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Medial Triceps to Axillary Nerve Transfer

Uncategorized / admin / febrero 9, 2015

Fuente
Este artículo es originalmente publicado en:
http://nblo.gs/13f1ay
http://youtu.be/HBTdfAPi_Vs

Courtesy : Authors: Susan E. Mackinnon, Andrew Yee Affiliation: Washington University School of Medicine Division of Plastic Reconstructive Surgery, Department of Surgery, Saint Louis, MO Peripheral Nerve Surgery: http://nervesurgery.wustl.edu

Injury to the axillary nerve results in the loss of shoulder function, specifically deltoid and teres minor deficits. This injury can either be isolated or more commonly associated with an upper brachial plexus injury that includes the C5,6 roots. The medial triceps is an available donor for nerve transfer into the axillary nerve and is one part of the double shoulder nerve transfers for shoulder reconstruction following nerve injury. Nerve transfers for the axillary nerve includes reinnervating the deltoid, teres minor, and superior lateral cutaneous nerve territory. In this case, the patient presented six months following a right pan brachial plexus injury with complete C5,6 injury and scapular fracture after a severe ATV accident. While some recovery occurred in the middle/lower plexus, electrodiagnostic studies confirmed no recovery to elbow flexion, deltoid and supra/infraspinatus muscles. The triceps were recovering and thus a medial triceps to axillary nerve transfer was elected with the spinal accessory to suprascapular nerve transfer for shoulder reconstruction. A superior lateral cutaneous end-to-side to radial sensory nerve transfer was also performed for sensation. This video details a reconstruction strategy for the axillary nerve.

Tables of Contents (Extended)
00:35 Incision and Superficial Dissection
04:45 Dissection along the Posterior Border of the Deltoid
07:40 Identifying the Superior Lateral Cutaneous Branch of Axillary Nerve
09:36 Identifying the Terminal Branches of the Axillary Nerve
11:56 Identification of the Axillary Nerve and Teres Minor Branch
15:45 Proximal Division of the Recipient Axillary Nerve
17:20 Dissection between the Long and Lateral Head of the Triceps
20:33 Identifying the Tendinous Leading-edge of Teres Major
21:33 Dissection of the Triangular Space
25:19 Identification of the Medial Triceps Branch and Radial Nerve
27:02 Neurolysis of the Sensory Component of the Radial Nerve
28:46 Distal Dissection and Division of the Medial Triceps Branch
32:53 Neurolysis of Superior Lateral Cutaneous Branch from Axillary Nerve
34:48 Medial Triceps to Axillary Nerve Transfer
35:24 Radial Sensory to Superior Lateral Cutaneous End-to-side Nerve Transfer
36:41 Release of the Tendinous Leading-edge of Teres Major

Narration: Susan E. Mackinnon
Videography: Andrew Yee

Categoría
- Educación
Licencia
- Licencia estándar de YouTube

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El fracaso de la osteotomía de la tuberosidad inferior después de la artroplastia total de hombro / Failure of the lesser tuberosity osteotomy after total shoulder arthroplasty

Uncategorized / admin / febrero 8, 2015

Fuente
Este artículo es originalmente publicado en:
http://www.ncbi.nlm.nih.gov/pubmed/25107599
http://www.jshoulderelbow.org/article/S1058-2746%2814%2900246-8/abstract
De:
Shi LL¹, Jiang JJ², Ek ET³, Higgins LD⁴.
J Shoulder Elbow Surg. 2015 Feb;24(2):203-9. doi: 10.1016/j.jse.2014.05.006. Epub 2014 Aug 5.

Abstract

BACKGROUND:

Lesser tuberosity osteotomy (LTO) as an approach during total shoulder arthroplasty (TSA) is a reliable technique with strong biomechanical fixation and a low failure rate. Complications have been infrequently reported in the literature.
METHODS:

We report a case series of 5 patients who sustained failure of the LTO repair after primary TSA. The data on the patient demographic characteristics, surgical technique, postoperative care, revision surgery, and clinical outcomes are reported.
RESULTS:

The mean age of the 5 patients was 52 years, all patients were men, and the mean body mass index was 28 kg/m(2). They were followed up for a mean of 29 months (range, 24-38 months). The mean time from initial TSA to diagnosis of LTO failure was 9 weeks (range, 5-12 weeks). Two patients reported no trauma, 2 had minor trauma (using a pulley, rolling over in bed), and 1 sustained a fall. At the latest follow-up, the mean visual analog scale; Single Assessment Numeric Evaluation; University of California, Los Angeles; and American Shoulder and Elbow Surgeons scores were 4 (range, 0-6), 48 (range, 20-70), 19 (range, 11-22), and 63 (range, 48-83), respectively. Only 1 patient required no additional procedures beyond the revision LTO repair. Another patient required a second revision LTO repair. The remaining 3 patients either underwent or were recommended to undergo reverse arthroplasty.
CONCLUSION:

Failure of the LTO repair after TSA may possibly be an under-reported complication that is associated with poor clinical outcomes and limited options for revision surgery. In patients with a high risk of LTO failure, considerations should be made to augment the LTO repair during the index TSA procedure.

Resumen

ANTECEDENTES:
LA osteotomía de la tuberosidad inferior (LTO) como un abordaje durante la artroplastia total de hombro (TSA) es una técnica fiable con fuerte fijación biomecánica y una baja tasa de fallos. Las complicaciones se han reportado con poca frecuencia en la literatura.

MÉTODOS:
Presentamos una serie de casos de 5 pacientes que sufrieron fracaso de la reparación LTO después TSA primaria. Se presentan los datos sobre las características demográficas de los pacientes, la técnica quirúrgica, el cuidado postoperatorio de cirugía de revisión, y los resultados clínicos.

RESULTADOS:
La edad media de los 5 pacientes fue de 52 años, todos los pacientes eran hombres, y el índice de masa corporal medio fue de 28 kg / m (2). Ellos fueron seguidos durante una media de 29 meses (rango, 24-38 meses). El tiempo medio desde TSA inicial al diagnóstico de insuficiencia LTO fue de 9 semanas (rango, 5-12 semanas). Dos pacientes no experimentaron trauma, 2 tenían un daño menor (utilizando una polea, rodando en la cama), y 1 sufrió una caída. En el último seguimiento, la escala analógica visual media; Evaluación simple Evaluación numérica; Universidad de California, Los Angeles; y puntuaciones de Hombro y Codo Cirujanos estadounidenses fueron 4 (rango, 0-6), de 48 años (rango, 20-70), 19 (rango, 11-22), y 63 (rango, 48-83), respectivamente. Sólo 1 paciente requirió hay procedimientos adicionales más allá de la reparación LTO revisión. Otro paciente requirió una segunda reparación LTO revisión. Los 3 pacientes restantes se sometieron ya sea o se recomendaron someterse a una artroplastia inversa.

CONCLUSIÓN:
El fracaso de la reparación LTO después TSA posiblemente puede ser una complicación se denuncia que se asocia con pobres resultados clínicos y opciones limitadas para la cirugía de revisión. En los pacientes con un alto riesgo de fracaso LTO, se deben hacer consideraciones para aumentar la reparación LTO durante el procedimiento TSA índice.