A brachial plexus injury BPI ), also known as leksus breksia plexus , is an injury to the brachial plexus, the nerve tissue that signals from the spinal cord to the shoulder, the arm and hands. These nerves come from the fifth, sixth, seventh and eighth cervical cervical (C5-C8), and the first thoracic spinal nerve (T1), and innervate the muscles and skin of the chest, shoulders, arms and hands.
Brachial plexus injury can occur as a result of shoulder, tumor, or inflammation of the trauma. The rare Parsonage-Turner Turner Syndrome causes brachial plexus inflammation with no apparent injury, but with crippling symptoms. But in general, brachial plexus injury can be classified as traumatic or obstetric. An obstetric injury may result from a mechanical injury involving shoulder dystocia during difficult labor. A traumatic injury can arise from several causes. "The brachial plexus can be injured by falling from the height to the sides of the head and shoulders, where the plexus nerve is stretched violently, the brachial plexus can also be injured by direct violence or gunshot wounds, by violent traction in the arm, or by reducing the dislocation of the shoulder joint".
Video Brachial plexus injury
Signs and symptoms
Signs and symptoms may include paralyzed or paralyzed arms, lack of muscle control in the arms, hands, or wrists, and lack of feeling or sensation in the arm or hand. Although some mechanisms explain the brachial plexus injury, the most common is compression or nerve stretching. Infants, in particular, may suffer brachial plexus injuries during labor and these present with a typical pattern of weakness, depending on the part of the involved brachial plexus. The most severe form of injury is the avulsion of the nerve roots, which usually accompanies the high-speed impact that generally occurs when a motor vehicle crash or a bicycle accident.
Disabled
Based on the location of nerve damage, brachial plexus injury may affect part or all of the arm. For example, musculocutaneous nerve damage weakens the elbow flexors, median nerve damage causes proximal forearm pain, and ulnar nerve paralysis causes weak claws and finger numbness. In some cases, these injuries can cause total and irreversible paralysis. In less severe cases, this injury limits the use of these limbs and causes pain.
The cardinal signs of later brachial plexus injury, are weakness in the arm, reduced reflexes, and corresponding sensory deficits.
- Erb's Ass. "The position of the extremity, under such conditions, is characteristic: the arm hangs on the side and is rotated medially, the forearm is extended and the pronation of the arm can not be lifted from the side, all elbow flexion strength is lost, as is the supine arm's support."
- In Klumpke's paralysis, a form of paralysis involving the muscles of the forearm and hand, the characteristic sign is clawed hands , due to the loss of ulnar nerve function and intrinsic muscles from passing on the supplies.
Maps Brachial plexus injury
Cause
In many cases, the nerve roots stretch or tear from origin, because the meningeal closure of the nerve roots is thinner than the enveloping nerve. Epineurium nerves adjacent to the dura mater, providing extra support to the nerves.
Brachial plexus lesions are usually the result of excessive stretching; of a ruptured injury in which the nerves are torn but not on the spinal cord; or from an avulsed injury, in which the nerves are torn from their attachment to the spinal cord. A bone fragment, pseudoaneurysm, hematoma, or clotting clavcile callus may also put pressure on the injured nerve, disturbing the innervation of the muscles. Direct trauma in the shoulder and neck area can destroy the brachial plexus between the clavicle and the first rib.
Although injuries can occur at any time, many brachial plexus lesions occur during birth: the infant's shoulder may become affected during the birth process causing the brachial plexus nerve to stretch or tear. An obstetric injury can occur due to a mechanical injury involving shoulder dystocia during difficult labor, most commonly due to the painful stretching of the child's brachial plexus during birth, most often during vaginal delivery, but occasionally caesarean section. Excessive stretching produces incomplete sensory and/or motor functions of the injured nerve.
Injury to the brachial plexus is caused by excessive stretching or tearing of the C5-T1 nerve fibers. These injuries can be found in front of or behind the clavicle, neurological disorders, or root avulsion of the spinal cord. These injuries are diagnosed based on clinical examination, axon reflex testing, and electrophysiological testing. Brachial plexus injuries require prompt treatment in order for patients to perform full functional recovery (Tung, 2003). This type of injury is most common in young adult males.
Trauma brachial plexus injuries can arise from several causes, including sports, high-speed motor vehicle accidents, especially on motorcyclists, but also all terrain vehicles (ATVs) and other accidents. Injuries from direct blows to the lateral side of the scapula are also possible. The severity of nerve injury may vary from mild stretching to torn nerve roots of the spinal cord (avulsion). "The brachial plexus can be injured by falling from the height to the sides of the head and shoulders, where the stretched plexus nerve, the brachial plexus can also be injured by direct violence or gunshot wounds, by traction in the arm, or by reducing the dislocation of the shoulder joint".
Brachial plexus lesions can be divided into three types:
- An upper brachial plexus lex , occurring from an excessive lateral neck flexion away from the shoulder. Most commonly, delivery of forceps or falling to the neck at an angle causes the upper plexus lexus to cause Erb palsy. This type of injury produces a very distinctive sign called the Change of Servant cheats due to loss of the lateral rotator of the shoulder, flexor of the arm, and the extensor muscle of the hand.
- Less often, whole brachial breccia lesions occur;
- most rarely, pulling up suddenly on the kidnapped arm (such as when a person fractures a fall by holding a tree branch) produces a lower brachial breccia lesion , in which the eighth cervix (C8) and first the thoracic nerve (T1 ) injured "either before or after they joined to form the rootstock.The subsequent paralysis affects, in particular, the intrinsic muscles of the hand and flexor of the wrist and fingers". This results in a form of paralysis known as Klumpke's paralysis.
Backpack palsy is caused by many use of heavy backpacks that chronically suppress the brachial plexus.
Mechanism
Injuries to the brachial plexus can occur in many environments. This may include contact sports, motor vehicle accidents, and births. Although these are just a few common occurrences, there is one of two injury mechanisms that remain constant during the point of injury. Two mechanisms that can occur are traction and severe impact.
Anatomy
The brachial plexus consists of the spinal cord that is part of the peripheral nervous system. These include the sensory and motor nerves that supply the upper limb. The brachial plexus includes the last 4 cervical nerves (C5-C8) and the first thoracic nerve (T1). Each nerve is divided into rods, divisions, and ropes. The cord includes the musculocutaneous nerve and the lateral branch of the median nerve. The medial wire includes the median branch of the median nerve and the ulnar nerve. Posterior cables include axillary nerves and radial nerves.
Traction
Traction occurs from severe movement and causes tension or tension between the nerves. There are two types of traction: downward traction and upward traction. In the downward traction there is an arm strain that forces the neck and shoulder angles to become wider. This tension is forced and can cause lesions in the roots and upper stems of the brachial plexus nerve. Motorcycle accidents and sports injuries usually cause injury to the brachial plexus. Upward traction also results in a scapulo-humoral angle expansion but this time the T1 and C8 nerves are torn. A humeral fracture and shoulder dislocation can also cause this type of injury with high energy injury.
Avulsion roots or nerve rupture may occur during severe trauma, improper surgical position, or inappropriate use of surgical retractors. There are two mechanisms for dealing with root avulsion: peripheral and central mechanisms. In the peripheral mechanism, traction is transmitted to the root, but the dura mater will tear with the root intact because the dura is less elastic when compared to the roots. Pseudomeningokel can be shown in cervical myelography. On the other hand, through a central mechanism, the head and neck are pushed together with the brachial plexus root of the plexus to the opposite site of the body, leading to a direct nerve root injury but the dura cover remains intact. In this case, the anterior root is more susceptible than the posterior root for the avulsion, so that the C8 and T1 nerve roots are more susceptible to injury. Root avulsion injuries can be subdivided by the location of the lesion: pre- and post-bronchial lesions. In preganglionic lesions, the sensory fibers remain attached to the sensory ganglion cell body, so there is no degeneration of the neural wall of the sensory fibers, so that the sensory action potential can still be detected at the distal end of the spinal cord. However, those with this type of lesions experience sensory loss over affected nerve roots. In this case, surgical repair of the lesion is not possible because the proximal nerve tissue is too short to stitch to become possible. For postganglionic lesions, the sensory ganglion cell body is released from the spinal nerve, leading to the degeneration of the walls of the sensory fibers. Thus, no potential action is detected at the distal end of the spinal cord. However, surgical improvement is possible because the proximal nerve tissue has a sufficient length to stitch.
Impact
The impact of weight to shoulder is the second common mechanism that causes injury to the brachial plexus. Depending on the severity of the impact, lesions can occur in all nerves in the brachial plexus. The location of the impact also affects the severity of the injury and depends on the location of the brachial plexus nerve may rupture or avulsion. When passing between the ribs and the first rib, the brachial plexus may be destroyed in the costoclavicular space. This is usually due to direct trauma to the shoulder or neck area due to motor accidents, occupational injuries or sports injuries. The brachial plexus may also be compressed by surrounding the damaged structures such as bone fragments or calluses from clavicular fractures, and hematoma or pseudoaneurism from vascular injury. Cervical ribs, prominent transverse processes, and congenital fibrous bands may also suppress the brachial plexus and cause chest outlet syndrome.
During childbirth, the baby's shoulders can graze on the mother's pelvis. During this process, the brachial plexus may receive damage resulting in injury. This incident occurs at birth is 1 in 1000. This is very low compared to other identified brachial plexus wounds.
Diagnosis
Diagnosis can be confirmed by EMG examination within 5 to 7 days. Denofant proof will be proven. If there is no neural conduction 72 hours after injury, then avulsion is most likely. The most advanced diagnostic method is MR imaging of the brachial plexus using a high Tesla MRI scanner such as 1.5 T or more. MR helps with assistance in the assessment of injuries in the context of certain sites, the extent and the nerve roots involved. In addition, cervical rope assessment and post traumatic changes in soft tissue may also be visualized.
Classification
The severity of the brachial plexus injury is determined by the type of nerve damage. There are several different classification systems to assess the severity of the nerve and brachial plexus injury. Most systems attempt to correlate the degree of injury with symptoms, pathology and prognosis. The Seddon classification, designed in 1943, continues to be used, and is based on three major types of nerve fiber injury, and whether there is nerve continuity.
- Neurapraxia: The most mild form of nerve injury. This involves a nerve conduction disturbance without loss of axon continuity. Recovery occurs without degeneration of wallerian. Axonotmesis: Involves axonal degeneration, with loss of relative continuity of the axon and closure of myelin, but preservation of the skeleton of neural connective tissue (tissue encapsulation, epineurium and perineurium, retained).
- Neurotmesis: The most severe form of nerve injury, in which the nerves are completely disturbed by contusions, traction or laceration. Not just axons, but the connective tissue that wraps up loses its continuity. The most extreme level of neurotermesis is transsection, although most neurotmic injuries do not result in permanent loss of nerve continuity, but the internal disturbance of the neural architecture is sufficient to involve the perineurium and endoneurium as well as the axons and closures. This requires surgery, with an unexpected recovery.
The more recent and commonly used system described by late Sir Sydney Sunderland, splits the nerve injury to five degrees: first level or neurapraxia, following from Seddon, where isolation around the nerves called myelin is damaged. but the nerve itself is spared, and seconds to five , which indicates an increase in injury severity. With a level five injury, the nerves are completely divided.
Treatment
Treatments for brachial plexus injuries include orthosis/splinting, occupational or physical therapy and, in some cases, surgery. Some brachial plexus wounds can heal without treatment. Many babies improve or recover within 6 months, but those who do not, have a very bad outlook and will need further surgery to try to compensate for the neural deficit. The ability to bend the elbow (biceps function) in the third month of life is considered an indicator of the likelihood of recovery, with the addition of wrist upward movements, and stronger thumb and toe indicator upgrades than excellent spontaneous improvement. Gentle range of motion exercises performed by parents, accompanied by repeated examination by a doctor, may be all that is needed for patients with a strong recovery indicator.
The exercises mentioned above can be done to help rehabilitate from minor injury cases. However, in surgical wounds of a more serious brachial plexus surgical intervention may be used. Functions can be recovered by neural repair, nerve replacement, and surgery to remove tumors that cause injury. Another important factor to note is that psychological problems can hinder the rehabilitation process due to lack of motivation from patients. Above promotes a lifelong physical healing process, it is important not to neglect the patient's psychological well-being. This is because of the possibility of depression or complications with head injury.
Rehabilitation
There are many treatments to facilitate the recovery process in people with brachial plexus injury. Repairs occur slowly and the rehabilitation process may take years. Many factors must be considered when estimating recovery time, such as initial diagnosis of injury, severity of injury, and the type of treatment used. Some forms of treatment include nerve grafts, medications, surgical decompression, nerve transfer, physical therapy, and occupational therapy.
Therapy
Physical and occupational therapy is important when handling brachial plexus injury. One of the main goals of rehabilitation is to prevent muscle atrophy until the nerves return to function. Electrical stimulation is an effective treatment to help patients achieve this fundamental goal. Exercises involving shoulder extension, flexion, elevation, depression, kidnapping and adductions facilitate healing by involving nerves in damaged locations and improving muscle function. Stretching is done daily to improve or maintain range of motion. Stretching is important to rehabilitate as it increases blood flow to injury and facilitates the nerve to function properly.
A study also showed that sensory motor deficits in the upper extremities after brachial plexus injury may affect physical balance in vertical position. The examined patient had a lower score on the Berg equilibrium scale, greater difficulty in maintaining a unipodal position for one minute and resting weight distribution to the affected side of the lesion. Patients also showed greater variability in postural oscillations, evaluated by directional stability index. The result reminded the clinical community of the need to prevent and treat the secondary effects of this condition.
Epidemiology
Brachial plexus injuries are found in children and adults, but there is a difference between children and adults with BPI.
Adult
The prevalence of brachial plexus injury in North American adults in 1900 was about 1.2%. BPI is most commonly found in young healthy adults, from ages 14 to 63, with 50% of patients between the ages of 19 and 34. 89% of patients with BPI are males The extent of brachial plexus injury has increased.
Children
OBPP, also known as obstetric brachial plexus palsy, occurs mainly in small children at the level of 0.38-1.56 per 1000 live births depending on the type of care and average birth weight of infants in different regions of the world. For example, a study in the United States showed and the incidence of OBPP was about 1.51 cases per 1000 live births, in a Canadian study, the incidence was between 0.5 and 3 injuries per 1000 live births, a Dutch study reported incidence 4, 6 per 1000 live births. The risk of BPI at birth is highest for infants weighing more than 4.5 kg at births born by diabetic women. This type of delivery also affects the risk of BPI. The risk of brachial plexus injury for newborns increases with increased birth weight, birth when vacuum is aided, and is unable to handle glucose.
Traumatic Injuries
BPI has been shown to occur in 44% to 70% of traumatic injuries, such as motorcycle accidents, sporting events, or workplace accidents. With 22% of motor injuries and about 4.2% experiencing damage to the plexus. People who experience accidents by riding motorbikes and snowmobiles, have a higher risk of getting a BPI.
Prognosis
The site and type of brachial plexus injury determine the prognosis. Avulsion and rupture injuries require timely surgical intervention for any possible recovery. For minor injuries involving scarring and for neurapraxia, the potential for improvement varies, but there is a fair prognosis for spontaneous recovery, with 90-100% function return.
References
External links
- "Brachial Plexus Injury: Description & amp; illustration". Children's Hospital of Cincinnati, health information website. (revised 9/09 - see the bottom of the web page) . Retrieved 2009-10-11 .
Source of the article : Wikipedia
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