1/10. Long-term results of multiple muscle transfer to reconstruct shoulder function in patients with birth palsy: eleven-year follow-up.We evaluated the long-term clinical results of multiple muscle transfer for reconstruction of shoulder function in 10 patients with birth palsy. Multiple muscle transfer consists mainly of Harmon's deltoid shift, Ober's biceps muscle transfer, and Hoffer's latissimus dorsi muscle transfer. The follow-up ranged from 5 to 14 years with an average of 10.5 years. Two of the 10 patients showed no improvement, one due to severely atrophied latissimus dorsi muscle, and the other who had not received Hoffer's latissimus dorsi muscle transfer. Except for these two patients, an averaged flexion and external angles were 114 degrees and 25 degrees, respectively. Harmon's deltoid shift and Hoffer's latissimus dorsi muscle transfer for reconstruction of shoulder function in patients with birth palsy have proven to be a useful method in reconstructing and maintaining the function of active elevation and external rotation of the shoulder.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
2/10. Upper cervical spinal cord injury in neonates: the use of magnetic resonance imaging.Neonatal upper cervical spinal cord injury is associated with rotational forceps delivery and presents with quadriparesis and diaphragmatic paralysis. The underlying pathology determines neurologic outcome but is difficult to assess clinically or with simple radiographic techniques. We report 4 cases in which early magnetic resonance imaging demonstrated the extent and severity of the injury and guided management.- - - - - - - - - - ranking = 6.1720188980018keywords = paresis (Clic here for more details about this article) |
3/10. brachial plexus paresis associated with fetal neck compression from forceps.Instrumental vaginal deliveries have been associated with higher risks of brachial plexus injuries. The proposed mechanisms involve the indirect association of instrumental deliveries with shoulder dystocia and nerve stretch injuries secondary to rotations of 90 degrees or more. We present a brachial plexus paresis resulting from direct compression of the forceps blade in the fetal neck. A term infant was delivered by a low Kielland forceps rotation. No shoulder dystocia was noted. The immediate neonatal exam revealed an Erb's palsy and an ipsilateral bruise in the lateral aspect of the neck. The paresis resolved during the first day of life. Direct cervical compression of the fetal neck by forceps in procedures involving rotations of the presentation may result in brachial plexus injuries.- - - - - - - - - - ranking = 37.032113388011keywords = paresis (Clic here for more details about this article) |
4/10. brachial plexus injury and hypoglossal paralysis.Two neonates born after traumatic deliveries presented with injuries of the upper brachial plexus and ipsilateral hypoglossal nerve. In addition, 1 patient presented with paresis of the diaphragm after breech delivery; the other patient presented with signs of recurrent laryngeal nerve involvement after vertex delivery. Both infants recovered spontaneously.- - - - - - - - - - ranking = 6.1720188980018keywords = paresis (Clic here for more details about this article) |
5/10. Migration of an extradural catheter into the subdural space. A case report.After repeated, successful extradural injections in a parturient, the extradural catheter migrated into the subdural space. The injection of 3% chloroprocaine 10 ml resulted in an extensive block, which extended to the cranial nerves and paralysed the respiratory muscles. The position of the catheter tip was confirmed by fluoroscopy. Subdural injection should always be suspected when tests for subarachnoid injection are negative, but an extensive block occurs gradually within 15-20 min. respiration and circulation should be supported until the block regresses.- - - - - - - - - - ranking = 0.090909090909091keywords = muscle (Clic here for more details about this article) |
6/10. Early microsurgical reconstruction in birth palsy.Most patients with birth palsy can be expected to recover spontaneously. But in some patients the recovery is unsatisfactory and the functional results are disappointing. One possible way to improve the prognosis for such patients is early surgical nerve reconstruction. In six infants, exploration of the brachial plexus was carried out at about six months after delivery, when there were no signs of recovery in shoulder and elbow joint movements. Preoperative metrizamide myelography, computerized tomography with intrathecal metrizamide (CT myelography), and axon reflex test (histamine test) were followed by intraoperative electrophysiologic examinations of root sensory evoked potential (SEP), nerve action potential (NAP), and evoked muscle response (M-response). Microsurgical nerve repair was performed on the basis of intraoperative diagnosis. metrizamide myelography showed 13% false-positive root avulsion. Reliability of the histamine test was 80%. The intraoperative electro-diagnosis is essential for understanding the actual condition of the brachial plexus lesion and obtaining better results from microsurgical reconstruction in birth palsy. The surgical results, with an average follow-up evaluation of two years and four months, have been encouraging enough to continue this diagnostic and therapeutic program, though its superiority to natural recovery has not yet been clarified.- - - - - - - - - - ranking = 0.090909090909091keywords = muscle (Clic here for more details about this article) |
7/10. The unusual features of traumatic neurogenic muscular atrophy in the infant: an anatomic study.A biopsy from the deltoid muscle of an 8-week old girl who had sustained a bilateral traumatic Erb's brachial plexus paresis at birth revealed the neurogenic atrophy to be different from that of adult muscle in that small, round fibers, similar to those observed in Werdnig-Hoffmann disease, were found. Detailed histochemistry of the fibers is submitted. On electron microscopy, there was focal degeneration of sarcomeres; a loss of myofibrils and myofilaments accompanied by increased autophagocytosis and increased amounts of glycogen; occasionally, preferential drop out of thick myofilaments and a peculiar displacement and deformation of the T-system, triads. In spite of the fact that the injury was sustained at one well defined point of time, the degree to which the muscle fibers were affected was quite variable from area to area. It is proposed that denervation in infantile muscle results in typical small rounded fibers and that this process, so different from that of adult neurogenic atrophy, is age-dependent.- - - - - - - - - - ranking = 6.5356552616382keywords = paresis, muscle (Clic here for more details about this article) |
8/10. Isolated radial nerve lesion in the newborn.Two newborn infants had isolated radial nerve lesion documented on electromygraphy. Fibrillation potentials present in one child at age 6 days suggest the possibility of an in utero onset. skin necrosis present above the triceps muscle and radial nerve favors an entrapment mechanism, possibly from the umbilical cord. Because both patients had complete resolution in 4 months, it is important to differentiate this lesion form the more common but more serious medial brachial plexus lesion.- - - - - - - - - - ranking = 0.090909090909091keywords = muscle (Clic here for more details about this article) |
9/10. The aetiological relationship between congenital torticollis and obstetrical paralysis.A statistical study was done to determine the incidence of congenital torticollis. The aetiological relationship between torticollis and obstetrical paralysis was analysed in an attempt to clarify the possible cause of torticollis. There were forty-three cases of torticollis in the 2,160 babies delivered at the Otsu red cross Hospital from 1978 to 1981. The overall incidence of torticollis was 1.9%; 1.2% in cephalic presentations, 6.5% in double breech presentations, 4.2% in footling presentations and 34.0% in single (frank) breech presentations. In addition, forty-three cases of obstetrical paralysis treated in Kyoto University Hospital from 1961 to 1981 were reviewed. torticollis was found in 26% of the cephalic presentations (6 out of 23) and in 80% of the breech presentations (16 out of 20) respectively. These findings suggest that a foetal posture with both the knees and the cervical spine extended seems to be closely related to the development of torticollis, which indicates that a direct cause may be stretching of the sternocleidomastoid muscle during delivery.- - - - - - - - - - ranking = 0.090909090909091keywords = muscle (Clic here for more details about this article) |
10/10. Infantile Erb's palsy (Smellie's palsy).Our experience with 32 infants seen with Erb's palsy, of whom 11 were followed as long as 18 years, suggests two management axioms. First, it is probably harmful to the infant to use airplane splints. Seocnd, passive stretching of the tight scapulohumeral adductors and passive normal range of motion exercises to shoulder and elbow will usually give a successful outcome in this obstetrical complication. Finally, even though the shoulder muscles regain their strenght, the "Erb engram" may remain as a mark of Erb's palsy.- - - - - - - - - - ranking = 0.090909090909091keywords = muscle (Clic here for more details about this article) |
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