RESUMO
OBJECTIVE: The aim of this study was to add to the understanding of nerve branching patterns in the proximal forearm and consider optimal nerve transfer options to address the various injuries that affect the function of the upper extremity. METHODS: Eleven upper-extremity cadaveric specimens were dissected to expose the radial, median, and ulnar nerves in the proximal forearm. The site of origin of nerve branches from the major nerves was assessed, with measurements made in reference to the lateral epicondyle for the radial nerve branches and the medial epicondyle for the median and ulnar nerve branches. The distances to where these branches entered their respective muscles (muscle entry point) were assessed using the same landmarks. To plan a transfer, the length of the nerve branches was then calculated as the difference from the apparent origin from the main nerve trunk to the location where the nerve entered the muscle. Importantly, the nerve branch origin was established as the location of obvious separation from the main nerve trunk without additional fascicular dissection from the major nerve trunk. The number of branches was determined, and the diameter for each branch was measured using a Vernier caliper. RESULTS: The radial nerve branch to the extensor carpi radialis brevis (ECRB) muscle had an average length of 50.7 mm and average diameter of 1.6 mm. The mean medial and lateral lengths of the radial branches to the supinator muscle were found to be 22.2 mm (diameter 1.4 mm) and 15.3 mm (diameter 1.3 mm), respectively. The anterior interosseous nerve (AIN) branch of the median nerve was found 67.8 mm distal to the medial epicondyle with a diameter of 2.3 mm. The flexor carpi ulnaris (FCU) muscle innervation from the ulnar nerve was provided by 3 or 4 branches in most specimens. The second and third of these branches were the longest, with means of 30.5 mm (diameter 1.4 mm) and 30.7 mm (diameter 1.3 mm), respectively. CONCLUSIONS: While there is variability of the nerve branching pattern in the proximal forearm between specimens, the authors provide evidence of commonalities (branching patterns and distances) that can facilitate planning for upper-extremity nerve reconstructions. Importantly, all measurements are provided with reference to easily identified bony landmarks and to their muscle entry points to aid operative decision-making. These data complement the growing practice of nerve transfers in the upper extremity for a variety of pathologies.
Assuntos
Antebraço , Transferência de Nervo , Humanos , Antebraço/inervação , Nervo Radial/patologia , Nervo Radial/cirurgia , Relevância Clínica , Nervos Periféricos , Nervo Ulnar/anatomia & histologia , Músculo Esquelético , CadáverRESUMO
El recorrido del nervio radial a través del codo constituye, para este elemento nervioso, un camino con riesgo de lesiones intrínsecas o extrínsecas. Cambios de la morfología de las estructuras osteomusculares que constituyen el desfiladero del nervio radial, tanto patológicos como traumáticos, pueden determinar el atrapamiento y compresión del mismo, determinando el daño del nervio y/o la inflamación localizada a nivel de las estructuras circundantes. Mediante la disección de 30 preparados, formolizados al 10 por ciento, y el análisis subsecuente de la disposición de las estructuras musculares e inserción de las mismas, se determinaron los posibles puntos de riesgo anatómico que pudiesen alterar al nervio radial o a sus ramos en la canal bicipital lateral o en su ingreso y distribución en el parte proximal del antebrazo (relación con el músculo supinador y los músculos extensores radial largo y corto). Definimos 4 zonas de posible atrapamiento y compresión del nervio radial y sus ramos: 1. Septo intermuscular lateral. 2. Músculo extensor radial corto. 3. Músculo supinator, a nivel de la Arcada de Frohse. 4. Músculo supinator, a la salida de la masa muscular, en el dorso del antebrazo. La compresión del nervio radial a nivel del codo es una de las neuropatías del miembro superior, más frecuentes. El objetivo de este trabajo fue analizar las implicancias anatómicas del recorrido del nervio radial en su pasaje desde el brazo al antebrazo, especialmente las relaciones con las estructuras osteomusculares, cuyas alteraciones pueden ser las responsables de patologías compresivas del nervio radial que puedan llevar a dolor, parestesias, con o sin pérdida sensorial y/o impotencia funcional.
The radial nerve route through elbow constitutes, for this nervous element, a way with risk of intrinsic or extrinsic injuries. Morphologic changes of the structures that constitute the denle of the radial nerve, pathological as much traumatic, can determine it atrapment and compression, determining the damage of the nerve and/or the inflammation located at level of the surrounding structures. 30 forearm-elbow, preserved with formol to 10 percent, were dissected, and the subsequent analysis of the disposition of the muscular structures and insertion of the same ones, will determine the possible points of anatomical risk that they will affect the radial nerve or its branches in the brachial track or in the proximal forearm (relation with the supinator muscle and extensor carpi radialis longus and brevis muscles).We defined 4 zones of atrapment and compression of the radial nerve and its branches: 1. External intermuscular setum; 2. Extensor carpi radialis brevis muscle; 3. Supinator muscle , atlevelof theFrohse's Arch;4. Supinator muscle, when coming out of the muscular mass, in the back of the forearm. The compression of the radial nerve at level of the elbow is one of the frequent neuropathies of the superior member. It is for that reason that the objective of this work consists of analyzing the anatomical aspects of the route of the radial nerve in its passage from the arm to the forearm, specially relations with morphological structures, whose alterations determines pathologies of the radial nerve which can take to pain, parestesies, with lost sensorial and functional impotence.
Assuntos
Humanos , Articulação do Cotovelo/inervação , Articulação do Cotovelo/patologia , Nervo Radial/patologia , Neuropatia Radial/patologia , Risco , Síndromes de Compressão Nervosa/patologiaAssuntos
Humanos , Nervo Radial/patologia , Neuropatia Radial/etiologia , Neuropatia Radial/diagnóstico , Neuropatia Radial/cirurgia , Neuropatia Radial/terapia , Paralisia , Transferência Tendinosa , Fraturas do Úmero/complicações , Cuidados Pré-Operatórios , Reabilitação , Complicações Pós-Operatórias , Resultado do TratamentoAssuntos
Humanos , Nervo Radial/patologia , Neuropatia Radial/etiologia , Neuropatia Radial/diagnóstico , Neuropatia Radial/cirurgia , Neuropatia Radial/terapia , Paralisia , Transferência Tendinosa , Fraturas do Úmero/complicações , Cuidados Pré-Operatórios , Reabilitação , Complicações Pós-Operatórias , Resultado do TratamentoRESUMO
Nerve entrapment and compression produce a pathology known as mononeuropathy, which consists in the isolated affectation of a peripheral nerve due to mechanical forces that act on themselves for a prolonged period. Neuropathies by entrapment affect diverse nerves along its path. The most frequent points of entrapment are in the upper limbs the path along the carpal tunnel for the median nerve, and the cubital channel at the level of the elbow for the cubital nerve. Diagnosis of these pathologies is based fundamentally on clinical and electrodiagnostic studies. Each one of the phases of the nerve entrapment lesion has its classification in the neurophysiological study, starting with a focal slowing of conduction (due to focal demyelinization), followed by a blocked nerve conduction and temporal dispersion through the compression site and, in later stages, the electromyography shows signs of denervation of the distal muscles (axonal damage).
Assuntos
Humanos , Nervo Radial/patologia , Neuropatias Ulnares/diagnóstico , Síndrome do Túnel Carpal/diagnóstico , Síndromes de Compressão Nervosa/diagnóstico , Cotovelo , Eletrodiagnóstico , Nervo MedianoAssuntos
Humanos , Nervo Radial/patologia , Neuropatia Radial/cirurgia , Neuropatia Radial/diagnóstico , Neuropatia Radial/etiologia , Neuropatia Radial/terapia , Paralisia , Transferência Tendinosa , Complicações Pós-Operatórias , Cuidados Pré-Operatórios , Fraturas do Úmero/complicações , Reabilitação , Resultado do TratamentoRESUMO
Brachial plexus avulsion injuries are devastating injuries to the upper limb, and nerve transfer remains the only option in reconstruction. Despite the encouraging results concerning recovery of shoulder and elbow function, no option is available for treatment of the paralytic hand. In rats, we sectioned the radial nerve in the elbow region and transferred it across the chest to reinnervate the lesioned contralateral medial cord of the brachial plexus. Rats were then evaluated for motor and sensory recovery, electrophysiologically, behaviorally and morphologically. Forepaw functional recovery was estimated to be 90%. In cadavers, the radial nerve and profunda brachii artery were dissected. It was observed that the radial nerve vascularized by the profunda brachii artery was able to reach the contralateral brachial plexus distal to the shoulder region without nerve grafts. After sectioning the radial nerve, sensory loss is minimal and motor palsy can be easily restored by tendon transfers. The results of tendon transfer for radial nerve palsy are better than for any other nerve. Cross-chest radial nerve transfer might be of clinical interest in the reconstruction of hand function in entire injury to the brachial plexus.
Assuntos
Plexo Braquial/lesões , Transferência de Nervo , Nervo Radial/cirurgia , Análise de Variância , Animais , Axônios/fisiologia , Comportamento Animal , Artéria Braquial/patologia , Artéria Braquial/cirurgia , Plexo Braquial/patologia , Plexo Braquial/cirurgia , Estimulação Elétrica , Eletrofisiologia , Potenciais Evocados/fisiologia , Feminino , Membro Anterior/inervação , Membro Anterior/fisiologia , Contração Isométrica/fisiologia , Movimento/fisiologia , Músculo Esquelético/inervação , Regeneração Nervosa/fisiologia , Limiar da Dor/fisiologia , Paralisia/cirurgia , Nervo Radial/irrigação sanguínea , Nervo Radial/patologia , Ratos , Ratos Sprague-Dawley , Sensação/fisiologia , Transferência TendinosaAssuntos
Doenças do Sistema Nervoso Periférico/complicações , Doenças do Sistema Nervoso Periférico/diagnóstico , Hanseníase Tuberculoide/complicações , Hanseníase Tuberculoide/diagnóstico , Nervo Radial/patologia , Nervo Ulnar/patologia , Neurofibromatoses/complicações , Neurofibromatoses/diagnóstico , Produção de Droga sem Interesse Comercial , Talidomida/uso terapêuticoAssuntos
Biópsia/efeitos adversos , Doenças do Sistema Nervoso Periférico/patologia , Hanseníase/patologia , Neoplasias do Sistema Nervoso/etiologia , Nervo Musculocutâneo/fisiopatologia , Nervo Musculocutâneo/patologia , Nervo Radial/fisiopatologia , Nervo Radial/patologia , Neuritos/patologia , Neuroma/etiologia , Neurônios Aferentes/fisiologia , Neurônios Aferentes/patologia , Sensação/fisiologiaRESUMO
FUNDAMENTOS - A reaçäo tipo I é pouco estudada na literatura. OBJETIVOS - Descrever a época de aparecimento da reaçäo tipo 1 e os nervos acometidos, nos pacientes portadores de hanseníase borderline tuberculóide (BT), durante a poliquimioterapia(PQT). PACIENTES E MÉTODOS - Estudo longitudinal realizado no Ambulatório de Dermatologia da Faculdade de Medicina da UFMG. Setenta e um pacientes com hanseníase BT foram incluídos no estudo de agosto de 1989 a agosto de 1993. RESULTADOS - 89,3 por cento dos pacientes hansenianos BT com reaçäo tipo 1 apresentaram esse surto atá a sexta dose de tratamento. O nervo ulnar foi o mais acometido nas reaçöes tipo 1 (37,0 por cento). CONCLUSÃO - A reaçäo tipo 1 nos pacientes hansenianos BT ocorre mais frequentemente até a sexta dose de PQT. O nervo ulnar foi o mais acometido
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Quimioterapia Combinada , Nervo Facial/patologia , Hanseníase Tuberculoide/tratamento farmacológico , Hansenostáticos/uso terapêutico , Nervo Radial/patologia , Nervo Tibial/patologia , Nervo Ulnar/patologia , Corticosteroides , Hanseníase Tuberculoide/etiologia , Hanseníase Tuberculoide/imunologia , Hanseníase/imunologia , Hipersensibilidade Tardia , Estudos Longitudinais , Neurite (Inflamação)/etiologiaRESUMO
Este trabalho demonstra, por meio de dissecçäo, o trajeto superficial dos nervos comprometidos na hanseníase. Nessa doença, as lesöes ocorrem com mais frequência em determinados nervos que, nesses casos, se tornam mais espessos do que o normal. Esses nervos específicos säo superficiais em alguma parte de seus trajetos anatômicos e, aí, mais facilmente palpáveis
Assuntos
Dissecação , Hanseníase/patologia , Nervos Periféricos/patologia , Palpação , Nervo Radial/patologia , Nervo Tibial/patologia , Nervo Ulnar/patologiaAssuntos
Bainha de Mielina/ultraestrutura , Citoplasma/ultraestrutura , Condução Nervosa , Células de Schwann/ultraestrutura , Eletrofisiologia , Endotélio Vascular/ultraestrutura , Fibroblastos/ultraestrutura , Hanseníase Virchowiana/fisiopatologia , Hanseníase Virchowiana/patologia , Hipertrofia , Microscopia Eletrônica , Nervo Radial/fisiologia , Nervo Radial/patologia , Potenciais de Ação/fisiologia , Valores de ReferênciaRESUMO
A total of six index finger branch of the radial cutaneous (IRC) nerves from three BL, two BB and one BT cases of leprosy, with less than 6 months history of disease were subjected for nerve conduction velocity (NCV) studies followed by biopsy. The biopsy was divided into three parts and subjected for light microscopy quantitative histology, electron-microscopy and fibre tease studies. The nerves revealed a slight reduction in NCV and a varying degree of segmental demyelination ranging from 10% to 35%. The earliest changes observed were the thickening and proliferation of Schwann cell processes of the unmyelinated fibres and degeneration of their axons regardless of the type of leprosy. A total of 35 contacts from 20 families of lepromatous index cases were screened clinically. All of them were subjected for nerve conduction velocity (NCV) studies of both left and right index branch of the radial cutaneous (IRC) nerve. Fifteen of these nerves were biopsied. Out of 15 IRC nerves biopsied 10 had slightly reduced average NCV values and 5 were normal. Four nerves out of 10 where average NCV was reduced and 1 nerve out of 5 where NCV was normal showed significant ultrastructural changes and higher percentage of segmental demyelination (10%--13%). There was a striking similarity between the changes seen in the IRC nerves of early cases of leprosy and of contacts.