Practical Management of Pediatric and Adult Brachial Plexus Palsies: Expert Consult

400 Pages·2011·70.3 MB·English

by  Kevin C. Chung MD MS

Practical Management
of Pediatric and Adult
Brachial Plexus
Palsies
Kevin C. Chung, MD, MS
Professor of Surgery
Section of Plastic Surgery
Department of Surgery
Assistant Dean for Faculty Affairs
University of Michigan Medical School
Ann Arbor, MI, USA
Lynda J.-S. Yang, MD, PhD
Associate Professor
Department of Neurosurgery
University of Michigan Medical School
Ann Arbor, MI, USA
John E. McGillicuddy, MD
Emeritus Professor of Neurosurgery and Orthopedic Surgery
Department of Neurosurgery
University of Michigan Health System
Ann Arbor, MI, USA
Clinical Professor of Neurosurgery
Division of Neurosurgery
Department of Neurosciences
Medical University of South Carolina
Charleston, SC, USA
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2012
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ISBN-13: 9781437705751
British Library Cataloguing in Publication Data
Practical management of pediatric and adult brachial plexus palsies.
1. Brachial plexus – Wounds and injuries – Treatment.
I. Chung, Kevin. II. Yang, Lynda J-S. III. McGillicuddy, John.
617.4′83044 – dc22
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PREFACE
On behalf of my co-editors Drs. Yang and McGil- openly to reach the best consensus treatment plan
licuddy, it is my distinct pleasure to introduce this for our patients. It is only through this collaborative
comprehensive brachial plexus textbook to you. approach that we can continue to advance the treat-
This textbook is a combination of an extensive ment of complex brachial plexus conditions by
amount of effort by our colleagues from around the incorporating not only expertise from various spe-
world who have produced the most updated and cialties, but also solicit contributions from various
inclusive chapters to help you take care of your regions of the world. As you can see from the author
patients with this devastating condition. The list, all the contributing authors are noted experts
uniqueness of this textbook is the collaborative who shared their knowledge from a life-long inter-
effort among all of the relevant specialties involved est in the care of brachial plexus conditions. Addi-
in the treatment of this condition, which includes tionally, this textbook contains carefully organized
Neurosurgery, Plastic/Hand Surgery, Orthopaedic videos, ranging from a detailed description of the
Surgery, Physical Medicine and Rehabilitation, anatomy of the brachial plexus to a comprehensive
Obstetrics and Gynecology, Occupational Physical physical examination of muscle deficits associated
Therapy and the Legal Profession. Patients with this with this condition. This is a richly illustrated text-
condition are not simply the territory of a particular book that should be the authoritative textbook in
specialty, but rather require the input and support this discipline.
of multiple specialties in order to help the patients I would be remiss without acknowledging certain
integrate into society. We included a chapter that people who have been critical in the success in this
discusses the predisposing factors for the neonatal textbook. I would like to acknowledge Dr. Lynda
brachial plexus condition that is mired in contro- Yang for her foresight in initiating the Comprehen-
versy with regard to the exact cause of this condi- sive Brachial Plexus Program at the University of
tion. Furthermore, brachial plexus conditions often Michigan and for her invaluable assistance in
have legal ramifications; we are privileged to incor- organizing all the chapters by meticulously check-
porate the expertise of our legal experts who give ing every single detail from the inception of this
practical instructions on how the legal system views textbook to its full production. I am certain that her
these conditions and how physicians should dedication to this effort is the main reason that this
approach these conditions in order to give an objec- textbook will be the pride of this specialty. We are
tive assessment. indebted to Dr. McGillicuddy for his implicit
The genesis of this textbook is derived from the support and dedication to the Program’s efforts.
concept of the Comprehensive Interdisciplinary Additionally, I would also like to acknowledge our
Brachial Plexus Program at the University of Michi- staff, Phil Clapham, Pouya Entezami, Lilly Bellfi,
gan with clinics that occur on a regular basis to Holly Wagner and Connie McGovern for their help
evaluate complex pediatric and adult brachial and our Elsevier development editor, Alex Mor-
plexus conditions. This clinic enjoys participation timer, whose patience has overcome many of the
by representatives from all the specialties in a single difficulties and obstacles in this multi-author, inter-
clinic setting. The interchange of ideas to a consen- national collaborative effort.
sus on a treatment course is particularly rewarding My most important acknowledgement is to our
for us as well as for our patients. There are no egos contributing authors who are all our closest col-
on this team, and each shares his/her opinions leagues in putting aside a certain portion of their
vii
Preface
practice and family life to share their expertise for textbook by keeping up with the advancement in
the advancement of this specialty. They have put surgical techniques and nerve research.
their heart and soul into every word in this volume,
and we are certainly appreciative of their generous Kevin C. Chung, MD, MS
contributions. Professor of Surgery
I hope that you will cherish this book in your Section of Plastic Surgery
care of patients with brachial plexus conditions. Assistant Dean for Faculty Affairs
I am certain that we will continue to update this University of Michigan Medical School
viii
LIST OF CONTRIBUTORS
Nasser I. Alhodaib, MBBS, FRCSC Wilson Chimbira, MBChB, FRCA
Consultant Plastic and Reconstructive Microsurgeon Pediatric Anesthesiologist
Department of Surgery Department of Anesthesia
King Abdulaziz Medical City University of Michigan
Riyadh, Saudi Arabia Ann Arbor, MI, USA
13  Outcomes of Treatment for Neonatal Brachial  4  Clinical Presentation and Considerations of Neonatal 
Plexus Palsy Brachial Plexus Palsy
Allan J. Belzberg, MD, FRCSC Kevin C. Chung, MD, MS
Department of Neurosurgery Professor of Surgery
Johns Hopkins School of Medicine Section of Plastic Surgery
Baltimore, MD, USA Department of Surgery
23  Strategies for Treating Pain Assistant Dean for Faculty Affairs
University of Michigan Medical School
Allen T. Bishop, MD
Ann Arbor, MI, USA
Professor of Orthopedic Surgery
1  Anatomy of the Brachial Plexus
Mayo Clinic College of Medicine,
2  Physiology of Nerve Injury and Regeneration
Consultant, Division of Hand Surgery
11  Reconstructive Strategies for Recovery of Hand 
Department of Orthopedic Surgery
Function
Mayo Clinic
20  Surgical Procedures for Recovery of Hand Function
Rochester, MN, USA
19  Reconstructive Procedures for the Upper Extremity Howard M. Clarke, PhD, MD, FRCSC, FACS, FAAP
Professor of Surgery
Richard C. Boothman, JD
Department of Surgery
Chief Risk Officer
University of Toronto
Adjunct Assistant Professor
Active Staff Surgeon
Department of Surgery
Division of Plastic Surgery
University of Michigan Medical School
The Hospital for Sick Children
Ann Arbor, MI, USA
Toronto, Ontario, Canada
6  Guidelines for Attorney-Physician Interactions About 
13  Outcomes of Treatment for Neonatal Brachial 
Brachial Plexus Palsy Patients
Plexus Palsy
Neal Chen, MD
Michael J. Dorsi, MD
Medsport
Chief Resident
Department of Orthopaedic Surgery
Department of Neurosurgery
University of Michigan Health System
Johns Hopkins School of Medicine
Ann Arbor, MI, USA
Baltimore, MD, USA
1  Anatomy of the Brachial Plexus
23  Strategies for Treating Pain
ix