Brachial Plexus Research Paper

Brachial plexus injuries:

The brachial plexus is a somatic network of nerve fibers that provides motor and sensory innevation to the upper limb as well as the shoulder girdle. Brachial plexus injuries are an uncommon complication in gynecologic laparoscopy surgeries, but it is one of the most serious and unfortunate complications due to improper positioning of anesthetized patient (13, 25). Extensive arm abduction, external rotation and posterior shoulder displacement can result in brachial plexus stretch and ischemia (11). Romanowski et al. retrospectively reviewed 3200 records of advanced laparoscopic surgeries the figure out the frequency of brachial plexus injuries. The researchers found that the incidence of brachial plexus injuries associated

The anatomical factors that increase the risks of brachial plexus injuries include a long superficial course of brachial plexus, firm attachment to the prevertebral and axillary fascia and its close relation to movable bony structures as clavicle, first rib, humeral head and coracoid process. The existence of associated anatomical factors as cervical rib or deformities due to the previous fracture in the neck or shoulder can increase the risk of positional nerve injuries.(52) The ulnar nerve can be susceptible to injury due to its superficial position of the medial humeral epicondyle.(11) Due to the sensitive position of the brachial plexus, the malposition injuries can affect it rather than the other peripheral nerve

Minor Brachial plexus injury can lead to transient sensory impairment on the medial side of the upper limb. The more severe affection of the upper roots can (C5, C6) classically leads to Erb’s palsy syndrome (Waiter’s tip hand). The injury of the lower roots (C8 and T1) classically causes Klumpke’s paralysis syndrome (Claw hand) (8, 17). Horner’s syndrome (ipsilateral ptosis, miosis and anhydrosis) may accompany brachial plexus injuries particularly with the injury of (T1) nerve root due to involvement of the nearby cervical chain (17). The radial nerve neuropathy can be manifested by paresthesia in the lateral 3.5 fingers and loss of the function of extensor muscles in the wrist and the figers (wrist drop). While the ulnar nerve neuropathy, can cause sensory loss or paresthesia in the medial 1.5 fingers and may result in claw hand.

Femoral nerve injury

The frequency of femoral nerve injury recorded in gynecologic surgeries has decreased in the recent years because of the orientation of the fact that the lateral plates of the self-retaining retractors can lead to femoral nerve compression. However, extended lithotomy position in the laparoscopic surgery still can cause femoral nerve stretching and result in its injury. A retrospective review estimated the femoral nerve motor injuries related to lithotomy position to be about 1 in 50000 surgeries (15).

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