Ebook Brachial plexus injuries: Part 2
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Ebook Brachial plexus injuries: Part 2
Obstetrical Paralysis16AetiologyJM Hans Ubachs and Albert (Bart) CJ SlooffHistoryThe aetiology of the obstetric brachial plexus injuries has an intere Ebook Brachial plexus injuries: Part 2esting history. As early as 1764, Smellie suggested the obstetric origin of a paralysis of the arm in children. But only in 1872, in the third edition of his book De I'clcctrisation localised Ct de son application á la pathologic Ct à la thérapeutique, Duchenne de Boulogne described four children wi Ebook Brachial plexus injuries: Part 2th an upper brachial plexus lesion as a result OÍ an effort to deliver the shoulder. The classical description by Erb in 1874 concerned the upper bracEbook Brachial plexus injuries: Part 2
hial plexus paral ysis in adults, with the same characteristics as those described by Duchenne de Boulogne. Using electric stimulation, he found in heObstetrical Paralysis16AetiologyJM Hans Ubachs and Albert (Bart) CJ SlooffHistoryThe aetiology of the obstetric brachial plexus injuries has an intere Ebook Brachial plexus injuries: Part 2contracted as those affected in his patients. It is the spot whore the fifth and sixth cervical roots unite, and whore they are optimally accessible to electric current by virtue of their superficial position. Pressure on this "point of Erb', caused either by fingers by traction on the armpits, by f Ebook Brachial plexus injuries: Part 2orceps applied too deep, or by a haematoma were for Erb, and many obstetricians after him, the only possible cause of the lesion.But not everybody accEbook Brachial plexus injuries: Part 2
epted the compression theory. Poliomyelitis and toxic causes were mentioned. Some even pointed to the possibility of an epiphysiolysis of the humerus,Obstetrical Paralysis16AetiologyJM Hans Ubachs and Albert (Bart) CJ SlooffHistoryThe aetiology of the obstetric brachial plexus injuries has an intere Ebook Brachial plexus injuries: Part 2 of Horner's syndrome, indicating damage of the sympathical nerve, together with an injury of the lower plexus. Augusta Klumpke, the first female intern in Paris, explained in 1885 Horner's sign in the brachial plexus lesion by avulsions of the roots C8-T1 and involvement of the homolateralcervical Ebook Brachial plexus injuries: Part 2sympathic nervous system (Klumpke 1885). Klumpkc later married Dejerine, and there fore the lower plexus palsy is sometimes called the Dejerine-KlumpkEbook Brachial plexus injuries: Part 2
e paralysis, as opposed to the upper plexus palsy, which is named the Erb Duchenne paralysis. Thornburn 11903) was one of the first to assume that theObstetrical Paralysis16AetiologyJM Hans Ubachs and Albert (Bart) CJ SlooffHistoryThe aetiology of the obstetric brachial plexus injuries has an intere Ebook Brachial plexus injuries: Part 2ALYSISresult of rupture or excessive stretching of the brachial plexus during the delivery.PathogenesisTo test Thornburn's assumption. Engelhard investigated the influence of different positions and assisted deliveries on a dead fetus, in which the brachial plexus was dissected. In his doctoral thes Ebook Brachial plexus injuries: Part 2is he demonstrated in 1906, with for that period excellent photographs, that the pressure theory was highly improbable (Fig. 1). Obstetric injury of tEbook Brachial plexus injuries: Part 2
he brachial plexus could only be the result of excessive stretching of that plexus during the delivery. In particular, he warned against strong downwaObstetrical Paralysis16AetiologyJM Hans Ubachs and Albert (Bart) CJ SlooffHistoryThe aetiology of the obstetric brachial plexus injuries has an intere Ebook Brachial plexus injuries: Part 2s. And his words still have their validity. More recently, Metaizeau et al <19791 repeated these studies and explained the differences in injury. The results of these investigations have been confirmed by our clinical and surgical observations (Ubachs et al 1995, Slooff 1997). Shoulder dystocia occu Ebook Brachial plexus injuries: Part 2rs mostly unexpected, and it is one of the more serious obstetric emergencies. The shoulder is impacted behind the symphysis pubis, and although thereEbook Brachial plexus injuries: Part 2
is a long list of manoeuvres to disimpact the shoulder, not one is perfect. Excessive dorsal traction, the first reaction in that situation, bears thObstetrical Paralysis16AetiologyJM Hans Ubachs and Albert (Bart) CJ SlooffHistoryThe aetiology of the obstetric brachial plexus injuries has an intere Ebook Brachial plexus injuries: Part 2 by difficulties in delivering the extended and entrapped arm and therefore a combination of forceful traction with too much lateral movement of the body.Reconstructive neurosurgery of the obstetric brachial plexus lesion, together with neurophysiological and radiological investigation, gives the op Ebook Brachial plexus injuries: Part 2portunity to gain a clear understanding of the relationship between the anatomical findings during operation and the obstetric trauma. The injury mayEbook Brachial plexus injuries: Part 2
be localized in the upper or lower part of the brachial plexus, resulting in different phenotypes. Erb's palsy results from an injury of the spinal neObstetrical Paralysis16AetiologyJM Hans Ubachs and Albert (Bart) CJ SlooffHistoryThe aetiology of the obstetric brachial plexus injuries has an intere Ebook Brachial plexus injuries: Part 2 damage of the brachial plexus (From Ubachs et al 1995.1resulting in a hanging upper arm in endorotation. a paralysis of the elbow flexors and consequently an extended elbow in pronating position, caused by the paralysis of the supinators. Combination with a lesion of C7 results in a paralysis of th Ebook Brachial plexus injuries: Part 2e wrist and finger extensors and the hand assumes the so-called waiter's tip position. The total palsy, often incorrectly called Klumpke's palsy, is cEbook Brachial plexus injuries: Part 2
aused by a severe lesion of the lower spinal nerves (C7-T1) but is always associated with an upper spinal nerve lesion of varying severity. The impairObstetrical Paralysis16AetiologyJM Hans Ubachs and Albert (Bart) CJ SlooffHistoryThe aetiology of the obstetric brachial plexus injuries has an intere Ebook Brachial plexus injuries: Part 2nd and the adjacent forearm. Involvement of T1 is frequently paralleled by cervical sympathetic nerve damage, an injury that will give rise to Horner's syndrome.Furthermore, stretching of the brachial plexus may result in two anatomically different lesions with different morbidities. The lesions are Ebook Brachial plexus injuries: Part 2 easily distinguished during surgery. Either the nerve is partially or totally ruptured beyond the vertebral foramen, causing a neuroma from expandingEbook Brachial plexus injuries: Part 2
axons and Schwann's cells at the damaged site, or the rootlets of the spinal nerve are torn from the spinal cord, a phenomenon called an avulsion.AETObstetrical Paralysis16AetiologyJM Hans Ubachs and Albert (Bart) CJ SlooffHistoryThe aetiology of the obstetric brachial plexus injuries has an intere Ebook Brachial plexus injuries: Part 2tive reference populations. Values are given as percentages (From Ubachs et al 1995ICharacteristicsCephalic deliveryBreech deliveryOBPL In = 102)Centre) (n = 138 702)pOBPL in = 102)Centre! (n = 7926)pProportionMultipara7556<0.053944NSMales5052NS4G4GNSIncidencePre term birth’714NS2133NSPost term birt Ebook Brachial plexus injuries: Part 2h76NS73NSSmall tor dates <5 10%)**010<0.0011418NSLarge for dates i> 90%)”7110< 0.000146NSBirth asphyxia (Apgar score < 6l6b1< 0.0001864< 0.0001CaesareEbook Brachial plexus injuries: Part 2
an birth*07<0.01038< 0.001kxceps/vacuurn bMth4911<0.00101NSObstetrical Paralysis16AetiologyJM Hans Ubachs and Albert (Bart) CJ SlooffHistoryThe aetiology of the obstetric brachial plexus injuries has an intereObstetrical Paralysis16AetiologyJM Hans Ubachs and Albert (Bart) CJ SlooffHistoryThe aetiology of the obstetric brachial plexus injuries has an intereGọi ngay
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