Friedenberg S M, Hermann R C
Department of Neurology, Geisinger Medical Center, Danville, Pennsylvania 17822, USA.
J Neurol Neurosurg Psychiatry. 2004 Jan;75(1):158-60.
It has been found that in cases of obstetric brachial plexopathy, injured phrenic nerve or C3/4/5 roots may sprout into the adjacent injured upper and middle trunks of the brachial plexus. This aberrant regeneration produces co-contraction of the diaphragm and proximal upper limb muscles. This phenomenon, referred to as respiratory synkinesis or "the breathing arm", may not be limited to the upper cervical roots. We present two cases, identified through electromyographic investigations, of respiratory synkinesis selectively affecting intrinsic hand muscles, and propose that upper thoracic roots and their intercostal nerves may also produce respiratory synkinesis, resulting in a "breathing hand." This novel brand of synkinesis indicates that obstetric brachial plexus neuropathies can have quite proximal nerve injury in all trunks. The findings in our patients may not be entirely unique. The time required to develop distal muscle synkinesis and the subtle nature of our findings may suggest that with time and the assistance of EMG the breathing hand may be more common. When considering brachial plexus surgery, the significance of respiratory synkinesis should not be overlooked as its presence indicates injury at a root or proximal trunk level and may come from either nerves destined for the diaphragm or for the intercostal muscles.
已发现，在产科臂丛神经病变的病例中，受损的膈神经或C3/4/5神经根可能会向相邻受损的臂丛上、中干发出新芽。这种异常再生会导致膈肌和上肢近端肌肉共同收缩。这种现象，称为呼吸联带运动或“呼吸臂”，可能并不局限于颈上部神经根。我们报告了两例通过肌电图检查确诊的、呼吸联带运动选择性影响手部固有肌的病例，并提出胸上部神经根及其肋间神经也可能产生呼吸联带运动，导致“呼吸手”。这种新型的联带运动表明，产科臂丛神经病变可能在所有干中都存在相当近端的神经损伤。我们患者的发现可能并非完全独特。出现远端肌肉联带运动所需的时间以及我们发现的细微性质可能表明，随着时间推移并借助肌电图检查，“呼吸手”可能更为常见。在考虑臂丛神经手术时，呼吸联带运动的重要性不应被忽视，因为其存在表明在神经根或近端干水平存在损伤，且可能源于支配膈肌或肋间肌的神经。
