Note: Descriptions are shown in the official language in which they were submitted.
WO 91/()X701 r~cr/El~s(~ 23~
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POC~ET CHART FOR LOCALIZIN~ LESIONS OF ~-~E PEP~IPHERAL NERVO~S
SYSTEM~
Description
The present invention refers to a pocket chart for localizing
lesions of the peripheral nervous system in the area of brachial-
and lumbosacral plexus distribution.
Said chart has the advantage of being a handy tool of rapid use for
a safe diagnosis of the location of a nerve lesion, which
constitutes the basis for an adequate prognosis and therapy
strategy.
Thus an aid is given to the physician, be he a specialist
(neurologist, neurosurgeon, physiatrist, orthopedist) or a general
practitioner, for acquiring a correct orientation in such
pathologies.
In particular, it is possible, by means of the chart according to
the invention, through the examination of a number of the member
muscles and of their normal or pathological condition, which can be
evaluated from a correct clinical muscle balance or from ~ne
analytical report of an accurate electromyographic examination, to
establish the location of the possible nerve lesion without the
laborious and time consuming consultation of more or less
exhaustive textbooks, which onl~ report the simple anatomical
distribution of the nervous fibers.
The chart of the invention allows thus to b~pass the task of
combining the study, in the books, of the anatomy and functionality
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of the brachial- or lumbosacral plexus with the clinical
electromyographic examination of the patient. In practice it is
often problematic, through the syr1thesis of said two elements, to
reach a rapid diagnostic conclusior" while the use of the chart
5 according to the invention permits to immediately integrate the two
elements.
The characteristics and advanta~es of the chart according to the
invention will be further illustrated in the following detailed
description.
With reference to the enclosed figures l .md 2, the chart consists
of a flexible card divided into four sections designed respectively
as A, B, C and D.
In section A are listed the test muscles for the innervation of the
upper extremity, in section B the consultation graph for locsting
the nerve lesion in the area of the brachial plexus is reported,
in section C are listed the test muscles for the innervation of the
lower extremity and in section D a consultation graph for locating
the nerve lesion in the lumbosacral plexus area is reported.
We are calling the attention to the fact that, as test muscles of
the radicular innervation, those muscles are considered which, in
most individuals, are prevailingly innervated by nervous fibers
coming from a motor root; their, normal or pathological, situation
~? may therefore be considered a test of the functionalit~ of the root
itself. For the trunk innervation not all muscles are considered,
but a number of them sufficient to allow to locate not only a
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lesion of the main trunk Dut also of its single ramifications.
Considering the test muscles for the upper extremity innervationlisted in section A, those for radicular innervation are in heavy
type, with the respective motor root in parenthesis, while the
muscles innervated by the three maii1 trunks (median, ulnar and
radial) are grouped separately, mainly for the sake of mnemonics.
~e muscles are indicated both with their names in extenso and with
the initials, which are reported also in the consultation graph of
section B.
In section B we represent the distribution graph of the brachial
plexus indicating, from left to right, the motor roots and the
various nervous trunks that are gradually formed down to their
terminal ramifications~ In the lower part of section B the various
abbreviations are listed.
More particularly, the brachial ple~us is represented in the
successive stages at which the mixing takes place of the nervous
fibers coming from motor roots (C5-Tl) and which converge to form
the primary trunks, which on their tur~ subdivide to form secondary
trunks from which last the peripheral trunks and the single
terminal ramifications originate.
For each stage are marked in apposite cases the initials of the
various muscles the deficit of which may al.low to locate the lesion
at that very point; the site of the lesion is given by the level of
the case in which all and onl~ the deter~orated muscles are
comprised.
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Because of the complexity of the brachial plexus, ~hile only a few
muscles are considered for the radi.cular levels. those at trunk
level are more numerous, often bei.ng muscles with such a multiple
root innervation as to indicate a clear deficit only in the lesions
of single nervous trunks.
The evaluation of the muscle functionality is expressed in a
numerical scale in which 5 indicates normality and O the to~al
absence of motion, the intermediate deficit degrees being indicated
with numbers between 0 and 5. As an example, let's consider a
patient showing a marked deficit (indicated with 2) of the deltoid-
, triceps brachii-, brachioradialis-, extensor digitorum-, abductor
pollicis longus-muscle. This situation is represented in the
following table l which reproduces section A of fig. 1. In the
third and in the sixth column the functionality evaluations for the
various muscles are reported.
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T.~BLE l: Test muscles, upper extreM1ty
Upper Trapezius ~T 5 Ulnar N.
Median " MT 5 Fle;cor Carpi FCU 5
Ulnaris
Lower " LT 5 Flexor Digitorum FP III-IV
Profundus III-IV
Serratus Anterior SA ; Abductor Digiti ADM 5
min:imi
Deltoid (C5) D 2 First Dorsal FDI
Interosseus
Infraspinatus (C5) IF 5 Adductor Pollicis AP
Biceps Br. (C6) BB 5 Radialis N.
Median N. Triceps Br.(C7) TB 2
Flexor Carpi Rad. FCR 5 Brachioradialis BR 2
~C6)
Flexor Digitorum FDS 5 Extensor Carpi ECP 2
Sup. Rad.
Flexor Digitorum FP I~II 5 Extensor Digitorum ED 2
15 Profundus I-II
Flexor Pollicis FPL 5 Abductor Pollicis APL 2
Longus Longus
Abductor Pollicis APB 5
Brevis
0=no contraction; l=Flicker or trace of contraction; 2=Actlve
movement with gravity eliminated; 3=Active movement agains~
gravity; 4=Active movement against gravit and resistance: 5=~orma~
power
The related lesion site is identified in the case which contains
all and only the deterior~ted muscles of diagram l which reproduces
section B of fig. l.
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WO 91/()g70' r~cr/Er~so/0~232
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In the specific examples the lesion is located in correspondence of
the brachial plexus posterior cord (PC).
In another case. the patient shows 5 deficit of the
brachioradialis-(BR), extensor carpi radialis- (ECR), extensor
digitorum-(ED); abductor Pollicis Longus (APL) muscles.
In diagram 1 one finds that said muscles are grouped in the case
corresponding to the spiral groove and therefore the lesion site
is the radial nerve at the level of the spiral groove.
In ~ection C of figure 1 are listed the test muscles for the lower
extremity innervation and in section D a graph of the lumbosacrsl
plexus distribution is represented.
For this sections the considerations made for section A and B
apply, both as to the interpretation and the use for diagnostic
ends.
In the following table 2 the list of section C is reproduced.
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TAf3LE 2
TEST MUSCLES LOWER EXTREMITY
Adductor Longus (L3) AL Common Peroneal N.
Iliopsoas (L3) IP Peroneus longus PL
5 Rectus Femoris (L4) RF Tibialis Anterior TA
Biceps Femoris BF Extensor Digitorum EDL
Longus (L5)
Tibial N. f~tensor Hallucis EHL
Longus
Medial Gastoonemius MG Cluteus medius CMe
Flexor Hallucis FHB Cluteus maximus CMa
Brevis
Diagram 2 reproduces the graph of saction B.
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On the back of the foldable card of the present inventlon
schematic drawings of the brachial- and of` the lumbosacral- plexus
are reported with the indication of the various nerve trunks, the
summary of its contents as well as the instructions for its use.
