Search

Peripheral nerve injuries in athletes affect the upper limb more commonly than the lower limb. Common mechanisms include compression, traction, laceration, and ischemia. Specific sports can have unique mechanisms of injury and are more likely to be associated with certain neuropathies. Familiarity with these sport‐specific variables and recognition of the common presentations of upper limb neuropathic syndromes are important in assessing an athlete with a suspected peripheral nerve injury. Evaluation may require imaging modalities and/or electrodiagnostic testing to confirm a nerve injury. In some cases, diagnostic injections may be needed to differentiate neuropathic versus musculoskeletal etiology. Early and accurate diagnosis is essential for treatment/management and increases the likelihood of a safe return‐to‐sport and avoidance of long‐term functional consequences. Most nerve injuries can be treated conservatively, however, severe or persistent cases may require surgical intervention. This monograph reviews key diagnostic, management, and preventative strategies for sports‐related peripheral nerve injuries involving the upper limb. [ABSTRACT FROM AUTHOR]

Treatment in oncology may lead to several adverse side effects, including those affecting the nervous system. These side effects may reduce the quality of life of patients, both during and after treatment, and may necessitate changes in the treatment regimen or reduction of drug doses, thus reducing the effectiveness of therapy. The knowledge of therapy-induced side effects is essential for their early recognition and differentiation from symptoms resulting from the progression of neoplastic disease, metabolic disorders, or infections, requiring prompt initiation of causal treatment. This article presents the current state of knowledge regarding central and peripheral neurotoxicity of treatment in oncology. Adverse effects described after chemo- and radiotherapy are better known but still limit the potential possibilities of the applied treatment. Neurotoxicities of targeted therapy and immunotherapy, which are of increasing importance in the era of personalization of treatment, are presented. [ABSTRACT FROM AUTHOR]

Relevance The brachial plexus is a complex anatomical structure the passes through three narrow anatomical spaces including the interscalene space, the space between the first rib and the clavicle (thoracic aperture), the space between the anterior chest wall and the pectoralis minor muscle. Compression of the brachial plexus and the vascular band can occur at the sites. Endoscopic approach to the brachial plexus is a promising surgical trend to allow neurolysis and decompression of the plexus with minimal trauma and blood loss and a good cosmetic result. The purpose was to explore topographic anatomy of the brachial plexus and surrounding structures and determine the possibility of endoscopic approach to the brachial plexus. Material and methods The shoulder and neck were dissected in 5 fresh cadavers. The study was performed at Trauma and Orthopaedics department of the Russian Peoples Friendship University and Department of pathological anatomy at the Buyanov’s Moscow State City Hospital between 2021 and 2022. Results The pectoralis minor muscle was detached from the coracoid process to endoscopically approach to the subclavian part of plexus. The lateral aspect of the subclavian muscle was detached from the clavicle to endoscopically approach to the thoracic aperture. Portals were produced at the supraclavicular fossa to endoscopically approach to the supraclavicular part of the plexus in the interscalene space considering the topographic anatomy of the jugularis external vein and accessory veins. The mean distance from the coracoid tip to the penetration point of the musculo-cutaneous nerve to the conjoint tendon was 3 cm. The mean distance between the anterior chest wall and the clavicle (width of thoracic aperture) was 1.86 cm. The mean distance between the sternal end of the clavicle to the point of passage of the subclavian artery under the clavicle was 5.7 cm. The mean width of the interscalene space was 1.4 cm. Discussion Aspects of topographic anatomy of the brachial plexus were examined in cadaveric studies of Sidorovich R.R. (2011), Chembrovich V.V. (2019), Anokhina Z.A. (2021), but endoscopic approach to the brachial plexus and possibility with endoscopic surgery were not discussed in the studies. Foreign cadaveric studies of Akaslan I. (2021), Koyyalamudi V. (2021), Costabeber I. (2010), Akboru (2010) were performed to examine topographic anatomy of the brachial plexus. The only study reporting the possibility of endoscopic approach to the brachial plexus and endoscopic anatomy was performed by Lafosse T. (2015). Our cadaveric series reported the possibility of endoscopic approach to the brachial plexus at the three levels for the first time in Russian literature. Conclusion Topographic anatomy of the supraclavicular and infraclavicular portions of the brachial plexus was examined in our series. The study showed the possibility of endoscopic approach to the brachial plexus at the interscalene space, thoracic aperture and subclavian area.

Background: Brachial and lumbosacral plexopathies can result from numerous non-traumatic etiologies, including those of inflammatory, autoimmune, or neoplastic origin, that often require nerve biopsy for diagnosis. The purpose of this study was to evaluate the diagnostic efficacy of medial antebrachial cutaneous nerve (MABC) and posterior femoral cutaneous nerve (PFCN) nerve biopsies in proximal brachial and lumbosacral plexus pathology. Method: Patients undergoing MABC or PFCN nerve biopsies at a single institution were reviewed. Patient demographics, clinical diagnosis, symptom duration, intraoperative findings, post-operative complications, and pathology results were recorded. Biopsy results were classified as diagnostic, inconclusive, or negative based on the final pathology. Results: Thirty patients undergoing MABC biopsies in the proximal arm or axilla and five patients with PFCN biopsies in the thigh or buttock were included. MABC biopsies were diagnostic in 70% of cases overall and 85% diagnostic in cases where pre-operative MRI also demonstrated abnormalities in the MABC. PFCN biopsies were diagnostic in 60% of cases overall and in 100% of patients with abnormal pre-operative MRIs. There were no biopsy-related post-operative complications in either group. Conclusions: In diagnosing non-traumatic etiologies of brachial and lumbosacral plexopathies, proximal biopsies of the MABC and PFCN provide high diagnostic value with low donor morbidity. [ABSTRACT FROM AUTHOR]

Introduction/Aims: Intraneural ganglion cysts (INGCs) are non‐neoplastic mucinous cysts within the epineurium of peripheral nerves. Characteristics of INGCs around the hip joint have not been adequately described. We aimed to describe clinical features, imaging findings, and treatment outcomes in patients with INGCs originating from the hip joint. Methods: We retrospectively included cystic lesions around the hip joint satisfying the following inclusion criteria over 6 years: (1) multilocular elongated hyperintense cystic mass on T2‐weighted imaging; and (2) distribution along the course of the peripheral nerve and its branches on magnetic resonance imaging (MRI). Results: Six patients with an INGC around the hip joint were identified. Parent peripheral nerves were the sciatic nerve (four patients), the superior gluteal nerve (one patient), and the nerve to quadratus femoris (one patient). Buttock, groin, or lower extremity pain/paresthesias were the initial symptoms in all patients. INGCs within the articular branches of the hip joint were identified on MRI. Four patients underwent arthroscopic debridement and capsulotomy. All patients showed generally favorable outcome regardless of treatment. Discussion: Physicians should consider the possibility of INGCs originating from the hip joint as a cause of nontraumatic hip, buttock, or lower extremity pain. This can occur in any nerve innervating the hip joint, and usually it originates in the posterior capsule of the hip joint. Arthroscopic surgery shows promising results; however, more information about the surgical technique and long‐term follow‐up results are needed. See Editorial on pages 236‐239 in this issue [ABSTRACT FROM AUTHOR]

Abstract Background Management of brachial plexopathy requires proper localization of the site and nature of nerve injury. Nerve conduction studies and electrophysiological studies (ED) are crucial when diagnosing brachial neuropathy but these do not determine the actual site of the lesion. Conventional MRI has been used to evaluate the brachial plexus. Still, it carried the disadvantage of the inability to provide multi-planar images that depict the entire length of the neural plexus .It might be difficult to differentiate the brachial plexus nerves from adjacent vascular structures. Magnetic resonance neurography (MRN) is an innovative imaging technique for direct imaging of the spinal nerves. Our study aims to detect the additive role of MRN in the diagnosis of brachial plexopathy over ED. Forty cases of clinically suspected and proved by clinical examination and ED—traumatic (N = 30) and non-traumatic (N = 10)—were included in our study. We compared MRN finding with results of clinical examination and ED. Results MRN findings showed that the root was involved in 80% of cases, trunks in 70% of cases affecting the middle trunk in 40% of cases, the middle and posterior cord in 25%, lateral cord in 50%, and terminal branches on 10% of cases. Ten percent of cases were normal according to MRN, and 90% had abnormal findings in the form of preganglionic nerve root avulsion in 30% of cases, mild perineural edema surrounding C6/7 nerve roots in 20%, lower brachial trunk high signal in 10%, complicated with pseudo meningocele in 20%, and with increased shoulder muscle T2 signal intensity with muscle atrophy in 10%. There were minimal differences between clinical examination finding and MRN findings, with very good agreement between electromyography and nerve conduction (p value < 0.05, with sensitivity and specificity values of 94.44% and 100%, respectively). Conclusion MRN is important in differentiating different types of nerve injuries, nerve root avulsion, and nerve edema, playing an important role in differentiating the site of nerve injury, both preganglionic or postganglionic and planning for treatment of the cause of nerve injury, either medical or surgical.

Abstract Background Varicella zoster virus is a Deoxyribonucleic acid (DNA) virus exclusively affecting humans. Reactivation of varicella zoster virus causes herpes zoster with vesicular eruptions in a restricted dermatomal distribution. Peripheral motor neuropathy is a very rare complication of varicella zoster virus. Case presentation A 57-year-old previously well Sri Lankan female presented with acute onset painful weakness of the left upper limb with a preceding history of a febrile illness. Subsequently she developed vesicular eruptions in the dermatomal distribution of cervical 5, 6, and 7. Electromyography was suggestive of acute denervation of cervical 5, 6, and 7 myotomes. Diagnosis of zoster-associated brachial plexopathy was made, and the patient was treated with acyclovir, steroids, and analgesics. She made a good recovery. Conclusion Brachial plexus neuritis due to varicella zoster infection should be considered in an acute monoparesis of a limb as it is a treatable and reversible condition

Resumen: Introducción: Analizamos la prevalencia, etiología y diagnóstico de los pacientes con plexopatía cervicobraquial o lumbosacra de nuestro centro, atendidos durante una década. Material y métodos: Análisis descriptivo, retrospectivo y observacional de adultos con diagnóstico de plexopatía, atendidos en la consulta monográfica de electromiografía, desde febrero de 2008 hasta diciembre de 2018 (ambos inclusive). Resultados: Setenta y siete pacientes (95,1%), edad media: 55,94 años ± 16,9 DE, 49 hombres (60,5%). Prevalencia: 2,37 por 100.000 habitantes/año. La plexopatía más frecuente es la cervical (84%). Las etiologías más frecuentes: traumática en el 35% (27 pacientes), Parsonage-Turner 20,9% (17 pacientes), tumoral en el 14,8% (12 pacientes) e idiopática en el 13,5% (11 pacientes). De los 12 pacientes con plexopatía de causa oncológica solo en 4 (33,3%) de los casos se confirmó la presencia de infiltración tumoral por prueba de neuroimagen. De los 77 pacientes con prueba de neuroimagen hecha (TAC o RM) el 85,2% (69 pacientes) no muestra enfermedad de plexo en la RMN o la TAC, p = 0,004, mostrando una imagen normal. Los servicios que más atienden a estos pacientes son: traumatología (36,36%), neurología (11,68%), rehabilitación (10,38%) y oncología (4%). Conclusiones: La prevalencia de las lesiones de plexo en nuestra área es de 2,37 por 100.000 habitantes/año. La etiología más frecuente en nuestra serie es la traumática en ambos sexos, asociándose a pacientes más jóvenes (menores de 55 años), aunque más de un tercio de la serie tiene etiología desconocida. La localización más frecuente es la cervicobraquial, donde además las pruebas de neuroimagen tienen más valor localizador. Abstract: Introduction: We analyse the prevalence, aetiology, and diagnosis of cervical-brachial and lumbo-sacral plexopathies at our hospital over a 10-year period. Material and methods: We conducted an observational, descriptive, retrospective analysis of adult patients diagnosed with plexopathy and attended at our centre's specialist electromyography clinic between February 2008 and December 2018, inclusive. Results: We included 77 patients (95.1% of the cases identified), with a mean (standard deviation) age of 55.94 (16.9) years; 49 patients (60.5%) were men. Prevalence amounted to 2.37 cases per 100 000 person-years. Cervical plexopathy was the most frequent type (84% of cases). The most frequent aetiologies were trauma (27 patients; 35%), Parsonage-Turner syndrome (17 patients; 20.9%), neoplasm (12 patients; 14.8%), and idiopathic (11 patients, 13.5%). Of the 12 patients with neoplastic aetiology, neuroimaging only confirmed tumour infiltration in 4 cases (33.3%). Of the 77 patients who underwent neuroimaging studies (CT or MRI), findings were normal in 69 (85.2%; P = .004). The hospital departments most frequently attending these patients were traumatology (36.36%), neurology (11.68%), rehabilitation (10.38%), and oncology (4%). Conclusions: The prevalence of plexopathies in our health district amounts to 2.37 cases per 100,000 person-years. In our series, the most frequent aetiology in both sexes was trauma, which was associated with younger age (under 55 years), although aetiology was unknown in more than one-third of patients. The cervical-brachial plexus was most frequently affected, and lesions to this region are more easily located with neuroimaging studies.

Four stages of medical rehabilitation of patients with differentiated thyroid cancer in Russia are described. Specific rehabilitation programs and methods are described for every stage. The pre-rehabilitation program includes psychological and nutritional support, exercise therapy, consultations by the surgeon and anesthesiologist, correction of concomitant disorders, prevention of thromboembolic complications and local hemodynamic abnormalities. At the rehabilitation stage in the ICU antibacterial therapy, patient positioning, percussion massage of the chest, passive mobilization, massage of the extremities are performed. The rehabilitation program at the specialized surgical department includes psychological rehabilitation, adequate pain management, exercise therapy, massage, nutritional support, prevention of thromboembolic complications, treatment of early postoperative complications. The in-hospital rehabilitation at medical facilities additionally includes treatment of delayed and late surgical complications, correction of radioiodine therapy consequences. The outpatient rehabilitation program also involves correction of hypothyroidism and minimization of adverse effects of suppressive hormone therapy, health resort treatment.

Klippel-Feil syndrome is a congenital malformation, the leading component of which is a violation of segmentation of the cervical vertebral bodies. The syndrome can be combined with other skeletal anomalies: skull asymmetry, scoliosis, high shoulder blades, and cervical ribs. Treatment of the syndrome is usually symptomatic; indications for surgical treatment are progressive neurological disorders and persistent pain syndrome, which usually develop due to instability of unblocked segments, or neurogenic pain. A clinical case of treatment of a 17-year-old patient with Klippel-Feil syndrome who developed a picture of severe upper limb monoparesis during three years due to compression of the brachial plexus associated with cervical ribs is presented. Decompression of the brachial plexus was performed, which led to rapid relief of pain syndrome and gradual partial regression of motor disorders. Due to incomplete restoration of the gripping function, tendon-muscle plasty of the right hand was performed, which significantly improved the possibility of self-care. The results of radiation and staged neurophysiological studies are described, as well as a review of the literature on the Klippel-Feil syndrome.

Though metastasis and malignant infiltration of the peripheral nervous system is relatively rare, physicians should have a familiarity with their presentations to allow for prompt diagnosis and initiation of treatment. This article will review the clinical presentations, diagnostic evaluation, and treatment of neoplastic involvement of the cranial nerves, nerve roots, peripheral nerves, and muscle. Due to the proximity of the neural structure traversing the skull base, metastasis to this region results in distinctive syndromes, most often associated with breast, lung, and prostate cancer. Metastatic involvement of the nerve roots is uncommon, apart from leptomeningeal carcinomatosis and bony metastasis with resultant nerve root damage, and is characterized by significant pain, weakness, and numbness of an extremity. Neoplasms may metastasize or infiltrate the brachial and lumbosacral plexuses resulting in progressive and painful sensory and motor deficits. Differentiating neoplastic involvement from radiation-induced injury is of paramount importance as it dictates treatment and prognosis. Neurolymphomatosis, due to malignant lymphocytic infiltration of the cranial nerves, nerve roots, plexuses, and peripheral nerves, deserves special attention given its myriad presentations, often mimicking acquired demyelinating neuropathies. [ABSTRACT FROM AUTHOR]

Radiation therapy (RT) is one of the main treatments administered to patients with cancer. The development of technology has improved RT accuracy by allowing more precise delivery of high doses to the target volumes with reduced exposure of healthy tissue. Life expectancy has increased due to these therapeutic advancements and the patients' quality of life remains a major concern. The adverse events related to RT are quite various and most likely will impair essential neurological functions, e.g. cognitive status. This literature review aims to describe the physiopathological processes, the neurological symptoms as well as the local modifications observed in magnetic resonance imaging following RT. The specific therapeutic options and preventive actions will also be discussed. [ABSTRACT FROM AUTHOR]

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects many organs of the body including the peripheral nervous system (PNS) which has potential significant impact. Plexopathy is rare but one of the serious PNS manifestations of lupus. Case: A 41-year-old female presented with recurrent attacks of painful brachial plexopathy and right hemi-diaphragmatic paralysis. After extensive workup, she was diagnosed with SLE and started on hydroxychloroquine and mycophenolate mofetil. The frequency and severity of the attacks of plexopathy has significantly improved after starting the immune suppressive therapy for SLE. Whole exome sequencing unveiled previously unreported mutations encoding non-synonymous amino acids in titin and minichromosome maintenance 3-associated protein. Conclusion: Recurrent attacks of painful brachial plexopathy may warrant careful evaluation for underlying SLE with a premise of therapeutic benefit. [ABSTRACT FROM AUTHOR]

Malignancies in the ENT (Ear, Nose, and Throat) area are mostly manifested by dysphagia, dysphonia, dyspnea, throat swelling, and other “traditional” head and neck symptoms. Sporadically, a primary tumor or metastasis can reach such a size and it can be localized in such an area in which it can cause the pathology of the brachial plexus. If this appears first, differential diagnosis may be more difficult.

Background: Varicella zoster virus is a Deoxyribonucleic acid (DNA) virus exclusively affecting humans. Reactivation of varicella zoster virus causes herpes zoster with vesicular eruptions in a restricted dermatomal distribution. Peripheral motor neuropathy is a very rare complication of varicella zoster virus.Case Presentation: A 57-year-old previously well Sri Lankan female presented with acute onset painful weakness of the left upper limb with a preceding history of a febrile illness. Subsequently she developed vesicular eruptions in the dermatomal distribution of cervical 5, 6, and 7. Electromyography was suggestive of acute denervation of cervical 5, 6, and 7 myotomes. Diagnosis of zoster-associated brachial plexopathy was made, and the patient was treated with acyclovir, steroids, and analgesics. She made a good recovery.Conclusion: Brachial plexus neuritis due to varicella zoster infection should be considered in an acute monoparesis of a limb as it is a treatable and reversible condition. [ABSTRACT FROM AUTHOR]

Background: Management of brachial plexopathy requires proper localization of the site and nature of nerve injury. Nerve conduction studies and electrophysiological studies (ED) are crucial when diagnosing brachial neuropathy but these do not determine the actual site of the lesion. Conventional MRI has been used to evaluate the brachial plexus. Still, it carried the disadvantage of the inability to provide multi-planar images that depict the entire length of the neural plexus.It might be difficult to differentiate the brachial plexus nerves from adjacent vascular structures. Magnetic resonance neurography (MRN) is an innovative imaging technique for direct imaging of the spinal nerves. Our study aims to detect the additive role of MRN in the diagnosis of brachial plexopathy over ED. Forty cases of clinically suspected and proved by clinical examination and ED—traumatic (N = 30) and non-traumatic (N = 10)—were included in our study. We compared MRN finding with results of clinical examination and ED. Results: MRN findings showed that the root was involved in 80% of cases, trunks in 70% of cases affecting the middle trunk in 40% of cases, the middle and posterior cord in 25%, lateral cord in 50%, and terminal branches on 10% of cases. Ten percent of cases were normal according to MRN, and 90% had abnormal findings in the form of preganglionic nerve root avulsion in 30% of cases, mild perineural edema surrounding C6/7 nerve roots in 20%, lower brachial trunk high signal in 10%, complicated with pseudo meningocele in 20%, and with increased shoulder muscle T2 signal intensity with muscle atrophy in 10%. There were minimal differences between clinical examination finding and MRN findings, with very good agreement between electromyography and nerve conduction (p value < 0.05, with sensitivity and specificity values of 94.44% and 100%, respectively). Conclusion: MRN is important in differentiating different types of nerve injuries, nerve root avulsion, and nerve edema, playing an important role in differentiating the site of nerve injury, both preganglionic or postganglionic and planning for treatment of the cause of nerve injury, either medical or surgical. [ABSTRACT FROM AUTHOR]

The management of brachial plexus injuries continues to evolve. Surgical treatment in the first several months typically begins with direct exploration of the plexus to confirm the location and type of injury. The literature is replete with historic and emerging techniques for nerve repair and transfer; however, a practical guide to the routine exploration of the plexus is not readily accessible. Anatomic variations and traumatic distortion make knowledge of multiple landmarks and common findings paramount to identify key structures while avoiding iatrogenic injury. This text details a step-by-step guide to anterior exploration of the brachial plexus with technical pearls. [ABSTRACT FROM AUTHOR]

Focal chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is defined as involving the brachial or lumbosacral plexus, or one or more peripheral nerves in one upper or one lower limb (monomelic distribution). However, other auto‐immune neuropathies such as Lewis‐Sumner syndrome (LSS) and multifocal motor neuropathy (MMN) can also have a focal onset. From a retrospective cohort of 30 focal CIDP patients with a monomelic onset dating back at least 2 years, we distinguished patients with plexus involvement (focal demyelinating plexus neuropathy [F‐PN], n = 18) from those with sensory or sensorimotor (F‐SMN, n = 7), or purely motor (F‐MN, n = 5) impairment located in one or several peripheral nerves. Few (39%) F‐PN patients had motor nerve conduction abnormalities, but the majority showed proximal conduction abnormalities in somatosensory evoked potentials (80%), and all had focal hypertrophy and/or increased short tau inversion recovery image signal intensity on plexus MRI. Impairment remained monomelic in most (94%) F‐PN patients, whereas abnormalities developed in other limbs in 57% of F‐SMN, and 40% of F‐MN patients (P =.015). The prognosis of F‐PN patients was significantly better: none had an ONLS score > 2 at the final follow‐up visit, vs 43% of F‐SMN patients and 40% of F‐MN patients (P =.026). Our findings from a large cohort of focal CIDP patients confirm the existence of different entities that are typically categorized under this one term: on the one hand, patients with a focal plexus neuropathy and on the other, patients with monomelic sensori‐motor or motor involvement of peripheral nerves. These two last subgroups appeared to be more likely to evolve to LSS or MMN phenotype, when F‐PN patients have a more distinctive long‐term, focal, benign course. [ABSTRACT FROM AUTHOR]

Focal chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is rare but should be considered in the differential diagnosis of chronic progressive neuropathy affecting a single limb. We report here a 66-year-old male presented with progressive right lower limb weakness and sensory deficits in keeping with a lower right lumbosacral plexopathy. His electrophysiological studies, whilst the distal motor latency and conduction velocities were within normal limits, showed marked asymmetry of right tibial and peroneal nerves with minimum F wave latency significantly prolonged on the right (greater than 120% upper limit of normal and also compared to the opposite side). This raised possibility of proximal demyelination. MRI with contrast revealed a diffused thickening of the right lumbosacral plexus and proximal right sciatic nerve. A lumbosacral plexus biopsy would have been helpful but was not undertaken due to patient's preference. No alternative cause was detectable upon extensive investigation. Patient was initiated on intravenous immunoglobulin for probable focal CIPD and has remained stable over a short period of follow up. In conclusion, even though lower limb involvement has rarely been described in literature, focal CIDP should be considered as a differential diagnosis of patients with focal neuropathies including unilateral lumbosacral plexopathy. [ABSTRACT FROM AUTHOR]

The incidence of the various types of neurologic complications that can occur after primary shoulder arthroplasty, as well as the factors associated with these complications, are unclear. We reviewed 309 cases of primary anatomic total shoulder arthroplasty (TSA) and 504 cases of reverse TSA performed from 2003–2017 with minimum 1-year follow-up. We defined 3 types of neurologic complication: iatrogenic nerve injury, new-onset compressive peripheral neuropathy (CPN), and worsening of preexisting CPN. Multivariate analyses were performed to identify factors associated with each type of neurologic complication. The overall rate of neurologic complication after primary shoulder arthroplasty was 16% (127/813) (95% confidence interval [CI]: 13%–19%). The rates by complication type were 10% (81/813) for iatrogenic nerve injury, 18% (39/216) for worsening of preexisting CPN, and 1.8% (15/813) for new-onset CPN. The incidence of the 3 complication types did not differ between anatomic and reverse TSA. All cases of iatrogenic nerve injury improved without operative treatment after 1 year, whereas 53% of cases of new-onset CPN and 36% of cases of worsening CPN required surgical release. We found no factors independently associated with iatrogenic nerve injury, but iatrogenic nerve injury was independently associated with new-onset CPN. Factors independently associated with worsening CPN were male sex and a history preexisting CPN not treated with previous surgery. Nearly 1 in 5 patients experienced neurologic complications after primary shoulder arthroplasty. Clinicians should be alert for neurologic symptoms because some patients develop CPN or worsening of CPN that may warrant surgical treatment. Level IV; Retrospective Cohort; Treatment Study [ABSTRACT FROM AUTHOR]

One of the complications of radiotherapy is persistent peripheral neuropathy. Most neurological disorders appear late and seem to be related to the fact that irradiation modifies the endothelial cells and some neural stem cells, hindering repair mechanisms. Post-actinal plexopathy is a form of mixed neuropathy, i.e. sensory-motor neuropathy, following radiation treatment, with symptoms appearing at a delay of 6 months to 20 years for brachial plexus plexopathy and 2-16 years later for lumbosacral plexopathy. They are due to direct histochemical and indirect histochemical direct toxic damage from neural and perineural fibrosis secondary to microvascular insufficiency. Pharmacological treatment is the first and indispensable therapy for the treatment of pain, but interventions in rehabilitation are equally important in order to contain the damage and facilitate the recovery of residual function. [ABSTRACT FROM AUTHOR]

The Parsonage-Turner Syndrome, also known as Neuralgic Amyotrophy, is classified as a plexopathy. A multifactorial arrangement of trigger factors are proposed, including traumatic injury and an autoimmune hypothesis. Treatment still lays on the empirical practice and the preventive measure is unclear and not available. The objectives of this article is describing an unusual case report of a patient, female, 12-years-old, who was diagnosed with Parsonage-Turner Syndrome, and more important, to display the fact that not only young adults and elderly individuals are predisposed to develop this injury.

Peripheral neuropathy is a common condition that can be encountered in a multitude of clinical settings. Treatment must be tailored to the underlying cause. This article reviews various causes of peripheral neuropathy and offers recommendations for evaluating patients to determine the cause of peripheral neuropathy. [ABSTRACT FROM AUTHOR]

Background: Peripheral neuropathy is a common complication of Lyme disease. Cranial mononeuropathy, particularly that affecting the facial nerve, can be a presenting symptom, and at times, it can be associated with polyradiculopathies or plexopathies. However, isolated femoral neuropathy has not yet been reported in Lyme disease; therefore, we felt the need to present this case. Case presentation: Laboratory investigations were performed on a 67-year-old man living in a region at high risk for Lyme disease after he developed erythema migrans on his chest, accompanied by the swelling of his left knee joint. A Western blot immunoglobulin assay was performed, including a screening for connective tissue disorders. Positive serological test results led to the administration of oral doxycycline therapy at a dosage of 100 mg twice daily. Shortly afterwards, he developed gait difficulties and frequent falls. The clinical examination and electrodiagnostic studies were consistent with femoral neuropathy. To look for etiologies other than Lyme disease, radiographic studies of his lumbar spine, pelvic cavity, retroperitoneal compartment, and hips were conducted. In addition, he was screened for diabetes. However, no other etiologies were found to explain the femoral neuropathy. Eventually, he recovered, and he was able to return to work. Conclusion: We firmly believe that the femoral neuropathy and Lyme disease seen in this patient were causally related. [ABSTRACT FROM AUTHOR]

Neurologic symptoms secondary to a paraneoplastic syndrome may be the presenting manifestation of a previously undiagnosed cancer, and alertness to these syndromes may provide an opportunity for early detection and treatment of a cancer. Paraneoplastic weakness is a rare manifestation of renal cell carcinoma and may present with variable electrophysiological features. We present a case of a patient with progressive weakness, sensory changes, and urinary retention, with electrophysiological features suggestive of a complex peripheral nervous system syndrome. Ultimately, a renal cell mass was detected and resected, resulting in significant clinical improvement. We review the literature, cataloging the known neurologic syndromes and antibodies associated with renal cell carcinoma. This case highlights that paraneoplastic neurological disorders associated with RCC can take on many features and provides a resource to practitioners for early detection of a neurologic paraneoplastic syndrome arising from renal cell carcinoma.

Varicella zoster reactivation ("shingles" or "herpes zoster") usually presents as a self-limiting, unilateral, dermatomal vesicular rash in older adults. We present the case of a 73 year-old woman with unilateral brachial plexopathy, an unusual but debilitating complication of shingles. Despite treatment with intravenous acyclovir and immunoglobulin she had a marked residual motor paresis that required an upper limb rehabilitation program after discharge. [ABSTRACT FROM AUTHOR]

A case study of 82-year-old woman presented to our Breast Clinic with a 6-month history of gradually worsening right shoulder pain and significant motor weakness of the ipsilateral arm. Topics include pain was severe and intractable and was radiating from the shoulder into the arm and hand; and symptoms continued to worsen, not responding to the treatment with anti-inflammatory and analgesic drugs.

Reliable assessment of brachial plexus disorders can be challenging due to the complexity of the anatomy and variation of potential pathology. Electrodiagnostic testing can be both uncomfortable for the patient and inconclusive. Ultrasound can serve as a complement to clinical assessment, electrodiagnostic testing, and other imaging modalities. This study describes a systematic approach for performing neuromuscular ultrasound for suspected pathology in the brachial plexus. The literature regarding techniques for brachial plexus ultrasound was reviewed. A team composed of specialists in neurology, physiatry, anesthesiology, orthopedic surgery, and vascular surgery used this as the basis for describing standardized techniques for performing brachial plexus ultrasound. Four standard views, along with other supplemental views, are described for the evaluation of the brachial plexus. An illustrative case is presented. Ultrasound is a high-resolution point of care diagnostic tool that allows assessment of structural pathology affecting the brachial plexus. Muscle Nerve 58: 618-624, 2018. [ABSTRACT FROM AUTHOR]