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Plastic Surgery( Grabb)Ali jasim > Brachial Plexus Injuries > Flashcards

Brachial Plexus Injuries Flashcards

1
Q

Surgery is undertaken for closed injuries when physical
examination and diagnostic modalities show a plateau or
absence of functional recovery (ideally 3-5 months post
trauma)

A

T

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2
Q

fibrosis of the neuromuscular junctions occurs in

A

approximately 12 to 18 months after
denervation

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3
Q

the time elapsed since trauma is the most important factor to consider when determining which surgical intervention is appropriate

A

T

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4
Q

The treatment course for these injuries can span a lifetime,

A

T

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5
Q

Permanent functional disability is certain

A

T

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6
Q

Lower-energy mechanisms
tend to produce postganglionic nerve ruptures

A

T

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7
Q

higher-energy mechanisms tend to produce tearing of the rootlets of the peripheral nerve directly from the spinal cord, proximal to the dorsal root ganglion

A

T

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8
Q

adult brachia!
plexus trauma mostly affects young males worldwide (>90%

A

T

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9
Q

CS to Tl.
The dorsal root, which contributes sensory nerves only, is thicker and
more resistant to avulsion forces

A

T

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10
Q

The spinal nerves coalesce
into the upper (CS and C6), middle (C7), and lower (C8 and Tl)
trunks which are contained between the anterior and posterior scalene muscles

A

F which are contained between the anterior and middle scalene muscles

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11
Q

Each trunk then splits into anterior and posterior divisions within the area deep to the clavicle

A

T

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12
Q

inferior to the clavicle, they become the lateral, posterior, and medial
cords in the area deep to the pectoralis minor

A

T

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13
Q

The axillary and radial nerve are separable at the region of the posterior cord deep to the lateral border of the pectoralis minor

A

T

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14
Q

The musculocutaneous nerve can be located at the proximal arm in
the plane between the coracobrachialis and biceps brachialis

A

T

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15
Q

The median and ulnar nerves are most easily found in the mid-distal arm
deep to the brachia! veins as they wrap around the brachia! artery

A

T

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16
Q

the posterior
division of lower trunk is quite small

A

T

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17
Q

At the cord level, the
axillary artery is sandwiched between the three cords

A

T

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18
Q

classification systems :Terzis’

A

root, supraclavicular postganglionic, and infraclavicular injuries

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19
Q

the Alnot classification

A

preganglionic root, postganglionic root,
supraclavicular and retroclavicular, and infraclavicular injuries

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20
Q

Chuang’s level 1 to 4 classification separates injuries into preganglionic (root avulsion), postganglionic, pre- and retroclavicular, and
infraclavicular injuries

A

T

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21
Q

The frequency of the nerve root injury

A

■ C5-C6: 15%
■ C5-C7: 20%-35%
■ C8-Tl: IO%
■ CS-Tl: 50%-70%

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22
Q

Cephalic traction upon the
arm with consequent lower trunk injuries much more rarely encountered

A

T

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23
Q

Most closed injuries of the brachia!
plexus are actually mixed in nature {Mackinnon’s sixth degree
injury)

A

T

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24
Q

Mackinnon’s first through third degrees of nerve
injury severity will recover spontaneously

A

T

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25
Exploration after 2 weeks should be accompanied by preparation for nerve grafting
T
26
low-velocity gunshot injuries inflicted by handguns only have a small shock wave and zone of temporary cavitation
T
27
most civilian gunshot wounds (handguns) are managed conservatively for the first 3 to 5 months in a manner similar to closed injuries
T
28
High-velocity gunshot injuries cause a large shock wave and permanent cavitation usually inflicting greater than Mackinnon's fourth degree nerve injury.
T
29
The prognosis for spontaneous recovery after a high-velocity gunshot wound is poor
T
30
exploration of these injuries is advisable at 2 to 3 months post-injury if clinical and electrodiagnostic evidence of recovery are still absent in high-velocity gunshot
T
31
Anterior shoulder dislocation and scapular fracture are associated with posterior cord damage.
T
32
Spine fractures indicate a more proximal focus of energy
T
33
Examination should proceed in a distal to proximal fashion
T
34
Horner syndrome indicates disruption of the sympathetic pathways likely the presence of a root avulsion involving the upper plexus
F likely presence of a root avulsion involving the lower plexus
35
Deafferentation pain (a.k.a. phantom limb pain and sensation) is a sign that root avulsion has occurred
T
36
Sequence of examination of Brachial plexus injury
History Tinnel sign Horner syndrome Deafferentation pain(Root avulsion)
37
diaphragmatic muscle paralysis (hemidiaphragmatic elevation the injured side) suggests alikelyinvolvement of the upper plexus
T
38
diaphragmatic innervation (C3, C4, and CS) that is involved in the zone of injury is located near the lower trunk
F diaphragmatic innervation (C3, C4, and CS) that is involved in the zone of injury is located near the upper trunk
39
presence of pseudo meningocele adjacent to the vertebrae with MRI and CT myelography indicates what?
which develop when the dura tears in conjunction with avulsion spinal nerve roots
40
using the phrenic donor nerve is safe in lower-BM! patients
T
41
MRI has not yet been proven as a reliable modality for delineating nerve rupture or injury within the plexus
T
42
The baseline nerve conduction study and EMG should be performed no earlier than 3 to 4 weeks after trauma, why?
certain acute phase injury changes take that amount of time to become detectable
43
Follow-up electrodiagnostic study should be repeated at 2-month intervals
T
44
Contraindications to surgery
Traumatic brain or spinal cord injuries that may prevent productive participation in a rehabilitative protocol medical comorbidities prohibitive of a prolonged general anesthetic session Joint contractures patient's willingness and ability to comply with postoperative rehabilitation
45
sensory nerve action potential (sensory nerve)-begins to decrease at day 6
T
46
sensory NCS tends to overestimate severity ofinjury
T
47
compound muscle action potential (motor nerve)-begin to decrease at day 2 or 3 after injury
T
48
CMAP amplitudes are the most useful for quantifying the amount of axon loss
T
49
Amplitude reflects the total number of conducting axons
T
50
at least 50% of the motor nerve must be disrupted before these MUAP changes can be discernible
T
51
If muscle is innervated, there are no spontaneous discharges
T
52
PSW (positive sharp waves)-acute phase injury sign (should subside by I y post injury
T
53
Fibrillations-acute phase injury sign (does not appear until 2-3 wk after injury
T
54
Fibrillations-acute phase injury sign (does not appear until 2-3 wk after injury
T
55
Complete denervation show no spontaneous discharge
T
56
completely reinnervated muscle will also return to the state of no spontaneous discharge
T
57
Polyphasic waves are a pathologic finding, but the nerve is still alive
T
58
Fasciculations indicative of upper motor neuron disorders
F. Lower motor
59
Ifmotor nerve conduction (amplitude) is absent at 4 months after injury, this as a bad prognostic indicator
T
60
The incision can be carried infraclavicular onto the chest for access this approach allows for both diagnostic and therapeutic objectives
T
61
Options for nerve graft
sural, saphenous, median antebrachial cutaneous, or lateral antebrachial cutaneous nerves
62
Allografts cant be used
Allografts should not be used
63
proximal stumps that are too short to support coaptation how you can mange ?
by nerve transfers using intraplexus transfer from proximal stumps of neighboring spinal nerves or from extra plexus donors (e.g., CN XI, contralateral C7, intercostal nerves, phrenic, or cervical motor branches of C3/C4)
64
Exploration of the lower trunk can be risky in this regard, as adhesions to the pleural cavity and the proximity to great vessels in this case can sometimes also lead to pneumothorax or vessel injury.
t
65
Postoperative neck immobilization is crucial
T
66
Proximal exploration should be done within the posttrauma 3- to 5-month timeframe, to ensure opportunity for reinnervation before the time of motor endplate fibrosis at the neuromuscular junction
T
67
Contralateral C7 can be used with five root injuries without other suitable donors.
t
68
Phrenic for shoulder abduction Suprascapular/posterior division ofC5/C6 is strong enough to use alone
T
69
For median nerve we can used c6-c7 as donor
T
70
The option of tendon transfer or functioning free muscle transplantation is often used as the lifeboat or for augmentation of function after previous reconstruction
T
71
tendon transfers are only viable options for incomplete brachia! plexus injury,
T
72
Tendon transfers are often paired with arthrodeses (shoulder or wrist) for an enhanced functional result.
T
73
The gracilis myocutaneous flap is the most popular option for the FFMT for the upper extremity
T
74
Distal transfer is more safe than proximal exploration
T
75
FFMTs also require a donor nerve for neurotization
T
76
reconstructive intervention is contraindicated if joints are ankylotic
T
77
Upper trapezius transfer-Shoulder abduction
T
78
Lower trapezius transfer-External rotation
T
79
he strongest risk factor is undoubtedly shoulder dystocia for OBPP
T
80
The most commonly encountered OBPP injury overall (46% of all OBPP) is a classic Erb palsy (CS and C6 palsy)
T
81
Fortunately, OBPP has a high frequency of spontaneous resolution (77% to 90%)
T
82
The most common pattern of injury that necessitates operative exploration in pediatric
is a combination of root avulsions and extraforaminal ruptures of CS, C6, and C7
83
Test for OBPP
The tickle test The towel test
84
Terzis advocated surgical exploration if total palsy with Horner syndrome was present at 2 months of age
T
85
Gilbert's threshold was 3 months of age without elbow flexion
T
86
Clarke and Curtis described 9 months as the limit for recovery of motor function in response to the "cookie test
T
87
Chuang found no difference in the recovery of elbow and shoulder function when surgical intervention was carried out at 2 versus 11 months
T
88
Chuang's threshold for surgical intervention was at 3 months if there was little to no wrist extension and finger flexion
T
89
persistent lack or stagnation of improvement in elbow or shoulder function warranted intervention at 6 to 12 months(Chuang's)
T
90
Electrodiagnosis in infants is notoriously unreliable because of its tendency to overestimate the axonal function that is present
T
91
the phrenic nerve is generally not used for OBPP
T
92
Options for nerve graft of pediatric
saphenous, median antebrachial cutaneous , or lateral antebrachial cutaneous nerves in addition to the sural nerves, given the short length of the sural nerve in an infant
93
What is the trumpet sign
cross-innervation between elbow flexors and shoulder abductors
94
The development of aberrant reinnervation ultimately leads to muscle imbalance that often causes joint deformities.
T
95
Elbow reconstruction should prioritize restoration of elbow extension first
T
96
Both shoulder and elbow reconstructions are typically done in the range of 4 to 6 years of age
T
97
Hand and forearm function until age 6 to 13 years
T
98
A Zancolli procedure might be used for supination contracture
T
99
joint contractures will recur without diligent therapy and continuous lifelong maintenance exercises
T
100
Latissimus dorsi transfer
Shoulder abduction, external rotation / Shoulder arthrodesis

Plastic Surgery( Grabb)Ali jasim (92 decks)

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