
Hemispherics es un podcast dirigido a profesionales de la neurorrehabilitacion
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#92: Plexopatías braquiales desde la neurorrehabilitación – Hemispherics
En este episodio nos adentramos en uno de los territorios más complejos del sistema nervioso periférico adulto: las plexopatías braquiales. ¿Qué significa realmente que el plexo se lesione? ¿Es solo un cable roto o algo mucho más complejo?
Exploramos cómo se organiza un nervio, qué ocurre en lesiones por tracción, compresión o inflamación y por qué muchas plexopatías son auténticos mosaicos intraneurales. Revisamos las clasificaciones de Seddon, Sunderland, el grado VI de Mackinnon y la clasificación quirúrgica por niveles de Chuang, entendiendo que no es solo anatomía, sino estrategia y pronóstico.
Hablamos de degeneración Walleriana, regeneración axonal, diferencias entre lesiones pre y postganglionares, prioridades reconstructivas y del papel clave de la neurorrehabilitación tras las transferencias nerviosas. Porque integrar cirugía, electrodiagnóstico y rehabilitación es esencial para comprender realmente el plexo braquial desde una mirada clínica y neurofisiológica.
Referencias del episodio:
1. Baradaran, A., El-Hawary, H., Efanov, J. I., & Xu, L. (2021). Peripheral Nerve Healing: So Near and Yet So Far. Seminars in plastic surgery, 35(3), 204–210. https://doi.org/10.1055/s-0041-1731630 (https://pubmed.ncbi.nlm.nih.gov/34526869/).
2. Chaudhry, V., & Cornblath, D. R. (1992). Wallerian degeneration in human nerves: serial electrophysiological studies. Muscle & nerve, 15(6), 687–693. https://doi.org/10.1002/mus.880150610 (https://pubmed.ncbi.nlm.nih.gov/1324426/).
3. Chim, H., & Hagan, R. R. (2024). Consensus Recommendations for Neurogenic Thoracic Outlet Syndrome from the INTOS Workgroup. Plastic and reconstructive surgery. Global open, 12(8), e6107. https://doi.org/10.1097/GOX.0000000000006107 (https://pubmed.ncbi.nlm.nih.gov/39206209/).
4. Chuang D. C. (2010). Brachial plexus injury: nerve reconstruction and functioning muscle transplantation. Seminars in plastic surgery, 24(1), 57–66. https://doi.org/10.1055/s-0030-1253242 (https://pmc.ncbi.nlm.nih.gov/articles/PMC2887004/).
5. Fisher, S., Wadhwa, V., Manthuruthil, C., Cheng, J., & Chhabra, A. (2016). Clinical impact of magnetic resonance neurography in patients with brachial plexus neuropathies. The British journal of radiology, 89(1067), 20160503. https://doi.org/10.1259/bjr.20160503 (https://pubmed.ncbi.nlm.nih.gov/27558928/).
6. Grinsell, D., & Keating, C. P. (2014). Peripheral nerve reconstruction after injury: a review of clinical and experimental therapies. BioMed research international, 2014, 698256. https://doi.org/10.1155/2014/698256 (https://pubmed.ncbi.nlm.nih.gov/25276813/).
7. Massie, R., Mauermann, M. L., Staff, N. P., Amrami, K. K., Mandrekar, J. N., Dyck, P. J., Klein, C. J., & Dyck, P. J. (2012). Diabetic cervical radiculoplexus neuropathy: a distinct syndrome expanding the spectrum of diabetic radiculoplexus neuropathies. Brain : a journal of neurology, 135(Pt 10), 3074–3088. https://doi.org/10.1093/brain/aws244 (https://pubmed.ncbi.nlm.nih.gov/23065793/).
8. Novak C. B. (2008). Rehabilitation following motor nerve transfers. Hand clinics, 24(4), 417–vi. https://doi.org/10.1016/j.hcl.2008.06.001 (https://pubmed.ncbi.nlm.nih.gov/18928890/).
9. Larkin, M. B., Goethe, E. A., Mohammad, M., Tummala, S., & North, R. Y. (2023). Ulnar fascicle to brachialis branch of musculocutaneous nerve for restoration of elbow flexion associated with spinal cord tumor and radiation-induced lower motor neuron disease. Neurosurgical focus: Video, 8(1), V9. https://doi.org/10.3171/2022.10.FOCVID2299 (https://pubmed.ncbi.nlm.nih.gov/36628102/).
10. Ray, W. Z., & Mackinnon, S. E. (2010). Management of nerve gaps: autografts, allografts, nerve transfers, and end-to-side neurorrhaphy. Experimental neurology, 223(1), 77–85. https://doi.org/10.1016/j.expneurol.2009.03.031 (https://pubmed.ncbi.nlm.nih.gov/19348799/).
11. Rocks, M. C., Comunale, V., Sanchez-Navarro, G. E., Nicholas, R. S., Hacquebord, J. H., & Adler, R. S. (2025). Diagnostic Capability of Ultrasonography in Evaluating Peripheral Nerve Injuries of the Brachial Plexus. Hand (New York, N.Y.), 20(8), 1252–1258. https://doi.org/10.1177/15589447241277844 (https://pubmed.ncbi.nlm.nih.gov/39289880/).
12. Rubin D. I. (2020). Brachial and lumbosacral plexopathies: A review. Clinical neurophysiology practice, 5, 173–193. https://doi.org/10.1016/j.cnp.2020.07.005 (https://pubmed.ncbi.nlm.nih.gov/32954064/).
13. Sakellariou, V. I., Badilas, N. K., Mazis, G. A., Stavropoulos, N. A., Kotoulas, H. K., Kyriakopoulos, S., Tagkalegkas, I., & Sofianos, I. P. (2014). Brachial plexus injuries in adults: evaluation and diagnostic approach. ISRN orthopedics, 2014, 726103. https://doi.org/10.1155/2014/726103 (https://pubmed.ncbi.nlm.nih.gov/24967130/).
14. Schierle, C., & Winograd, J. M. (2004). Radiation-induced brachial plexopathy: review. Complication without a cure. Journal of reconstructive microsurgery, 20(2), 149–152. https://doi.org/10.1055/s-2004-820771 (https://pubmed.ncbi.nlm.nih.gov/15011123/).
15. Segal, D., Cornwall, R., & Little, K. J. (2019). Outcomes of Spinal Accessory-to-Suprascapular Nerve Transfers for Brachial Plexus Birth Injury. The Journal of hand surgery, 44(7), 578–587. https://doi.org/10.1016/j.jhsa.2019.02.004 (https://pubmed.ncbi.nlm.nih.gov/30898464/).
16. Sturma, A., Hruby, L. A., Farina, D., & Aszmann, O. C. (2019). Structured Motor Rehabilitation After Selective Nerve Transfers. Journal of visualized experiments : JoVE, (150), 10.3791/59840. https://doi.org/10.3791/59840 (https://pubmed.ncbi.nlm.nih.gov/31475970/).
17. Tjoumakaris, F. P., Anakwenze, O. A., Kancherla, V., & Pulos, N. (2012). Neuralgic amyotrophy (Parsonage-Turner syndrome). The Journal of the American Academy of Orthopaedic Surgeons, 20(7), 443–449. https://doi.org/10.5435/JAAOS-20-07-443 (https://pubmed.ncbi.nlm.nih.gov/22751163/).
18. Vancea, C. V., Hodea, F. V., Bordeanu-Diaconescu, E. M., Cacior, S., Dumitru, C. S., Ratoiu, V. A., Stoian, A., Lascar, I., & Zamfirescu, D. (2025). Functional outcomes following nerve transfers for shoulder and elbow reanimation in brachial plexus injuries: a 10-year retrospective study. Journal of medicine and life, 18(4), 375–386. https://doi.org/10.25122/jml-2025-0079 (https://pubmed.ncbi.nlm.nih.gov/40405933/).
19. Van Eijk, J. J., Groothuis, J. T., & Van Alfen, N. (2016). Neuralgic amyotrophy: An update on diagnosis, pathophysiology, and treatment. Muscle & nerve, 53(3), 337–350. https://doi.org/10.1002/mus.25008 (https://pubmed.ncbi.nlm.nih.gov/26662794/).
20. Wade, R. G., Takwoingi, Y., Wormald, J. C. R., Ridgway, J. P., Tanner, S., Rankine, J. J., & Bourke, G. (2019). MRI for Detecting Root Avulsions in Traumatic Adult Brachial Plexus Injuries: A Systematic Review and Meta-Analysis of Diagnostic Accuracy. Radiology, 293(1), 125–133. https://doi.org/10.1148/radiol.2019190218 (https://pubmed.ncbi.nlm.nih.gov/31429680/).
21. Willmott, A. D., White, C., & Dukelow, S. P. (2012). Fibrillation potential onset in peripheral nerve injury. Muscle & nerve, 46(3), 332–340. https://doi.org/10.1002/mus.23310 (https://pubmed.ncbi.nlm.nih.gov/22907222/).
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