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Brachial Plexus Injuries Brachial Plexus Injuries Edited by Alain Gilbert MD Institut de la Main Paris, France Published in association with the Federation of European Societies for Surgery of the Hand MARTIN᭿ DUNITZ © 2001 Martin Dunitz Ltd, a member of the Taylor & Francis group First published in the United Kingdom in 2001 by Martin Dunitz Ltd, The Livery House, 7–9 Pratt Street, London NW1 OAE Tel: +44 (0)20 7482 2202 Fax: +44 (0)20 7267 0159 Email: [email protected] Website: http://www.dunitz.co.uk This edition published in the Taylor & Francis e-Library, 2003. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the publisher or in accordance with the provisions of the Copyright Act 1988 or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1P OLP. A CIP record for this book is available from the British Library. ISBN 0-203-21640-7 Master e-book ISBN ISBN 0-203-27262-5 (Adobe eReader Format) ISBN 1-84184-015-7 (Print Edition) Distributed in the USA by: Fulfilment Center Taylor & Francis 7625 Empire Drive Florence, KY 41042, USA Toll Free Tel: 1 800 634 7064 Email: cserve@routledge_ny.com Distributed in Canada by: Taylor & Francis 74 Rolark Drive Scarborough Ontario M1R G2, Canada Toll Free Tel: 1 877 226 2237 Email: [email protected] Distributed in the rest of the world by: ITPS Limited Cheriton House North Way, Andover Hampshire SP10 5BE, UK Tel: +44 (0)1264 332424 Email: [email protected] Composition by Scribe Design, Gillingham, Kent, UK CONTENTS List of contributors v 8 Complete palsy Chantal Bonnard and I THE BRACHIAL PLEXUS Dimitri J Anastakis 67 1 Anatomy of the brachial plexus 9 Update on the treatment of adult brachial Alexandre Muset i Lara, Carlos Dolz, and plexus injuries Alfonso Rodríguez-Baeza 3 Hanno Millesi 77 2 Physical examination 10 Injuries of the terminal branches of the Türker Özkan and Atakan Aydın 17 brachial plexus Rolfe Birch 91 3 Radiological and related investigations Albert (Bart) CJ Slooff, Corneleus (Cees) 11 The place of arthrodesis WM Versteege, Gerhard Blaauw, and Giorgio A Brunelli 107 Willem JR van Ouwerkerk 31 12 Palliative surgery: tendon transfers to the 4 Clinical neurophysiological investigations shoulder in adults Jan W Vredeveld 39 Aydın Yücetürk 115 13 Palliative surgery: the elbow and forearm II THE ADULT TRAUMATIC BRACHIAL Alfred C Berger, Robert Hierner, and PLEXUS Lutz Kleinschmidt 123 5 Etiology Panupan Songcharoen 47 14 Palliative surgery: the hand Jamal Gousheh 131 6 Surgical techniques: neurolysis, sutures, grafts, neurotizations 15 Palliative surgery: free muscle transfers Michel Merle and Aymeric Lim 51 Kazuteru Doi 137 7 Supraclavicular plexus injuries III OBSTETRICAL PARALYSIS Jean Y Alnot 57 16 Aetiology JM Hans Ubachs and Albert (Bart) CJ Slooff 151 iv CONTENTS 17 Examination and prognosis 25 Medial rotation contracture and posterior Howard M Clarke and dislocation of the shoulder Christine G Curtis 159 Rolfe Birch 249 18 Conservative treatment of obstetrical 26 Palliative surgery: elbow paralysis brachial plexus palsy (OBPP) and rehabili- Vincent R Hentz 261 tation Robert S Muhlig, Gerhard Blaauw, 27 Palliative surgery: pronosupination in Albert (Bart) CJ Slooff, Jan W Kortleve, obstetrical palsy and Alfons J Tonino 173 Eduardo A Zancolli (II) 275 19 Surgical technique 28 Palliative surgery: forearm and hand Jose L Borrero 189 deformities David C-C Chuang 293 20 Indications and strategy Alain Gilbert 205 29 Treatment of co-contraction Robert Hierner and Alfred C Berger 303 21 Results of repair to the obstetrical plexus Alain Gilbert 211 IV SPECIAL LESIONS 22 Results of surgery after breech delivery 30 Traumatic brachial plexus injuries in Gerhard Blaauw, Albert (Bart) CJ Slooff, children and Robert S Muhlig 217 Alain Gilbert and Christian Dumontier 315 23 Palliative surgery: shoulder paralysis 31 War Injuries Piero L Raimondi, Alexandre Muset i Lara, Jamal Gousheh 321 and Elisabetta Saporiti 225 Index 326 24 Palliative surgery: tendon transfers to the shoulder in children Aydın Yücetürk 239 LIST OF CONTRIBUTORS Jean Y Alnot Gerhard Blaauw Service de Chirurgie Orthopédique et Department of Neurosurgery Traumatologique University Hospital Maastricht Département de Chirurgie de la Main et des PO Box 5800 Nerfs Périphériques 6202 AZ Centre Urgences Mains Maastricht Hôpital Bichat-Claude Bernard The Netherlands 46, rue Henri Huchard Paris 75877 Chantal Bonnard Cedex 18 Service Universitaire de Chirurgie Plastique et France Reconstructive Permanence de Longeraie Dimitri J Anastakis Avenue de la Gare 9 Minimally Invasive Surgery Program CH-1003 Lausanne Surgical Services Switzerland Toronto Western Hospital Jose L Borrero 399 Bathurst Street Florida Hand Center Fell Pavillion 4-140 610 Jasmine Road Toronto, ON M5T 2S8 Altamonte Springs, FL 32701 Canada USA Atakan Aydın Giorgio A Brunelli Division of Hand Surgery Via Galvani 26 Plastic and Reconstructive Department 25123 Brescia Istanbul Medical Faculty Italy Istanbul University Istanbul David C-C Chuang Turkey Department of Plastic and Reconstructive Surgery Alfred C Berger Chang Gung Memorial Hospital International Institute for Neuroscience 199 Tung Hwa North Road Alexis-Carrel-Strasse 4 Taipei, Taiwan 105 Hannover 30625 Germany Howard M Clarke Division of Plastic Surgery Rolfe Birch Department of Surgery Royal National Orthopaedic Hospital University of Toronto PNI Unit The Hospital for Sick Children Brockley Hill 555 University Avenue, Suite 1524 Stanmore, Middlesex Toronto, ON M5G 1X8 UK Canada vi LIST OF CONTRIBUTORS Christine G Curtis Robert Hierner Department of Rehabilitation Medicine Clinic for Plastic, Hand and Reconstructive University of Toronto Surgery The Hospital for Sick Children Burn Center 555 University Avenue, Suite 1524 Hannover Medical University Toronto, ON M5G 1X8 School of Medicine Canada Podbielskistrasse 380 30569 Hannover Kazuteru Doi Germany Department of Orthopaedic Surgery Ogori Daaichi General Hospital Lutz Kleinschmidt Ogori Clinic for Plastic, Hand and Reconstructive Yamaguchi-ken 754-0002 Surgery Japan Burn Center Hannover Medical University Carlos Dolz School of Medicine Servicio de Cirugia Ortopedica y Traumatologia Podbielskistrasse 380 Hospital de Viladecans 30569 Hannover Barcelona Germany Spain Jan W Kortleve Christian Dumontier Plastic Surgery Department Institut de la Main Atrium Medical Center Clinique Jouvenet 6401 CX Heerlen 6, Place Jouvenet The Netherlands Paris 75016 France Aymeric Lim Hand and Reconstructive Microsurgery Alain Gilbert National University Hospital Institut de la Main 5 Lower Kent Ridge Road Clinique Jouvenet Main Building, Level 3 6, Place Jouvenet Singapore 119074 Paris 75016 France Michel Merle Institut Européen de la Main Jamal Gousheh 13, rue Blaise Pascal Department of Reconstructive and Microsurgery F-54320 Maxéville-Nancy Shahid Behesti University of Medical Sciences France 38 Keshavarz Boulevard Tehran 14167 Hanno Millesi Iran University of Vienna Medical School Ludwig-Boltzmann Institute of Experimental Vincent R Hentz Plastic Surgery 900 Welch Road Lange Gasse 48 Suite 15 A-1090 Vienna Palo Alto, CA 94304 Austria USA Robert S Muhlig Department of Rehabilitation Atrium Medical Center 6401 CX Heerlen The Netherlands LIST OF CONTRIBUTORS vii Alexandre Muset i Lara Panupan Songcharoen Orthopaedic Surgery Department Hand and Microsurgery Unit Viladecans Hospital Department of Orthopaedic Surgery 08840 Barcelona Faculty of Medicine Siriraj Hospital Türker Özkan Mahidol University Division of Hand Surgery Bangkok 10700 Plastic and Reconstructive Department Thailand Istanbul Medical Faculty Istanbul University Alfons J Tonino Istanbul Orthopaedic Surgery Department Turkey Atrium Medical Center 6401 CX Heerlen Piero L Raimondi The Netherlands Plastic and Hand Surgery Department Legnano Hospital JM Hans Ubachs 20025 Legnano Pijnsweg 33 Milan 6419 CJ Heerlen Italy The Netherlands Alfonso Rodríguez-Baeza Willem JR van Ouwerkerk Unidad de Anatomia y Embriologia Department of Neurosurgery Departamento de Ciencias Morfologicas Free University Facultad de Medicina Amsterdam Universidad Autonoma de Barcelona The Netherlands Barcelona Spain Corneleus (Cees) WM Versteege Department of Radiology Elisabetta Saporiti Atrium Medical Center Plastic and Hand Surgery Department 6401 CX Heerlen Legnano Hospital The Netherlands 20025 Legnano Milan Jan W Vredeveld Italy Department of Clinical Neurophysiology Atrium Medical Center Albert (Bart) CJ Slooff Postbox 4446 Department of Neurosurgery 6401 CX Heerlen University Hospital Maastricht The Netherlands PO Box 5800 6202 AZ Aydın Yücetürk Maastricht, Clinic Plexus Department of Neurosurgery Tahran Cad. 3/3 Free University Kavaklıdere PO Box 7057 06700 Ankara 1007 MB Turkey Amsterdam The Netherlands, Eduardo A Zancolli (II) (contact address:) Avenida Alvear 1535 Rozenlaan 20 1014 Buenos Aires 3620 Lanaken Argentina Belgium The Brachial Plexus 1 Anatomy of the brachial plexus Alexandre Muset i Lara, Carlos Dolz, and Alfonso Rodríguez-Baeza Introduction of the anterior branches of C5 and C6 forms the superior trunk. The union of the anterior The brachial plexus, on account of the progres- branches of C8 and T1 forms the inferior trunk. sive unions and divisions of its constituent The lower branch of C7, situated between these nerves, is a more or less complex nerve forma-
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