2-point Discrimination Test Research Articles

Nerve conduits for treating peripheral nerve injuries: A systematic literature review

Peripheral nerve injuries are a major public health problem. Nerve conduits have been developed in the recent years, although it is still not clear if they should replace nerve grafting and neurorrhaphy. This systematic review aims to gather evidence regarding the use of nerve conduits for peripheral nerve repair.The following electronic databases were searched: MEDLINE, Cochrane Library (CENTRAL) and Embase. Study selection and data extraction followed the PRISMA guidelines.The systematic review of the literature retrieved 6767 articles. Only 27 studies were retained accounting for 1022 patients: 10 randomized controlled trials, 15 case series and 2 cohort studies. Ten different types of tubes were described and a variety of evaluation methods were used to assess outcomes in terms of efficacy (motor and sensory recovery) and complications. The Semmes–Weinstein monofilament test and the static and moving 2-point discrimination test were the most commonly applied tests to evaluate nerve recovery. In general, outcomes showed no significant difference between groups. Synthetic conduits had more complications.Despite major methodological limitations in the studies, we can conclude that use of nerve conduits is preferable over suture repair and nerve grafting, as the functional recovery rates are above 80%. The choice of conduit is based on the surgeon's expertise, but use of synthetic conduits is discouraged due to their higher complication rates.

Determining the functional sensibility of the hand in patients with peripheral nerve repair: Feasibility of using a novel manual tactile test for monitoring the progression of nerve regeneration

Study DesignCase-controlled cohort study. IntroductionSensory function is difficult to observe during nerve regeneration processes. Traditional sensory tests are limited to identifying the level of functioning hand sensation for sensory stimulus is given passively to the cutaneous surface of the hand. Purpose of the StudyTo examine the outcome changes in the manual tactile test (MTT), Semmes–Weinstein monofilament (SWM) and 2-point discrimination (2PD) tests for patients with nerve repair and to investigate the concurrent validity of MTT by comparing it with the results of traditional tests. MethodsFifteen patients with nerve injury of the upper limbs were recruited, along with 15 matched healthy controls. The MTT, SWM, and 2PD tests were used to examine the sensory status of the subjects. ResultsThree subtests (barognosis, roughness differentiation, and stereognosis) in MTT showed that the patients improved with time. A moderate and mild correlation was found between the MTT and 2PD results and between the barognosis and SWM results. ConclusionsThe MTT provides practical and functional perspectives on detecting nerve progression during the courses of degeneration and regeneration. Level of EvidenceIV.

Pulp Rotation Flap for Lateral Oblique Fingertip Defects

Fingertip amputations are among the most common injuries seen in the hand. According to the geometry of the amputation, it may be classified as transverse or oblique (dorsal, volar, or lateral type). Although numerous repair techniques have been described in the literature, there are few alternatives suitable for lateral oblique type fingertip amputations. Between 2012 and 2016, we operated on 16 patients with simple rotation flap from the remaining part of the pulpa in a rotation and advancement manner for the reconstruction of lateral oblique type fingertip amputations. All but two of the flaps healed completely with full flap survival. Superficial distal flap necrosis was observed in two patients. They healed by secondary intention. No obvious hooked nail occurred in patients. Cold intolerance was observed in one patient; joint stiffness or hypersensitivity was not observed in any of the patients. Stiffness of the proximal interphalangeal joint did not occur. Two point discrimination test results were found to be normal. This technique is simple, rapid, and free from relatively major complications. This flap allows for anatomical reconstruction of the fingertip by using a similar tissue in cases of lateral oblique fingertip amputations, where only a few flap options can be successful.

Fingertip replantation (zone I) without venous anastomosis: clinical experience and outcome analysis.

PurposeThe purpose of this study was to report our experience of fingertip replantation without venous anastomosis using alternate method to counter post-operative venous congestion.Methods30 Patients (18 men and 12 women) with 30 fingertip amputations (Tamai zone I) were treated with artery-only anastomosis fingertip replantation between March 2010 and July 2014. Postoperative venous outflow was maintained by allowing bleeding through wound gaps combined with topical (12500u:250mlNS) and systemic (4000 IU SC once daily) heparin. The outcomes of replantation were evaluated using standard evaluating systems.ResultsThe average duration of hospital stay was 10 days (range 7–14 days). Twenty-eight (93 %) replanted fingertips survived. Five replanted fingertip experienced postoperative vascular crisis. The estimated post-operative blood loss was about 200–450 ml (mean, 292 ml). Follow-up period ranged from 12 to 24 months (average, 18 months). At final follow-up examinations, the average value of static two point discrimination test was 5.6 mm (range 3–9 mm) and Semmes–Weinstein monofilament test was 3.35 g (range 2.83–4.56 g). The mean range of motion of distal interphalangeal joint was 65.2° (range 0–90°) and all patients returned to their work within 7–18 weeks (average, 11 weeks).ConclusionArtery-only fingertip replantation can provide satisfactory cosmetic and functional results. Adequate venous outflow can be obtained by allowing minimal external bleeding through wound gaps combined with topical and systemic heparin.

Reconstruction of totally degloved fingers: a novel application of the bilobed spiraled innervated radial artery superficial palmar branch perforator flap design provides for primary donor-site closure.

To investigate the results of resurfacing completely degloved digits using bilobed innervated radial artery superficial palmar branch (RASPB) perforator flap in a spiral fashion. A detailed anatomic study on 30 adult fresh frozen cadavers preinjected with silicone rubber compound to demarcate arterial anatomy documented locations, numbers, and diameters of arteries and skin perforators with surrounding nerves. The flap-raising procedure was performed using four fresh cadaver specimen. We reviewed the reconstruction of 12 digits by using a bilobed spiraled innervated RASPB free perforator flap after non-replantable degloving injury. Two skin paddles were marked out using standard points of reference. At least two separate cutaneous perforator vessels were identified using a hand-held Doppler and were dissected back to the RASPB in retrograde fashion. The skin paddles were then divided between the two cutaneous perforators to provide two separate paddles with a common vascular supply. The skin paddles were stacked in a spiral fashion on the flap inset, effectively increasing the width of the flap to cover the totally degloved finger while still allowing closure of the primary donor-site. The RASPB was present within the flap in all cadavers. The direct perforator and the musculocutaneous perforator were available in 93.33 and 76.67%, respectively, with neither of them in 6.67% of the cases. The constantly present two perforators allowed the design of a new bilobed spiraled innervated radial artery superficial palmar branch perforator flap. We used the proposed flap to reconstruct completely degloved digits in 12 patients (mean age 28.6years; range 17-35years). With our proposed flap, no flap failure or re-exploration occurred and the donor site was closed primarily in all cases. All the flaps survived uneventfully. Total active motion ranged from 92° to 140° and 111° to 155° in the cases with and without metacarpophalangeal joint involvement, respectively. The static 2 point discrimination test varied from 6 to 11mm. All the patients were satisfied with the overall results. The bilobed flap is large enough to cover totally degloved finger defects and contain direct skin perforators, provides a bespoke cover for complex soft tissue defects of completely degloved digits while also improving morbidity and cosmesis of the donor site. Level IV, retrospective series.

Upper Extremity Disability Is Associated With Grip Strength and Psychological Stress in Carpal Tunnel Syndrome According to a Patient-reported Questionnaire

Objective: We investigated which clinical factors influenced upper extremity disability in carpal tunnel syndrome (CTS). Materials and Methods: We analyzed 45 hands with CTS of patients enrolled in a prospective cohort study conducted from December 2012 to January 2015. The age among the participant group of 40 females and 5 males ranged from 30 to 86 (mean, 60.3 years). Forty-three patients were right-handed. Twenty-seven had bilateral CTS (36 hands). Operations were performed on 25 right and 20 left hands. Thirty-nine hands were classified as “Extreme CTS” (absence of median motor and sensory responses) according to the severity scale proposed by Padua. Hand10 was used as a validated upper-extremity disability assessment tool. Clinical assessments were comprised of patients’ characteristic, physical and psychological parameters. Patients’ characteristic consisted of age, body mass index, and duration of symptom. Physical parameters included grip strength, key pinch strength, pulp pinch strength, Semmes Weinstein Monofilament Test, static 2 point discrimination test (s2PD test), numerical rating scale for numbness, visual analogue scale for pain (pain VAS), and Japanese version of Short-Form McGill Pain Questionnaire (SF-MPQ). Psychological parameters included Japanese version of Self-rating Depression Scale, Japanese version of Pain Anxiety Symptom Scale–20 (PASS-20), and Stress Response Scale–18 (SRS-18). These assessments were conducted on the day before operation. Statistical Analysis: Factors that were significantly associated with Hand10 scores in bivariate analysis (Pearson correlation test or Spearman rank correlation test as appropriate) were entered into a multivariable analysis. A multiple regression analysis was used to identify factors that were independently associated with Hand10 scores. Results: Hand10 scores showed no statistical differences in terms of unilateral/bilateral CTS and sex differences. Single regression analysis showed that Hand10 scores correlated significantly with the pain VAS, SF-MPQ, PASS-20, SRS-18, s2PD at index and middle scores, and grip strength. Multiple regression analysis showed that grip strength ( B = 1.47, β = 0.49, P = .00) and SRS-18 score ( B = −0.91, β = −0.36, P = .02) were significant correlation factors for the Hand10 score ( R2 = 0.49). Conclusions: In patients with CTS, grip strength and psychological stress are significant correlating factors of disability according to a patient-administered upper extremity assessment.

Two Reverse Pedicle Flaps for Repairing Soft Tissue Defects of the Finger

Objective: The objective of this study was to evaluate and compare the effect of 2 reverse pedicle flaps for repairing soft tissue defects of the finger. Methods: In this prospective study, 46 patients with finger soft tissue defects planned for flap repair of soft tissue were enrolled from April 2011 to March 2015, and randomized to undergo either repair of reversed island flap pedicled on a perforating branch of the dorsal metacarpal artery in group A (25 cases) or retrograde island flap of dorsal branch of the proper digital artery in group B (21 cases). The survive rate, hand function, postoperative complications, and appearance were compared between the 2 groups. Results: Patients were followed up for an average of 18 months in group A while 15 months in group B. All flaps in both groups survived, with satisfactory sensory function. The 2-point discrimination testing of group A was from 6.0 to 9.0 mm (7.1 ± 0.5 mm) while it was from 4.0 to 7.0 mm (5.2 ± 0.4 mm) in group B, significantly superior to that of group A ( P < .05). Motion of finger interphalangeal joint in both groups was not significantly different, nor was affected in comparison with the healthy side. As for complications, 2 cases of early venous congestion and 2 cases of superficial skin necrosis occurred in group A while 1 case of flap blister occurred in group B. In addition, we observed that the appearance of the flap was 5mm higher than normal skin in 5 cases in group A, while only in one case in group B. The difference was significative ( P < .05). Conclusion: Both reverse pedicle flaps were safe and reliable for repairing finger defects, while in consideration of sensory function and appearance, retrograde island flap of dorsal branch of the proper digital artery may suit better in fingertip defects repair than reversed island flap pedicled on a perforating branch of the dorsal metacarpal artery.

Results of Major Upper Extremity Replantation or Revascularization

Objectives: Major upper extremity replantation is defined as replantation of limbs proximal to the wrist. Advancements of microsurgical techniques and equipment have improved functional results of major replantations. The goal of the treatment is to obtain a nearly normal functioning extremity with an acceptable cosmetic result. This study is to review our experience with major upper extremity replantations or revascularizations after complete or incomplete amputation injury performed from 2000 to 2013. This report provides an indirect comparative analysis of the functional results after major replantation versus previously published reports of arm transplantation in upper extremity. Materials and Methods: Twenty-five consecutive patients who underwent major upper extremity replantations or revascularizations were evaluated retrospectively in this study. The mean age at the time of surgery was 35.6 (range, 14-70) years. The mean follow-up was 34.4 (range, 7-85) months. There was no bilateral amputation. There were 4 complete amputations and 21 incomplete amputations. The mechanism of injury was crush-avulsion in 5, guillotine or deep laceration in 16, crush in 2, and avulsion in 2. There were 8 shoulder and upper arm level, 7 elbow and forearm level, and 10 distal forearm and wrist level amputations in upper extremities. Functional results were assessed using the Korean version of the Disabilities of the Arms, Shoulder and Hand (DASH) and the Chen criteria. Results: The mean ischemic time was 380.1 (range, 120-600) minutes. A total of 23 of 25 limbs survived. There were no significant differences in ischemia time between the 2 groups of patients with respect to limb survival. ( P = .273) The type of amputation and level of injury had no significant association with limb survival ( P = .65 and P = .076, respectively). In the upper extremity, the mean 2-point discrimination test result was 7.7 (range, 4-15) mm, mean visual analog score was 2.91 (range, 1-7), and mean DASH score was 13.2 (range, 2-85). When analyzed by the Chen criteria, there were 15 grade I, 3 grade II, 3 grade III, and 2 grade IV results. One of 2 patients with reperfusion events had proximal amputation. None of the patients developed nonunion or osteomyelitis. Twelve of the successful 23 replants underwent at least 1 secondary procedure. Ten of the successful replants had pain or cold intolerance, but improved with time, and all used the replanted arm for daily activities. Conclusions: The promising results achieved in our major upper extremity replantation or revascularization patients, which was in some respects superior to those in arm transplantation patients, lead us to recommend that replantations or revascularizations continue to be considered as first-line treatment.

V Advancement Flap for Fingertip Injury Preventing Necrosis and Hook Nail Deformity

Objectives: V-Y advancement flap has been a reliable method to reconstruct fingertip defect, since described by Tranquilli-Leali originally in 1935 and popularized by Atasoy later in 1970. But flap necrosis and hook nail deformity due to suture line tension have been pointed out as relatively common complications in V-Y advancement flap for fingertip reconstruction. Concern about this problems, several authors have been described a modification of this technique. The aim of this study was to describe our modification of V advancement flap based on V-Y concept and to review the outcome of this procedure for fingertip amputation in 28 patients. Materials and Methods: This study was conducted from January 2006 to February 2014 and involved 28 consecutive patients (20 men and 8 women; 30 fingertip amputations) with fingertip injury that were treated operatively with the same procedure. All patients with a fingertip defect of more than 1.0 cm2 in area from the tip to lunula were included in this study. The causes of injuries were crushing with or without avulsion in 21, amputation with sharp laceration in 8, and human bite in 1. Twenty-seven injuries were transverse or dorsal oblique type and 3 were mild volar oblique type. According to Allen’s classification, 18 cases were type 2, 11 were type 3, and 1 was type 1. To allow for a tension-free closure, the proximal incision was left unclosed to heal by secondary intension. In addition, the distal nail bed was supported and maintained eversion against base of the flap with a minimal number of horizontal mattress sutures, and there was no suture crossing over the top to prevent hook nail deformity. Postoperatively, dressing changes were performed once daily for 3 or 4 weeks until reepithelialization was observed. Results: The mean age of the patients was 43.6 years (range, 24-65 years). The average follow-up periods was 15 months (range, 12-37 months). All patients underwent objective and subjective assessment at 6 and 12 months routinely and at final follow-up. At final follow-up, all flap healed uneventfully. In objective evaluation with Semmes-Weinstein monofilaments test, 24 cases recognized the 2.83 monofilament (0.07 g), 6 cases recognized the 3.61 monofilament (0.4 g). In static 2-point discrimination test, the mean values were 4.61 mm in injured finger and 4.00 mm in contralateral finger. None of the patients developed a noticeable hook nail deformity. None of the patients complained of hypersensitive digit. However, 3 patients had some residual short nails and 2 patients had mild nail ridges. Patients’ subject rating of the outcome was recorded: “excellent,” “good,” “fair,” and “poor.” Excellent or good results were achieved in 28 cases. Two cases had fair results and none of the patients had a poor result. Conclusions: This modified V advancement flap technique, when properly designed and executed, can minimize morbidity and successfully results in good wound healing without necrosis and hook nail deformity for fingertip injury.

Reconstruction of totally degloved fingers with a spiraled parallelogram medial arm free flap

To investigate the therapeutic results of completely degloved digital injury using a parallelogram free flap from the medial arm in a spiral fashion. From January 2011 to June 2013,13 defects in 13 patients with non-replantable degloved digital injury were treated with a parallelogram free flap from the medial arm in a spiral fashion.The longitudinal axis of the flap was along the line from the axilla to the medial humeral epicondyle.The medial brachial cutaneous nerve of the arm was harvested for sensory restoration.The non-replantable degloved finger was reconstructed with the medial arm flap in a spiral fashion.The digital artery and dorsal veins were prepared as the recipient pedicle,and the medial brachial cutaneous nerve was sutured to the digital nerve stump.All the wounds at the donor sites were closed directly. The dimension of the flaps ranged from 5.0 cm × 2.0 cm to 7.5 cm × 4.0 cm.Excetp for one partial flap loss,all the other flaps survived uneventfully with conservative therapy.The static 2-point discrimination test varied from 6 to 13 mm.No linear scar contracture was recorded in these patients.All the patients were satisfied with the overall results. Resurfacing the defect in a spiral fashion is a valuable and reliable technique for the reconstruction of complete finger degloved injuries.The medial arm flap is a good option for this procedure,with satisfactory functional recovery and good aesthetic restoration.

A Multicenter, Prospective, Randomized, Pilot Study of Outcomes for Digital Nerve Repair in the Hand Using Hollow Conduit Compared With Processed Allograft Nerve.

Current repair options for peripheral nerve injuries where tension-free gap closure is not possible include allograft, processed nerve allograft, and hollow tube conduit. Here we report on the outcomes from a multicenter prospective, randomized, patient- and evaluator-blinded, pilot study comparing processed nerve allograft and hollow conduit for digital nerve reconstructions in the hand. Across 4 centers, consented participants meeting inclusion criteria while not meeting exclusion criteria were randomized intraoperatively to either processed nerve allograft or hollow conduit. Standard sensory and safety assessments were conducted at baseline, 1, 3, 6, 9, and 12 months after reconstruction. The primary outcome was static 2-point discrimination (s2PD) testing. Participants and assessors were blinded to treatment. The contralateral digit served as the control. We randomized 23 participants with 31 digital nerve injuries. Sixteen participants with 20 repairs had at least 6 months of follow-up while 12-month follow-up was available for 15 repairs. There were no significant differences in participant and baseline characteristics between treatment groups. The predominant nerve injury was laceration/sharp transection. The mean ± SD length of the nerve gap prior to repair was 12 ± 4 mm (5-20 mm) for both groups. The average s2PD for processed allograft was 5 ± 1 mm (n = 6) compared with 8 ± 5 mm (n = 9) for hollow conduits. The average moving 2PD for processed allograft was 5 ± 1 mm compared with 7 ± 5 mm for hollow conduits. All injuries randomized to processed nerve allograft returned some degree of s2PD as compared with 75% of the repairs in the conduit group. Two hollow conduits and one allograft were lost due to infection during the study. In this pilot study, patients whose digital nerve reconstructions were performed with processed nerve allografts had significantly improved and more consistent functional sensory outcomes compared with hollow conduits.

Innervated Digital Artery Perforator Flap: A Versatile Technique for Fingertip Reconstruction

To demonstrate the advanced use of innervated digital artery perforator (IDAP) flaps for fingertip reconstruction. From August 2011 to May 2014, 65 fingers (59 patients) underwent fingertip or finger stump reconstruction using IDAP flaps. Sixty-one fingers from 55 patients who were followed up for more than 6 months were included in this study. The objective outcomes of patient evaluations consisted of the results of static 2-point discrimination tests, Semmes Weinstein monofilament tests, and extension loss tests. The subjective patient outcome evaluations consisted of the results of hypersensitivity and cold intolerance tests and patient satisfaction. All flaps survived completely, and no patients required early secondary interventions. The mean follow-up period was 18 months (range, 6-36 months). The static 2-point discrimination in the flaps ranged from 2 to 6 mm (mean, 3.5 mm) compared with a range of 2 to 3 mm (mean, 2.5 mm) in the contralateral hands. The Semmes Weinstein monofilament test results ranged from 0.07 to 1.4 g compared with 0.04 to 0.4 g for the contralateral hand. One patient exhibited mild extension loss in the reconstructed finger, 4 patients experienced mild cold intolerance, and 2 patients exhibited mild hypersensitivity. The IDAP flaps are sensitive, reliable, and versatile and should be considered for reconstructing acute fingertip defects. The use of IDAP flaps for revisions of previously reconstructed defects is also possible. Therapeutic IV.

The Extended Flexor Carpi Radialis Approach for Concurrent Carpal Tunnel Release and Volar Plate Osteosynthesis for Distal Radius Fracture

To determine the relative benefits of an extended flexor carpi radialis (FCR) (eFCR) approach with prophylactic carpal tunnel release at the time of volar plate osteosynthesis for distal radius fracture via a single incision into the traditional volar Henry (VH) approach. This was a prospective cohort comparison of preoperative and postoperative median nerve function of 27 patients (15 eFCR and 12 VH) with unilateral, isolated distal radius fractures requiring open reduction internal fixation without preoperative acute carpal tunnel syndrome. Patients were operated on via either the eFCR or VH approach. The validated Levine-Katz Carpal Tunnel Questionnaire (symptom and functional severity scores) was administered and Semmes-Weinstein monofilament and 2-point discrimination testing were conducted preoperatively and at 6 weeks and 3 months postoperatively. Grip and pinch strength were measured at 6 weeks and 3 months. The groups were comparable in terms of age, sex, and fracture type and displacement. Comparing across groups, there were no statistically significant differences in any outcome measured preoperatively or postoperatively. The eFCR and VH groups demonstrated significant improvement in functional severity scores, symptom severity, and grip strength. The symptom severity score improved to statistical significance at 6 weeks in the eFCR group and at 3 months in the VH group. In this small comparative study, the eFCR approach was found to be safe and efficacious. There was no increased surgical morbidity, which suggests that this technique can be used safely for all patients undergoing volar plating and not just in cases of concurrent carpal tunnel syndrome. It allows easier retraction of carpal tunnel contents; therefore, it is our preferred approach.

Mini-open double-incision technique versus limited-open technique for carpal tunnel release: A prospective double-cohort study

Background There is no universal agreement on the effectiveness and safety of various methods for carpal tunnel release, and their numerous modifications. Multiple minimally invasive techniques have been proposed to decrease postoperative morbidity. However, there are concerns regarding the risk for neurovascular injury and incomplete decompression. Patients and methods To evaluate the safety and efficacy of carpal tunnel release using a mini-open, blind, double-incision technique (group I) versus the limited-open technique (group II), a prospective double-cohort study on a total of 90 consecutive patients presenting with idiopathic carpal tunnel syndrome resistant to conservative treatment was conducted. Safety was measured by the prevalence of complications and revision surgery, whereas efficacy was measured by the Boston Carpal Tunnel Syndrome Questionnaire, pinch grip strength, the static 2-point discrimination test, and patient satisfaction with the cosmetic result of the procedure. Results All parameters (except the median pinch strength at 1 month) showed progressive postoperative improvement, with no significance difference between the two groups. The mini-open, blind, double-incision technique resulted in a higher degree of postoperative patient satisfaction with the cosmetic result, fewer surgical site complications and less painful scar, shorter operative time, and earlier restoration of pinch grip strength. This, however, did not translate directly into Levine functional and symptom scores that differed significantly between the two groups. Conclusion Both techniques described in the study led to good, comparable clinical results. However, experience with the mini-open double-incision technique is encouraging as it represents a safe and effective line of management for idiopathic carpal tunnel syndrome.

Reconstruction of the transverse and dorsal-oblique amputations of the distal thumb with volar cross-finger flap using the index finger.

We performed a retrospective review of 12 patients with dorsal oblique and transverse amputations of the distal thumb who were treated with a volar cross-finger flap from the index finger. The mean patient follow-up period was 28 months postoperatively (range: 19-43 months). There were no instances of flap loss, infection, or donor site complication in our series. The mean Semmes-Weinstein monofilament testing scores on the injured thumb and the donor site were 0.65 g (range: 0.16-2 g) and 0.51 g (range: 0.16-1 g), respectively. The mean 2-point discrimination testing scores on the injured thumb and the donor site were 4.5 mm (range: 3-8 mm) and 4.3 mm (range: 3-7 mm), respectively. This study suggests that the volar cross-finger flap using the index finger is a reliable technique in repairing dorsal oblique and transverse amputations of the distal thumb. Therapeutic IV.

Studies on the sensory nerve action potentials of lingual nerve

Lingual nerve (LN) injury is common trauma disease in the field of oral surgery such as an iantrogenic injury during the third molar extration. The early diagnose and proper treatment lead to good convalescence for nerve regeneration. In order to identify the symptoms associated with LN injury, and the subjective symptoms such as the sensory tests were recorded. In addition, the 2-point discrimination, pain and temperature tests and the SW (Semmes Weinstein pressure) esthesiometer which performs a tactile threshold test (SW test) were used. In case of inferior alveolar nerve (IAN), it is generally possible to diagnose by using X-ray and CT that can which easily to image a mandibular canal damage. However LN injury is difficult to be diagnosed the degree of damage because it is surrounded by soft tissue. Our recently study proved a sensory nerve action potential (SNAP) is usefulness for the diagnosis of IAN injury. The object of this study is to establish diagnosis of LN nerve injury by using SNAP.

Trigeminal and Taste Sensations of the Tongue After Middle Ear Surgery

To establish clinical tests for measurement of trigeminal sensitivity on the human tongue and objectively assess changes in oral trigeminal sensitivity and taste ability after chorda tympani nerve (CTN) injury. Prospective study. University hospital. One-hundred and twenty-six patients with unilateral middle ear diseases who underwent primary middle ear surgery. Trigeminal sensation was measured each operated side as well as nonoperated side both before and 14 days after surgery using 3 kinds of tests: Semmes-Weinstein sensory test (SW test), 2-point discrimination test, and the electrostimulator test. Taste function was assessed with electrogustometry (EGM) similarly. The patients which the CTN was not touched (n = 6) showed no differences between preoperative and postoperative thresholds in any tests. In the patients with sectioned CTN (n=30), postoperative thresholds on the operated side were significantly higher than preoperative thresholds on the electrostimulator test, 2-point discrimination test, and EGM. In the patients with manipulated but not sectioned CTN (n = 90), postoperative thresholds were significantly higher than preoperative thresholds on the electrostimulator test and EGM. The patients with manipulated but not sectioned CTN and abnormal EGM postoperative thresholds (n = 48) showed that postoperative thresholds were significantly higher than preoperative thresholds in all tests. These findings suggest that the electrostimulator test was most useful to objectively assess small changes of trigeminal sensation among the 3 tests. The finding that trigeminal sensitivity of the tongue deteriorated on the operated side after CTN injury suggests that CTN function affected both taste sensation and trigeminal sensation of the tongue.

Sensibilitätsrückkehr nach kindlichen Nervenverlet­zungen der Hand - welche Rolle spielt das Patientenalter?

The regenerative capacity after nerve reconstruction in children is believed to be superior compared to that in adults. However, the available data on this topic are limited. The aim of this work is to improve the age-dependent assessment of the prognosis after surgical treatment of peripheral nerve injuries of the hand. 44 of 147 children with complete transections of proper and common digital nerves who were treated from 2000 to 2009 and who were currently 6 years or older, could be included for follow-up (mean time, 7.5 years). In total there were 60 nerve injuries, of which 56 were directly coaptated, 4 needed grafting. Sensitivity of the fingertips was assessed using the 2-point discrimination (2PD) test and the Semmes-Weinstein monofilament test. We also recorded hypersensitivity, sensitivity to cold, and paresthesia. To account for inter-individual differences in normal 2PD, the difference of the 2PD to the uninjured contralateral side was calculated as delta-2PD. The age at the time of the injury, divided into groups of 0-5, 6-10 and 11-15 years was correlated with the clinical outcome (2PD, monofilamenttest). Taking into account the results classified by age presented by Lohmeyer et al. and Mailänder et al., we assessed the correlation between age at injury (0-85 years) and clinical outcome. After 52 of the 56 direct nerve coaptations (93%) normal sensitivity was found with a 2PD<6 mm, 4 times the 2PD was 6 mm. Following nerve grafting a static 2PD of 6-7 mm was measured. Disturbing paresthesia, sensitivity to cold or hypersensitivity were not reported by any patient. The 2PD of the fingers of the opposite uninjured side showed great inter-individual differences. Patient's age and 2PD significantly correlated with significantly poorer results already in the second decade of life. In relation to adults, children have an excellent prognosis after nerve reconstruction. The high inter-individual differences in regular sensitivity, depending on age, co-morbi-dities, etc., suggest putting the results of the injured and uninjured sides into relation. Estimation of the Δs2PD may solve this -problem.

Upper extremity hemodynamics and sensation with backpack loads

Heavy backpacks are often used in extreme environments, for example by military during combat, therefore completion of tasks quickly and efficiently is of operational relevance. The purpose of this study was to quantify hemodynamic parameters (brachial artery Doppler and microvascular flow by photoplethysmography; tissue oxygenation by near-infrared spectroscopy; arterial oxygen saturation by pulse oximeter) and sensation in upper extremities and hands (Semmes-Weinstein monofilament test and 2-point discrimination test) while wearing a loaded backpack (12 kg) in healthy adults for 10 min. All values were compared to baseline before wearing a backpack. Moderate weight loaded backpack loads significantly decreased upper extremity sensation as well as all macrovascular and microvascular hemodynamic values. Decreased macrovascular and microvascular hemodynamics may produce neurological dysfunction and consequently, probably affect fine motor control of the hands.

Effects of a new sensory re-education training tool on hand sensibility and manual dexterity in people with multiple sclerosis

To describe and evaluate the effects of a new home-based sensory re-education training tool on hand sensibility and manual dexterity in people with MS experiencing upper limb sensory deficits. Twenty-five people with relapsing-remitting MS (18 women), mean age 50.6 years (SD = 11.4), volunteered to participate. Participants were initially assigned to a 7-week control phase followed by a 3-week home-based sensory re-education phase. Measurements used were the nine-hole peg test, the two point discrimination test, the monofilaments test and the functional dexterity test. Measurements were collected at baseline, following the control phase and at the end of the trial. Participants demonstrated an improvement in the nine-hole peg (26.8 (SD = 3.5) vs. 22.6 (SD = 3.2); mean difference (95% CI) 4.9 (0.9, 7.1), P = 0.03) and functional dexterity tests (38.6 (SD = 4.4) vs. 33.8 (SD = 4.9); mean difference (95% CI) 4.8 (1.8, 7.0); P = 0.02) at the end of the sensory re-education phase compared to the end of the control phase. No differences were observed as to the monofilaments and two-point discrimination tests. Sensory re-education training does not affect the level of sensory impairment in the hand but may lead to improvement in select measures of manual dexterity.