Partial Nerve Lesion Research Articles

Transmission block in terminal nerve twigs: a single fibre electromyographic finding in man.

Single fibre electromyography has been performed in patients with partial nerve lesions, amyotrophic lateral sclerosis, progressive spinal muscle atrophy, muscular dystrophy, and distal hereditary myopathy. The recorded action potentials were often more complex than in the normal muscle due to increased fibre density in the motor unit and the individual spike components showed a large jitter and occasional blockings. Sometimes two or more spikes in a complex disappeared and reappeared simultaneously upon successive discharges. This phenomenon, called `paired blocking', has been further investigated. The jitter of the blocking potentials in relation to the rest of the complex was large, up to 500 μsec. The degree of blocking increased with increasing innervation frequency until it eventually proceeded to total block during continuous activity. Sometimes a slight effect on blocking was seen after edrophonium. This type of block is probably localized in the terminal nerve twigs, perhaps in newly formed sprouts. The phenomenon of neurogenic blocking may contribute to the fatigue clinically experienced in different denervation-reinnervation cases.

Outline of the Spinal Nerves.

The author employs the root-nerve-muscle-movement relationship as the basis of his outline. Each of four chapters is devoted to one of these factors. In addition to a complete and accurate anatomic and functional listing of all the roots, nerves and muscles Dr. Favill gives a concise clinical description of total and partial nerve lesions. The fifth chapter contains a consideration of the anatomic and clinical aspects of the brachial and lumbosacral plexuses, a discussion of the essentials of electrical testing of nerves and muscles, a short summary of the principal features of causalgia and several diagrams of the body dermatomes. This chapter adds nothing except to make the outline more complete. Medical students and practitioners, especially those in the fields of neurology, orthopedics and physical therapy, may find this integrated outline of practical use as a source of quick reference.

MOTOR DISTURBANCES IN PERIPHERAL NERVE LESIONS

The order in which movement is restored to muscles paralyzed as the result of peripheral nerve lesions and the particular muscles involved in partial or dissociated nerve lesions have a sufficient constancy to attribute to each nerve a clinical individuality (Marie and Benisty 1 ). This analysis was made from a certain number of records which were competent, selected from a large amount of material. They may be divided into three groups: first, records of cases seen in France soon after injury; second, records of cases seen in U. S. General Hospital No. 28 a number of months after injury, and third, an analysis of motor disturbances in median nerve lesions from the whole material in the Surgeon-General's office. The records of the group studied at U. S. General Hospital No. 28 are especially adapted for this study, as muscle power was ascertained by dynamometric examination, described elsewhere (Pollock 2 ). ULNAR

THE SURGERY OF THE PERIPHERAL NERVES.

In contrast to the CNS, peripheral nerves have the ability to regenerate. This ability has been utilized for a long time in the therapy of injuries of peripheral nerves. The aim of the present research was to assess the achievements in reconstructive surgery including nerve grafting and peripheral nerve suture repair in our clinic.During the 16-year period from 1986 to 2001 we surgically treated 116 patients with peripheral nerve lesions. The cases of lesions of the brachial plexus, partial peripheral nerve lesions and postoperative revision, as well as the attempts of reconstruction of cervical nerves and neurolysis are not included in this work. We analysed the results of surgery in our patients who where subjected to treatment of peripheral nerves in the arms (95 patients) and legs (21 patients). In 53 patients reconstructive surgery was performed by suture repair of peripheral nerve, which included treatment of 65 nerves, 10 patients were treated by suture repair of 2 nerves and repair of 3 nerves in one patient. In 42 patients we reconstructed 45 peripheral nerves of the hand by autograft. The total number of 42 patients compromised 37 males and five females. The average age was 36 years. Double nerve reconstruction (ulnar and median) was accomplished in three patients. In the remaining 21 patients (14 males and seven females) we performed 21 reconstruction operations of 24 injured nerves in the lower extremities, of which 8 operations of 9 nerves involved suture repair of peripheral nerves and 13 operations of 15 nerves were performed using a nerve graft. Their average age was 39.7 years. The average period between primary treatment and operation was 6.7 months. In five cases the interval exceeded 12 months. Operations were performed by microtechnique. All patients were subject to several postoperational tests aimed at the estimation of the degree of recovery in sensory and motor adaptation. The evaluation was performed according the Seddon classification (1975). Motor recovery was evaluated according to a five-point scale and the degree of sensory recovery according to a four-point scale. Recovery of grade M4 and S3 (or higher) was considered an excellent or very good result and grades M3 and S2 were considered a good result. Results corresponding to grades M0-M2 and S0-S1 were considered to be insufficient.The results of reconstruction operations of peripheral nerves injuries were dependent on the patient's age, the period between the injury and operation, the length of the autograft, the location of the injury, the type of injured nerve and the character of the injury (Fig. 2, Tab. 7, Ref: 15).