[Surgical repair of the axillary nerve. Results of a five-year follow-up]. / Réparations chirurgicales du nerf axillaire. Résultats à cinq ans de recul.

INTRODUCTION: We report a series of 19 cases of axillary nerve lesions, which were operated between 1981 and 1995. MATERIAL AND METHODS: There were 14 isolated lesions of the axillary nerve and in 5 patients the lesion to the axillary nerve was associated either with a lesion of the radial nerve or with a lesion of the suprascapular nerve. Fourteen patients sustained shoulder stretch injury, three had fractures of the scapular girdle and two anterior shoulder dislocation. Patients were operated on 9 months after trauma through a combined anterior and posterior approach. The lesion was located in the quadrilateral space. In 17 cases the neuroma was excised and the nerve was reconstituted, using sural nerve grafts. In two cases the nerve was only freed from the surrounding scar tissue. RESULTS: Results were considered as satisfactory in 10 out of 14 isolated axillary nerve lesions. According the Constant score there were 2 very good, 8 good and 2 fair results. In this study, neurolysis and axillary nerve associated with suprascapular nerve lesions gave poor results. DISCUSSION: The successfully reinnervated deltoid muscle adds strength and endurance to the affected shoulder. Electromyographic study remains important in detecting spontaneous return of muscle function and determining the most favorable operative period before severe amyotrophy appears.

[Amyotrophy of parietal origin: Silverstein's syndrome. Clinical and electrophysiologic study]. / L'amyotrophie d'origine pariétale: syndrome de Silverstein. Etude clinique et electrophysiologique.

Clinical and electrophysiological data in two cases of amyotrophy of parietal origin (Silverstein's syndrome) are reported. Some parietal lesions provoke amyotrophy, usually with a sensory deficit but sometimes isolated, of rapid onset and affecting mainly the upper limb extremity. In the two cases reported, a spontaneous electromyographic activity was present with fibrillation and positive sharp waves, an unusual finding in central nervous system diseases. Despite its lack of specificity an activity of this type is observed mainly with peripheral axonal lesions. The physiopathology of Silverstein's syndrome is entirely hypothetical. The decreased transsynaptic trophic influence of central on peripheral cells could result in a reduced trophic effect of peripheral nerves on muscles, and the spontaneous activity could be related to muscle cell membrane instability.

[Involvement of the first 2 lumbar roots and paralysis of the abdominal-genital nerves. Clinical and electrical data]. / Atteinte des deux premières racines lombaires et paralysie des nerfs abdomino-genitaux. Données cliniques et électriques.

We report two observations of ilio-hypogastric and ilio-inguinal palsy. In both cases, an inguino-scrotal pain occurs just after low back effort. Clinically, we observed an infero-lateral 'pseudo-eventration' and trochantero-inguino-scrotal hypoesthesia in the first patient and an inguino-scrotal hypoesthesia in the second. The EMG recording shows an isolated, severe or total peripheric denervation of the inferior part of lateral abdominal muscles, associated in one case with a partial denervation of the upper lumbar paravertebral muscles. Scan shows L2 radicular asymmetry in the first patient and L1 in the second. This observation is discussed in relation to the literature.

[Effects of local corticoids on the nerve fiber. Experimental study (author's transl)]. / Action des corticoïdes locaux sur la fibre nerveuse. Etude expérimentale.

The intra-operative establishment of some impairments of the median nerve, in patients who are operated for carpal tunnel syndrome and who previously received several local injections of corticoids, led the authors to try to see the respective responsibility of the compression and of the injection in the degenerative process. In 60- dog cubital nerves, it has been possible, to study different parameters by intra and perineural (recurrent or not injections: the puncture, the dilatation, the solvents, the benzylic alcool and two long action corticoids very often used (triamcinolone acetonide, cortivazol). In the first of our series, the injections were done around the nerve and inside the nerve under visual or blind control (as for an infiltration). The nerves are then cut off after 1, 2, or 3 months. In the second of our series, the injections were done in the same way, but recurrently on the first, second and third month, and the nerve was cut off within the fourth month. An electrophysiological study was performed before taking the samples; they were then prepared for reading on the optical and electron microscope. The results show lesions characterized by an epineural spumous sediment, a localized decrease in the large fibers under the perineurium in the first and second series. These impairments seem to be diminishing with time. However when the injections are done recurrently, the lesions are more important, showing a wallerian degeneration and regeneration.