Search Our Scientific Publications & Authors

PLoS Med 2020 Jun 5;17(6):e1003108. Epub 2020 Jun 5.

Department of Anesthesiology, Weill Cornell Medicine, New York, New York, United States of America.

Background: An estimated 87% of torture survivors experience chronic pain such as brachial plexopathy from upper extremity suspension or lumbosacral plexus injury from leg hyperextension. However, a vast majority of pain is undetected by evaluators due to a lack of diagnostic tools and confounding psychiatric illness. This diagnostic gap results in exclusive psychological treatment rather than multimodal therapies, substantially limiting rehabilitation. Read More

J Pediatr Orthop 2020 Jul;40(6):e466-e472

Health and Care Foundation, Ahmedabad, Gujrat India.

Background: Shoulder imbalance secondary to residual brachial plexus birth palsy requires release of internal rotation contracture and tendon transfer. Subscapularis is considered as the prime element of internal rotation contracture and various methods have been described for subscapularis lengthening. It includes open subscapularis slide or lengthening and arthroscopic release. Read More

J Pediatr Orthop 2020 Jul;40(6):e460-e465

Department of Orthopedics, Musculoskeletal Research Center, Children's Hospital Colorado.

Background: Brachial plexus birth injury (BPBI) is a condition in which the brachial plexus is thought to be damaged during the birth process. Studies have cited a varying incidence rate ranging from 0.5 to 4. Read More

Korean J Anesthesiol 2020 Jun 5. Epub 2020 Jun 5.

Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea.

Background: Interscalene brachial plexus block (ISBPB) is commonly used with general anesthesia for postoperative pain management in shoulder surgery. This study investigated the incidence of hypothermia and changes in the body temperature in patients undergoing arthroscopic shoulder surgery under ISBPB with propofol sedation.

Methods: This retrospective study enrolled 220 patients who underwent arthroscopic shoulder surgery. Read More

J Vasc Surg 2020 Jun 1. Epub 2020 Jun 1.

The Center for Thoracic Outlet Syndrome and the Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO. Electronic address:

The global SARS-CoV-2/COVID-19 pandemic has required a reduction in non-emergency treatment for a variety of disorders. This report summarizes conclusions of an international multidisciplinary consensus group assembled to address evaluation and treatment of patients with thoracic outlet syndrome (TOS), a group of conditions characterized by extrinsic compression of the neurovascular structures serving the upper extremity. The following recommendations were developed in relation to the 3 defined types of TOS (neurogenic, venous, and arterial) and 3 phases of pandemic response (preparatory, urgent with limited resources, and emergency with complete diversion of resources): (1) In-person evaluation and treatment for neurogenic TOS (interventional or surgical) is generally postponed during all pandemic phases, with telephone/telemedicine visits and at-home physical therapy exercises recommended when feasible. Read More

Oper Neurosurg (Hagerstown) 2020 Jun 4. Epub 2020 Jun 4.

Department of Neurological Surgery, Sarah Network of Rehabilitation Hospitals, Brasilia, Brazil.

Background: The phrenic nerve has been extensively reported to be a very powerful source of transferable axons in brachial plexus injuries. The most used technique used is supraclavicular sectioning of this nerve. More recently, video-assisted thoracoscopic techniques have been reported as a good alternative, since harvesting a longer phrenic nerve avoids the need of an interposed graft. Read More

JSES Int 2020 Jun 3;4(2):357-361. Epub 2020 Mar 3.

Department of Orthopedics, Penn State Hershey Medical Center, Hershey, PA, USA.

Background: Optimal modalities for pain control in shoulder arthroplasty are not yet established. Although regional nerve blockade has been a well-accepted modality, complications and rebound pain have led some surgeons to seek other pain control modalities. Local injection of anesthetics has recently gained popularity in joint arthroplasty. Read More

Indian J Anaesth 2020 Apr 28;64(4):347-348. Epub 2020 Mar 28.

Department of Anaesthesiology, Sri Venkateshwaraa Medical College, Hospital and Research Centre, Puducherry, India.

Indian J Anaesth 2020 Apr 28;64(4):310-315. Epub 2020 Mar 28.

Department of Anaesthesiology and Critical Care, Shrimati Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India.

Background And Aims: Axillary brachial plexus block is commonly performed for surgeries on the hand and forearm. However, there are very few studies on the use of magnesium sulphate in axillary brachial plexus block and, hence, the study was designed to evaluate magnesium as an adjuvant to ropivacaine-induced axillary block with respect to onset and duration of sensorimotor block and postoperative analgesia.

Methods: Sixty patients of the American Society of Anesthesiologists (ASA) physical status I and II, undergoing surgeries on the hand and forearm were randomly recruited to receive ultrasound-guided axillary block with either 150 mg magnesium sulphate or 1 mL normal saline added to 0. Read More

Hand (N Y) 2020 Jun 2:1558944720918325. Epub 2020 Jun 2.

Hand Surgery and Microsurgery Group, Faculdade de Medicina do ABC, Santo Ándre, Brazil.

Oberlin et al presented a new technique for nerve transfer that completely changed the prognosis of patients with brachial plexus injury. Currently, most of the literature addresses cases submitted to early surgical intervention, before 12 months from injury, showing consistent good results. The aim of this study was to evaluate the feasibility of the Oberlin procedure in late presentation cases (≥12 months), comparing the elbow flexion strength with patients operated earlier. Read More

Ann Vasc Surg 2020 May 29. Epub 2020 May 29.

Research Institute for Convergence of Biomedical Science and Technology, Division of Vascular and Endovascular Surgery, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea. Electronic address:

Objective: Several factors affect the outcomes of arteriovenous fistula (AVF) and end-stage renal disease (ESRD). This study aimed to evaluate the efficacy of regional anesthesia in secondary procedures or revisions of arteriovenous fistula.

Methods: Medical records of patients who underwent treatment for AVF secondary procedures or revisions under brachial plexus block (BPB) between March 2016 and June 2019 were retrospectively analyzed. Read More

Br J Anaesth 2020 May 28. Epub 2020 May 28.

Department of Physiology & Pharmacology, Karolinska Instituet, Karolinska University Hospital, Stockholm, Sweden. Electronic address:

Reg Anesth Pain Med 2020 May 30. Epub 2020 May 30.

Department of Anesthesiology and Perioperative Medicine, University of Chile, Santiago, Chile

Anaesthesia 2020 May 30. Epub 2020 May 30.

Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway.

Rebound pain after brachial plexus block resolution and development of long-lasting pain are problems associated with volar plate fixation for distal radius fractures. The aim of this double-blind study was to evaluate the effect of a single prophylactic intravenous dose of dexamethasone in this setting. The primary endpoint was highest pain score during the first 24 hours after surgery. Read More

J Pediatr Orthop B 2020 Jul;29(4):412-413

Trauma & Orthopaedics, Cambridge University Hospitals NHS Trust, Cambridge, UK.

Ann Plast Surg 2020 May 27. Epub 2020 May 27.

From the Department of Orthopedics Surgery and Traumatology, Faculty of Medicine, University of Alexandria, Egypt.

Background: Spontaneous recovery of elbow flexion in obstetric brachial plexus palsy at 4 to 6 months of age is sufficient to exclude the child from the early microsurgical intervention. However, lack of complete active external rotation of shoulder is a common finding in such cases despite ongoing other arm and shoulder functions. Nerve transfer is proposed to manage such cases before the age of 18 months. Read More

Reg Anesth Pain Med 2020 May 28. Epub 2020 May 28.

Anesthesia and Pain Management, Toronto Western Hospital, Toronto, Ontario, Canada

Background: Nerve injury from peripheral nerve block (PNB) is an uncommon but potentially serious complication. We present a retrospective cohort study to evaluate the incidence and etiology of new postoperative neurological symptoms after surgery and regional anesthesia.

Methods: We performed a retrospective cohort study of all PNBs performed on elective orthopedic and plastic surgical patients over 6 years (2011-2017). Read More

Reg Anesth Pain Med 2020 May 28. Epub 2020 May 28.

Anaesthesiology, General Intensive Care Medicine and Pain Therapy, Medical University of Vienna, Vienna, Austria

Safety and effectiveness are mandatory requirements for any technique of regional anesthesia and can only be met by clinicians who appropriately understand all relevant anatomical details. Anatomical texts written for anesthetists may oversimplify the facts, presumably in an effort to reconcile extreme complexity with a need to educate as many users as possible. When it comes to techniques as common as upper-extremity blocks, the need for customized anatomical literature is even greater, particularly because the complex anatomy of the brachial plexus has never been described for anesthetists with a focus placed on regional anesthesia. Read More

Childs Nerv Syst 2020 May 28. Epub 2020 May 28.

Peripheral Nerve Surgery Unit, Division of Functional Neurosurgery, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, SP, Brazil.

This historical review presents the relevant data about the evolution of the surgical treatment of neonatal brachial plexus palsy. Starting with the first clinical description by Smellie in 1754, we will present the initial enthusiasm for the surgery followed by a lack of interest that lasted many years, the resurgence of interest in operative management in the 1970s, and the consolidation in the 1980s of surgery as the standard indication in cases of neonatal brachial plexus palsy without a functional spontaneous recovery. Read More

J Plast Reconstr Aesthet Surg 2020 Mar 13. Epub 2020 Mar 13.

Oxford Reconstructive Plastic Hand surgery Innovation Collaboration (ORPHIC), Department of Plastic, Reconstructive and Hand Surgery, Oxford University Hospitals NHS Foundation Trust, United Kingdom.

Revascularisation of the brachial plexus is controversial. Traditional techniques use free tissue transfer of omentum, groin fat or muscle, on the principle of supplying rich quantities of vascularised tissue to wrap around the nerves permitting neural gliding and revascularising the scarred nerves. However, the complexity of an additional microsurgical procedure coupled with uncertainty of their effectiveness have curtailed their clinical application. Read More

World Neurosurg 2020 May 23. Epub 2020 May 23.

Neurosurgery Unit, Department of Neuroscience, University of Turin, The City of Health and Science, Corso Bramante 88/90, 10126 Turin (It).

Pacing Clin Electrophysiol 2020 May 25. Epub 2020 May 25.

Department of Surgery, Catholic University Hospital "A. Gemelli", Roma, Italy.

Background: The venous access for the insertion of permanent leads of cardiac implantable electronic devices is often achieved by venous cutdown of the cephalic vein, or by "blind" puncture of the subclavian vein using anatomical landmarks, or by fluoroscopy-assisted methods.

Methods: We have retrospectively analyzed our clinical experience to verify the feasibility, the safety, and efficacy of the adoption of ultrasound-guided puncture/cannulation of the axillary vein for this purpose.

Results: Nine hundred eighty-seven leads were placed during 548 consecutive procedures, accessing the axillary vein in the infraclavicular area using real-time ultrasound guidance. Read More

AMA J Ethics 2020 May 1;22(5):E380-387. Epub 2020 May 1.

Orthopedic hand surgeon at Washington University School of Medicine in St Louis, Missouri.

Illness and injury often entail lasting health and social consequences beyond the acute event. During the immediate and long-term recovery period, consequences of illness or injury can often be mitigated and addressed. As patients and their clinicians discuss care decisions, whether for initial or ongoing management of illness or injury, they must consider patients' personal goals of recovery alongside possible clinical outcomes to choose the best path forward. Read More

Injury 2020 May 21. Epub 2020 May 21.

Department of Orthopedic Surgery and Traumatology, Saint Georges University Medical Center, Balamand University, P.O. Box 166378, Achrafieh, Beirut, 1100 2807, Lebanon.

Injury of the brachial plexus and peripheral nerve often result in significant upper extremity dysfunction and disability. Nerve transfers are replacing other techniques as the gold standard for brachial plexus and other proximal peripheral nerve injuries. These transfers require an intimate knowledge of nerve topography, a technically demanding Intraneural dissection and require extensive physical therapy for retraining. Read More

Semin Thorac Cardiovasc Surg 2020 May 21. Epub 2020 May 21.

Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Queens, NY.

Objective: Thoracic outlet syndrome (TOS) comprises a constellation of signs and symptoms that arise from neurologic and vascular compression of the brachial plexus and subclavian vasculature, respectively. Surgical decompression of the neurovascular structures is often indicated to alleviate TOS. We report here our robotic surgical approach and experience for resection of the first rib. Read More

Oper Neurosurg (Hagerstown) 2020 May 23. Epub 2020 May 23.

Miami Project to Cure Paralysis, Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida.

Presence of a cervical rib results from overdevelopment of the seventh cervical vertebrae.1-3 The cervical rib along with scalene muscles can cause neurogenic thoracic outlet syndrome.4,5 Rib resection is typically done via anterior approach, using either supraclavicular or transaxillary route. Read More

J Pediatr Rehabil Med 2020 May 15. Epub 2020 May 15.

??? Read More

Diagnostics (Basel) 2020 May 20;10(5). Epub 2020 May 20.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, 06100 Ankara, Turkey.

The brachial plexus (BP) is a complicated neural network, which may be affected by trauma, irradiation, neoplasm, infection, and autoimmune inflammatory diseases. Magnetic Resonance Imaging is the preferred diagnostic modality; however, it has the limitations of high cost and lack of portability. High-resolution ultrasound has recently emerged as an unparalleled diagnostic tool for diagnosing postganglionic lesions of the BP. Read More

Biosci Rep 2020 May 22. Epub 2020 May 22.

The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.

Ultrasound-guided costoclavicular block (CC-approach) is a recently described brachial plexus block and an alternative approach to the supraclavicular approach (SC-approach). The relevant sonoanatomy is analogous in terms of the brachial plexus and its adjacent artery for both approaches. In this study, we hypothesized that the two approaches will result in similar block dynamics when used the modified double-injection (MDI) technique. Read More

Plast Reconstr Surg Glob Open 2020 Apr 30;8(4):e2814. Epub 2020 Apr 30.

[This corrects the article DOI: 10.1097/GOX.0000000000002605. Read More

Plast Reconstr Surg Glob Open 2020 Apr 24;8(4):e2804. Epub 2020 Apr 24.

Division of Plastic Surgery, Children's National Hospital, Washington, D.C.

Anatomic variations in peripheral nerves and the perineural environment are common and can contribute to acute or chronic neuropathy in certain individuals. Awareness of these variants is relevant to understanding both the etiopathogenesis and the increased susceptibility to nerve injury in some patients. We present a 4-year-old boy who sustained a permanent injury to the upper brachial plexus from a relatively minor trauma. Read More

Semin Musculoskelet Radiol 2020 Apr 21;24(2):101-112. Epub 2020 May 21.

Department of Health Sciences (DISSAL), Università di Genova, Genova, Italy.

With the advent of high-frequency ultrasound (US) transducers, new perspectives have been opened in evaluating millimetric and submillimetric nerves that, despite their dimensions, can be considered relevant in clinical practice. In the posterior triangle of the neck, the suprascapular, long thoracic, phrenic, supraclavicular, great auricular, lesser occipital, and transverse cervical nerves are amenable to US examination and the object of special interest because they may be involved in many pathologic processes or have a value as targets of advanced therapeutic procedures. The correct identification of these nerves requires a deep knowledge of local neck anatomy and the use of a complex landmarks-based approach with US. Read More

Childs Nerv Syst 2020 May 20. Epub 2020 May 20.

Department of Neurosurgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham, AL, USA.

SARS-CoV-2 COVID-19, coronavirus, has created unique challenges for the medical community after national guidelines called for the cancellation of all elective surgery. While there are clear cases of elective surgery (benign cranial cosmetic defect) and emergency surgery (hemorrhage, fracture, trauma, etc.), there is an unchartered middle ground in pediatric neurosurgery. Read More

J Pediatr Orthop 2020 May 15. Epub 2020 May 15.

Department of Orthopedics Musculoskeletal Research Center Children's Hospital Colorado.

Local Reg Anesth 2020 23;13:33-35. Epub 2020 Apr 23.

Department of Anaesthesia, Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Kathmandu, Nepal.

Introduction: Brachial plexus blocks are frequently practiced and safe mode of anaesthsia. Although minor complications may occur, major complications are a rarity. However, we report a rare case of prolonged supraclavicular brachial plexus block which required almost 4 months to recover without a perceivable cause. Read More

Taiwan J Obstet Gynecol 2020 May;59(3):392-397

Department of Obstetrics and Gynecology, Istanbul Medeniyet University Goztepe Education and Research Hospital, Doktor Erkin caddesi, Kadıkoy/Istanbul, Turkey. Electronic address:

Objective: Breech presentation is the most common form of malpresentation, and associated with perinatal asphyxia and mortality, and maternal morbidity. Data associated with labor induction in breech presentation are limited. The aim of this study was to compare maternal and fetal complication rates in induced and spontaneous vaginal, and cesarean delivery with breech presentation. Read More

Int J Dev Neurosci 2020 May 16. Epub 2020 May 16.

Faculty of Medicine, Department of Psychiatry, Kırıkkale University, Kırıkkale, Turkey.

Introduction: Brachial plexus birth injury (BPBI) may cause permanent disability. It is recently thought to result from the (mal)adaptive reorganizational central nervous system problems.

Methods: In this study, adult patients with BPBI and age-matched healthy controls were compared for the cortical activity during action observation by functional magnetic resonance imaging (fMRI). Read More

Pediatr Neurol 2020 Apr 13. Epub 2020 Apr 13.

Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan.

Background: Acute flaccid myelitis is a recently defined clinically distinct syndrome of polio-like acute flaccid paralysis. Acute flaccid myelitis cases show characteristic neuroradiological features of longitudinal spinal cord lesions with predominant gray matter involvement. Current evidence suggests injury to the anterior horn neurons as the underlying mechanism. Read More

Childs Nerv Syst 2020 May 12. Epub 2020 May 12.

Peripheral Nerve Surgery Unit, Division of Functional Neurosurgery, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, SP, Brazil.

Purpose: Long-term evaluation of hand function in children who underwent transfer procedures to reinnervate the biceps muscle, using fascicles from the ulnar and median nerves as donors.

Methods: In the last follow-up evaluation, the children underwent a neurological examination, and their hand status was classified according to the Raimondi grading system for hand function. Two physical measurements, the child health assessment questionnaire (CHAQ) and the Sollerman hand function test, were applied to assess upper extremity function. Read More

Clin Imaging 2020 Apr 25;64:97-102. Epub 2020 Apr 25.

Hospital for Special Surgery, Department of Radiology and Imaging, United States of America.

Objective: Long thoracic neuropathy results in serratus anterior muscle denervation and presents with scapular winging. Previously published studies have been unable to identify the long thoracic nerve on MRI; instead, secondary imaging features of serratus anterior muscle denervation are used to infer nerve injury. Our study's purpose was to evaluate the ability of high-resolution MRI to depict the long thoracic nerve. Read More

BMJ Case Rep 2020 May 6;13(5). Epub 2020 May 6.

Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA

We report a patient who has been on tacrolimus for bilateral lung transplantation and presented with a brachial plexus injury (BPI), with unusual improvement of lower trunk innervated hand function. The lower trunk injury with resultant left hand paralysis had developed after his sternotomy 18 months ago. He has been treated with tacrolimus as part of his immunosuppression protocol since the surgery, without severe side effects. Read More

J Hand Surg Eur Vol 2020 May 7:1753193420923524. Epub 2020 May 7.

Department of Orthopedics, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.

J Hand Surg Eur Vol 2020 May 7:1753193420922184. Epub 2020 May 7.

Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Ogori, Japan.

We compared the outcomes of 23 partial ulnar nerve and 15 intercostal nerve transfers for elbow flexion reconstruction in patients with C56 or C567 brachial plexus injuries using manual muscle power, dynamometric measurements of elbow flexion strength and electromyography. The range of elbow flexion and muscle strength recovery to Grade 3 or 4 were comparable between the two groups. The patients with C567 injuries had significantly stronger eccentric contraction after the partial ulnar nerve transfer than after the intercostal nerve transfer ( < 0. Read More

Plast Reconstr Surg 2020 May 4. Epub 2020 May 4.

Background: Shoulder release and tendon transfer is frequently performed to address persistent weakness from neonatal brachial plexus palsy. Although postoperative improvements in motion are well described, associated deficits are poorly documented and functional assessments are lacking. Loss of ability to reach midline can occur with surgery and may result in impairment. Read More

Neurocirugia (Astur) 2020 May 3. Epub 2020 May 3.

Servicio de Neurocirugía, Hospital General Universitario Gregorio Marañón, Madrid, España.

Background And Objectives: The treatment of deafferentation pain by spinal DREZotomy is a proven therapeutic option in the literature. In recent years, use of DREZotomy has been relegated to second place due to the emergence of neuromodulation therapies. The objectives of this study are to demonstrate that DREZotomy continues to be an effective and safe treatment and to analyse predictive factors for success. Read More