{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:50:51Z","timestamp":1786125051718,"version":"build-2736575974"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["NEUROSURGERY","NEUROS"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Psychiatric patients are often kept immobilized during hospitalization to avoid self-inflicted injuries and danger to third parties. Inadequate positioning can lead to brachial plexus injuries (BPI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To present a series of 5 psychiatric patients with BPI after being left sedated and restrained for prolonged periods of time during hospitalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We retrospectively reviewed the charts of 5 psychiatric patients with iatrogenic BPI referred by other institutions to our service. The restraint technique adopted by those institutions consisted of a high-thoracic restraint. All patients underwent complete clinical and neurological examination at our center. Information concerning patient demographics, BPI characteristics, treatment choice, and ultimate outcome was recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Three patients were male. The age of our patients ranged from 25 to 61 years old (mean: 41.2; median: 43). Three patients had a diagnosis of bipolar disorder while 2 had schizophrenia. Duration of immobilization ranged from 5 to 168 h (mean: 77.8; median: 72). Four patients presented with a unilateral right-sided lesion. Time to presentation ranged from 1 to 9 mo (mean: 4.2; median: 4). All patients also had intense pain and axillary lesions. Four patients received conservative treatment with partial or full functional recovery and complete pain resolution. The remaining patients underwent surgical repair and experienced good functional outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Psychiatric patients who need to be sedated and immobilized must be monitored closely, as BPI can occur from high-thoracic restraints. When such an injury occurs, the patient must be referred to a center specialized in peripheral nerve surgery and rehabilitation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuros\/nyx162","type":"journal-article","created":{"date-parts":[[2017,3,10]],"date-time":"2017-03-10T23:41:29Z","timestamp":1489189289000},"page":"307-311","source":"Crossref","is-referenced-by-count":7,"title":["A Neglected Cause of Iatrogenic Brachial Plexus Injuries in Psychiatric Patients"],"prefix":"10.1227","volume":"82","author":[{"given":"Jos\u00e9\u00a0Fernando","family":"Guedes-Corr\u00eaa","sequence":"first","affiliation":[{"name":"Division of Neurosurgery. Gaffr\u00e9e e Guinle University Hospital, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil"},{"name":"Deolindo Couto Neurology Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maristella Reis da Costa","family":"Pereira","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery. Gaffr\u00e9e e Guinle University Hospital, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco Jos\u00e9 Louren\u00e7o","family":"Torr\u00e3o-Junior","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery. Gaffr\u00e9e e Guinle University Hospital, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Vicente","family":"Martins","sequence":"additional","affiliation":[{"name":"Deolindo Couto Neurology Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Alves Neiva","family":"Barbosa","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery. Gaffr\u00e9e e Guinle University Hospital, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,3]]},"reference":[{"issue":"2","key":"bib1-20231011","first-page":"Cd001163","article-title":"Seclusion and restraint for people with serious mental illnesses","author":"Sailas","year":"2000","journal-title":"Cochrane Database Syst Rev"},{"issue":"16","key":"bib2-20231011","first-page":"273","article-title":"Iatrogenic nerve injuries: prevalence, diagnosis and treatment","volume":"111","author":"Antoniadis","year":"2014","journal-title":"Dtsch \u00c4rztebl Int"},{"issue":"1","key":"bib3-20231011","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1097\/00000542-200207000-00011","article-title":"Positioning in anesthesiology: toward a better understanding of stretch-induced perioperative neuropathies","volume":"97","author":"Coppieters","year":"2002","journal-title":"Anesthesiology"},{"issue":"2","key":"bib4-20231011","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1007\/s00540-003-0220-6","article-title":"Brachial plexus injury related to improper positioning during general anesthesia","volume":"18","author":"Ngamprasertwong","year":"2004","journal-title":"J Anesth"},{"issue":"10","key":"bib5-20231011","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1046\/j.1365-2044.2000.01614.x","article-title":"Peripheral nerve injuries associated with anaesthesia","volume":"55","author":"Sawyer","year":"2000","journal-title":"Anaesthesia"},{"issue":"1","key":"bib6-20231011","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.nec.2008.07.025","article-title":"Iatrogenic nerve injuries","volume":"20","author":"Kretschmer","year":"2009","journal-title":"Neurosurg Clin N Am"},{"issue":"1","key":"bib7-20231011","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/S0733-8619(05)70367-4","article-title":"Iatrogenic nerve injuries","volume":"16","author":"Wilbourn","year":"1998","journal-title":"Neurol Clin"},{"issue":"4","key":"bib10-20231011","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1002\/nur.4770130405","article-title":"A critical review of visual analogue scales in the measurement of clinical phenomena","volume":"13","author":"Wewers","year":"1990","journal-title":"Res Nurs Health"},{"issue":"5","key":"bib11-20231011","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/J.JHSB.2004.02.008","article-title":"The two-point discrimination test\u2013time for a re-appraisal?","volume":"29","author":"Lundborg","year":"2004","journal-title":"J Hand Surg Br"},{"issue":"3","key":"bib12-20231011","doi-asserted-by":"crossref","first-page":"427","DOI":"10.3109\/00048679709073855","article-title":"Bilateral ulnar nerve paralysis: an unreported complication of drug-induced extrapyramidal rigidity","volume":"31","author":"Sampath","year":"1997","journal-title":"Aust N Z J Psychiatry"},{"issue":"2","key":"bib13-20231011","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/0735-6757(90)90200-J","article-title":"Subclavian artery false aneurysm associated with brachial plexus palsy: a complication of parenteral drug addiction","volume":"8","author":"O\u2019Leary","year":"1990","journal-title":"Am J Emerg Med"},{"issue":"6 suppl","key":"bib14-20231011","doi-asserted-by":"crossref","first-page":"S196","DOI":"10.2214\/AJR.05.1014","article-title":"Imaging the anatomy of the brachial plexus: review and self-assessment module","volume":"185","author":"Castillo","year":"2005","journal-title":"AJR Am J Roentgenol."},{"issue":"5","key":"bib15-20231011","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/S0196-0644(89)80850-9","article-title":"Anterior dislocation of the shoulders with bilateral brachial plexus injury","volume":"18","author":"Mehta","year":"1989","journal-title":"Ann Emerg Med"},{"issue":"12","key":"bib17-20231011","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1136\/jnnp-2013-306637","article-title":"Brachial palsy after deep sleep","volume":"85","author":"Di Lazzaro","year":"2014","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"12","key":"bib18-20231011","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1136\/jnnp.40.12.1160","article-title":"Electrophysiological findings in pressure palsy of the brachial plexus","volume":"40","author":"Trojaborg","year":"1977","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"5","key":"bib19-20231011","first-page":"1","article-title":"Infraclavicular brachial plexus stretch injury","volume":"16","author":"Kim","year":"2004","journal-title":"Neurosurg Focus"},{"issue":"2","key":"bib20-20231011","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1302\/0301-620X.55B2.390","article-title":"Effects of stretching the tibial nerve of the rabbit. A preliminary study of the intraneural circulation and the barrier function of the perineurium","volume":"55","author":"Lundborg","year":"1973","journal-title":"J Bone Joint Surg Br."},{"issue":"12","key":"bib21-20231011","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.1016\/S0003-9993(96)90200-2","article-title":"Vest restraint palsy","volume":"77","author":"Bromberg","year":"1996","journal-title":"Arch Phys Med Rehabil"},{"issue":"9","key":"bib22-20231011","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1056\/NEJM198903023200917","article-title":"Brachial plexus injury due to vest restraints","volume":"320","author":"Scott","year":"1989","journal-title":"N Engl J Med"},{"issue":"7","key":"bib23-20231011","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1136\/jnnp.44.7.621","article-title":"Brachial plexus injury after median sternotomy","volume":"44","author":"Graham","year":"1981","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"5","key":"bib24-20231011","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1212\/WNL.39.5.736","article-title":"Brachial plexus injury following liver transplantation","volume":"39","author":"Katirji","year":"1989","journal-title":"Neurology"},{"issue":"1","key":"bib25-20231011","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1046\/j.1524-4741.2003.09114.x","article-title":"Bilateral brachial plexus palsy after a right-side modified radical mastectomy with immediate TRAM flap reconstruction","volume":"9","author":"Grunwald","year":"2003","journal-title":"Breast J."}],"container-title":["Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/neurosurgery\/article-pdf\/82\/3\/307\/32600329\/nyx162.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/00006123-201803000-00016","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:49:33Z","timestamp":1786121373000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00006123-201803000-00016"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,5,18]]},"references-count":22,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.1093\/neuros\/nyx162","relation":{},"ISSN":["0148-396X","1524-4040"],"issn-type":[{"value":"0148-396X","type":"print"},{"value":"1524-4040","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,5,18]]}}}