Cirugía de Mano y Traumatología
Dr Pedro Gerardo Alisedo
miércoles, 17 de septiembre de 2014
Spinal Accessory to Suprascapular Nerve Transfer for Brachial plexus injury
Publicado el 3/7/2014
Posterior Approach - Spinal Accessory to Suprascapular Nerve Transfer
Extended Edition (130422.120309)
Reconstructing shoulder function following a nerve injury is a challenge due to its dynamic movement originating from several muscles. The supra/infraspinatus muscles are critical for shoulder function in that they initiate abduction of the arm, external rotation, and stabilization of the shoulder joint. In upper brachial plexus injuries, it is common to find a deficit in the suprascapular nerve associated with the axillary and musculocutaneous nerves due to their C5,6 root origins. These patients present with no shoulder function or elbow flexion. Reconstruction includes nerve transfers to innervate the axillary and suprascapular nerves for shoulder function. An available donor nerve for restoring the suprascapular nerve includes the spinal accessory nerve from a posterior or anterior approach. The posterior approach utilizes the distal branches of the accessory nerve that innervates the inferior segments of the trapezius. This video portrays that posterior approach. In this case, a 49-year-old male presented post-Schwannoma resection from the upper brachial plexus with a shoulder and elbow flexion deficit. To reconstruct shoulder function, a spinal accessory to suprascapular nerve transfer was elected with a medial triceps to axillary nerve transfer. To reconstruct elbow flexion, a double fascicular nerve transfer was elected. This video details the posterior approach to reconstructing the suprascapular nerve using the spinal accessory nerve.
Table of Contents (Extended)
00:35 Pre-operative Discussion on Anatomical Landmarks
02:21 Incision / Exposure
04:28 Developing a Superficial Plane to the Trapezius
06:42 Dissection through the Trapezius
08:40 Identifying the Fascial Plane and Fat Deep to the Trapezius
10:24 Identifying and Exposing the Spinal Accessory Nerve
12:53 Dissection through the Trapezius towards the Suprascapular Notch
14:40 Palpating the Suprascapular Notch for Orientation
15:19 Identifying and Exposing the Suprascapular Ligament
16:53 Releasing the Suprascapular Ligament
17:52 Identifying the Suprascapular Nerve
19:02 Proximal Dissection of the Suprascapular Nerve
19:35 Dividing the Suprascapular Nerve Proximally
20:24 Distal Dissection of the Spinal Accessory Nerve
24:04 Dividing the Spinal Accessory Nerve Distally
25:15 Spinal Accessory to Suprascapular Nerve Transfer
Authors: Susan E. Mackinnon, Andrew Yee
Terms of Use and Private Policy: nervesurgery.wustl.edu/pages/termsofuse.
Extended Edition (130422.120309)
Reconstructing shoulder function following a nerve injury is a challenge due to its dynamic movement originating from several muscles. The supra/infraspinatus muscles are critical for shoulder function in that they initiate abduction of the arm, external rotation, and stabilization of the shoulder joint. In upper brachial plexus injuries, it is common to find a deficit in the suprascapular nerve associated with the axillary and musculocutaneous nerves due to their C5,6 root origins. These patients present with no shoulder function or elbow flexion. Reconstruction includes nerve transfers to innervate the axillary and suprascapular nerves for shoulder function. An available donor nerve for restoring the suprascapular nerve includes the spinal accessory nerve from a posterior or anterior approach. The posterior approach utilizes the distal branches of the accessory nerve that innervates the inferior segments of the trapezius. This video portrays that posterior approach. In this case, a 49-year-old male presented post-Schwannoma resection from the upper brachial plexus with a shoulder and elbow flexion deficit. To reconstruct shoulder function, a spinal accessory to suprascapular nerve transfer was elected with a medial triceps to axillary nerve transfer. To reconstruct elbow flexion, a double fascicular nerve transfer was elected. This video details the posterior approach to reconstructing the suprascapular nerve using the spinal accessory nerve.
Table of Contents (Extended)
00:35 Pre-operative Discussion on Anatomical Landmarks
02:21 Incision / Exposure
04:28 Developing a Superficial Plane to the Trapezius
06:42 Dissection through the Trapezius
08:40 Identifying the Fascial Plane and Fat Deep to the Trapezius
10:24 Identifying and Exposing the Spinal Accessory Nerve
12:53 Dissection through the Trapezius towards the Suprascapular Notch
14:40 Palpating the Suprascapular Notch for Orientation
15:19 Identifying and Exposing the Suprascapular Ligament
16:53 Releasing the Suprascapular Ligament
17:52 Identifying the Suprascapular Nerve
19:02 Proximal Dissection of the Suprascapular Nerve
19:35 Dividing the Suprascapular Nerve Proximally
20:24 Distal Dissection of the Spinal Accessory Nerve
24:04 Dividing the Spinal Accessory Nerve Distally
25:15 Spinal Accessory to Suprascapular Nerve Transfer
Authors: Susan E. Mackinnon, Andrew Yee
Terms of Use and Private Policy: nervesurgery.wustl.edu/pages/termsofuse.
martes, 16 de septiembre de 2014
Closed Reduction and K-Wiring With the Kapandji Technique for Completely Displaced Pediatric Distal Radial Fractures
http://www.healio.com/orthopedics/journals/ortho/2014-9-37-9/%7B3a1112c5-17af-422e-afe4-343921be9cd5%7D/closed-reduction-and-k-wiring-with-the-kapandji-technique-for-completely-displaced-pediatric-distal-radial-fractures
ATURE ARTICLE
Closed Reduction and K-Wiring With the Kapandji Technique for Completely Displaced Pediatric Distal Radial Fractures
- Orthopedics
- September 2014 - Volume 37 · Issue 9: e810-e816
- DOI: 10.3928/01477447-20140825-58
Closed Reduction and K-Wiring With the Kapandji Technique for Completely Displaced Pediatric Distal Radial Fractures Read more
lunes, 15 de septiembre de 2014
lunes, 8 de septiembre de 2014
Ulnar Neuropathy as a Result of Anconeus Epitrochlearis
http://www.healio.com/orthopedics/journals/ortho/2014-8-37-8/%7B7b67ab7f-5d93-4b7a-b71e-4de4df541c51%7D/ulnar-neuropathy-as-a-result-of-anconeus-epitrochlearis#
CASE REPORT
Ulnar Neuropathy as a Result of Anconeus Epitrochlearis
- Orthopedics
- August 2014 - Volume 37 · Issue 8: e743-e745
- DOI: 10.3928/01477447-20140728-92
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Orthopedics — August 2014
Ulnar Neuropathy as a Result of Anconeus Epitrochlearis — by Kate Nellens, MD, MPH; et al After carpal tunnel syndrome, cubital tunnel syndrome is the second most common compression neuropathy in the upper extremity. Various sites of ulnar nerve compression at the elbow exist, with the most common being between the two heads of the flexor carpi ulnaris. Read more | |||
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