Extremity Nerve Research Articles

State of the art review. Upper extremity revision nerve compression surgery.

Although surgical release of upper extremity nerve compression syndromes is highly effective, persistence or recurrence of symptoms and signs may occur. Thorough investigation is necessary in this situation before treatment is recommended. If the symptoms cannot be explained by other pathology than compression of the affected nerve and if conservative management has not provided improvement, reoperation may be considered. This review provides an overview of the diagnostic and surgical considerations in the revision of carpal tunnel syndrome, cubital tunnel syndrome and thoracic outlet syndrome.Level of evidence: V.

Unilateral biportal endoscopic lumbar interbody fusion (ULIF) versus endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) in the treatment of lumbar spinal stenosis along with intervertebral disc herniation: a retrospective analysis

ObjectiveThis study aims to compare the clinical effects and imaging data of patients who underwent endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) with those who received unilateral biportal endoscopic lumbar interbody fusion (ULIF).MethodsA retrospective analysis was conducted on the clinical data of 69 patients presenting with typical intermittent claudication and signs and symptoms indicative of unilateral lower extremity nerve root compression, meeting inclusion criteria between April 2022 and June 2022. Among the cohort, 35 patients underwent ULIF group, while 34 patients underwent Endo-TLIF group. We compared perioperative parameters, including intraoperative blood loss, duration of hospital stay, and operation time between the two groups. Pre-operative and post-operative changes in the height and cross-sectional area of the target intervertebral space were also compared between the groups. Finally, we evaluated bone graft size and interbody fusion rates at 6 and 12 months post-surgery using the Brantigan scoring system.ResultsThe ULIF group had significantly shorter operative times compared to the Endo-TLIF group (P < 0.05). Conversely, the Endo-TLIF group exhibited significantly shorter hospital stays compared to the ULIF group (P < 0.05). However, there were no significant differences in intraoperative bleeding between the two groups (P > 0.05). Furthermore, both groups exhibited postoperative increases in vertebral canal volume compared to baseline (P < 0.05), with no significant difference in the change in the cross-sectional area of the target intervertebral space between the two surgical methods (P > 0.05). Interbody fusion rates were comparable between the two groups at both 6 and 12 months after surgery (P > 0.05). Lastly, the ULIF group had a significantly larger area of bone graft than the Endo-TLIF group (P < 0.05).ConclusionIn summary, the ULIF technique, as a novel spinal endoscopy approach, is a safer and more effective minimally invasive surgical method for addressing lumbar spinal stenosis and intervertebral disc herniation in patients. Both surgical methods have their own advantages and drawbacks. With the development of technology and related instruments, the limitations of both techniques can be mitigated for to a certain extent, and they can be applied by more doctors in diverse medical fields in the future.

Effect of Lower Extremity Nerve Decompression in Patients With Painful Diabetic Peripheral Neuropathy: The Diabetic Neuropathy Nerve Decompression Randomized, Observation Group and Placebo Surgery-Controlled Clinical Trial.

To evaluate the effect of nerve decompression on pain in patients with lower extremity painful diabetic peripheral neuropathy (DPN). Currently, no treatment provides lasting relief for patients with DPN. The benefits of nerve decompression remain inconclusive. This double-blinded, observation and same-patient sham surgery-controlled randomized trial enrolled patients aged 18 to 80 years with lower extremity painful DPN who failed 1 year of medical treatment. Patients were randomized to nerve decompression or observation group (2:1). Decompression-group patients were further randomized and blinded to nerve decompression in either the right or left leg and sham surgery in the opposite leg. Pain (11-point Likert score) was compared between decompression and observation groups and between decompressed versus sham legs at 12 and 56 months. Of 2987 screened patients, 78 were randomized. At 12 months, compared with controls (n=37), both the right-decompression group (n=22) and left-decompression group (n=18) reported lower pain (mean difference for both: -4.46; 95% CI: -6.34 to -2.58 and -6.48 to -2.45, respectively; P < 0.0001). Decompressed and sham legs equally improved. At 56 months, compared with controls (n=m 14), pain was lower in both the right-decompression group (n=20; mean difference: -7.65; 95% CI: -9.87 to -5.44; P < 0.0001) and left-decompression group (n=16; mean difference: -7.26; 95% CI: -9.60 to -4.91; P < 0.0001). The mean pain score was lower in decompressed versus sham legs (mean difference: 1.57 95% CI: 0.46 to 2.67; P =0.0002). Although nerve decompression was associated with reduced pain, the benefit of surgical decompression needs further investigation as a placebo effect may be responsible for part or all of these effects.

Nerve Transfers in Peripheral Nerve Lesions

Lesions of peripheral nerves of the upper extremities often lead to persistent, serious limitations in motor function and sensory perception. Affected patients suffer from both private and professional restrictions associated with long-term physical, psychological and socioeconomic consequences. An early indication for a nerve transfer shortens the reinnervation distance and improves the growing of motor and sensory axons into the target organ to facilitate early mobility and sensitivity. When planning the timepoint of the surgical procedure, the distance to be covered by reinnervation as well as the morbidities of donor nerves must be considered individually. Nerve transfers can achieve earlier and safer reinnervation to improve motor and sensory functions after nerve injuries in the upper extremity.

Rare nerve compression neuropathies

In regard to the complex anatomical relationship of peripheral nerves and muscles, tendons, fasciae as well as their long course within those anatomical structures and additional close contact to bony structures, they are prone to suffer from local compression syndromes. Hence creating a vast majority of entrapment syndromes - well described in literature for almost every single nerve. The purpose of this article is to give an overview of symptoms, signs, diagnostic studies and treatment options, addressing especially the less known syndromes. Compression syndromes of the upper arm and shoulder region include the suprascapular nerve syndrome the compression of the axillary nerve within the spatium quadrilaterale and the compression of the long thoracic nerve at the chest wall. The upper extremity offers a variety of infrequent entrapment syndromes, as the pronator teres syndrome and anterior interosseus syndrome, both resulting from pressure to the median nerve in the forearm. Compression neuropathy in the course of the radial nerve in the distal upper extremity is also known as supinator syndrome. Guyon's canal syndrome is the ulnar side equivalent to the well-known carpal tunnel syndrome. In the case of a Cheiralgia paresthetica, a compression of a sensory branch of the superficial radial nerve can be seen. In the lower extremities, a variety of nerves especially in the groin and thigh area can be compressed as they pass through the narrow spaces between the abdominal muscles or underneath the inguinal ligament. Compression of the lateral femoral cutaneous nerve is the most common syndrome. Compression syndromes of the femoral and obturator nerves are most often iatrogenic. Pain around the knee, especially the lateral part and following orthopedic procedures of the knee, can arise from a compression or a lesion of a small infrapatellar branch of the saphenous nerve. Another probably underdiagnosed syndrome is piriformis syndrome, resulting from an entrapment of the sciatic nerve as it passes through certain muscular structures. In the distal lower extremity, the peroneal and tibial nerves can be compressed at multple sites, clinically known as peroneal nerve paralysis resulting from nerve compression around the fibular head, the anterior and posterior tarsal tunnel syndrome, and Morton's metatarsalgia.

Core outcomes in nerve surgery: development of a core outcome set for brachial plexus and upper extremity nerve injuries.

When considering traumatic brachial plexus and upper extremity nerve injuries, iatrogenic nerve injuries, and nontraumatic nerve injuries, brachial plexus and upper extremity nerve injuries are commonly encountered in clinical practice. Despite this, data synthesis and comparison of available studies are difficult. This is at least in part due to the lack of standardization in reporting and a lack of a core outcome set (COS). Thus, there is a need for a COS for adult brachial plexus and upper extremity nerve injuries (COS-BPUE). The objective of this study was to develop a COS-BPUE using a modified Delphi approach. A 5-stage approach was used to develop the COS-BPUE: 1) consortium development, 2) literature review to identify potential outcome measures, 3) Delphi survey to develop consensus on outcomes for inclusion, 4) Delphi survey to develop definitions, and 5) consensus meeting to finalize the COS and definitions. The study followed the Core Outcome Set-STAndards for Development (COS-STAD) recommendations. The Core Outcomes in Nerve Surgery (COINS) Consortium comprised 23 participants, all neurological surgeons, representing 13 countries. The final COS-BPUE consisted of 36 data points/outcomes covering demographic, diagnostic, patient-reported outcome, motor/sensory outcome, and complication domains. Appropriate instruments, methods of testing, and definitions were set. The consensus minimum duration of follow-up was 24 months, with the consensus optimal time points for assessment being preoperatively and 3, 6, 12, and 24 months postoperatively. The COINS Consortium developed a consensus COS and provided definitions, methods of implementation, and time points for assessment. The COS-BPUE should serve as a minimum set of data that should be collected in all future neurosurgical studies on adult brachial plexus and upper extremity nerve injuries. Incorporation of this COS should help improve consistency in reporting, data synthesis, and comparability, and should minimize outcome reporting bias.

A new classification of lumbar Basstrup's disease based on radiographic and clinical symptoms.

To propose a new classification method for lumbar Basstrup's disease based on radiographic and clinical symptoms, and to test its credibility and reproducibility. A retrospective analysis of 116 patients with complete data of lumbar Basstrup's disease in our hospital from January 2019 to January 2022, radiological imaging including X-ray, CT and MRI, were divided into two main types according to the number of segments: type I (single segment) and type II (multiple segments), each type was divided into a total of eight subtypes according to the degree of degeneration: Ia, Ib, Ic, Id, IIa, IIb, IIc, IId; it was further divided into 16 subtypes according to the presence or absence of clinical symptoms (i.e. low back pain or/and lower limb neurological symptoms: no 0, yes 1): Ia0, Ia1, Ib0, Ib1, Ic0, Ic1, Id0, Id1; IIa0, IIa1, IIb0, IIb1, IIc0, IIc1, IId0, IId1.The 116 patients with Basstrup's disease were successively typed twice (1month interval) by five physicians according to the new classification method, and the reliability and reproducibility of the new classification were assessed using the Kappa consistency test. Among 116 patients with lumbar Basstrup's disease: there were 60 cases of type I (single segment), accounting for 51.72%, including Ia 19 cases, Ib 16 cases, Ic 10 cases, and Id 15 cases; there were 56 cases of type II (multiple segments), accounting for 48.28%, including IIa 10 cases, IIb 20 cases, IIc 14 cases, and IId 12 cases. Of the 116 patients, 47 cases had no clinical symptoms (Ia0 16 cases, Ib0 3 cases, Ic0 6 cases, Id0 1 case, IIa0 8 cases, IIb0 2 cases, IIc0 10 cases, IId0 1 case), accounting for 40.52%; 69 cases were accompanied by low back pain or/and lower extremity nerve symptoms (Ia1 3 cases, Ib1 13 cases, Ic1 4 cases, Id1 14 cases, IIa1 2 cases, IIb1 18 cases, IIc1 4 cases, IId1 11 cases), accounting for 59.48%.Five physicians completed two rounds of a total of 1160 typings, with inter-assessor typing agreement of 82.47% (80.17-85.34%) and a mean Kappa value of 0.723 (0.771-0.831); intra-assessor typing agreement of 82.76% (77.59-86.21%) and a mean Kappa value of 0.801 (0.742-0.841). The new classification method for lumbar Basstrup's disease based on radiographic and clinical symptoms is simple, practical, with good credibility and reproducibility, and provides some guidance for clinical treatment.

Ultrasound evaluation and grading of neuromuscular disease in lower extremities among diabetic patients.

To explore the clinical utility of ultrasound in evaluating and grading neuromuscular diseases in the lower extremities of patients with diabetes mellitus. A total of 126 inpatients from the Department of Diabetes at Zhangzhou Affiliated Hospital of Fujian Medical University, China, were recruited from June 2020 to December 2022. The cohort included 69 patients with type 2 diabetes mellitus (T2DM) and diabetic peripheral neuropathy (DPN group) and 57 patients with T2DM but without DPN (non-DPN group). Additionally, 80 healthy controls were included. High-frequency ultrasound was used to scan the common peroneal, sural, and tibial nerves, measuring their transverse (D1) and anteroposterior (D2) diameters, and calculating the cross-sectional area (CSA). Changes in the internal echo of the extensor digitorum brevis (EDB) muscle, including maximum thickness and CSA, were also recorded. The DPN group was further subdivided based on disease duration to assess ultrasonic changes over time and the statistical significance of these variations. Ultrasonic changes such as uneven internal echo reduction, ill-defined epineurial boundaries, and obscured cribriform structures were most prevalent in the DPN group. Significant differences in ultrasound parameters (D1, D2, CSA) were observed among the groups (all P<0.05), with the most pronounced changes in the DPN group. In patients with a disease duration of over 15 years, a significant increase in CSA of lower extremity nerves and a decrease in CSA of the EDB were noted compared to those in the 5-10 years subgroup (19.89±0.98 vs 19.00±0.94; 5.25±0.74 vs 5.93±0.94; all P<0.05). High-frequency ultrasound provides a valuable imaging basis for diagnosing and monitoring DPN, demonstrating significant changes in nerve and muscle parameters among diabetic patients.

Chapter 10 - Sciatic and tibial neuropathies

The sciatic nerve is the body's largest peripheral nerve. Along with their two terminal divisions (tibial and fibular), their anatomic location makes them particularly vulnerable to trauma and iatrogenic injuries. A thorough understanding of the functional anatomy is required to adequately localize lesions in this lengthy neural pathway. Proximal disorders of the nerve can be challenging to precisely localize among a range of possibilities including lumbosacral pathology, radiculopathy, or piriformis syndrome. A correct diagnosis is based upon a thorough history and physical examination, which will then appropriately direct adjunctive investigations such as imaging and electrodiagnostic testing. Disorders of the sciatic nerve and its terminal branches are disabling for patients, and expert assessment by rehabilitation professionals is important in limiting their impact. Applying techniques established in the upper extremity, surgical reconstruction of lower extremity nerve dysfunction is rapidly improving and evolving. These new techniques, such as nerve transfers, require electrodiagnostic assessment of both the injured nerve(s) as well as healthy, potential donor nerves as part of a complete neurophysiological examination.

The Scope and Distribution of Upper Extremity Nerve Injuries Associated With Combat-Related Extremity Limb Salvage

Chronic pain and functional limitations secondary to nerve injuries are a major barrier to optimal recovery for patients following high-energy extremity trauma. Given the associated skeletal and soft tissue management challenges in the polytraumatized patient, concomitant nerve injuries may be overlooked or managed in delayed fashion. Whereas previous literature has reported rates of peripheral nerve injuries at <10% in the setting of high-energy extremity trauma, in our experience, the incidence of these injuries has been much higher. Thus, we sought to define the incidence, pain sequelae, and functional outcomes following upper extremity peripheral nerve injuries in the combat-related limb salvage population. We performed a retrospective review of all patients who underwent limb salvage procedures to include flap coverage for combat-related upper extremity trauma at a single institution between January 2011 and January 2020. We collected data on patient demographics; perioperative complications; location of nerve injuries; surgical interventions; chronic pain; and subjective, patient-reported functional limitations. A total of 45 patients underwent flap procedures on 49 upper extremities following combat-related trauma. All patients were male with a median age of 27 years, and 96% (n= 47) of injuries were sustained from a blast mechanism. Thirty-three of the 49 extremities (67%) sustained associated nerve injuries. The most commonly injured nerve was the ulnar (51%), followed by median (30%) and radial/posterior interosseous (19%). Of the 33 extremities with nerve injuries, 18 (55%) underwent surgical intervention. Nerve repair/reconstruction was the most common procedure (67%), followed by targeted muscle reinnervation (TMR, 17%). Chronic pain and functional limitation were common following nerve injury. Upper extremity peripheral nerve injury is common following high-energy combat-related trauma with high rates of chronic pain and functional limitations. Surgeons performing limb salvage procedures to include flap coverage should anticipate associated peripheral nerve injuries and be prepared to repair or reconstruct the injured nerves, when feasible. Therapeutic IV.

Neurophysiological and psychological indicators of liquidators of chemical pollution of the environment

Introduction. Elimination of the consequences of emergency situations (ES) involves increased physical and psychological stress, as well as the direct aggressive impact of chemical and physical factors. Currently, the problem of environmental hazard is environmental pollution from the activities of «Usolyekhimprom», where on an area of 610 hectares there are tens of thousands of tons of harmful substances, including metallic mercury. On the territory of this enterprise, employees of the Federal Environmental Operator and the Ministry of Emergency Situations are currently engaged in eliminating environmental pollution. Over the past two years, a number of measures have been taken at the industrial site of «Usoliekhimprom» to dismantle buildings and demercurize. For 2023–2024 reconstruction, dismantling and disposal of the destroyed buildings of the enterprise are planned, in this regard, the liquidators may be affected by an even wider range of adverse factors. Employees of the East-Siberian Institute of Medical and Ecological Research conduct dynamic monitoring of the liquidators.&#x0D; The purpose of the study was to evaluate the neurophysiological and psychological indicators in liquidators in eliminating environmental pollution associated with the production of chemical products to prevent the occurrence of occupational pathology.&#x0D; Materials and methods. Forty males were examined. Electroneuromyographic examination (ENMG) was performed with testing of the sensory and motor components of the nerves of the upper extremities, electroencephalography (EEG), and psychological testing.&#x0D; Results. According to data of obtained ENMG parameters in the group of liquidators, a subthreshold decrease in the speed of impulse conduction in the area of the elbow joint was established during stimulation of the motor and sensory components of the ulnar nerve (up to 50 m/s). Analysis of interhemispheric coherence in the α-range in the group of liquidators revealed an increase in coherence in the right temporal leads (0.6 (0.4–0.7) G) compared with the standard values (0.35 (0.3–0.4) D) and weakening of coherent connections in the left frontal leads (0.35 (0.17–0.4) D). Changes in the mnestic sphere and the quality of life of the subjects were not revealed.&#x0D; Limitations. The limitation of the study was the lack of data on testing the motor and sensory components of the lower extremities during an electroneuromyographic examination and the lack of registration of evoked potentials during electroencephalography.&#x0D; Conclusion. The changes detected by ENMG indicate the manifestations of polyneuropathy at the preclinical stage. The analysis of interhemispheric coherence in the α-band revealed an increase in coherence in the right temporal leads and a weakening of coherent connections in the left frontal leads. The results of the medical and psychological study did not reveal any changes on the part of the mnestic sphere and the quality of life in the group of liquidators.

Ultrasound assessment of peripheral nerves in patients with type 1 diabetes mellitus of varying duration in childhood and adolescence

The annual increase in the number of patients with diabetes mellitus (DM) requires additional attention to the issue of improving the quality of life of patients and reducing the risks of developing complications in the long term. Purpose. To study changes in ultrasound parameters of peripheral nerves in patients with type 1 diabetes mellitus (T1DM) of varying duration in childhood and adolescence. Material and methods. The study included data from 190 children aged 5–18 years, including 139 children with an established diagnosis of T1DM of varying duration and 51 children from the control group. All patients underwent ultrasound of the peripheral nerves of the lower extremities using B-mode, color Doppler mapping, preppler microvascularization, and shear wave elastography mode. Results. The data obtained indicate the promise of using ultrasound for diagnosis and dynamic monitoring of the condition of peripheral nerves in patients with T1DM in childhood and adolescence. The combination of increased stiffness and increased size of peripheral nerves of the lower extremities is a sign of nerve changes in T1DM in childhood and adolescence.

Ultrasound imaging of median nerve neurolipomatosis: literature review and clinical case description

Neurolipomatosis is a rare benign tumor of peripheral nerves. The nerves of the upper extremities are more often involved, in most cases, the median nerves in the carpal canal. Children and young people suffer mainly. The article describes a case of fibrolipomatous hamarthroma of the median nerve in a 24-year-old patient, the ultrasound image is compared with the results of intraoperative observation. Despite the characteristic clinical and pathomorphological picture of this condition, the issues of diagnosis and differential diagnosis remain relevant. A special role is given to ultrasound as a non-invasive, widespread method of lifetime diagnosis of the condition of peripheral nerves. The median nerve, due to its superficial location, is available for visualization, and understanding the ultrasound semiotics of fibrolipomatous hamartoma will allow timely determination of it at the stage of initial clinical manifestations and avoid unnecessary and aggravating neurological deficits of examination methods such as biopsy.

Ultrasound of nerves of the lower extremities

The ability to visualize the nerves of the lower extremities differs from that of the upper extremities in sonography because the soft tissue cover is significantly larger in some cases. Landmarks are also defined for the lower extremities, which enable precise visualization of the nerves. Nerves and muscles are to be understood as afunctional unit. In addition to the clarification of nerve compression syndromes, polyneuropathies and nerve tumors, sonography is also used to visualize muscle atrophy.

Clinical and instrumental features of vertebrogenic lumbosacral pathology in machine milking operators

In the structure of occupational pathology, female workers of modern agricultural production, along with diseases of the musculoskeletal system and soft tissues of the upper extremities, vertebrogenic lesions of the lumbosacral level have become more often diagnosed. The aim of the study was to study the features of vertebrogenic pathology of the lumbosacral region with the analysis of radiological and electroneuromyographic data in machine milking operators of the Republic of Bashkortostan. The following results were obtained. On radiographs of the lumbosacral spine, degenerative-dystrophic changes in the form of a decrease in the height of discs, spondylosis, spondyloarthrosis were noted in machine milking operators. Electroneuromyographic criteria revealed a decrease in amplitude and velocity parameters of conduction along the peripheral nerves of the lower extremities. The revealed changes in vertebrogenic lumbosacral pathology in the examined patients make it possible to ensure timely diagnosis and prevention of production-related pathology with the formation of rational schemes of therapeutic and recreational measures.

Clinical Symptoms of Carpal Tunnel Syndrome and Its Correlation With Vitamin D Level

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy of the peripheral nerves in the upper extremities that is often found in workers. Nerve conduction disorders occur due to compression of the carpal tunnel, resulting in motor and sensory symptoms in the hands and wrists. This causes clinical symptoms and characteristic neurophysiological examinations. Vitamin D is an intrinsic factor that causes CTS which is now widely studied and is expected to play a role in the choice of CTS management. Vitamin D is important for maintaining health and has been found to have neuroprotective function. Several studies have proven the association between vitamin D deficiency and the incidence of CTS. Supplementation can improve clinical symptoms and neurophysiological features of mild to moderate CTS patients.

SUMOylation Modulates Reactive Oxygen Species (ROS) Levels and Acts as a Protective Mechanism in the Type 2 Model of Diabetic Peripheral Neuropathy.

Diabetic peripheral neuropathy (DPN) is the prevalent type of peripheral neuropathy; it primarily impacts extremity nerves. Its multifaceted nature makes the molecular mechanisms of diabetic neuropathy intricate and incompletely elucidated. Several types of post-translational modifications (PTMs) have been implicated in the development and progression of DPN, including phosphorylation, glycation, acetylation and SUMOylation. SUMOylation involves the covalent attachment of small ubiquitin-like modifier (SUMO) proteins to target proteins, and it plays a role in various cellular processes, including protein localization, stability, and function. While the specific relationship between high blood glucose and SUMOylation is not extensively studied, recent evidence implies its involvement in the development of DPN in type 1 diabetes. In this study, we investigated the impact of SUMOylation on the onset and progression of DPN in a type 2 diabetes model using genetically modified mutant mice lacking SUMOylation, specifically in peripheral sensory neurons (SNS-Ubc9-/-). Behavioural measurement for evoked pain, morphological analyses of nerve fibre loss in the epidermis, measurement of reactive oxygen species (ROS) levels, and antioxidant molecules were analysed over several months in SUMOylation-deficient and control mice. Our longitudinal analysis at 30 weeks post-high-fat diet revealed that SNS-Ubc9-/- mice exhibited earlier and more pronounced thermal and mechanical sensation loss and accelerated intraepidermal nerve fibre loss compared to control mice. Mechanistically, these changes are associated with increased levels of ROS both in sensory neuronal soma and in peripheral axonal nerve endings in SNS-Ubc9-/- mice. In addition, we observed compromised detoxifying potential, impaired respiratory chain complexes, and reduced levels of protective lipids in sensory neurons upon deletion of SUMOylation in diabetic mice. Importantly, we also identified mitochondrial malate dehydrogenase (MDH2) as a SUMOylation target, the activity of which is negatively regulated by SUMOylation. Our results indicate that SUMOylation is an essential neuroprotective mechanism in sensory neurons in type 2 diabetes, the deletion of which causes oxidative stress and an impaired respiratory chain, resulting in energy depletion and subsequent damage to sensory neurons.

Are Sensory Repairs More Tolerant of Delayed Repair than Motor Nerves? A Systematic Review and Meta-Analysis of Individual Participant Data in Upper Extremity Nerve Repairs

Are Sensory Repairs More Tolerant of Delayed Repair than Motor Nerves? A Systematic Review and Meta-Analysis of Individual Participant Data in Upper Extremity Nerve Repairs

The Effect of Surgical Timing on Upper Extremity Nerve Repair.

The purpose of this study was to evaluate the association between timing of nerve repair and the ability to perform a primary nerve repair versus a bridge repair requiring the use of allograft, autograft, or a conduit in lacerated upper extremity peripheral nerve injuries. This is a retrospective case-control study of patients who underwent upper extremity nerve repair for lacerated peripheral nerves identified by Current Procedural Terminology codes. Timing of injury and surgery, as well as other information such as demographic information, mechanism of injury, site of injury, and type of nerve repair, was recorded. The odds of a patient requiring bridge repair based on the duration of time between injury and surgery was evaluated using logistic regression. A total of 403 nerves in 335 patients (mean age 35.87 ± 15.33 years) were included. In all, 241 nerves were primarily repaired and 162 required bridge repair. Patients requiring bridge repair had a greater duration between injury and surgery compared with patients who underwent primary repair. Furthermore, the nerves requiring bridge repair were associated with a greater gap compared with the nerves repaired primarily. Based on logistic regression, each 1-day increase in duration between injury and surgery was associated with a 3% increase in the odds of requiring bridge repair. There is no defined critical window to achieve a primary nerve repair following injury. This study demonstrated that nerve injuries requiring bridge repair were associated with a significantly greater delay to surgery.

Features of the use of ischemic preconditioning for the correction of vibration polyneuropathy of the upper extremities

Introduction. The study of the methods for non-pharmacological correction of vibration polyneuropathy is relevant in view of the high prevalence of vibration disease in various industries, and high occurrence of disability of workers. Ischemic preconditioning has shown its effectiveness in correcting the manifestations of vibration polyneuropathies. The high frequency of nerve compression in tunnels against the background of polyneuropathic lesions in vibration disease dictates the need to study the effectiveness of the method in various forms of vibration polyneuropathy.&#x0D; The aim of the study was to investigate the effectiveness of ischemic preconditioning in various forms of vibration polyneuropathy.&#x0D; Materials and methods. Twenty nine patients with a proven diagnosis of vibration disease were examined and treated uisng the ischemic preconditioning. They were divided into 2 groups: group 1 – 18 individuals with upper extremities polyneuropathy without nerve compression, group 2 – 11 subjects with compression complications of polyneuropathy. The examinations included neurological survey, electroneuromyographic investigation before and after the course of ischemic preconditioning conducted according to a patented technique.&#x0D; Results. A decrease in sensory disturbances and improvement in the impulse conduction along the sensory fibers of the nerves of the upper extremities after a course of ischemic preconditioning in the group of the patients without compression neuropathies were noted. In the group of the patients with polyneuropathies complicated by the nerve compression in tunnels, the positive effect was less significant.&#x0D; Limitations. The study was limited by the assessment of clinical and electroneuromyographic parameters in 29 patients with vibration disease due to the exposure to local vibration before and after the course of ischemic preconditioning.&#x0D; Conclusion. The method of ischemic preconditioning is effective as a method for non-pharmacological correction of vibration polyneuropathy. Compression neuropathies are predictors of lower efficiency of the method, and therefore it is important to select patients for the treatment by this method with the preferred inclusion of the patients with uncomplicated vibration polyneuropathies.