(Neurosurgery. 2007 Feb;60(ONS1):13-18)
Abstract: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17297361&query_hl=5&itool=pubmed_docsum
Wednesday, February 7, 2007
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This anatomical report revealed that T2 had a connection with the brachial plexus in 100% of 107 cadavers: 17% had a proximal intrathoracic connection, while 86% had more distal axillary connections (one or more) via the intercostobrachial nerve.
In bland cadavers, and even at surgery (e.g., finding the lateral femoral cutaneous nerve), dissection and isolation of these small cutaneous nerves is not easy: sometimes isolated elements are not necessarily neural. In this report, the authors did not histologically confirm that each communication was indeed neural. The fact that most previous studies disagree with each other regarding the incidence of communication between T2 and the brachial plexus heightens this concern. Furthermore, the polarity and content (motor, sensory, sympathetic) of these communications is unknown.
A truly interesting finding, however, was the 26% incidence of pre-fixed brachial plexuses (C4 contribution without T1 contribution). This, I believe has more clinical significance than a T2 contribution; the latter currently being of likely minor clinical and surgical significance considering these nerves are not readily exposed during brachial plexus surgery. The C4 nerve root contribution on the other hand is important. It may be useful during repairs, or as an explanation for unusual patterns of deficits. Does C4 provide both motor and sensory input? This could be answered electrophysiologically during TOS surgery, for example.
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