DOCSLIB.ORG

Obstetrical Nerve Injury

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Obstetrical Nerve Injury Volume 31 Spring 2008 Obstetrical Nerve Injury Alison McDonald, MD, Obstetrical Resident Dept. of Obstetrics & Gynecology, Faculty of Medicine & Dentistry, UWO Edited by Renato Natale, MD, FRCSC Chief, Dept. of Obstetrics, London Hospitals Obstetrical Co-Director, Perinatal Outreach Program of Southwestern Ontario Introduction which generally resolves quickly via remyelination. In more serious injuries, there lthough neurologic injury sustained can be axonal damage, which resolves more during labour and delivery are slowly, and can cause permanent impairment relatively rare (0.008-0.92%)1, it is A of nerve function.2 Signs and symptoms of important to prevent these injuries, and to impending nerve damage may be masked in recognize them when they occur. Nerve labour by anaesthesia, or may be dismissed injuries sustained by the obstetric patient are by health care providers who consider them generally short-lived, but can be a cause of part of labour discomfort.2 Also, patients with significant short-term and, more rarely, long- epidural anaesthesia may be unaware of term morbidity. We most often consider discomfort and the need to change position lower extremity neuropathies in association regularly.1 with labour and delivery, but upper extremity injuries can be sustained as well. Neurologic injury can occur during labour, spontaneous Lumbosacral Plexus vaginal delivery, operative vaginal delivery, or The lumbosacral trunk is formed by the L-4 cesarean section. This article will review the and L-5 nerve roots. It travels in close common lower and upper extremity contact with the ala of the sacrum adjacent to neuropathies associated with labour and the sacroiliac joint and is cushioned by the delivery, pertinent neuroanatomy, psoas muscle except at its terminal portion mechanisms of injury, and means of preventing injury during care of the obstetrical patient. The discussion will not include neurologic injury specifically related to obstetrical anaesthesia, although it must be What’s Inside . understood that Obstetrics and Anaesthesia work in concert in our patients’ care. Obstetrical Nerve Injury 1 Newborn Hearing Loss 4 Acute nerve injury may occur as a result of For Your Information: 7 transection, traction, compression, or vascular You Asked Us: 9 injury. Compression or traction on a nerve Upcoming Events: 10 can result in compromised perineural blood flow and resulting ischemia. This can cause focal demyelination and conduction block, Page 2 near the pelvic brim where it is joined by the symptoms of the anteromedial thigh. Motor S-1 nerve root to form the sciatic nerve. It is compromise can cause significant functional here that the plexus becomes susceptible to impairment. Compression of the femoral compression by the fetal head as it descends nerve under the inguinal ligament can occur into the pelvis.2 Radicular symptoms can also with prolonged pushing in extreme hip flexion be caused by bulging or ruptured 4. Since the femoral nerve does not traverse intervertebral discs, trauma, infection, the true pelvis, it is relatively unaffected by inflammation, or muscle spasm.1 factors such as cephalopelvic disproportion which is implicated in lumbosacral trunk and Lumbosacral plexus or trunk injury can cause sciatic lesions.3 foot drop, and other neurologic symptoms consistent with peripheral mononeuropathies Common Peroneal Nerve (single or multiple) of the nerves that branch The common peroneal nerve separates from from the plexus. Risk factors for lumbosacral the posterior tibial branch of the sciatic nerve plexus or trunk injuries include fetal above the popliteal fossa, perforates between macrosomia, malpresentations (occiput the insertions of the gastrocnemius and posterior or brow presentation), and certain plantaris muscles to pass over the lateral pelvic features like platypelloid pelvis, shallow head of fibula and descend down the lateral anterior sacral ala, and flattened sacral calf. Injury to the common peroneal nerve 3 promontory. can result in paresthesias on the dorsa of the feet and lateral calves, as well as foot drop. Lateral Femoral Cutaneous Nerve There have been several cases of peroneal The lateral femoral cutaneous nerve exits the nerve palsy related to prolonged squatting pelvis under the inguinal ligament and then during childbirth5, hyperflexion of the knees passes medial and inferior to the anterior during delivery6, and direct compression of superior iliac spine. It is a pure sensory nerve the nerve over the fibular head by the patient which supplies the anterolateral thigh. Injury holding her own legs with fingers placed over to the lateral femoral cutaneous nerve causes the anterior tibia and palms over the fibular burning, pain, or numbness of the head.7 Certain types of stirrups which may be anterolateral thigh, known as meralgia used for pushing during the second stage of paresthetica syndrome.4 The lateral femoral labour in patients with epidurals, may also cutaneous nerve is at risk of injury during cause compression of the common peroneal prolonged pushing with hip flexion as the nerve. This seems more likely to occur nerve is compressed under the inguinal though during gynecologic surgery when the ligament. A wide Pfannensteil incision at patient needs to be placed in stirrups for the cesarean section may lead to transection of lithotomy position. the lateral femoral cutaneous nerve 4. Compression injuries due to the use of self- Sciatic Nerve retaining retractors used in abdominal Reports in the gynecology literature suggest gynecologic procedures can also occur. the possibility of sciatic nerve stretch injury in Obstetricians may consider frequent position high lithotomy position with prolonged hip changes in labour, avoidance of prolonged hip hyperflexion and excessive external rotation. flexion, and shortening the pushing time by Certainly this mechanism of injury during allowing for passive descent of the fetus vaginal delivery is plausible as well. The before pushing begins as means of avoiding sciatic nerve may be compressed by the fetal 4 lateral femoral cutaneous nerve injury . head at the pelvic brim during descent into the pelvis.3 One case report suggests that Femoral Nerve positioning of the patient undergoing cesarean The femoral nerve emerges from the psoas section in the dorsal supine position with left muscle, travels between psoas and iliacus lateral tilt can apply enough pressure to the muscles, then passes under the inguinal left buttock to cause a sciatic neuropathy, ligament, lateral to the femoral vein and especially if the pressure is prolonged.8 artery. Injury to the femoral nerve can result in quadriceps weakness and/or sensory Page 3 Obturator Nerve plexopathy. Muscle Nerve 2002;26:340-7 The obturator nerve crosses the pelvic brim 3. Vargo MM, Robinson LR, Nicholas JJ, Rulin MC. and may be compressed by the descending 4 Postpartum Femoral Neuropathy: Relic of an fetal head or by forceps. The lithotomy Earlier Era? Arch Phys Med Rehabil position causes angulation of the obturator 1990;71:591-6 1 nerve as it leaves the obturator foramen. Pudendal nerve blocks have also been known 4. Borg-Stein J, Dugan SA, Gruber J. to cause hematomas and entrapment of the Musculoskeletal Aspects of Pregnancy. Am J obturator nerve.1 Phys Med Rehabil 2005;84:180-92 5. Babayev M, Bodack MP, Creatura C. Common Upper Extremity Nerves Peroneal Neuropathy Secondary to Squatting The upper extremities of obstetrical patients During Childbirth. Obstet Gynecol can also be affected by neurologic injury. For 1998;91(5):830-1 the patient undergoing cesarean section under general anaesthesia, the usual arm 6. Colachis SC, Pease WS, Johnson EW. A positioning risks apply. The brachial plexus preventable cause of foot drop during childbirth. can be injured by improper arm positioning Am J Obstet Gynecol 1994;171(1):270-1 including hyperabduction or positioning of the 7. Adornato BT, Carlini WG. “Pushing palsy”: A armboards below the level of the operating case of self-induced bilateral peroneal palsy table. Inadequate or improper padding over during natural childbirth. Neurology the bony prominences of the elbow may result 1992;42:936-7 in ulnar nerve injury. Radial nerve injury has been reported with use of the birthing bar 8. Roy S, Levine AB, Herbison GJ, Jacobs SR. when patients position their arms to rest on Intraoperative Positioning During Cesarean as a the bar directly across the spiral groove of the Cause of Sciatic Neuropathy. Obstet Gynecol humerus.9 2002;99:652-3 Nerve injury in the obstetrical patient must be 9. Roubal PJ, Chavinson AH, LaGrandeur RM. a consideration by obstetricians. It is Bilateral Radial Nerve Palsies from Use of the Standard Birthing Bar. Obstet Gynecol important to prevent these injuries by 1996;87(5):820-1 avoiding prolonged hyperflexion and abduction of the hips during birth. This may be accomplished by allowing for passive descent of the fetal head into the pelvis before pushing begins. However, this technique may not be successful in preventing nerve injuries related to compression of nerves in the pelvis by the fetal head. Most of the nerve injuries sustained by our Did you know . obstetrical patients will be short-lived and Neonatal Resuscitation Program (NRP) most often spontaneously resolve. Patients with motor impairments, or with longer-lived Instructor Courses may be requested through symptoms may be aided by referral to a the St. Joseph's Health Centre Respiratory physiatrist, neurologist, or physical therapist. Therapy Department, provided there
Load more

Recommended publications
  • Intrapartum Lesions to the Lumbar Portion of the Lumbosacral Plexus: an Anatomical Review
    REVIEW Eur. J. Anat. 23 (2): 83-90 (2019) Intrapartum lesions to the lumbar portion of the lumbosacral plexus: an anatomical review Shanna E. Williams, Asa C. Black, Jr. Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, USA SUMMARY Key words: Plexopathy – Radiculopathy – Neu- The lumbosacral plexus is formed by the ventral ropathy – Pregnancy – Foot drop rami of L2-S3 and provides sensory and motor branches to the lower extremity. The spatial orien- INTRODUCTION tation of the lumbar portion of the plexus above the pelvic brim leaves it particularly susceptible to in- The lumbosacral plexus is formed by the ventral trapartum injury by the fetal head. Such lesions are rami of the L2-S3 segments, with some contribu- subdivided into two groups: upper lumbar plexus tions from L1 and S4 segments. It gives rise to six (L1-L4) and lumbosacral trunk (L4-L5). Given the sensory nerves of the thigh and leg, and six major root levels involved, upper lumbar plexus lesions sensorimotor nerves responsible for innervating 43 produce symptoms suggestive of iliohypogastric, muscles of the lower extremity (Van Alfen and ilioinguinal, genitofemoral, femoral, and obturator Malessy, 2013). As the name would suggest, it neuropathies or L4 radiculopathies. Alternatively, consists of two components, the lumbar plexus involvement of the lumbosacral trunk can imitate a and the sacral plexus, which are spatially separat- common fibular (peroneal) neuropathy or L5 ed. This anatomical separation results in a clinical radiculopathy. This symptomatic overlap with vari- division of lumbosacral plexus lesions into those ous neuropathies and radiculopathies, makes di- affecting the lumbar plexus and those affecting the agnosis of such lesions particularly challenging.
    [Show full text]
  • Clinical Presentations of Lumbar Disc Degeneration and Lumbosacral Nerve Lesions
    Hindawi International Journal of Rheumatology Volume 2020, Article ID 2919625, 13 pages https://doi.org/10.1155/2020/2919625 Review Article Clinical Presentations of Lumbar Disc Degeneration and Lumbosacral Nerve Lesions Worku Abie Liyew Biomedical Science Department, School of Medicine, Debre Markos University, Debre Markos, Ethiopia Correspondence should be addressed to Worku Abie Liyew; [email protected] Received 25 April 2020; Revised 26 June 2020; Accepted 13 July 2020; Published 29 August 2020 Academic Editor: Bruce M. Rothschild Copyright © 2020 Worku Abie Liyew. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Lumbar disc degeneration is defined as the wear and tear of lumbar intervertebral disc, and it is mainly occurring at L3-L4 and L4-S1 vertebrae. Lumbar disc degeneration may lead to disc bulging, osteophytes, loss of disc space, and compression and irritation of the adjacent nerve root. Clinical presentations associated with lumbar disc degeneration and lumbosacral nerve lesion are discogenic pain, radical pain, muscular weakness, and cutaneous. Discogenic pain is usually felt in the lumbar region, or sometimes, it may feel in the buttocks, down to the upper thighs, and it is typically presented with sudden forced flexion and/or rotational moment. Radical pain, muscular weakness, and sensory defects associated with lumbosacral nerve lesions are distributed on
    [Show full text]
  • 4-Brachial Plexus and Lumbosacral Plexus (Edited).Pdf
    Color Code Brachial Plexus and Lumbosacral Important Doctors Notes Plexus Notes/Extra explanation Please view our Editing File before studying this lecture to check for any changes. Objectives At the end of this lecture, the students should be able to : Describe the formation of brachial plexus (site, roots) List the main branches of brachial plexus Describe the formation of lumbosacral plexus (site, roots) List the main branches of lumbosacral plexus Describe the important Applied Anatomy related to the brachial & lumbosacral plexuses. Brachial Plexus Formation Playlist o It is formed in the posterior triangle of the neck. o It is the union of the anterior rami (or ventral) of the 5th ,6th ,7th ,8th cervical and the 1st thoracic spinal nerves. o The plexus is divided into 5 stages: • Roots • Trunks • Divisions • Cords • Terminal branches Really Tired? Drink Coffee! Brachial Plexus A P A P P A Brachial Plexus Trunks Divisions Cords o Upper (superior) trunk o o Union of the roots of Each trunk divides into Posterior cord: C5 & C6 anterior and posterior From the 3 posterior division divisions of the 3 trunks o o Middle trunk Lateral cord: From the anterior Continuation of the divisions of the upper root of C7 Branches and middle trunks o All three cords will give o Medial cord: o Lower (inferior) trunk branches in the axilla, It is the continuation of Union of the roots of the anterior division of C8 & T1 those will supply their respective regions. the lower trunk The Brachial Plexus Long Thoracic (C5,6,7) Anterior divisions Nerve to Subclavius(C5,6) Posterior divisions Dorsal Scapular(C5) Suprascapular(C5,6) upper C5 trunk Lateral Cord C6 middle (2LM) trunk C7 lower C8 trunk T1 Posterior Cord (ULTRA) Medial Cord (4MU) In the PowerPoint presentation this slide is animated.
    [Show full text]
  • Electrophysiological Study of the Posterior Cutaneous Femoral Nerve
    logy & N ro eu u r e o N p h f y o s l i a o l n o Brooks, J Neurol Neurophysiol 2011, 2:5 r g u y o J Journal of Neurology & Neurophysiology ISSN: 2155-9562 DOI: 10.4172/2155-9562.1000119 Research Article Article OpenOpen Access Access Electrophysiological Study of the Posterior Cutaneous Femoral Nerve: Normative Data Brooks1*, Silva C MD2, Kai MR2 and Leal GXP2 1Setor de Eletroneuromiografia do Instituto de Assistência à Saúde do Servidor Público Estadual de São Paulo – São Paulo- Brasil 2Hospital do Servidor Publico Estadual de São Paulo, São Paulo, Brazil Abstract The posterior cutaneous femoral nerve provides cutaneous inervation of the posterior surface of the thigh and leg, as well as the skin of the perineum. Using Dumitru et al. [1] technique for the assessment of this nerve, we studied one hundred and sixteen limbs from fifty-eight healthy volunteers. The mean values for the posterior cutaneous femoral nerve were as follows: onset latency 2.0 msec (±0.5), amplitude 7.0µV (±2.1), nerve conduction velocity 52 m/s (±4). The assessment of the posterior femoral cutaneous nerve is simple and reproducible. The results of this standardization were similar to the ones described in international literature. Keywords: Femoral nerve; Posterior cutaneous nerve Results Introduction The mean values for the posterior cutaneous femoral nerve were as follows: onset latency 2.0msec (±0.5), amplitude 7.0µV (±2,1), nerve The posterior cutaneous nerve of the thigh leaves the pelvis through conduction velocity 52 m/s (±4); Table 1 summarizes our findings.
    [Show full text]
  • Lumbosacral Plexus Entrapment Syndrome. Part One: a Common Yet Little-Known Cause of Chronic Pelvic and Lower Extremity Pain
    3-A Running head: ANAESTHESIA, PAIN & INTENSIVE CARE www.apicareonline.com ORIGINAL ARTICLE Lumbosacral plexus entrapment syndrome. Part one: A common yet little-known cause of chronic pelvic and lower extremity pain Kjetil Larsen, CES, George C. Chang Chien, D O2 ABSTRACT Corrective exercise specialist, Training & Rehabilitation, Oslo Lumbosacral plexus entrapment syndrome (LPES) is a little-known but common cause Norway of chronic lumbopelvic and lower extremity pain. The lumbar plexus, including the 2 Director of pain management, lumbosacral tunks emerge through the fibers of the psoas major, and the proximal Ventura County Medical Center, sciatic nerve beneath the piriformis muscles. Severe weakness of these muscles may Ventura, CA 93003, USA. lead to entrapment plexopathy, resulting in diffuse and non-specific pain patterns Correspondence: Kjetil Larsen, CES, Corrective throughout the lumbopelvic complex and lower extremities (LPLE), easily mimicking Exercise Specialist, Training & other diagnoses and is therefore likely to mislead the interpreting clinician. It is a Rehabilitation, Oslo Norway; pathology very similar to that of thoracic outlet syndrome, but for the lower body. This Kjetil@trainingandrehabilitation. two part manuscript series was written in an attempt to demonstrate the existence, com; pathophysiology, diagnostic protocol as well as interventional strategy for LPES, and Tel.: +47 975 45 192 its efficacy. Received: 23 November 2018, Reviewed & Accepted: 28 Key words: Pelvic girdle; Pain, Pelvic girdle; Lumbosacral plexus entrapment syndrome; February 2019 Piriformis syndrome; Nerve entrapment; Double-crush; Pain, Chronic; Fibromyalgia Citation: Larsen K, Chien GCC. Lumbosacral plexus entrapment syndrome. Part one: A common yet little-known cause of chronic pelvic and lower extremity pain.
    [Show full text]
  • The Peripheral Nerves of the Neck, Shoulders and Arms Many Spinal Nerves Form Interlacing Nerve Networks – the Cervical, Brachial, Lumbar and Sacral Nerve Plexuses
    The Peripheral Nerves of the Neck, Shoulders and Arms Many spinal nerves form interlacing nerve networks – the cervical, brachial, lumbar and sacral nerve plexuses. The cervical plexus in the neck involves the upper 4 cervical nerves and forms the phrenic nerve which supplies both sensory and motor innervation to the diaphragm which is important for breathing. The brachial plexus in the neck and armpit (axilla) involves C4-T2 and innervates the upper limb (arm and shoulder). These give rise to the axillary nerve, musculocutaneous nerve, median nerve, ulnar nerve and radial nerve (and a few others). The axillary nerve comes out behind the head of humerus to innervate the shoulder joint and the deltoid and teres minor muscles. The musculocutaneous nerve comes down the anterior arm innervates flexion of the forearm and sensory for the laterally forearm. The median nerve comes all the way down the central anterior arm to innervate the forearm flexor muscles and activate pronation of the forearm, flexion of the wrist and fingers and opposition of the thumb. It receives sensory from the forearm skin The ulnar nerve comes down the medial and the lateral palm. side of the arm, goes behind medial condyle of the elbow, down the medial forearm and innervates muscles of the forearm and fingers for wrist and medial finger flexion, adduction and abduction. It receives sensory from the medial side of the hand. The radial nerve is the largest of the nerves off the brachial plexus. It comes down the posterior arm, then wraps around the anterior aide of the lateral epicondyle of the elbow, then splits into a superficial branch and deep branch.
    [Show full text]
  • Anatomy of Spinal Nerves in the First Turkish Illustrated Anatomy Handwritten Textbook
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by DSpace@HKU Childs Nerv Syst DOI 10.1007/s00381-016-3136-9 COVER EDITORIAL Anatomy of spinal nerves in the first Turkish illustrated anatomy handwritten textbook Murat Çetkin1 & Mustafa Orhan1 & İlhan Bahşi1 & Begümhan Turhan2 Received: 26 May 2016 /Accepted: 30 May 2016 # Springer-Verlag Berlin Heidelberg 2016 BTeşrih-ül Ebdan ve Tercümânı Kıbale-i Feylesûfan^ is the the book, İtâḳî acknowledges the contributions of the Grand first handwritten anatomy textbook with illustrations written Vizier [4, 7]. in Turkish in 17th century by Şemseddîn-i İtâḳî. BTeşrih^ has Not many textbooks about anatomy existed in the Islamic different meanings such as anatomy, skeleton, and cutting a World and the Ottoman Empire until İtâḳî’sbook[9]. In other corpse into pieces [1]. BTeşrih-ül Ebdan ve Tercümânı Kıbale- medical textbooks, anatomy occupies only a few pages in i Feylesûfan ^ means dissection of the body and scholars’ different sections [4]. İtâḳî’s book is a pioneer in its area as birth knowledge [2]. Since this is the first handwritten text- it is written in Turkish, and it is supported with illustrations book in Turkish, it has great importance in the development of [4]. In addition to Turkish, the book contains mostly Arabic medicine in Ottoman Empire. This book was written while and rarely Persian terms as well [4, 6, 7]. Some editions of this Grand Vizier Recep Pasha was in power, and it was dedicated book which was written in the 17th century were reprinted in to the Sultan of that period, Murat the IVth [3, 4].
    [Show full text]
  • Lower Extremity Focal Neuropathies
    LOWER EXTREMITY FOCAL NEUROPATHIES Lower Extremity Focal Neuropathies Arturo A. Leis, MD S.H. Subramony, MD Vettaikorumakankav Vedanarayanan, MD, MBBS Mark A. Ross, MD AANEM 59th Annual Meeting Orlando, Florida Copyright © September 2012 American Association of Neuromuscular & Electrodiagnostic Medicine 2621 Superior Drive NW Rochester, MN 55901 Printed by Johnson Printing Company, Inc. 1 Please be aware that some of the medical devices or pharmaceuticals discussed in this handout may not be cleared by the FDA or cleared by the FDA for the specific use described by the authors and are “off-label” (i.e., a use not described on the product’s label). “Off-label” devices or pharmaceuticals may be used if, in the judgment of the treating physician, such use is medically indicated to treat a patient’s condition. Information regarding the FDA clearance status of a particular device or pharmaceutical may be obtained by reading the product’s package labeling, by contacting a sales representative or legal counsel of the manufacturer of the device or pharmaceutical, or by contacting the FDA at 1-800-638-2041. 2 LOWER EXTREMITY FOCAL NEUROPATHIES Lower Extremity Focal Neuropathies Table of Contents Course Committees & Course Objectives 4 Faculty 5 Basic and Special Nerve Conduction Studies of the Lower Limbs 7 Arturo A. Leis, MD Common Peroneal Neuropathy and Foot Drop 19 S.H. Subramony, MD Mononeuropathies Affecting Tibial Nerve and its Branches 23 Vettaikorumakankav Vedanarayanan, MD, MBBS Femoral, Obturator, and Lateral Femoral Cutaneous Neuropathies 27 Mark A. Ross, MD CME Questions 33 No one involved in the planning of this CME activity had any relevant financial relationships to disclose.
    [Show full text]
  • The Neuroanatomy of Female Pelvic Pain
    Chapter 2 The Neuroanatomy of Female Pelvic Pain Frank H. Willard and Mark D. Schuenke Introduction The female pelvis is innervated through primary afferent fi bers that course in nerves related to both the somatic and autonomic nervous systems. The somatic pelvis includes the bony pelvis, its ligaments, and its surrounding skeletal muscle of the urogenital and anal triangles, whereas the visceral pelvis includes the endopelvic fascial lining of the levator ani and the organ systems that it surrounds such as the rectum, reproductive organs, and urinary bladder. Uncovering the origin of pelvic pain patterns created by the convergence of these two separate primary afferent fi ber systems – somatic and visceral – on common neuronal circuitry in the sacral and thoracolumbar spinal cord can be a very dif fi cult process. Diagnosing these blended somatovisceral pelvic pain patterns in the female is further complicated by the strong descending signals from the cerebrum and brainstem to the dorsal horn neurons that can signi fi cantly modulate the perception of pain. These descending systems are themselves signi fi cantly in fl uenced by both the physiological (such as hormonal) and psychological (such as emotional) states of the individual further distorting the intensity, quality, and localization of pain from the pelvis. The interpretation of pelvic pain patterns requires a sound knowledge of the innervation of somatic and visceral pelvic structures coupled with an understand- ing of the interactions occurring in the dorsal horn of the lower spinal cord as well as in the brainstem and forebrain. This review will examine the somatic and vis- ceral innervation of the major structures and organ systems in and around the female pelvis.
    [Show full text]
  • New Insights in Lumbosacral Plexopathy
    New Insights in Lumbosacral Plexopathy Kerry H. Levin, MD Gérard Said, MD, FRCP P. James B. Dyck, MD Suraj A. Muley, MD Kurt A. Jaeckle, MD 2006 COURSE C AANEM 53rd Annual Meeting Washington, DC Copyright © October 2006 American Association of Neuromuscular & Electrodiagnostic Medicine 2621 Superior Drive NW Rochester, MN 55901 PRINTED BY JOHNSON PRINTING COMPANY, INC. C-ii New Insights in Lumbosacral Plexopathy Faculty Kerry H. Levin, MD P. James. B. Dyck, MD Vice-Chairman Associate Professor Department of Neurology Department of Neurology Head Mayo Clinic Section of Neuromuscular Disease/Electromyography Rochester, Minnesota Cleveland Clinic Dr. Dyck received his medical degree from the University of Minnesota Cleveland, Ohio School of Medicine, performed an internship at Virginia Mason Hospital Dr. Levin received his bachelor of arts degree and his medical degree from in Seattle, Washington, and a residency at Barnes Hospital and Washington Johns Hopkins University in Baltimore, Maryland. He then performed University in Saint Louis, Missouri. He then performed fellowships at a residency in internal medicine at the University of Chicago Hospitals, the Mayo Clinic in peripheral nerve and electromyography. He is cur- where he later became the chief resident in neurology. He is currently Vice- rently Associate Professor of Neurology at the Mayo Clinic. Dr. Dyck is chairman of the Department of Neurology and Head of the Section of a member of several professional societies, including the AANEM, the Neuromuscular Disease/Electromyography at Cleveland Clinic. Dr. Levin American Academy of Neurology, the Peripheral Nerve Society, and the is also a professor of medicine at the Cleveland Clinic College of Medicine American Neurological Association.
    [Show full text]
  • VARIABILITIES in ANATOMICAL ARRANGEMENT of SACRAL PLEXUS ROOTS Viktor Matejčík1, Zora Haviarová2*
    Anatomical variations of sacral plexus Rev Arg de Anat Clin; 2010, 2 (3): 95-99 __________________________________________________________________________________________ Original Communication VARIABILITIES IN ANATOMICAL ARRANGEMENT OF SACRAL PLEXUS ROOTS Viktor Matejčík1, Zora Haviarová2* 1Department of Neurosurgery, Medical Faculty and University Hospital, Comenius University, Limbová 5, 833 05 Bratislava, Slovak Republic, Europe 2Institute of Anatomy, Medical Faculty, Comenius University, Sasinkova 2, 813 72 Bratislava, Slovak Republic, Europe RESUMEN Introducción. Las ramas del plexo sacro juegan un rol aimed on determination of the sacral plexus formation importante en la inervación motora y sensitiva del from its exit of particular roots from sacral foramina up miembro inferior. En operaciones de la médula espinal to their formation into terminal branches. Material and observamos diversas variedades y nos motivó para method. One hundred sacral plexuses have been iniciar este estudio dirigido a determinar la formación examined on 50 adult cadavers for a purpose to find del plexo sacro desde la emergencia de cada raíz en out an incidence of its neural variations. We have los agujeros sacros hasta la formación de sus ramas considered also the course of their branches, the terminales. Material y método. Se examinaron 100 anatomoses and their thickness. We highlighted the plexos sacros en 50 cadáveres adultos con el motor innervation particularities in the relation to the propósito de determinar incidencia de las variaciones diagnosis besides its anatomical complexity and nerviosas. También consideramos el recorrido de sus variability. Results. Commonly were observed 3 sacral ramas, sus anastomosis y grosor. Destacamos las roots with the share of S4 and lumbosacral trunk of L4 particularidades de la inervación motora en el and L5 and 4 sacral nerves.
    [Show full text]
  • Current Overview of Neurovascular Structures in Hip Arthroplasty
    1mon.qxd 2/2/04 10:26 AM Page 73 REVIEW Current Overview of Neurovascular Structures in Hip Arthroplasty: Anatomy, Preoperative Evaluation, Approaches, and Operative Techniques to Avoid Complications John-Paul H. Rue, MD* Nozomu Inoue, MD, PhD* Michael A. Mont, MD† A major neurovascular injury during total hip arthroplasty (THA) is uncom- Educational Objectives mon. Nevertheless, these are worri- some due to their devastating conse- As a result of reading this article, physicians should be able to: quences. As more THAs are performed 1. Identify the bony, vascular, and neural anatomy that is relevant to the each year, the chances of this potential- surgeon performing total hip arthroplasty. ly life- or limb-threatening injury 2. Describe the common approaches to avoid neurovascular complica- increase.1 It is crucial for the orthope- tions. dic surgeon to have a thorough under- 3. Discuss the appropriate clinical work-up of these patients. standing of the anatomy of the region 4. Describe the various neurovascular complications and how to handle and the potential complications. them. This article reviews the exposures to the acetabulum for simple and complex primary THA, as well as revision cases, with particular attention to the neu- ischium, and pubis (Figure 1). The Damage to any of these vessels by rovascular anatomy of the region. acetabulum is located at the junction of retraction, drilling, reaming, or dissec- these three bones. These bones unite tion can cause massive hemorrhage, ANATOMY anteriorly at the pubic symphysis and which can lead to exsanguination with- Bone posteriorly to the sacrum to form a ring in minutes.
    [Show full text]