Macro anatomical investigation of brachial plexus of the White New Zealand rabbit (Orycotolagus cuniculus)

Morphological variation of the brachial plexus in four phyllostomid bat species (Chiroptera, Phyllostomidae)

Despite the remarkable morphological modifications that occurred in the thoracic limbs of bats, information about the brachial plexus in this group is still scarce. The present study aimed to describe the origin, structure, and distribution of these peripheral nerves in four Phyllostomidae species. Both antimeres of six Artibeus lituratus, five Desmodus rotundus, seven Glossophaga soricina, and five Phyllostomus hastatus-all adult males from the Adriano Lúcio Peracchi Collection (UFRRJ)-were dissected. After complete exposure of the structure, we found that the brachial plexus of D. rotundus and P. hastatus is formed by the same roots (C5-T1), whereas the fourth cervical spinal nerve and the second thoracic spinal nerve are present in G. soricina (C4-T1) and A. lituratus (C5-T2), respectively. There was intraspecific variation and asymmetry in the origin of the structure and the combinations of nerve segments forming terminal branches. The distribution to the target muscles and patagium, however, was not subject to significant variation in our sample. Data presented here support the presence of two prevailing conditions in distribution of nerves to the bat muscles, and the innervation of the membranes seems to be explained by embryogenesis. Although the brachial plexus in phyllostomid bats is similar to that of other terrestrial Laurasiatheria, aspects identified in these bats, apparently unique to Chiroptera, may be related to anatomical changes in the thoracic limbs functionally linked to flight.

In vivo biomechanical responses of neonatal brachial plexus when subjected to stretch

Neonatal brachial plexus palsy (NBPP) results from over-stretching of the neonatal brachial plexus during complicated birthing scenarios. The lack of information on the biomechanical response of the neonatal brachial plexus complex when subjected to stretch limits our understanding of the NBPP injury mechanism. This study aims to fill that critical gap by using a neonatal piglet animal model and providing the in vivo biomechanical properties of the neonatal brachial plexus complex when subjected to stretch. Forty-seven brachial plexus levels (identified by the four brachial plexus terminal nerve branches namely musculocutaneous, median, ulnar, and radial), obtained from 16 neonatal Yorkshire piglets (3-5 days old), were subjected to stretch-induced failure. The average maximum load and corresponding strain were reported to be 16.6 ± 1.3 N and 36.1 ± 1.6%, respectively. Maximum loads reported at the musculocutaneous level were significantly lower than the median and radial levels. No differences in strains at failure were reported at all four tested levels. Proximal or distal failure locations were reported in 83% of the tests with 17% mid-length ruptures that were primarily reported at the bifurcation of the median and ulnar brachial plexus levels. Histological studies reported an overall loss of wavy pattern of the nerve fibers, an increase in nerve spacing, fiber disruptions, and blood vessel ruptures in the stretched tissue. This in vivo piglet animal study offers insight into the NBPP mechanism by reporting biomechanical, injury location, and structural damage responses in neonatal brachial plexus when subjected to stretch.

A Systematic Review of the Tensile Biomechanical Properties of the Neonatal Brachial Plexus

Brachial plexus (BP) birth injury has a reported incidence of 1 to 4 per 1000 live births. During complicated deliveries, neonatal, maternal, and other birth-related factors can cause over-stretching or avulsion of the neonatal brachial plexus leading to injury. Understanding biomechanical responses of the neonate brachial plexus when subjected to stretch can offer insight into the injury outcomes while guiding the development of preventative maneuvers that can help reduce the occurrence of neonatal brachial plexus injuries. This review article aims to offer a comprehensive overview of existing literature reporting biomechanical responses of the brachial plexus, in both adults and neonates, when subjected to stretch. Despite the discrepancies in the reported biomechanical properties of the brachial plexus, available studies confirm the loading rate and loading direction dependency of the brachial plexus tissue. Future studies, possibly in vivo, that utilize clinically relevant neonatal large animal models can provide translational failure values of the biomechanical parameters for the neonatal brachial plexus when subjected to stretch.

Morphology of the spinal nerves from the cervical segments of the spinal cord of the African giant rat (Cricetomys Gambianus)

This study provides detailed description of the gross morphology and distribution of the nerves arising from the cervical segments of the spinal cord of the African Giant Rat (AGR). Two (2) AGRs were used for this study. The rats were euthanized using halothane. The skin and superficial fascia were removed, and dissection of the muscles in the cervical region and thoracic limbs was carried out. The vertebral canal was opened by means of a rongeur. Eight (8) pairs of spinal nerves (C1-C8) arose from the cervical segments of the spinal cord of the AGR by means of dorsal and ventral roots which merged lateral to the spinal cord to form spinal nerves. Each cervical spinal nerve divided into a dorsal and ventral ramus just before exiting the intervertebral foramen. The dorsal rami divided into medial and lateral branches distributed on the medial faces of the semispinalis and splenius muscles, respectively. The ventral rami of C1, C2 and a branch from C3 interconnected to form the cervical plexus from which branches were distributed to the M. cleidomstoideus, M. cleidooccipitalis, M. occipitoscapularis, M. omotransversarius and M. trapezius. The ventral rami of C5, C6, C7, C8 and T1 (first thoracic spinal nerve) interconnected to form the brachial plexus. The cervical spinal nerves gave rise to dorsal rami or primary branches that supplied the skin and muscles of the dorsal part of the neck and the ventral primary branches which interconnected to give rise to the cervical plexus and brachial plexuses of the AGR.

Brachial plexus nerve injury and repair in a rabbit model part II: Does middle trunk injury result in loss of biceps function while repair results in recovery of biceps function

INTRODUCTION

There is conflicting anatomic and innervation data regarding the rabbit brachial plexus injury model. This study aims to validate a rabbit brachial plexus injury model. We hypothesize the middle trunk (C6, C7) is the primary innervation of the biceps, and when cut and unrepaired, would demonstrate lack of recovery and when repaired would demonstrate evidence of recovery.

MATERIALS AND METHODS

Twenty two male New Zealand white rabbits (3-4 kg) underwent unilateral surgical division of the middle trunk. Five rabbits were randomly assigned to the "no-repair" group while the remaining 17 rabbits underwent direct coaptation ("repair" group). Rabbits were followed for 12 weeks, with ultrasound measurement of biceps cross-sectional area performed preoperatively, and at 4, 8, and 12 weeks postoperatively. At a euthanasia procedure, bilateral compound muscle action potential (CMAP) and isometric tetanic force (ITF) were measured. Bilateral biceps muscles were harvested and wet muscle weight was recorded. The operative side was expressed as a percentage of the non-operated side, and differences between the no repair and repair rabbits were statistically compared.

RESULTS

The repair group demonstrated significantly higher CMA (23.3 vs. 0%, p < .05), ITF (25.6 vs. 0%, p < .05), and wet muscle weight (65.8 vs. 52.0%, p < .05) as compared to the unrepaired group. At 4 weeks postoperatively, ultrasound-measured cross-sectional area of the biceps demonstrated atrophy in both groups. At 12 weeks, the repair group had a significantly larger cross-sectional area as compared to the no-repair group (89.1 vs. 59.3%, p < .05).

CONCLUSIONS

This injury model demonstrated recovery with repair and lack of function without repair. Longer survival time is recommended for future investigations.

Validation of Isometric Tetanic Force as a Measure of Muscle Recovery After Nerve Injury in the Rabbit Biceps

PURPOSE

The purpose of this study was to describe and validate a technique for measurement of isometric tetanic force (ITF) in the rabbit biceps muscle.

MATERIALS AND METHODS

Eighteen New Zealand White rabbits were randomized to test either the right side or the left side first. Under propofol anesthesia, the brachial plexus and biceps brachii were exposed. The middle trunk (C6, C7) was secured in a bipolar electrode. Compound muscle action potential (CMAP) was measured. The proximal, tendinous portion of the biceps was severed at the shoulder and clamped in a custom-made force transducer. Muscle preload and electrical stimulation variables were optimized to obtain the highest tetanic muscle contraction. Wet muscle weight (WMW) and nerve histomorphometry were analyzed. Statistical analysis was performed to determine side-to-side equivalence.

RESULTS

The rabbit biceps muscle force demonstrated side-to-side equivalence with overlapping 95% confidence intervals (95% CI). The right side, expressed as a percentage of the left, averaged 99.69% (95% CI, 88.89%-110.5%). The WMW of the right expressed as a percentage of the left was 98.9% (95% CI, 95.8%-102%).

CONCLUSIONS

The ITF is equivalent from side to side in the rabbit as demonstrated by the high degree of overlap in the 95% CIs for each side. The width of the 95% CI implies that there is more variability in the rabbit upper extremity than for the lower extremity of the rabbit or rat models, and researchers should take this into account when performing sample size estimates in pre-experimental planning.

CLINICAL RELEVANCE

The rabbit biceps muscle ITF measurements can be used to measure motor recovery in a rabbit model of brachial plexus injury and compared with the contralateral uninjured side.