donor fascicle was from the ulnar nerve and in four from the median nerve. The average interval between surgery and the last evaluation was 8.3 years (range 6-10 years). Five patients scored 5 points in the Raimondi grading system, and 3 patients scored 4 points. The results from the CHAQ ranged from 0.03 to 0.41. The results from the Sollerman test were between 60 and 77 for the affected upper limb and between 65 and 79 for the dominant upper limb. CONCLUSION: Nerve transfer of a fascicle from the ulnar or median nerve to the biceps motor branch in children with neonatal brachial plexus palsy does not result in hand dysfunction.
Asunto(s)
Neuropatías del Plexo Braquial , Transferencia de Nervios , Brazo , Neuropatías del Plexo Braquial/cirugía , Niño , Humanos , Recién Nacido , Músculo Esquelético , Resultado del Tratamiento , Nervio Cubital/cirugíaRESUMEN
This historical review presents the relevant data about the evolution of the surgical treatment of neonatal brachial plexus palsy. Starting with the first clinical description by Smellie in 1754, we will present the initial enthusiasm for the surgery followed by a lack of interest that lasted many years, the resurgence of interest in operative management in the 1970s, and the consolidation in the 1980s of surgery as the standard indication in cases of neonatal brachial plexus palsy without a functional spontaneous recovery.
Asunto(s)
Traumatismos del Nacimiento , Neuropatías del Plexo Braquial , Plexo Braquial , Parálisis Neonatal del Plexo Braquial , Traumatismos del Nacimiento/cirugía , Plexo Braquial/lesiones , Plexo Braquial/cirugía , Neuropatías del Plexo Braquial/etiología , Neuropatías del Plexo Braquial/cirugía , Humanos , Recién Nacido , Recuperación de la FunciónRESUMEN
Background: Although reinnervation of the suprascapular nerve is frequently obtained through brachial plexus surgery, reestablishment of infraspinatus muscle function is rarely achieved.Methods: The viability of transfer of the radial nerve to the nerve branch to the infraspinatus muscle was determined anatomically, including histomorphometrical analysis on 30 adult cadavers. Eleven adult patients were then treated using the proposed nerve transfer.Results: The branch to the medial head was more suitable for the nerve transfer. In one cadaver, nerve transfer was impossible because there was no donor of sufficient length. According to axon counts, the branches to the lateral and medial heads had sufficient numbers of axons (means = 994.2 ± 447.6 and 1030.8 ± 258.5, respectively) for reinnervation of the branch to the infraspinatus (means = 830.2 ± 241.2 axons). In the surgical series, one patient was lost in the follow-up and only two patients achieved a good result from the transfer. Recovery of external shoulder rotation started 14 months after surgery in one patient and 8 months in the other. The first patient reached 90° of external rotation 6 months later and the second, achieved 120°of shoulder external rotation 6 months after surgery . Four other patients recovered small amounts of movement: 20, 35, 40 and 45°.Conclusions: Although anatomically feasible, the proposed nerve transfer resulted in a small number of good clinical outcomes.
Asunto(s)
Hombro/cirugía , Neuropatías del Plexo Braquial/cirugía , Humanos , Transferencia de Nervios , Nervio Radial/cirugía , Rotación , Manguito de los Rotadores/cirugíaRESUMEN
PURPOSE: The outcome from microsurgical reconstruction of neonatal brachial plexus palsy (NBPP) varies, and comparison between different series is difficult, given the differences in preoperative evaluation, surgical strategies, and outcome analysis. To evaluate our results, we reviewed a series of children who underwent surgical treatment in a period of 14 years. METHODS: We made a retrospective review of 104 cases in which microsurgical repair of the brachial plexus was performed. Strength was graded using the Active Movement Scale. Whenever possible, upper palsies underwent surgery 4 to 6 months after birth and total lesions around 3 months. The lesions were repaired, according to the type of injury: neurolysis, nerve grafting, nerve transfer, or a combination of techniques. The children were followed for at least 24 months. RESULTS: The majority of cases were complete lesions (56/53.8%). Erb's palsy was present in 10 cases (9.6%), and 39 infants (37.5%) presented an extended Erb's palsy. The surgical techniques applied were neurolysis (10.5%), nerve grafts (25.9%), nerve transfers (34.6%), and a combination of grafts and transfers (30.7%). The final outcome was considered poor in 41.3% of the cases, good in 34.3%, and excellent in 24%. A functional result (good plus excellent) was achieved in 58.3% of the cases. CONCLUSIONS: There is no consensus regarding strategies for treatment of NBPP. Our surgical outcomes indicated a good general result comparing with the literature. However, our results were lower than the best results reported. Maybe the explanation is our much higher number of total palsy cases (53.8% vs. 25% in the literature).
Asunto(s)
Parálisis Neonatal del Plexo Braquial/cirugía , Procedimientos Neuroquirúrgicos/métodos , Procedimientos de Cirugía Plástica/métodos , Femenino , Humanos , Recién Nacido , Masculino , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Shoulder stability, abduction and external rotation are vital for the performance of usual daily tasks. AIMS: To compare the functional outcomes in the shoulder following spinal accessory to suprascapular nerve transfer (SASNT). PATIENTS AND METHODS: Comparison of the outcome of adult patients with upper traumatic brachial plexus palsy undergoing SASNT with patients with complete palsy submitted to the same procedure. STATISTICAL ANALYSIS: Ranges of motion were compared via the Mann-Whitney U test. The percentages of patients with a favorable outcome were compared by the chi-square test. All tests were two-tailed and P values <0.05 were considered statistically significant. RESULTS: SASNT was performed in 76 patients: 23 cases (30.2%) of upper-plexus injuries and 53 cases (69.7%) of complete brachial plexus palsy. Good shoulder abduction was achieved in 15 patients (65.2%) with upper plexus palsy and a good external rotation in 5 (21.7%). In those patients with a good recovery, the average range of motion (ROM) was 53° for shoulder abduction and 71.2° for external rotation. Thirty-six patients (67.9%) with complete palsy had a good shoulder abduction recovery with 30.7° of average ROM, but only 3 patients (5.6%) recovered a good shoulder external rotation with 68.3° of average ROM. There was no statistical difference for the abduction outcome, but the external rotation outcome was superior in the upper plexus palsy group. CONCLUSION: SASNT is a consistent procedure to achieve functional recovery of shoulder abduction after a partial or complete plexus injury, but the outcomes of external rotation were quite disappointing in both the groups.
Asunto(s)
Nervio Accesorio/cirugía , Plexo Braquial/cirugía , Traumatismos de los Nervios Periféricos/cirugía , Hombro/inervación , Hombro/cirugía , Adulto , Plexo Braquial/lesiones , Humanos , Transferencia de Nervios , Recuperación de la Función , Hombro/fisiopatología , Resultado del Tratamiento , Adulto JovenRESUMEN
Objective To present the functional outcomes of distal nerve transfer techniques for restoration of elbow flexion after upper brachial plexus injury. Method The files of 78 adult patients with C5, C6, C7 lesions were reviewed. The attempt to restore elbow flexion was made by intraplexus distal nerve transfers using a fascicle of the ulnar nerve (group A, n » 43), or a fascicle of themedian nerve (group B, n » 16) or a combination of both (group C, n » 19). The result of the treatment was defined based on the British Medical Research Council grading system: muscle strength < M3 was considered a poor result. Results The global incidence of good/excellent results with these nerve transfers was 80.7%, and for different surgical techniques (groups A, B, C), it was 86%, 56.2% and 100% respectively. Patients submitted to ulnar nerve transfer or double transfer (ulnar þ median fascicles transfer) had a better outcome than those submitted to median nerve transfer alone (p < 0.05). There was no significant difference between the outcome of ulnar transfer and double transfer. Conclusion In cases of traumatic injury of the upper brachial plexus, good and excelent results in the restoration of elbow flexion can be obtained using distal nerve transfers.
Asunto(s)
Nervio Cubital/trasplante , Transferencia de Nervios/rehabilitación , Transferencia de Nervios/estadística & datos numéricos , Articulación del Codo , Nervio Mediano/trasplante , Registros Médicos , Interpretación Estadística de Datos , Transferencia de Nervios/métodos , Estadísticas no Paramétricas , Neuropatías del Plexo Braquial/cirugíaRESUMEN
OBJECTIVE: To establish the correlation between clinical evaluation of motor function recovery and daily living activities in 30 patients with upper traumatic brachial plexus injury submitted to surgery. METHODS: The score of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Louisiana State University Health Sciences Center (LSUHSC) scale were determined in 30 patients. Epidemiologic factors were also examined and correlations were determined. RESULTS: There was a significant correlation between the clinical evaluation and the daily living activities after a 12-month period (r = 0.479 and p = 0.007). A direct correlation was observed between the functional recovery of the upper limb and the time between injury and surgery (r = 0.554 and p = 0.001). The LSUHSC scores (p = 0.049) and scores from the DASH questionnaire (p = 0.013) were better among patients who returned to work. CONCLUSIONS: Clinical evaluation and daily living activities in adult patients who underwent nerve transfer after brachial plexus injury showed significant and measurable improvements.
Asunto(s)
Actividades Cotidianas , Plexo Braquial/cirugía , Transferencia de Nervios/métodos , Recuperación de la Función/fisiología , Adulto , Anciano , Plexo Braquial/lesiones , Neuropatías del Plexo Braquial/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Regeneración Nerviosa/fisiología , Encuestas y Cuestionarios , Extremidad Superior , Adulto JovenRESUMEN
ABSTRACT Objective To establish the correlation between clinical evaluation of motor function recovery and daily living activities in 30 patients with upper traumatic brachial plexus injury submitted to surgery. Methods The score of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Louisiana State University Health Sciences Center (LSUHSC) scale were determined in 30 patients. Epidemiologic factors were also examined and correlations were determined. Results There was a significant correlation between the clinical evaluation and the daily living activities after a 12-month period (r = 0.479 and p = 0.007). A direct correlation was observed between the functional recovery of the upper limb and the time between injury and surgery (r = 0.554 and p = 0.001). The LSUHSC scores (p = 0.049) and scores from the DASH questionnaire (p = 0.013) were better among patients who returned to work. Conclusions Clinical evaluation and daily living activities in adult patients who underwent nerve transfer after brachial plexus injury showed significant and measurable improvements.
RESUMO Objetivo Avaliar a correlação entre a avaliação clínica e as atividades de vida diária em 30 paciente adultos com lesão do plexo braquial superior. Métodos O valor do questionário Dash (Disabilities of the Arm, Shoulder and Hand) e da escala Louisiana State University Health Sciences Center (LSUHSC) foram quantificados prospectivamente em 30 pacientes. Fatores epidemiológicos foram também examinados e correlações específicas determinadas. Resultados Houve correlação significativa entre avaliação clínica e as atividades de vida diária 12 meses após a cirurgia (r = 0.479 e p = 0.007). Uma correlação direta foi observada entre a recuperação funcional do membro superior e o tempo entre a lesão e a cirurgia (r = 0.554 e p = 0.001). Os valores da escala LSUHSC (p = 0.049) e do DASH (p = 0.013) foram melhores entre aqueles que retornaram ao trabalho. Conclusões A avaliação clínica e as atividades de vida diária em pacientes submetidos à cirurgia de transferência de nervos após lesão do plexo braquial mostraram correlação significativa.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Plexo Braquial/cirugía , Actividades Cotidianas , Transferencia de Nervios/métodos , Recuperación de la Función/fisiología , Plexo Braquial/lesiones , Encuestas y Cuestionarios , Neuropatías del Plexo Braquial/cirugía , Extremidad Superior , Regeneración Nerviosa/fisiologíaRESUMEN
PURPOSE: Ulnar and median nerve transfers to arm muscles have been used to recover elbow flexion in infants with neonatal brachial plexus palsy, but there is no direct outcome comparison with the classical supraclavicular nerve grafting approach. METHODS: We retrospectively analyzed patients with C5-C7 neonatal brachial plexus palsy submitted to nerve surgery and recorded elbow flexion recovery using the active movement scale (0-7) at 12 and 24 months after surgery. We compared 13 patients submitted to supraclavicular nerve grafting with 21 patients submitted to distal ulnar or median nerve transfer to biceps motor branch. We considered elbow flexion scores of 6 or 7 as good results. RESULTS: The mean elbow flexion score and the proportion of good results were better using distal nerve transfers than supraclavicular grafting at 12 months (p < 0.01), but not at 24 months. Two patients with failed supraclavicular nerve grafting at 12 months showed good elbow flexion recovery after ulnar nerve transfers. CONCLUSION: Distal nerve transfers provided faster elbow flexion recovery than supraclavicular nerve grafting, but there was no significant difference in the outcome after 24 months of surgery. Patients with failed supraclavicular grafting operated early can still benefit from late distal nerve transfers. Supraclavicular nerve grafting should remain as the first line surgical treatment for children with neonatal brachial plexus palsy.
Asunto(s)
Neuropatías del Plexo Braquial/cirugía , Nervio Mediano/trasplante , Transferencia de Nervios/métodos , Nervio Cubital/trasplante , Articulación del Codo , Femenino , Humanos , Lactante , Masculino , Rango del Movimiento Articular , Estudios RetrospectivosRESUMEN
INTRODUCTION: Adult traumatic brachial plexus lesions are devastating injuries. Their real incidence is difficult to ascertain, but are certainly growing due to the increasing number of high-speed motor-vehicle accidents, especially in big cities. OBJECTIVES: Analysis of the epidemiological characteristics of patients with traumatic brachial plexus lesions in São Paulo, Brazil, the sixth largest city in the world. METHODS: This was a retrospective analysis of the epidemiological characteristics of patients submitted to surgical treatment of traumatic brachial plexus lesions in the Peripheral Nerve Surgery Unit of the Department of Neurosurgery of the University of São Paulo Medical School. RESULTS: In the period from 2004 to 2012, 406 patients underwent surgery. There were 384 (94.6 %) men and 22 (5.4 %) women. In 45.9 % the compromised plexus was the right and in 54.1 %, the left. The average age was 28.38 years. Among the causes, the most frequent was motorcycle accidents (79 %). Most of the lesions were supraclavicular. In 46.1 % of cases the lesions were complete, in 30.1 % the lesions compromised C5/C6 roots, in 20.9 % the C5/C6/C7 roots were lesioned and in 2.9 % the lesion was in the lower roots, C8/T1. Among the associated lesions the most prevalent were head trauma, observed in 34.2 % of the cases; lesions of long bones in 38.8 %; clavicle fractures in 25.9 %; and thoracic trauma in 12.9 %. CONCLUSION: In a population of adult patients with brachial plexus lesions with surgical indication, most of them comprise young male adults involved in high-energy motorcycle accidents.
Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Plexo Braquial/lesiones , Traumatismos de los Nervios Periféricos/epidemiología , Población Urbana/estadística & datos numéricos , Adolescente , Adulto , Anciano , Plexo Braquial/cirugía , Brasil/epidemiología , Niño , Traumatismos Craneocerebrales/complicaciones , Femenino , Fracturas Óseas/complicaciones , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Motocicletas , Neurocirugia , Traumatismos de los Nervios Periféricos/complicaciones , Traumatismos de los Nervios Periféricos/cirugía , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: Although peripheral schwannomas can be resected without postoperative neurological complications, surgeons must anticipate the possibility that new neurological deficits could develop. In order to evaluate the risk of neurological complications in the surgical treatment of these tumours, we performed a retrospective review of cases involving schwannomas in the extremities, as well as an analysis of the related literature. METHOD: We reviewed a combined series of 72 schwannomas from the extremities presenting for surgical excision. Meticulous analysis of the files was undertaken, searching for pre-operative findings that could be more frequent in patients with surgical complications. The incidence, severity, and transitory nature of post-operative complications in our series was observed and compared against the literature. RESULTS: Eleven patients (15.2 %) developed new neurological deficits after surgery: sensory disturbance in seven cases, motor weakness in three, and a single wound hematoma. Most of these complications were temporary. Statistical analysis demonstrated a positive relationship between the presence of complications and both patient age under 50 years (p = 0.02) and tumours greater than 3 cm in greatest diameter (p = 0.02). CONCLUSIONS: Although relatively infrequent, the potential for novel post-operative deficits after the surgical treatment of peripheral schwannomas does exist and should be included during pre-operative counseling.
Asunto(s)
Neurilemoma/cirugía , Neoplasias del Sistema Nervioso Periférico/cirugía , Complicaciones Posoperatorias/prevención & control , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/métodos , Periodo Posoperatorio , Estudios Retrospectivos , Medición de Riesgo , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: In brachial plexus injuries, when there are no available roots to use as a source for graft reconstruction, nerve transfers emerge as an elective technique. For this purpose, transfer of an ulnar nerve fascicle to the biceps motor branch (Oberlin's procedure) is often used. Despite the high rate of good to excellent results in adults, this technique is seldom used in children. OBJECTIVE: To evaluate the efficacy and safety of Oberlin's procedure in the surgical treatment of brachial plexus birth palsy. METHODS: Striving to restore elbow flexion, we performed Oberlin's procedure in 17 infants with brachial plexus birth palsy. After follow-up of at least 19 months, primary outcomes were the strength of elbow flexion (modified British Medical Research Council scale), hand function measured using Al-Qattan's scale, and comparative x-rays of both hands to detect altered growth. RESULTS: Good to excellent results related to biceps contraction were obtained in 14 patients (82.3%) (3/MRC3, 11/MRC4). The preoperative Al-Qattan scale score for the hand was maintained at final follow-up. Comparing the treated and normal limb, no difference was observed in hand development by x-ray. CONCLUSION: Oberlin's procedure is an effective and safe option for the surgical treatment of upper brachial plexus birth palsy.
Asunto(s)
Neuropatías del Plexo Braquial/cirugía , Transferencia de Nervios/métodos , Nervio Cubital/cirugía , Neuropatías del Plexo Braquial/diagnóstico por imagen , Codo/cirugía , Femenino , Humanos , Lactante , Masculino , Transferencia de Nervios/efectos adversos , Radiografía , Rango del Movimiento Articular , Recuperación de la Función , Resultado del Tratamiento , Nervio Cubital/diagnóstico por imagen , Nervio Cubital/fisiología , Nervio Cubital/trasplanteRESUMEN
OBJECTIVE: To evaluate the prognostic value of absent thumb pain sensation in newborns and young infants with birth brachial plexopathy. METHODS: We evaluated 131 patients with birth brachial plexopathy with less than two months of age. Pain sensation was evoked by thumb nail bed compression to evaluate sensory fibers of the upper trunk (C6). The patients were followed-up monthly. Patients with less than antigravity elbow flexion at six months of age were considered to have a poor outcome. RESULTS: Thirty patients had absent thumb pain sensation, from which 26 showed a poor outcome. Sensitivity of the test was 65% and specificity was 96%. CONCLUSION: Evaluation of thumb pain sensation should be included in the clinical assessment of infants with birth brachial plexopathy.
Asunto(s)
Traumatismos del Nacimiento/fisiopatología , Neuropatías del Plexo Braquial/diagnóstico , Plexo Braquial/lesiones , Hipoestesia/diagnóstico , Umbral del Dolor/fisiología , Pulgar/fisiopatología , Traumatismos del Nacimiento/complicaciones , Plexo Braquial/fisiopatología , Neuropatías del Plexo Braquial/fisiopatología , Articulación del Codo/fisiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Pronóstico , Rango del Movimiento Articular , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: To evaluate the prognostic value of absent thumb pain sensation in newborns and young infants with birth brachial plexopathy. METHODS: We evaluated 131 patients with birth brachial plexopathy with less than two months of age. Pain sensation was evoked by thumb nail bed compression to evaluate sensory fibers of the upper trunk (C6). The patients were followed-up monthly. Patients with less than antigravity elbow flexion at six months of age were considered to have a poor outcome. RESULTS: Thirty patients had absent thumb pain sensation, from which 26 showed a poor outcome. Sensitivity of the test was 65% and specificity was 96%. CONCLUSION: Evaluation of thumb pain sensation should be included in the clinical assessment of infants with birth brachial plexopathy.
OBJETIVO: Avaliar o valor prognóstico da hipoestesia dolorosa no polegar em recém-nascidos e lactentes jovens com plexopatia braquial obstétrica. MÉTODOS: Avaliamos 131 pacientes com plexopatia braquial obstétrica com menos de dois meses de idade. A sensação dolorosa foi provocada pela compressão do leito ungueal do polegar para avaliar fibras sensitivas do tronco superior (C6). Os pacientes foram seguidos mensalmente. Prognóstico desfavorável foi atribuído aos pacientes sem força antigravitacional para flexão do cotovelo aos seis meses de idade. RESULTADOS: Trinta pacientes apresentaram hipoestesia dolorosa do polegar, dos quais 26 tiveram prognóstico desfavorável. A sensibilidade do teste foi de 65% e a especificidade 96%. CONCLUSÃO: A avaliação da sensibilidade dolorosa do polegar deve ser incluída na avaliação clínica de pacientes com plexopatia braquial obstétrica.
Asunto(s)
Femenino , Humanos , Lactante , Recién Nacido , Masculino , Traumatismos del Nacimiento/fisiopatología , Neuropatías del Plexo Braquial/diagnóstico , Plexo Braquial/lesiones , Hipoestesia/diagnóstico , Umbral del Dolor/fisiología , Pulgar/fisiopatología , Traumatismos del Nacimiento/complicaciones , Neuropatías del Plexo Braquial/fisiopatología , Plexo Braquial/fisiopatología , Articulación del Codo/fisiología , Pronóstico , Rango del Movimiento Articular , Sensibilidad y EspecificidadRESUMEN
Desmoid-type fibromatosis is an uncommon and aggressive neoplasia, associated with a high rate of recurrence. It is characterized by an infiltrative but benign fibroblastic proliferation occurring within the deep soft tissues. There is no consensus about the treatment of those tumors. We present a surgical series of four cases, involving the brachial plexus (two cases), the median nerve and the medial brachial cutaneous nerve. Except for the last case, they were submitted to multiple surgical procedures and showed repeated recurrences. The diagnosis, the different ways of treatment and the prognosis of these tumoral lesions are discussed. Our results support the indication of radical surgery followed by radiotherapy as probably one of the best ways to treat those controversial lesions.
Asunto(s)
Fibromatosis Agresiva/cirugía , Neoplasias del Sistema Nervioso Periférico/cirugía , Adulto , Plexo Braquial , Femenino , Fibromatosis Agresiva/diagnóstico , Humanos , Masculino , Nervio Mediano , Recurrencia Local de Neoplasia , Neoplasias del Sistema Nervioso Periférico/diagnóstico , Adulto JovenRESUMEN
Desmoid-type fibromatosis is an uncommon and aggressive neoplasia, associated with a high rate of recurrence. It is characterized by an infiltrative but benign fibroblastic proliferation occurring within the deep soft tissues. There is no consensus about the treatment of those tumors. We present a surgical series of four cases, involving the brachial plexus (two cases), the median nerve and the medial brachial cutaneous nerve. Except for the last case, they were submitted to multiple surgical procedures and showed repeated recurrences. The diagnosis, the different ways of treatment and the prognosis of these tumoral lesions are discussed. Our results support the indication of radical surgery followed by radiotherapy as probably one of the best ways to treat those controversial lesions.
A fibromatose do tipo desmoide é uma lesão tumoral agressiva e rara, associada a alto índice de recorrência. É caracterizada pela fibroblástica infiltrativa, porém benigna, que ocorre no interior de tecidos moles profundos. Não existe consenso com relação ao tratamento desses tumores. Apresentamos uma série cirúrgica de quatro casos comprometendo o plexo braquial (dois casos), o nervo mediano e o nervo cutâneo medial do braço. Com exceção do último caso, todos foram submetidos a múltiplos procedimentos cirúrgicos e apresentaram recorrências repetidas. São discutidos o diagnóstico, as diferentes formas de tratamento e o prognóstico dessas lesões tumorais. Nossos resultados apoiam o conceito de que cirurgia radical seguida por radioterapia é uma das melhores formas de se tratar essas controvertidas lesões.
Asunto(s)
Adulto , Femenino , Humanos , Adulto Joven , Fibromatosis Agresiva/cirugía , Neoplasias del Sistema Nervioso Periférico/cirugía , Plexo Braquial , Fibromatosis Agresiva/diagnóstico , Nervio Mediano , Recurrencia Local de Neoplasia , Neoplasias del Sistema Nervioso Periférico/diagnósticoRESUMEN
OBJECTIVE: To evaluate donor site morbidity following sural nerve harvesting, with special attention to the recovery of sensory loss. METHODS: We prospectively followed 38 subjects who underwent sural nerve harvest, including two with bilateral nerve excision. Symptoms related to sural nerve excision were evaluated and demarcation of the area with reduced touch sensation was quantified. Assessments were performed periodically up to 1 year after surgery and the results of different sensory evaluations were compared. RESULTS: A significant reduction of sensory deficit was identified between consecutive evaluations (p<0.05). Decreases of 26.85%, 20.69% and 24.29% were observed 3, 6 and 12 months after surgery, respectively. Shock-like pain (7.5%), stabbing pain (7.5%), and numbness (5%) were the most frequently reported symptoms. All symptoms were brief and resolved spontaneously 3-6 months after surgery. CONCLUSION: Sural nerve harvest can be performed with acceptable morbidity. When present, symptoms resolve between the third and sixth month after surgery and a significant reduction of sensory loss in the area innervated by the sural nerve was observed during the first year of follow-up.
Asunto(s)
Hipoestesia/etiología , Nervio Sural/trasplante , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Morbilidad , Procedimientos Neuroquirúrgicos , Dimensión del Dolor , Dolor Postoperatorio/etiología , Estudios Prospectivos , Donantes de Tejidos , Recolección de Tejidos y Órganos , Tacto/fisiología , Resultado del Tratamiento , Adulto JovenRESUMEN
Traumatic injuries to the brachial plexus in adults are severely debilitating. They generally affect young individuals. A thorough understanding of the anatomy, clinical evaluation, imaging and electrodiagnostic assessments, treatment options and proper timing of surgical interventions will enable nerve surgeons to offer optimal care to patients. Advances in microsurgical technique have improved the outcome for many of these patients. The treatment options offer patients with brachial plexus injuries the possibility of achieving elbow flexion, shoulder stability with limited abduction and the hope of limited but potentially useful hand function.