Search Our Scientific Publications & Authors

Ortop Traumatol Rehabil 2021 Apr;23(2):59-64

Artemis Hospital, Gurgaon, Haryana, India.

Background: Glenohumeral joint arthrodesis has become a rare entity due to the introduction of shoulder arthroplasty. It is an excellent salvage procedure for patients with severe shoulder dysfunction, with limited treatment options, indicated for brachial plexus injury, tumour resection, chronic infection, failed prosthetic arthroplasty, or pseudoparalysis of the shoulder due to combined rotator cuff and deltoid deficiency. Shoulder arthrodesis relieves the patient of pain and gives a decent amount of function. Read More

J Orthop Case Rep 2020 May-Jun;10(3):43-46

Department of Orthopaedic Surgery, Necker-Enfants Malades University Hospital, 149 Rue de Sèvres, 75015 Paris, France.

Introduction: Traumatic posterior dislocation of the shoulder is exceedingly rare in pediatric patients. Main causes are obstetrical brachial plexus injury; congenital abnormalities of the glenohumeral joint; and voluntary dislocation, which are often multidirectional. Treatment is not consusual and depends on early diagnosis. Read More

J Hand Ther 2021 Mar 6. Epub 2021 Mar 6.

Clinical Fellow, Trauma & Orthopaedics, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom.

Am J Perinatol 2021 May 3. Epub 2021 May 3.

Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon.

Objective:  The aim of the study is to evaluate differences in maternal and neonatal outcomes based on updated criteria for defining active labor at 6 cm of cervical dilation and to determine if these recommendations are cost-effective.

Study Design:  A decision-analytic model was built using TreeAge Pro 2020 software. We included maternal outcomes of mode of delivery, endometritis, postpartum hemorrhage requiring transfusion, and death. Read More

Tech Hand Up Extrem Surg 2021 Apr 28. Epub 2021 Apr 28.

Shoulder Unit, Clinique Bizet, Paris Hopital Ambroise Paré, Boulogne-Billancourt, France.

The therapeutic management of the paralytic shoulder after an obstetric brachial plexus injury is complex. When nerve repair or neurotization fail, or if the biological times for nerve reconstruction is over, tendon transfer to restore active external rotation of the shoulder becomes the main surgical alternative. The purpose of this manuscript is to describe the surgical technique of the lower trapezius muscle transfer to the infraspinatus muscle, to restore active shoulder external rotation in the child with paralytic shoulder, step by step with details and pearls. Read More

Agri 2021 Apr;33(2):122-123

Department of Physical Medicine and Rehabilitation, Malatya Training and Research Hospital, Malatya, Turkey.

Brachial plexus injury is a complication that can be seen after coronary artery bypass grafting (CABG), especially median sternotomy. Brachial plexus injury was detected by clinical, examination, and electromyography in the presence of pain in the left arm who underwent CABG operation about 3 months ago. Our case was diagnosed early and improved with appropriate treatment. Read More

Medicine (Baltimore) 2021 Apr;100(17):e25698

Department of Neurology, Washington University School of Medicine, Saint Louis, MO.

Rationale: Peripheral nerve injury related to vascular complications associated with extracorporeal membrane oxygenation (ECMO) is perhaps underappreciated. Compared to the well-described central nervous system complications of ECMO, brachial plexopathy and lumbosacral plexopathy have rarely been reported. We report this case to heighten awareness of lumbosacral plexus injury due to pelvic hematoma formation after ECMO. Read More

J Hand Surg Am 2021 Apr 23. Epub 2021 Apr 23.

Department of Orthopedic Surgery, Hand and Upper Extremity, Hospital for Special Surgery, New York, NY.

Purpose: Case reports of nerve injuries following arthroscopic capsulolabral repair emphasize the proximity of major nerves to the glenoid. This study describes preoperative localization using nerve-sensitive magnetic resonance imaging in a small cohort of patients with iatrogenic nerve injuries following arthroscopic capsulolabral repair and the outcomes of nerve repair in these patients.

Methods: Cases of iatrogenic nerve injury following arthroscopic capsulolabral repair referred to 2 surgeons from January 2017 to December 2019 were identified. Read More

Ann Phys Rehabil Med 2021 Apr 23. Epub 2021 Apr 23.

Department of Pediatric Physical and Medical Rehabilitation, Fondation ILDYS, Brest, Bretagne, France; Laboratory of Medical Information Processing, INSERM U1101, Brest, Bretagne, France; Department of Physical and Medical Rehabilitation, CHRU Morvan, Brest, Bretagne, France; Université de Bretagne Occidentale, Brest, France.

Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2021 Apr 23;42(1):91-103. Epub 2021 Apr 23.

University Clinic for Plastic and Reconstructive Surgery, Skopje, RN Macedonia.

Brachial plexus injuries are still challenging for every surgeon taking part in treating patients with BPI. Injuries of the brachial plexus can be divided into injuries of the upper trunk, extended upper trunk, injuries of the lower trunk and swinging hand where all of the roots are involved in this type of the injury. Brachial plexus can be divided in five anatomical sections from its roots to its terminal branches: roots, trunks, division, cords and terminal branches. Read More

Hand (N Y) 2021 Apr 21:1558944721998008. Epub 2021 Apr 21.

Division of Hand Surgery and Microsurgery, ABC Medical School, Sto. André, SP, Brazil.

Background: The external rotation and abduction of shoulder are considered one of the priorities of reconstruction in brachial plexus injury. The aim of this study was to evaluate the functional results and complications of shoulder arthrodesis in patients with brachial plexus injury to better comprehend the benefits of this procedure.

Methods: Between 2015 and 2019, 15 shoulder arthrodesis were performed in patients with long-standing brachial plexus injury. Read More

Can J Anaesth 2021 Apr 21. Epub 2021 Apr 21.

Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.

Purpose: The costoclavicular block is a relatively novel alternative to the infraclavicular block. We aimed to determine the anatomical structures vulnerable to needle injury during a costoclavicular block.

Methods: The needle path consistent with a costoclavicular block approach was performed bilaterally on four lightly embalmed cadavers using ultrasound guidance. Read More

J Bone Joint Surg Am 2021 Mar 11. Epub 2021 Mar 11.

Departments of Orthopaedic Surgery (M.F., R.P., and T.L.) and Plastic and Reconstructive Surgery (R.P. and H.B.), University of Toronto, Toronto, Ontario, Canada.

»: Nerve injuries during shoulder arthroplasty have traditionally been considered rare events, but recent electrodiagnostic studies have shown that intraoperative nerve trauma is relatively common.

»: The brachial plexus and axillary and suprascapular nerves are the most commonly injured neurologic structures, with the radial and musculocutaneous nerves being less common sites of injury.

»: Specific measures taken during the surgical approach, component implantation, and revision surgery may help to prevent direct nerve injury. Read More

J Neurosurg Sci 2021 Apr 16. Epub 2021 Apr 16.

Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland.

Introduction: Spinal cord injury (SCI) may lead to tetraplegia. Several nerve transfers have been successfully used for the restoration of the upper limb in tetraplegia. Reconstruction of an upper limb is individualized based on the functional level. Read More

Neurohospitalist 2021 Jan 6;11(1):75-79. Epub 2020 Aug 6.

Neurology Department, Concord Hospital, Concord, New South Wales, Australia.

Proximal median nerve injury is an uncommon consequence of anterior shoulder dislocation, especially occurring in isolation of other upper limb peripheral nerve injury. We report the case of an 82-year-old woman with a median nerve injury as detected by clinical and neurophysiological examination following a fall and anterior shoulder dislocation. Magnetic resonance neurography confirmed the diagnosis, but also detected asymptomatic brachial plexus and ulnar nerve involvement. Read More

J Int Med Res 2021 Apr;49(4):3000605211006610

Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Objective: The purpose of this retrospective observational study was to assess the feasibility of electrodiagnostic parameters, perioperatively, and to discover optimal values as prognostic factors for patients with brachial plexus injury undergoing nerve transfer operations.

Methods: We retrospectively reviewed the records of 11 patients who underwent nerve transfer surgery. The patients underwent perioperative electrodiagnosis (EDX) before and approximately 6 months after surgery. Read More

Am J Obstet Gynecol 2021 Apr 15. Epub 2021 Apr 15.

Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas.

Background: Insulin detemir, being used increasingly during pregnancy, may have pharmacological benefits compared to neutral protamine Hagedorn (NPH).

Objective: We evaluated the probability that treatment with insulin detemir compared to NPH reduces the risk for adverse neonatal outcome among individuals with Type 2 diabetes mellitus or overt type 2 (gestational diabetes diagnosis <20 weeks).

Study Design: We performed a multiclinic randomized controlled trial (09/2018 to 01/2020), which included singleton gestation with Type 2 diabetes or overt type 2 who sought obstetrical care ≤21 weeks. Read More

J Reconstr Microsurg 2021 Apr 14. Epub 2021 Apr 14.

Department of Orthopedics and Traumatology, Reconstructive Microsurgery Unit, Assiut University Hospitals and School of Medicine, Assiut, Egypt.

Background:  Traumatic brachial plexus injuries in children represent a definite spectrum of injuries between adult and neonatal brachial plexus injuries. Their characteristics have been scarcely reported in the literature. The priority of functional restoration is not clear. Read More

Radiology 2021 Apr 13:202817. Epub 2021 Apr 13.

From the Department of Medical Imaging and Intervention (Y.J.Y., Y.M.W.) and Center for Big Data Analytics and Statistics (J.L.H.), Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC; and Department of Medical Imaging and Intervention, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan, ROC (K.M.Y., I.H.S., C.M.C., J.H.T.).

Background MRI, Tinel test, and rhomboid electromyography (EMG) can be used to predict whether C5 spinal nerve stumps are healthy and eligible for grafting in acute adult brachial plexus injuries, but their comparative diagnostic efficacies have not been evaluated. Purpose To compare diagnostic performances of MRI, Tinel test, and rhomboid EMG in predicting healthy C5 spinal nerve stumps that are eligible for grafting. Materials and Methods This retrospective study included consecutive adult patients with acute brachial plexus injury who underwent microreconstructions between January 2008 and December 2018. Read More

Angiol Sosud Khir 2021 ;27(1):159-163

Department of General Surgery #1, Perm State Medical University named after Academician E.A. Wagner under the RF Ministry of Public Health, Perm, Russia.

A false aneurysm of the axillary artery is an extremely rare complication of a lesion of this vessel. As few as several dozens of similar cases have been described in the available literature. We herein report a clinical case concerning surgical treatment of a 41-year-old patient who after a knife-inflicted injury had developed a 66x67 mm pseudoaneurysm of the axillary artery. Read More

J Matern Fetal Neonatal Med 2021 Apr 4:1-8. Epub 2021 Apr 4.

Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA.

Background: Recommendations from the American College of Obstetricians and Gynecologists for the safe prevention of primary cesarean deliveries propose that cesarean delivery for active phase arrest in the first stage of labor should be performed only if women fail to progress despite four hours of adequate uterine activity and no cervical change. This is a change in recommendation from a two-hour threshold.

Objective: To determine the economic and clinical implications of waiting four hours compared to two hours for cervical progression before diagnosing active phase labor arrest. Read More

Indian J Plast Surg 2021 Jan 10;54(1):29-37. Epub 2021 Mar 10.

Department of Plastic and Reconstructive Surgery, Apollo First Med Hospital, Chennai, Tamil Nadu, India.

 Total brachial plexus palsy (TBPP) accounts for nearly 50% of all brachial plexus injuries. Since achieving a good functional hand was almost impossible, the aim was settled to get a good shoulder and elbow function. It was Gu, who popularized the concept of utilizing contralateral C7 (CC7) with vascularized ulnar nerve graft (VUNG) to get some hand function. Read More

J Hand Surg Am 2021 Mar 30. Epub 2021 Mar 30.

Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.

Purpose: The treatment of traumatic brachial plexus injury (BPI) is time-sensitive, and early nerve reconstruction is associated with superior nerve recovery. The objective of this study was to determine the rate of delayed referral to our centers for traumatic BPI, identifiable causes of delayed referral, and factors associated with delayed referral to a brachial plexus surgeon.

Methods: We identified 84 patients with traumatic BPI referred to and evaluated by brachial plexus surgeons at 2 tertiary care referral centers from 2015 to 2019. Read More

Ned Tijdschr Geneeskd 2021 03 18;165. Epub 2021 Mar 18.

UMC Utrecht, afd. Traumachirurgie, Utrecht.

Background: Compartment syndrome is a rare but serious entity with various causes. Timely diagnosis and treatment are essential.

Case Description: We present a case of a 14-year-old boy with a crush injury of the forearm including a fracture of the radius and ulna. Read More

A A Pract 2021 Mar 30;15(4):e01430. Epub 2021 Mar 30.

Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.

A 48-year-old woman with a history of cardiac surgery developed severe dyspnea and anxiety following right-sided supraclavicular nerve block for hand surgery. In this case, right phrenic nerve blockade from a supraclavicular block unmasked a subclinical hemidiaphragmatic paresis from phrenic nerve injury on the left, the latter likely due to previous cardiac surgery. When performing brachial plexus block at or above the clavicle, particularly for prior cardiothoracic surgical patients, anesthesiologists can easily, quickly, and inexpensively use point-of-care ultrasound to assess whether any degree of phrenic nerve dysfunction exists on the contralateral side, as patients may be asymptomatic at baseline. Read More

BMJ Case Rep 2021 Mar 25;14(3). Epub 2021 Mar 25.

Neurology, Weill Cornell Medicine, New York City, New York, USA.

COVID-19 affects a wide spectrum of organ systems. We report a 52-year-old man with hypertension and newly diagnosed diabetes mellitus who presented with hypoxic respiratory failure due to COVID-19 and developed severe brachial plexopathy. He was not treated with prone positioning respiratory therapy. Read More

Patient Educ Couns 2021 Mar 15. Epub 2021 Mar 15.

Department of Physical Therapy, University of Toronto, Toronto, Canada; Bloorview Research Institute, Toronto, Canada.

Objective: The objective of this study is to elucidate the decision-making experiences of youth with brachial plexus birth injuries who face preference-sensitive decisions regarding treatment options for a persistent elbow contracture.

Methods: Transcripts, research-created drawings, and field notes from in-depth interviews with 5 young adults and 14 youth-parent dyads, and 15 participant observation sessions of families and clinicians in the clinic setting were deductively and inductively coded and thematically analyzed.

Results: Youth's shared decision making was influenced by relational processes with their clinicians and parents. Read More

Injury 2021 Mar 20;52(3):511-515. Epub 2020 Oct 20.

Paul Brand Centre for Hand Surgery, Christian Medical College, Vellore, TN 632004, India. Electronic address:

Background: Restoration of elbow flexion is one of the key components of adult brachial plexus surgery. Nerve transfers are routinely used to attain elbow flexion.

Purpose: This study aims to quantify the recovery of elbow flexion power and to compare the outcome following single nerve transfer and double nerve transfer to branches of the musculocutaneous nerve in adult traumatic brachial plexus injury. Read More

J Bone Joint Surg Am 2021 Mar 18. Epub 2021 Mar 18.

Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada.

Background: Avulsion of either the C5 or C6 root with intact middle and lower trunks in brachial plexus birth injury is rare. In these cases, only 1 proximal root is available for intraplexal reconstruction. The purpose of the present study was to determine the outcomes of these patients when single-root reconstruction was balanced across the anterior and posterior elements of the upper trunk. Read More

J Neurosurg 2021 Mar 19:1-10. Epub 2021 Mar 19.

6Department of Anatomy, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.

Objective: The purpose of this study was to describe the anatomy of donor and recipient median nerve motor branches for nerve transfer surgery within the cubital fossa.

Methods: Bilateral upper limbs of 10 fresh cadavers were dissected after dyed latex was injected into the axillary artery.

Results: In the cubital fossa, the first branch was always the proximal branch of the pronator teres (PPT), whereas the last one was the anterior interosseous nerve (AIN) and the distal motor branch of the flexor digitorum superficialis (DFDS) on a consistent basis. Read More