2006 Major Sky Athletic Preparing Sports Drug Gathering.

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2006 Big Sky Athletic Training Sports Medicine Conference Traumatic Brachial Plexus Injury In A Collegiate Football Player: A Case Study Report Background 20 year old, African-American, Male Junior Position: Strong Safety Height: 6’ 2” Weight: 210 lb.
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2006 Big Sky Athletic Training Sports Medicine Conference

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Traumatic Brachial Plexus Injury In A Collegiate Football Player: A Case Study Report

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Background 20 year old, African-American, Male Junior Position: Strong Safety Height: 6\' 2" Weight: 210 lb. No history of Brachial Plexus harm

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Mechanism Direct contact in football game Mechanism of damage included direct contact to the competitors right shoulder/neck by adversaries head protector

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Sideline Evaluation Signs and Symptoms No loss of cognizance No cervical spine torment Athlete ready to stroll off field Numbness/shivering/torment into R furthest point No engine control in R furthest point No sensation in R furthest point Normal neurological exam in lower limits/left furthest point.

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Immediate Care Transported to healing facility X-beams - Cervical spine CT Scan - Upper cervical spine Pain administration Sling

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Immediate Care Return to Minneapolis Hospitalized (3 days) Repeat x-beams MRI – Brachial plexus Referred to neurologist Referred to neurosurgeon

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Immediate Care Conclusions Brachial plexus neuropathy Some arrival of C5, C7, C8,T1 sensation Finger flexion Wrist flexion Shoulder shrugs Shoulder Protraction/Retraction No sign of nerve root separation RX pharmaceutical Medrol measurements pack Pain solution Sling/wrist augmentation prop

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Immediate Care Plan Manage Pain Maintain ROM Shoulder Elbow Wrist Hand Observation

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Day 3 - 10 Released from doctor\'s facility Gradual decline in neck/shoulder torment Increased sensation C5, C7, C8, T1 Athlete ready to effectively flex fingers/thumb, flex wrist, some natural movements, shoulder shrugs, shoulder protraction/withdrawal Physical Therapy – Weekly arrangements

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Day 3-10 – Physical Therapy ROM Finger/thumb expansion Wrist expansion Pronation/supination Ulnar/spiral deviation Elbow expansion Shoulder inner/outer pivot Shoulder flexion Strength Finger/thumb flexion Pronation Wrist Flexion Shoulder Elevation Shoulder Protraction/Retraction

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Day 10 Increasing agony in low back Pain with leg expansion Pain with Straight Leg Test Radiating torment down into hindquarters

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Day 10 Diagnostic Testing Lumbar Spine MRI Blood in distal thecal sac Additional Testing Brain MRI Brain MRA Cervical Spine MRI Thoracic Spine MRI

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Day 10 Re-Hospitalized 3 days Pain administration Medrol dosage pack

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Day 10 Conclusions Brachial Plexopathy Possible nerve root separation at C6

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Brachial Plexus Picture

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Brachial Plexus Picture

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4 Weeks - Referral Mayo Clinic EMG Neurologist Meet with brachial plexus group Neurosurgeon Orthopedists

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4 Weeks - Referral Conclusions Diffuse Brachial Plexopathy Plan Observation Physical Therapy Schedule extra testing at 3 months from DOI

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4 Weeks - Rehabilitation Continue movement and quality activities Wrist expansion prop Shoulder bolster support Sling

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12 Weeks Mayo Clinic Repeat EMG CT Myelogram Seen by brachial plexus group

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12 Weeks Conclusions EMG demonstrated no confirmation of critical reinnervation CT myelogram indicated proof of separations at C7 and C8 on right side No noteworthy increment in engine capacity

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Surgery ought to be performed just without clinical or electrical confirmation of recuperation or when unconstrained recuperation is unthinkable Surgery ought to be performed 3 to 6 months post damage. The ideal opportunity for the nerve to recover to the objective muscles is more prominent than the survival time of the engine end plate after deenervation.

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Surgery Surgical investigation Electrodiagnostic procedures – permit the specialist to test a nerve specifically over a sore to distinguish reinnervation Combination of nerve uniting/nerve exchanges Possible tendon move in 6 months

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Surgery - Goals Highest Priority of Restoration Elbow flexion Shoulder Abduction/Stability Hand Sensitivity Wrist Extension Finger Extension

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Surgical Expectations No arrival to football action Limited shoulder capacity Shoulder Abduction < 60 degree Elbow flexion – Strength < 2 lbs. Triceps No wrist expansion No finger augmentation

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13 weeks - Surgery Electrodiagnostic investigation demonstrated nerve root separations at C6, C7, and C8 Surgical Plan figured

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13 Weeks - Surgery Nerve uniting from C5 root to suprascapular Nerve joining from C5 root to axillary nerve Restores shoulder soundness Restores restricted dynamic shoulder snatching

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13 Weeks - Surgery Intercostal engine nerve exchange of the 4 th , 5 th , and 6 th intercostal nerve to the engine branch of the musculataneous nerve, including the brachialis and biceps branch Restores constrained dynamic elbow flexion

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13 Weeks - Surgery Sensory intercostal neurotization Intercostal tactile nerve exchange of the 4 th , 5 th , and 6 th intercostal nerve to the middle nerve Restore sensation to palmar part of hand/fingers.

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13 Weeks - Surgery Nerve Transfer Spinal extra nerve exchange to triceps branch Restores dynamic elbow expansion

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13 Weeks - Surgery Surgical strategy – 8 hours Released following 4 days in healing center

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Expected Recovery 2-3 years before full advantage of surgery Nerve development 1mm/day or 1"/month

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24 weeks - Surgery Tendon exchange Restore restricted wrist augmentation Restore constrained finger augmentation

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Conclusions Severe brachial plexus wounds in games can be cataclysmic in nature and result in perpetual handicap Evaluation, demonstrative studies, and referral are vital in deciding the seriousness of these wounds Surgical mediation might be expected to reestablish restricted capacity Patient determination, timing, and organizing reclamation of capacity are basic while considering surgical intercession

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Thank You

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