Arthrogryposis

what is arthrogryposis 

multiplex congenital? Arthrogryposis life expectancy | 

Arthrogryposis baby | 

arthrogryposis treatment

Arthrogryposis : 

Arthrogryposis is a term that refers to a group of diseases that affect the joints. 

Both the arms and legs are frequently affected.

What is arthrogryposis?

Arthrogryposis, commonly known as arthrogryposis multiplex congenital (AMC), refers to a group of disorders characterized by multiple joint contractures (or stiffness). A contracture is a condition in which a joint's range of motion is restricted. It may be unable to bend or stretch fully or partially.

What are the causes of arthrogryposis?

The cause is unknown, however, arthrogryposis is assumed to be linked to a lack of space in the uterus and a lack of amniotic fluid. A neurological or connective tissue problem may be present in the patient.

What are the symptoms of arthrogryposis?

Muscle contractures of the joints are frequent on both sides of the body in the wrist, hand, elbow, and shoulder, Hips, knees, and ankles are all commonly included in lower extremity involvement. 

Muscle weakness can be found all over the body. 

The curvature of the spine can occur in some patients.

How is arthrogryposis diagnosed?

Arthrogryposis does not have a prenatal diagnostic test. Ultrasound may reveal abnormalities, necessitating additional testing to determine the underlying cause. 

To fully analyze each patient, a thorough medical history and examination will be performed. When a patient has two or more joint contractures in separate places of their body, they are diagnosed with arthrogryposis. Once you've been diagnosed, genetic testing will almost certainly be recommended to rule out a major cause.

What is Treatment for Arthrogryposis?

Nonoperative Treatment

The first line of treatment for improving range of motion is occupational and physical therapy. Physical therapists work on the lower extremities and gait, whereas occupational therapists work on the upper extremities. Aquatic treatment may be suggested as a supplement to traditional strengthening and range-of-motion exercises.

 

Surgical Treatment

Children with elbow, wrist, or hand flexion contractures that do not improve with occupational or physical therapy may benefit from orthopedic surgery to increase their range of motion.

Bracing or orthopedic surgery may be suggested for children with severe spine curvature to rectify the deformity.

Brachial Plexus injury and their treatment

 

What is a brachial plexus injury?

The brachial plexus can be damaged in a variety of ways, including pressure, tension, and overstretching. Cancer or radiation treatment can potentially cause the nerves to be severed or damaged. Brachial plexus injuries can occur in newborns during birth. 

 

Brachial plexus injuries disrupt the communication between the spinal cord and the arm, wrist, and hand completely or partially. This could prevent you from using your arm or hand. Brachial plexus injuries frequently result in a complete loss of sensation in the affected area.

 

Types of Brachial Plexus Injuries

Brachial Plexus Neuropraxia (Stretch)

Neuropraxia is a condition in which the nerves are stretched to the point of damage. Compression and traction are the two main causes of this damage. The brachial plexus nerve root is squeezed in a compression injury, which is commonly caused by head rotation. The most prevalent type is compression neuropraxia, which affects mostly older adults. 

 

Traction neuropraxia is a condition in which the nerve is dragged downward. This damage is less prevalent than compression neuropraxia, although it affects teenagers and young adults more frequently.

 

Brachial Plexus Rupture

A severe stretch causes the nerve to rip, either partially or fully, in a brachial plexus rupture. Unlike neuropraxia, this is a more devastating injury. Ruptures can cause weakness in the shoulder, arm, or hand, as well as the inability to use certain muscles. These injuries can also cause excruciating agony.

 

Brachial Plexus Neuroma

Scar tissue can occur when nerve tissue is harmed, such as via a cut during surgery, as the nerve tries to repair itself. A neuroma is a type of scar tissue that can cause a painful knot on one of the brachial plexus nerves. 

 

Surgical excision of the damaged nerve tissue is used to treat brachial plexus neuromas. To prevent another neuroma from growing, the surgeon either plugs the nerve or connects it to another nerve.

 

Brachial Neuritis

Brachial neuritis, often known as Parsonage Turner syndrome, is a rare, degenerative illness affecting the brachial plexus nerves. This syndrome begins with significant shoulder and upper arm pain and develops to weakening, muscle atrophy, and even sensory loss. The shoulder and arm are the most commonly affected areas, however, the legs and diaphragm can also be affected. Brachial neuritis has no established etiology, however, it could be linked to an immunological reaction produced by infections, injury, childbirth, or other events.

 

Brachial Plexus Avulsion

When the root of the nerve is entirely removed from the spinal cord, it is called a brachial plexus avulsion. Trauma, such as a car or motorbike accident, is the most common cause of this injury. Avulsions, which are more severe than ruptures, frequently produce excruciating agony. Avulsions can cause permanent weakness, paralysis, and loss of feeling since reattaching the root to the spinal cord is difficult, if not impossible.

 

The injury to the brachial plexus at birth usually takes one of two forms: 

 

Erb's palsy:- is a frequent upper brachial plexus nerve damage that results in numbness and loss of motion around the shoulder, as well as the inability to flex the elbow, lift an arm, or bring things to the mouth. 

Klumpke's palsy:- is a less common lesion to the lower brachial plexus that causes loss of motion and/or feeling in the wrist and hand, including the inability to move fingers.

 

Causes of Brachial Plexus Injuries 

· Blunt trauma: such as falls or motor vehicle accidents/road traffic accidents.

· Athletic injuries: especially any sports like injury football.

· Gunshot wounds: a bullet tears to the nerves.

· Medical trauma: a nerve is cut during a surgical procedure, or damaged by an injecting needle.

· Cancer: a tumor attacking the brachial plexus.

· Radiation therapy: radiation treatment that area damages the nerves.

 

Brachial Plexus Injury Symptoms

Common symptoms of brachial plexus injuries are:

· Numbness/paraesthesia or loss of feeling in the hand or arm.

· Inability to control or move the shoulder, arm, wrist, or hand actively.

· Burning, throbbing, or severe and sudden pain in the shoulder or arm.

 

Brachial plexus injuries diagnosis

•x-ray to find out fracture or other bone which affects the brachial plexus.

•CT-scan or MRI to see the clear image of nerve injury.

•Nerve Conduction Study (NCS) to find out function and electrical activity of the nerve.

 

Brachial Plexus Injury Treatment

Brachial plexus injuries do not usually necessitate medical attention. Some people, particularly babies born with a brachial plexus birth damage or adults with neuropraxia, recover without therapy, however, the injury can take weeks or months to heal.

 

Nonsurgical Treatment for Brachial Plexus Injuries

· Physical therapy exercises that may help restore function in the arms and hands and improve range of motion and flexibility in stiff muscles and joints.

Pain control via acupuncture and TENS.

Managing chronic edema via compression garments.

· Corticosteroid creams or injections to manage pain during healing to the nerve.

· Assistive devices such as braces, splints, and compression sleeves to reduce further damage of nerve.

· Medications to help manage pain onset.

· Occupational therapy to help with practical skills like dressing and cooking in cases, that involve severe muscle weakness, numbness, and pain.

Surgical Treatment of Brachial Plexus Injuries

If a brachial plexus injury does not heal on its own, surgery may be required to repair the damage. Because nerve tissue grows and repairs slowly, the consequences of brachial plexus surgery can take months to years to show.

Procedures your surgeon might include:

· Nerve repair: rejoin a torn nerve.

· Neurolysis: removing scar tissue from the damaged nerve to improve function.

· Nerve graft: using a healthy nerve from another part of the body to connect two ends of a separated nerve, make them healthy.

· Nerve transfer: attaching a less important but still functional nerve to the damaged nerve, creating a network for new growth.

· Tendon and muscle transfers: moving a less important tendon or muscle from part of the body to the arm to restore the function of a particular nerve.

 

 

 

 

 

 

 

 

 

Minor Nerve Distribution of Brachial Plexus

 

Minor Branches of Brachial Plexus

There are a number of minor nerves that emerge from the brachial plexus in addition to the five major branches which we discuss in previous brachial plexus topic . They can do so from any of the five sections of the brachial plexus, as described below:

 

Roots

Dorsal Scapular nerve 

•Originate From C5 nerve root.

•The Rhomboid major, Rhomboid minor, and levator scapulae muscles are all innervated by the dorsal scapular nerve, which is a motor nerve. 

•These muscles work together to elevate and retract the scapula.

 

Long Thoracic nerve

•Also know as nerve of bell.

•Originate from C5, C6, C7 nerve root. 

•The serratus anterior muscle, which is one of the most important muscles for rotating the scapula and elevating the arm, is innervated by the long thoracic nerve, which is motor nerve.

 

Trunks 

Supra-scapular nerve

•Originate from C5, C6 nerve root in Upper (Superior) trunk of brachial plexus.

•Its mixed nerve provide motor innervation to two muscles: the supraspinatus and infraspinatus muscles. 

•The supra-scapular nerve also gives sensory input to the shoulder joints (the glenohumeral and acromioclavicular joints).

 

Subclavian nerve

•Originate from C5, C6 nerve root in Upper (Superior) trunk of brachial plexus.

•Its innervate to Subclavius muscle, which is responsible to stabilize clavicle during movement of shoulder girdle.

 

Cords

Lateral Cord:- 

Lateral pectoral nerve

•Originate from C5, C6, C7 nerve root in lateral Cord of brachial plexus.

•Its motor nerve innervate to the pectorals major and minor muscles, which is responsible for adduction, flexion and medial rotation of arm. 

 

Medial Cord:-

Medial Pectoral nerve

•Originate from C8, T1 nerve in between Lower (inferior) trunk and medial cord of brachial plexus.

•Its motor nerve innervate to the pectorals major and minor muscles, which is responsible for Adduction, flexion and medial rotation of arm.

 

Medial Cutaneous nerve of arm

•Originate from C8, T1 nerve root in medial cord of brachial plexus.

•Its smallest sensory nerve which provide sensation to medial side of arm.

 

Medical Cutaneous nerve of forearm

•Originate from C8, T1 nerve root in medial cord of brachial plexus.

•Its smallest sensory nerve which provide sensation to medial side of forearm.

 

Posterior Cord:-

Superior (Upper) sub-scapular nerve

•Originate from C6, C7, C8 nerve root in posterior cord of brachial plexus as a result of upper, middle and lower trunk attachment.

•Its innervate the superior portion of sub scapularis muscle.

 

Thoracodorsal nerve 

•Originate from C6, C7, C8 nerve root in posterior cord of brachial plexus as a result of upper, middle and lower trunk attachment.

•Its motor nerve innervates in the latissimus dorsi muscle. 

 

Inferior (lower) sub-scapular nerve

•Originate from C6, C7, C8 nerve root in posterior cord of brachial plexus as a result of upper, middle and lower trunk attachment.

•Its innervate the inferior portion of sub scapularis muscle.

 

Brachial Plexus, Anatomy of Brachial plexus

Brachial Plexus Palsy | Brachial Plexus Injury Treatment | Brachial plexus nerve | Brachial plexus pain | Brachial plexus test 

What is the Brachial Plexus?

The brachial plexus is a network of nerves that connects the nerves in the arm and stems from nerve roots in the cervical (neck) and upper trunk (torso) regions of the spinal cord (C5-T1). The motions of your wrists, hands, and arms are controlled by these nerves, allowing you to raise your arm, type on a computer, or throw a baseball. 

The brachial plexus nerves are sensory and extend to the skin. For example, they may inform you that the pan you just took is too hot to hold.

Brachial Plexus Anatomy

The brachial plexus nerves branch and merge from the roots via the shoulder and down the arm, and are divided into several sections: trunks, divisions, cords, and branches. These portions are not functionally distinct, however they do assist in explaining the brachial plexus' complicated structure.

Roots

The anterior rami of the spinal nerves that make up the brachial plexus are referred to as the 'roots.' The anterior rami of spinal nerves C5, C6, C7, C8, and T1 are located here.

The anterior and posterior ramus of each spinal nerve are then separated. The anterior rami of spinal nerves C5-T1 produce the roots of the brachial plexus. 

 

These nerves emerge at the base of the neck and run between the anterior and medial scalene muscles.

 

Trunks

The roots of the brachial plexus unite at the base of the neck to form three trunks. The relative anatomical placement of these structures is used to name them: 

 

C5 and C6 roots combine to form a superior trunk. 

C7 continues in the middle trunk. 

C8 and T1 roots combine in the inferior trunk. 

The trunks pass the posterior triangle of the neck and proceed laterally.

 

Divisions

Within the posterior triangle of the neck, each trunk splits into two branches. One division goes Anteriorly(toward the front of the body), while the other moves Posteriorly(toward the back of the body). As a result, they're referred to as the anterior and posterior divisions.

 

Cords

When the anterior and posterior divisions have entered the axilla, they combine together to form three cords.

The lateral cord is formed by:

· The anterior division of the superior trunk

· The anterior division of the middle trunk

The posterior cord is formed by:

· The posterior division of the superior trunk

· The posterior division of the middle trunk

· The posterior division of the inferior trunk

The medial cord is formed by:

· The anterior division of the inferior trunk.

 

Branches

Five primary nerve branches run down the arm from the brachial plexus: 

 

The Musculocutaneous nerve:- The musculocutaneous nerve originates from nerve roots C5-C7 and flexes muscles in the upper arm at the shoulder and elbow. 

The axillary nerve:- which originates from the C5 and C6 nerve roots, aids shoulder rotation and allows the arm to raise away from the body. 

The median nerve:- which originates in the C6-T1 nerve roots, allows movement in the forearm and parts of the hand.

 

The radial nerve:- originates in the C5-T1 nerve roots and regulates muscles in the upper arm, elbow, forearm, and hand. 

The Ulnar nerve:- which is rooted in C8-T1, is responsible for fine motor control of the fingers.