This document summarizes obstetric brachial plexus injuries, including history, causes, mechanisms, classification, treatment, and surgical techniques. It discusses the incidence of 1 in 1000 live births, various root injuries that can occur, and classifications including the Narakas system. Treatment indications, surgical strategies like neurotization and nerve transfers, and outcomes are outlined. Priority is given to reconstructing nerves for shoulder and elbow function in upper plexus injuries and hand function in total palsies. Secondary surgeries may be needed to address issues like shoulder contractures.
Presentation contain etiology, blood supply of femoral head & neck,pathogenesis ,classification system ,clinical features,diagnosis,managment, pelvic & femoral osteotomies in detail
Presentation contain etiology, blood supply of femoral head & neck,pathogenesis ,classification system ,clinical features,diagnosis,managment, pelvic & femoral osteotomies in detail
MIROS (Minimally Invasive Reduction and Osteosynthesis System®)CHAUDHARY ARPAN
MIROS (Minimally Invasive Reduction and Osteosynthesis System
MIROS consists of four 2.5 mm thick and 50 cm long stainless steel or titanium wires the end
of which is introduced into a metallic clip.
Assumed that the MIROS might provide greater fracture stability and less complications
with respect to traditional percutaneous pinning (TPP).
paediatric injuries around the elbow
supracondylar elbow injuries
pulled elbow in paediatric age r
radiological signs around elbow in supracondylar fracture humerus
This presentation talks about the anatomy of facial nerve and the facial nerve palsy. Few diagrams and tables have been taken from Neligan's textbook of Plastic Surgery.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
Obstetric brachial plexus injury...ppt
1. PROF. MIRA SEN (BANERJEE) C.M.E. ARTICLE
Authors: MUKUND R. THATTE, RUJUTA MEHTA
Journal: INDIAN JOURNAL OF PLASTIC SURGERY SEPTEMBER-
DECEMBER 2011 VOL 44 ISSUE 3
Compiled by- Dr Raghav Shrotriya
Department of Plastic Surgery
KEM Hospital, Mumbai
For Journal Club
Obstetric brachial plexus
injury
2. History
The first known documentation was by Smellie in 1764
and Duchenne in 1872 surmised that traction was
the cause of the palsy.
Erb described a similar palsy in adults in 1874 and
suggested that traction or compression of the C5 and
C6 roots could produce the injury.
3. INCIDENCE
● There is a wide variation in reported figures of
incidence ranging from 0.15 to 3 per 1000 live births.
These figures reflect health care availability,
reporting methods, referral bias and population
differences.
● In general, a figure of 1:1000 live births is generally
agreed upon as an average of various series.
● Spontaneous recovery is reported in all series, but
varies from as high as 90% to as low as 30%.
4. CAUSES
Foetal
• Macrosomia
• Breech
Maternal
• Diabetes in pregnancy
• Shoulder dystocia
• Small stature/cephalopelvic disproportion
• Primi or multiparity
• Prolonged second stage of labour
5. MECHANISM
● The generally accepted mechanism in cases of shoulder
dystocia is traction to the neck caused by pull of the
obstetrician’s hand or instruments like forceps or
vacuum.
● It has been shown that the Posterior shoulder can get
stuck on the Sacral promontory and cause injury
through a stretch on that side while the baby is in early
stage of labour before any question about shoulder
dystocia and traction. Bicornuate uterus has also given
rise to OBPI with phrenic palsy.
● Thus, there is no agreement among scholars about the
mechanism or active prevention and this has medico-
legal implications.
6. Pathophysiology
● The classical injury is a C5, C6 palsy, but all roots can
be involved.
● The level and nature of root involvement varies from
a neuropraxia to varying levels of axonotomesis to
neurotomesis.
● In the worst injuries, even a root avulsion is possible
and one can find ganglia in the neck
7. ● there are three different kinds of lesions:
● Neuroma in continuity: This represents a
postganglionic rupture, i.e. a Sunderland type 2, 3or
4 injury which is healed with fibrosis and some axons
may be attempting to go across the scar tissue.
8. ● Rupture: This is a postganglionic neurotomesis, i.e.
Sunderland type 5 causing a separation of proximal
and distal ends often bridged by scar tissue
● Avulsion: This is a preganglionic lesion showing
avulsed ganglia in the neck or a pseudomeningocoele
9. INITIAL TREATMENT
● Consists of coming to a proper diagnosis, which includes a
careful history taking, detailed clinical examination,
including a check for associated injuries like fractures of the
clavicle and humerus.
● Electrophysiology is recommended at 4 weeks initially to
confirm the diagnosis and get a baseline reading of the
involvement of various nerves and muscles as well as
sensory parameters.
● Counselling of parents is critical and clear open
communication is strongly recommended.
● Gentle mobilisation of all joints of the affected limb is
suggested to avoid stiffness.
10. ● Repeat examinations are carried out every 4–6
weeks until 3 months.
● At this time, a decision is made about the need for
surgery, which in turn depends on clinical and
electrophysiological findings.
11. IMAGING
● The following modalities are available:
○ Plain X-ray of arm and chest for fractures and phrenic palsy
○ Computed tomography (CT) myelography
○ MR scans
● The authors do not routinely perform MR scans in
infants. Clinical exam and electrophysiology can give
adequate evidence of the status of the plexus and the
indication for surgery.
12. Narakas classification
● Type I: Upper Erb’s C5, C6
○ Shoulder abduction/external rotation, elbow flexion affected. Good
spontaneous recovery expected in over 80% of cases
● Type II: Extended Erb’s C5, C6, C7
○ As above with wrist drop. Good spontaneous recovery in about 60% of cases
● Type III: Total palsy with no Horner syndrome C5, C6, C7, C8, T1
○ Complete flaccid paralysis good spontaneous recovery of the shoulder and
elbow in 30–50% of cases. A functional hand may be seen in many patients
● Type IV: Total palsy with Horner syndrome C5, C6, C7, C8, T1
○ Complete flaccid paralysis with Horner syndrome. The worst outcome.
Without surgery, severe defects throughout the limb function
13. INDICATIONS FOR SURGERY
● In case of global involvement, involvement of the
hand or a flail upper limb, there is no real dispute
about indication or timing of surgery.
● The dispute arises in the upper plexus lesions of
Narakas Type I and II
14. ● The author follows Prof. Gilbert’s criteria of using
the biceps brachii as an indicator of recovery in
upper plexus lesions.
● It is generally agreed that a lack of antigravity biceps
function at 3 months is an indication for surgery in
C5C6+/−C7 lesions.
● The logic behind this caveat is that the biceps is the
only C5–C6 innervated muscle whose function
cannot be duplicated by other muscles, and therefore
is a good uncluttered indicator of C5-C6 recovery
15. Toronto active movement scale of Clarke
and Curtis
With gravity eliminated:
● No contraction 0
● Contraction without movement 1
● Movement <½ of ROM 2
● Movement >½ of ROM 3
● Full movement 4
Against gravity:
● Movement <½ of ROM 5
● Movement >½ of ROM 6
● Full movement 7
16. ● The author MRT personally uses Gilbert’s criteria for
the decision, i.e. if a child with upper plexus lesion does
not have a biceps function exceeding MRC grade 3
(antigravity movement) at 3 months of age, then
surgery is recommended for nerve repair.
● In cases where there is visible biceps contraction but
triceps co-contraction preventing elbow flexion, or
biceps being 2+ but not really 3, etc., we can wait and
watch with/without botox to triceps up to 6 months by
which time the picture is clear.
● If the bicpes continues to be under MRC grade 3, then
surgery is better than conservative treatment.
17. SURGICAL TREATMENT
● Surgery in these indications consists of a complete
exploration of the supra and infraclavicular plexus
and nerve repair using microsurgical techniques
based on merits, i.e. after assessing the injury and its
pathophysiology, the surgeon can decide on the
strategy to be used.
18. Priorities
● The preference in a total palsy is to hand function, while
in an upper plexus it is of course to reconstruct the
nerves for elbow and shoulder function.
● The suprascapular nerve (SSN) supplying the supra and
infraspinatus is a crucial nerve for shoulder abduction
and external rotation and needs to be targeted with
priority, either from one of the roots or separately with
the spinal accessory (XI) nerve as the donor.
● The lower trunk/medial cord for hand and
musculocutaneous nerve (MCN) for biceps are the other
priorities.
19. ● Intraplexus neurotisation thus uses existing healthy
root stumps, which are ruptured for reconstruction
by joining them with the distal target trunks, cords
or nerves using nerve grafts.
● The source of nerve grafts is both sural nerves and
the ipsilateral medial cutaneous nerve of forearm
(MCNF) and superficial radial nerve (SRN),
especially in global severe palsies if grafts are falling
short.
20. Global palsy strategy
● Four or five roots available: Very rare; just direct
them to respective trunks/cords.
● Three roots available: One each to medial, lateral
and posterior cords. SAN to SSN depending on the
pathoanatomy of the upper trunk lesion.
● Two roots available: Root 1 to lower trunk/medial
cord, Root 2 to lateral cord (or shared between
lateral and posterior cords) and XI to SSN.
21. ● One root available: Root to lower trunk/medial cord + XI to SSN, 2
or 3 ICNs to biceps. Shoulder will need secondary transfers if
possible.
● • Zero roots – rare total avulsion: Opp. C7 root (posterior division)
to lower trunk/medial cord and XI to MCN or XI to SSN and ICNs to
MCN plus one ICN to long head of triceps.
Upper plexus: C5–C6
• Both roots available: Typically C5 to anterior divisionof upper
trunk and C6 to posterior division of upper trunk.
• One root available: Root to anterior division of upper trunk (or
both divisions if they are of really good quality with plenty of healthy
axons) and XI nerve to SSN. ICNs can be used for additional
neurotisation depending on situation and fitness.
22. DISTAL NERVE TRANSFERS
● Oberlin[45] described the use of motor fascicles of the
ulnar nerve for reinnervation of the biceps via the MCN.
Subsequently, this has been modified to ulnar to biceps
and median to brachialis.
● Somsak[46] described the useof the branch to long head
of triceps for the anterior division of the axillary nerve to
reinnervate the deltoid.
● The interesting point about distal transfers is the speed
of neurotisation, since the nerve is coapted very close to
the hilum of the muscle and the growing axons reach the
end plates much faster.
23. ● Gilbert and Raimondi, argue that if roots are
available, it is preferable to do a classical
reinnervation and reserve distal transfers for later
use.
● This allows reinnervation of all muscles supplied by
those trunks/cords in a proper manner and yet
leaves the distal transfers in reserve in case of
unfavourable outcome.
● Distal transfers can be done at a late stage as they
reach the muscle very rapidly.
24. SECONDARY SURGERY
● Secondary surgery is performed to treat either
untreated older children or as a follow-up to primary
nerve reconstruction. Secondary surgery involves
surgery on shoulder, elbow as well as the hand.
25. Shoulder
● Typically, shoulder surgery is performed to treat an
internal rotation (IR) contracture combined with
poor abduction. This is typically caused by co-
contraction of abductors with adductors and
internal with external rotators.
● In the recovering plexus (both natural and in those
with nerve reconstruction), there is a tendency of
mix-up of the growing axons to target muscles.
This results in co-contraction of these groups.
26.
27.
28. Elbow
● Surgery is directed towards restoration of either
flexion or extension.
● For elbow flexion, typical transfers are triceps to
biceps and Steindler’s flexoroplasty. Rarely, an LD
transfer can be theoretically used
● For extension, the transfer of choice is deltoid to
triceps. The posterior half of the deltoid is detached
and extended with fascia lata to attach it to the
triceps insertion
29. Hand
● A plethora of tendon transfers can be used to
improve hand function. They are based on standard
tendon transfers done for peripheral nerve lesions
30.
31. ● OBPI cases have relatively weaker donors to achieve the
desired function as the donor muscle too is often
reinnervated. Full function, therefore, may not be
achieved.
● Children keep recovering hand function for 3–4 years
both naturally as well as after nerve surgery (unless of
course you know that a particular nerve is not targeted at
all).
● It is better to splint with appropriate splints in the
interim.
● Start transfers only after about 3.5–4 years to get
optimum results.
32. CONCLUSIONS
● Surgery for OBPI is rewarding, early decisions are
very helpful in long term results and that these
children need to be seen early by experts in the
field.
● OBPI is a relatively neglected field in this country.
● Currently it is showing one of the fastest growths
amongst surgeons interested in nerve surgery.
● Considering the incidence, the need and potential
for doing some good is immense.
33. ● Early primary nerve surgery, when indicated, is
strongly recommended.
● In late referrals, distal nerve transfers and secondary
reconstruction can yield useful results.
● No child should be abandoned; there is always some
useful function that can be improved.
● The brachial plexus surgeon can never comment about
medico-legal liability, as he/she is unaware of the
emergency that could have developed intrapartum,
which necessitated the traction manoeuvres.