A Rare Variation in the Course of C5 Root of Brachial Plexus.

Variations in the formation of the upper trunk of the brachial plexus are relatively rare. Knowledge of its possible variation is useful to orthopedic surgeons dealing with the problems of cervical spine, anesthesiologists performing brachial plexus blocks and general surgeons performing lower neck surgeries. In this report, we present a variation in the formation of the upper trunk of the brachial plexus. The upper trunk was formed by the union of ventral rami of fifth and sixth cervical spinal nerves. The fifth cervical ventral ramus passed ventral to the scalanus anterior muscle, while the sixth cervical ventral ramus passed between the scalanus anterior and medius muscles. The upper trunk was formed at the lateral border of the scalenus anterior muscle.

A pilot study on the functional outcome using markerless motion analysis tool and surface emg of nerve transfers for upper trunk brachial plexus injuries

INTRODUCTION@#Brachial plexus injuries (BPI) have devastating functional effects. Clinical outcomes of BPI reconstruction have been documented in literature; however, these do not use EMG and quantitative kinematic studies.@*OBJECTIVE@#This study aims to use a markerless motion analysis tool (KINECT) and surface EMG to assess the functional outcomes of adult patients with traumatic upper trunk BPI who have undergone nerve transfers for the shoulder and elbow in comparison to the normal contralateral limb.@*METHODS@#This is an exploratory study which evaluated three participants with BPI after nerve reconstruction. KINECT was used to evaluate the kinematics (range of motion, velocity, and acceleration) and the surface EMG for muscle electrical signals (root mean square, peak EMG signal, and peak activation time) of the extremities. The means of each parameter were computed and compared using t-test or Mann-Whitney U test.@*RESULTS@#Participant C, with the best clinical recovery, showed mostly higher KINECT and EMG values for the BPI extremity. There was a significant difference between the KINECT data of Participants A and B, with lower mean values for the BPI extremity. Most of the EMG results showed lower signals for the BPI extremity, with statistical significance.@*CONCLUSION@#The KINECT and surface EMG provide simple, cost-effective, quick, and objective assessment tools. These can be used for monitoring and as basis for formulating individualized interventions. A specific algorithm should be developed for the KINECT sensors to address errors in data collection. A fine needle EMG may be more useful in evaluating the muscles involved in shoulder external rotation.

Unipolar pedicled latissimus dorsi transfer for elbow reanimation in traumatic brachial plexus injuries

Background: Brachial plexus injuries are troubling for the patients socially, economically and emotionally. Elbow joint being a large and vital joint needs to be reanimated so that the patient can carry out his routine work and bring the hand to the mouth. Number of procedures have been defined but latissimus dorsi being a large muscle is the muscle of choice for transfer in cases who present late. Bipolar latissimus dorsi transfers have often been reported but unipolar latissimus dorsi transfer has also been described. Authors have studied the unipolar muscle transfer, it’s surgical technique and results.Methods: In this study 18 patients were studied for demographic data, pre- and post-operative flexion of the elbow and the MRC grade of the corresponding movements. Diagnostic work up in the form of nerve conduction velocity, electromyography and magnetic resonance imaging were carried out and evaluated for their significance in traumatic brachial plexus injuries.Results: In this study 13 patients had avulsion of the C5-6 roots on magnetic resonance imaging. The patients presented after a period of 128.83±56.76 days. Substantial time elapsed and ruled out primary brachial plexus reconstruction or nerve transfers. The average elbow flexion improved from 6.67±5.69 degrees (range: 0-20 degrees) to 86.94±12.38 degrees (range: 65-110 degrees) following unipolar latissimus dorsi transfer. 12 patients (66.67%) developed M4 or M4+ power.Conclusions: Unipolar latissimus dorsi muscle transfer is a reliable method and most of the patients develop adequate strength and satisfactory function at the elbow joint.

Cadaveric Study of Variation in the Formation of Trunks of Brachial Plexus, Embryological Basis and its Clinical Significance

Background: Brachial plexus is the plexus of nerves that supplies the upper limb. Variations in the branches of brachial plexus are common but variations in the roots and trunks are very rare. Methods: Here, we report one of such rare variations in the formations of the upper trunk, middle trunk, and lower trunk of the brachial plexus in the right and left upper limb of a male and female cadaver. Results: In the present study1 limb (1.6%), there was absence of the upper trunk on the left side of a male cadaver with approximate age of 20 years. And In 1 limb (1.6%), upper trunk of the brachial plexus was found unilaterally on the right side of a male cadaver aged approximately 55 years. the upper trunk was present in 2 limbs (3.3%), both on the right side of male cadavers with approximate age of 55 and 50 years In both cases, C5 and C6 roots were split in anterior and posterior divisions (Figure No. 5). Both anterior divisions joined to give origin to an “anterior superior trunk” and both posterior divisions joined to give origin to a “posterior superior trunk”. These trunks joined to give origin to the superior (upper) trunk. In 2 limbs (3.3%) The middle trunk was absent. in the right upper limb (1.6%) of a male cadaver with approximate age of 35 years the lower trunk was formed by the union of ventral rami of C7, C8 and T1 nerve roots. Conclusions: The knowledge of variations in the formation of brachial plexus is very useful for the anatomists, radiologists, anesthesiologists, neurosurgeons and orthopedic surgeons.