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Progression of partial experimental injury to peripheral nerve

Part 1: Periodic measurements of muscle contraction strength

David G. Kline, Alan R. Hudson, Earl R. Hackett and Bert R. Bratton

): Recovery following injury to the brachial plexus , in Peripheral Nerve Regeneration: A Follow-up Study of 3,656 World War II Injuries Washington, DC , US Government Printing Office , 1957 , pp 389 – 408 Nulsen F, Slade H: Recovery following injury to the brachial plexus, in Woodhall B, Beebe G (eds): Peripheral Nerve Regeneration: A Follow-up Study of 3,656 World War II Injuries. Washington, DC, US Government Printing Office, 1957, pp 389–408 11. Rosenblueth A , Alanis J , Rubio R : A comparative

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David G. Kline, Joseph Kott, George Barnes and Lester Bryant

H istorically , the posterior approach to the brachial plexus is based on the evolution of the posterolateral approach for removal of the first thoracic rib for thoracic outlet syndrome. The technique of posterolateral first-rib resection had its origin during the pre-antibiotic era of treatment of tuberculosis and empyema. Simon in 1869 and Estlander in 1879 employed a trapezius-splitting incision for thoracoplasty in the treatment of chronic empyema. 8 De Cerenville in 1885 and Quincke and Sprengler in 1888 formalized and named the procedure. 8 In the

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David G. Kline and Donald J. Judice

S ome disagreement persists concerning the value of operative intervention for brachial plexus lesions. Thus, a few clinical investigators believe that most gunshot wounds (GSW) to the plexus recover without surgery; some view with some justifiable skepticism operations for stretch palsies of the plexus; others consider that some tumors intrinsic to the plexus are not resectable without serious loss of function, and that perhaps the rewards from repair even of sharply transected plexus elements are small due to their proximal location and the distance that

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David G. Kline

T he British experience with gunshot wounds (GSW's) to the brachial plexus in World War II indicated that some upper trunk and posterior cord lesions recovered spontaneously. Resection and suture led to functional improvement only in lesions of the upper trunk or C-5 and C-6 spinal nerve roots; although neurolysis of other elements did help pain, it seldom improved outcome. 3, 14 The experience in the United States, although larger and analyzed in a more detailed fashion, revealed similar limitations to operations on the plexus. 4, 13 In the interim, several

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Neurosurgical Forum: Letters to the editor To The Editor David G. Kline , M.D. , Alan R. Hudson , F.R.C.S. Louisiana State University Medical Center New Orleans, Louisiana Toronto Hospital Toronto, Ontario, Canada 667 668 Yamada, et al. , have further described a valuable neurotization procedure for avulsive stretch injuries involving the brachial plexus at the C-5 and C-6 levels (Yamada S, Peterson GW, Soloniuk DS, et al: Coaptation of the anterior rami of C-3 and C-4 to the upper trunk of the

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Deepak Awasthi, David G. Kline and Edwin N. Beckman

forearm as well as shortness of breath during exercise. These symptoms persisted for the 3 months prior to admission. She denied any noticeable weakness in her left upper extremity. The patient was referred to our clinic after magnetic resonance imaging had revealed a large mass in the left brachial plexus area. In 1954, the patient had undergone a partial resection of a left supraclavicular mass at the age of 7 months. During the initial surgery the mass was noted to involve intimately the brachial plexus and the subclavian artery. It was considered that the tumor

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David G. Kline, Thomas R. Donner, Leo Happel, Barbara Smith and Hans P. Richter

M ost plexus surgery is performed for stretch injuries involving proximal elements. 14, 23, 25, 32 Current surgical approaches to the proximal brachial plexus are limited because it is difficult to expose the intraforaminal portion of the spinal nerve roots which are surrounded by bone. Some stretch injuries affect nerves at this level, as do (less frequently) other lesions due to knife and gunshot wounds. 20, 24, 30, 36, 38 Some of this nerve damage might be reparable if this area were more accessible. This study was undertaken to develop a practical and

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Annie S. Dubuisson, David G. Kline and Steven S. Weinshel

the brachial plexus was developed when one of the authors (D.G.K.) was approached by a thoracic surgeon who requested help with a patient suffering TOS-like symptoms complicated by neurological impairment. It was decided that a posterior approach might provide exposure for both first-rib resection and for visualization of the proximal brachial plexus. In 1978, 12 examples of brachial plexus lesions explored through the posterior subscapular approach were presented and preliminary indications for the procedure were discussed. 9 Since then, 105 posterior subscapular

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Thomas R. Donner, Rand M. Voorhies and David G. Kline

, × 130. B and E: The neurofibroma usually tends to have more stainable reticulum. Gridley, × 130. C and F: Many Schwann cells and some fibroblasts can be seen in both types of tumor, but there are fewer axons in the schwannoma than the neurofibroma. Bodian, × 130. Operative Technique In each of the 263 patients, complete excision of the lesion was attempted. The technique used has been described previously for brachial plexus tumors. 44 At exploration, the tumor and the nerve fascicles proximal and distal to the tumor were dissected. The usual finding

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). The patient appears to have been dramatically cured by an operation but the case report does not clearly define the pathology seen at operation. The authors state: “At surgery, a tight anterior scalene muscle was discovered compressing the left vertebral artery and lower cord of the brachial plexus between the anterior and middle scalene muscles.” This is an anatomical impossibility. These cords are in the axilla. Presumably, what is meant is the lower “trunk” of the brachial plexus. Because the scalenus anticus originates from the anterior tubercles of the