Semmes-Weinstein Monofilament Research Articles

Effects of performing microsurgery on fine motor skills and sensation of the hand

Training can help improve both the sensory and motor functions because of neuroplasticity of the nervous system. A study on the improvement of fine motor and sensory functions of the hand in microsurgery has not been found in the available literature. The purpose of this study was to investigate the changes in sensory and motor abilities caused by exposure to microsurgery. Surgeons were divided into two groups: The group of microsurgeons (MS) and the group of surgeons not performing microsurgery (NMS). The MS group was also divided into two groups: MS –J (junior microsurgeon), who have been performing microsurgery for less than 15 years, and MS –S (senior microsurgeon), who have been performing microsurgery for 15 years or more. Age, sex, dominant hand, presence of concomitant diseases, and hobbies of each surgeon were recorded. The Semmes-Weinstein monofilament test, the 9-hole peg test, and the McKinnon static 2-point discrimination tests were performed on all surgeons. The static 2-point discrimination tests on the index and ring fingers of the MS group were found to be statistically better than those of the NMS group (p < 0.05). When comparing the Semmes-Weinstein monofilament test, the results of the thumb, index, ring and little fingers in the MS -J group were significantly better than those of the MS -S group. Although microsurgery improves sensation in the second and fourth fingers, this is more evident among younger microsurgeons.

Subclinical finding in the perception of tactile sensation involvement after SARS-CoV2 infection: comparison with healthy controls using Semmes-Weinstein monofilament testing.

Post-acute COVID-19 syndrome patients complain of sensory alterations, mainly positive symptoms such as paresthesia or neuropathic pain but also decreased tactile sensation. Using the Semmes-Weinstein monofilament test (SWMT), our study aims to confront recently infected SARS-CoV2 subjects with a control group. This is a cross-sectional, single-centric study. We performed the SWMT (North Coast Medical Inc.) on 30 patients with previous SARS-CoV2 infection (COVID group) and 46 controls (control group). These patients did not present comorbidities or sensory impairment and did not take any medications. The control group tested negative for SARS-CoV2 infection since the COVID-19 pandemic; the COVID group was examined for this study after the resolution of the infection. We tested the threshold of tactile sensation of the tips of the thumb, index, and little finger of each hand, one hand at a time; the dorsum and the hypothenar regions were also tested. Both groups presented the perception of tactile sensation within the reference value. Despite this result, subclinical changes suggestive of the involvement in peripheral sensory nerve function have been identified in the tested sites in the COVID group compared to the control group. The overall mean target force (grams) was higher in the COVID group than in the control group: 27 (7) vs. 19 (10) mg, p < 0.001. Controls and the COVID group infection had normal tactile sensation thresholds. However, the COVID group presented a higher threshold than the control group, suggesting a possible subclinical perception of tactile sensation involvement of A-beta nerve fibers.

Risk Factors for Underreporting of Life-Limiting Comorbidity Among Adults With Lower-Limb Loss.

Peripheral neuropathy (PN) and peripheral arterial disease (PAD) are life-limiting comorbidities among adults with lower-limb loss that may not be adequately addressed in current care models. The objective of this study was to evaluate underreporting of PN and PAD among adults with lower-limb loss. We conducted a secondary analysis of a cross-sectional dataset of community-dwelling adults with unilateral lower-limb loss seen in an outpatient Limb Loss Clinic (n = 196; mean age = 56.7 ± 14.4 years; 73.5% male). Individuals participated in standardized clinical examinations including Semmes-Weinstein monofilament testing to assess for PN and pedal pulse palpation to assess for PAD. Bivariate regression was performed to identify key variables for subsequent stepwise logistic regression to discern risk factors. Clinical examination results indicated 16.8% (n = 33) of participants had suspected PN alone, 15.8% (n = 31) had suspected PAD alone, and 23.0% (n = 45) had suspected PN and PAD. More than half of participants with clinical examination findings of PN or PAD failed to self-report the condition (57.7% and 86.8%, respectively). Among adults with lower-limb loss with suspected PN, participants with dysvascular amputations were at lower risk of underreporting (odds ratio [OR] = 0.2, 95% CI: 0.1-0.6). For those with suspected PAD, those who reported more medication prescriptions were at lower risk of underreporting (OR = 0.8, 95% CI: 0.7-1.0). Adults with lower-limb loss underreport PN and PAD per a medical history checklist, which may indicate underdiagnosis or lack of patient awareness. Routine assessment is highly recommended in this population and may be especially critical among individuals with non-dysvascular etiology.

Nerve-Preserving Superomedial Pedicle Breast Reduction Approach for Chest Wall Masculinization: A Case Report

Introduction: Gender affirming chest surgeries are a treatment for transgender and gender diverse individuals who suffer from gender dysphoria. Double incision mastectomy with free nipple grafts is the most common technique used for masculinization of the chest for Fischer grade 2B to 4 patients. However, this technique sacrifices the nerves to the nipple-areolar complex (NAC). While multiple nipple pedicles have been described in cisgender reduction mammoplasty, only an inferior pedicled mammaplasty approach has been described for chest wall masculinization for Fischer grade 2B to 4 patients. Case Presentation: We describe the surgical technique of a superomedial pedicle chest masculinization surgery for an individual with Fischer grade 2B breasts. Sensation was preserved at 2-weeks post-surgery. At 4-months, using a 0 to 10 numeric rating scale, patient satisfaction was 9 for the overall cosmetic outcome and a 9 for the masculinization. Using inferior sternum sensation as a reference (10), areola sensation on the superior side adjacent the nipple was a 6.5 on the right and an 8 on the left. Chest sensation was a 10 in the superolateral, inferolateral, and superomedial quadrants bilaterally, and was an 8 in bilateral inferomedial quadrants. 2-point discrimination of the areola was assessed on the inferior side adjacent the nipple and was 13mm on the left and 14mm on the right. Semmes-Weinstein monofilament testing of the areola was performed adjacent to the nipple superiorly (R: 4.31, L: 4.56), inferiorly (R: 4.31, L: 6.65), medially (R: 4.31, L: 6.65), and laterally (R: 4.31, L: 6.65). Conclusion: A mastectomy technique using a superomedial pedicle can preserve the nerve to the nipple-areolar complex to retain sensation while providing sufficient cosmetic outcome.

Influence of vibrotactile random noise on the smoothness of the grasp movement in patients with chemotherapy-induced peripheral neuropathy.

Patients with chemotherapy-induced peripheral neuropathy (CIPN) often suffer from sensorimotor dysfunction of the distal portion of the extremities (e.g., loss of somatosensory sensation, numbness/tingling, difficulty typing on a keyboard, or difficulty buttoning/unbuttoning a shirt). The present study aimed to reveal the effects of subthreshold vibrotactile random noise stimulation on sensorimotor dysfunction in CIPN patients without exacerbating symptoms. Twenty-five patients with CIPN and 28 age-matched healthy adults participated in this study. To reveal the effects of subthreshold vibrotactile random noise stimulation on sensorimotor function, participants were asked to perform a tactile detection task and a grasp movement task during random noise stimulation delivered to the volar and dorsal wrist. We set three intensity conditions of the vibrotactile random noise: 0, 60, and 120% of the sensory threshold (Noise 0%, Noise 60%, and Noise 120% conditions). In the tactile detection task, a Semmes-Weinstein monofilament was applied to the volar surface of the tip of the index finger using standard testing measures. In the grasp movement task, the distance between the thumb and index finger was recorded while the participant attempted to grasp a target object, and the smoothness of the grasp movement was quantified by calculating normalized jerk in each experimental condition. The experimental data were compared using two-way repeated-measures analyses of variance with two factors: experimental condition (Noise 0, 60, 120%) × group (Healthy controls, CIPN patients). The tactile detection threshold and the smoothness of the grasp movement were only improved in the Noise 60% condition without exacerbating numbness/tingling in CIPN patients and healthy controls. The current study suggested that the development of treatment devices using stochastic resonance can improve sensorimotor function for CIPN patients.

Tactile Perception of the Hand in Children With an Upper Neonatal Brachial Plexus Palsy

ObjectiveTo investigate factors that cause impairment of hand function in children with an upper Neonatal Brachial Plexus Palsy (NBPP), we performed an in-depth analysis of tactile hand sensibility, especially the ability to correctly localize a sensory stimulus on their fingers. DesignA cross-sectional investigation of children with NBPP, compared with healthy controls. The thickest Semmes-Weinstein (SW) monofilament was pressed on the radial or ulnar part of each fingertip (10 regions), while a screen prevented seeing the hand. SettingTertiary referral center for nerve lesions in an academic hospital in The Netherlands. The control group was recruited at their school. ParticipantsForty-one children with NBPP (mean age 10.0 y) and 25 controls (mean age 9.5 y; N=41). InterventionsNot applicable. Main Outcomes MeasuresCorrect localization of the applied stimuli was evaluated, per region, per finger, and per dermatome with a test score. The affected side of the NBPP group was compared with the non-dominant hand of the controls. ResultsThe ability to localize stimuli on the tips of the fingers in children with an upper NBPP was significantly diminished in all fingers, except for the little finger, as compared with healthy controls. Mean localization scores were 6.6 (thumb) and 6.3 (index finger) in the NBPP group and 7.6 in both fingers for controls (maximum score possible is 8.0). Localization scores were significant lower in regions attributed to dermatomes C6 (P<.001) and C7 (P=.001), but not to C8 (P=.115). ConclusionChildren with an upper NBPP showed a diminished and incorrect ability to localize sensory stimuli to their fingers. This finding is likely 1 of the factors underlying the impairment of hand function and should be addressed with sensory focused therapy.

Corset trunkoplasty is able to preserve postoperative abdominal skin sensation in massive weight loss patients

Conventional abdominoplasty techniques commonly cause postoperative peri- and infraumbilical skin hypesthesia due to abdominal skin flap undermining. The aim of this study was to evaluate abdominal skin sensation after corset trunkoplasty in massive weight loss patients. Forty-nine massive weight loss patients suffering from excess skin underwent corset trunkoplasty between April 2017 and July 2021. Patient demographics and perioperative complications were recorded. Sensibility of the abdominal skin was measured in three qualities postoperatively using a Semmes-Weinstein monofilament, Tip-Therm® device for thermal sensation and a cotton wooden stick for sharp/blunt discrimination. Results were compared with a control group of healthy individuals to create a baseline. Revision surgery for major complications was necessary in five cases (10%) including hematoma and major wound healing disturbances. Minor complications that did not require surgical intervention were observed in eight cases (16%). Postoperative abdominal sensibility did not show any significant difference between the patient and the control group in all 16 measured areas. Sharp/blunt and thermal discrimination was positive in all patients for the whole abdominal surface area. The corset trunkoplasty technique is able to address both horizontal and vertical soft tissue excess in massive weight loss patients and at the same time limits loss of sensibility of the abdominal skin. Compared to conventional abdominoplasty techniques the abdominal sensation can mainly be preserved due to absence of undermining abdominal skin flaps.

Clinical effects of resurfacing fingertip amputations in long fingers using homodigital dorsal neurofascial broaden pedicle island flaps

The use of homodigital dorsal neurofascial broaden pedicle island flaps (HDNBPIF) to treat fingertip amputations is an ongoing research topic. Here, we evaluated the clinical effects of resurfacing fingertip amputations in long fingers using HDNBPIF. Seventeen patients with 18 long fingers were treated with HDNBPIF from December 2018 to May 2021. Total active motion (TAM) scores, Semmes Weinstein monofilament (SWM) test, static 2PD test, visual analogue scale (VAS), Vancouver scar scales (VSS), and quick DASH scores were evaluated at 12–25 months postoperation. The aesthetic satisfaction of the patients was estimated subjectively using a 5-point Likert scale. The mean defect size was 1.11 × 1.13 cm and mean flap size was 1.32 × 1.32 cm. All flaps survived and the mean TAM of injured fingers was 255.6° (Contralateral side: 268.4°, p < 0.05). Mean SWM score in the flap was 3.90 g, and 3.22 g in the donor zone. Mean static 2PD discrimination in the flap was 5.61 mm and 4.33 mm in the donor zone. Mean quick Dash scores were 5.81 whereas Mean VAS score in the flap was 0.7 and 0.2 in the donor site. Vancouver scar scales at the donor and recipient sites ranged from 0 to 2. At the end of the follow-up, all patients reported good aesthetic appearance and curative effects. These results show that HDNBPIF is a promising strategy that achieves good curative effects and recovery of fingertip functions. Type of Study and Level of Evidence: Therapeutic IV

Manual therapy improves symptom severity and disability in patients with carpal tunnel syndrome

Aim: The aim of the study was to assess early outcomes of manual therapy in patients with carpal tunnel syndrome. Materials and methods: In this study, patients diagnosed with electrophysiologically confirmed carpal tunnel syndrome received manual therapy. The therapy was used in 41 individuals who received one session in line with IFOMPT (International Federation of Orthopaedic Manipulative Physical Therapists) standards per week for 5 weeks. Grip strength was assessed using a dynamometer, disability was assessed using the DASH (Disability of Arm, Shoulder and Hand) questionnaire, and the quality of life was assessed using VASEQ5D5L (Visual Analog Scale of the 5-level EQ-5D). Data was collected before the first treatment and one week after the last treatment. Results: We observed significant change in DASH score and quality of life. Grip strength tended to improve, but the effect was statistically significant only in patients over 50 years of age. Symptom severity (Carpal Tunnel 6 score, Douleur Neuropathique 4 score and peripheral cutaneous threshold assessed with Semmes–Weinstein monofilament) improved significantly. There was no significant correlation between changes in DASH score and grip strength. Conclusion: Manual therapy significantly improves quality of life and reduces upper limb disability in patients with carpal tunnel syndrome.

Surgical experience and different glove wearing conditions affect tactile sensibility

BackgroundThe fingers’ tactile sensibility is essential in surgery, especially in microsurgery. Therefore, surgeons seeking to improve their performance often prefer certain glove brands and wearing habits. There is the need of objectively testing these glove wearing conditions and determine the effect of surgical experience with regard to tactile sensibility by comparing surgeons with non-surgeons. MethodsThis cross-sectional single-center pilot-study was conducted between June and August 2021. Two groups of 27 surgeons and 27 non-surgeons underwent two-point-discrimination (2PD) and Semmes-Weinstein monofilament testing (SWMT) of both index fingers with bare hands and with wearing six different brands of surgical gloves. Different wearing conditions, such as single-gloving, double-gloving, well-fitted, under- and oversized gloves, were evaluated within and between the groups. ResultsMost glove types decreased tactile sensibility (2PD and SWMT) of surgeons and non-surgeons. Interestingly, the thinnest gloves showed similar 2PD values to bare hands in both groups. Double-gloving negatively impacted SWMT, without influencing 2PD. Undersized gloves showed better 2PD and SWMT than well-fitted gloves, while oversized gloves showed no tactile drawbacks. With bare hands and certain glove conditions, the surgeons' 2PD and SWMT was significantly better than the non-surgeons’, indicating a positive effect of surgical experience on tactile sensibility. ConclusionOur study demonstrated the positive impact of surgical experience on tactile sensibility, as demonstrated by the surgeons. The sensibility of the gloved hand varies on the surgical glove type, but favors thinner gloves, single gloving (rather than double gloving) and undersized or well-fitted gloves.

Validity and Reliability of Criteria for Plantar Sensation Assessment Using Semmes-Weinstein Monofilament as a Clinically Usable Index.

There is no standard clinically adaptable criterion for assessing plantar sensation for pre- and post-intervention comparisons. Studies using Semmes-Weinstein monofilaments (SWMs) to investigate intervention effects on plantar sensation vary in procedure and do not consider measurement errors. This study aimed to develop a simple criterion using SWMs to assess plantar sensation, determine the measurement error range, and identify areas of low error. Six examiners assessed 87 healthy young adults in Experiment 1, while two examiners assessed 10 participants in Experiment 2. Filaments were graded from 1 to 20 based on increasing diameter. The smallest grade that could be perceived for three sequential stimuli was used as the criterion (smallest perceivable grade, SPG). The SPG was significantly smaller at the hallux and larger at the heel than at other sites. There were no significant differences between the SPG of the repeated tests performed by the same versus different examiners. The interquartile range of the differences was <±3 at all sites. Thus, our criteria were reliable in evaluating the effects of plantar sensation interventions, especially at the heel and the middle of the metatarsal heads and could contribute to the development of more effective treatments for plantar sensations.

Outcomes of bipedicle V-Y 'cup' flap for repair of volar oblique fingertip amputations.

We used bipedicle V-Y 'cup' flaps to reconstruct 13 consecutive volar oblique fingertip amputations encountered in a nearly 2-year period. All flaps survived completely with no bone protuberance, scarring or neuroma evident at the end of follow-up (mean, 7 months; range 4-13 months). Two of the 13 patients had moderate or severe tenderness, three had moderate or severe cold intolerance and two had noticeable hook nails. There were no significant (≥10°) flexion contracture in the interphalangeal joints. The mean static two-point discrimination score was 4 mm (range 3-6) and the modal Semmes-Weinstein monofilament test score was 3.6 g (range 3.2-4.2). All patients were satisfied with their surgical outcomes. The bipedicle V-Y 'cup' flap provides good results in terms of fingertip contour, padding and sensation, and has a low complication rate when used to treat volar oblique fingertip amputations.Level of evidence: IV.

Mid-Term Results of the First Dorsal Metacarpal Artery Flap for Thumb Defects.

Background: The thumb plays an important role in the function of the hand. Sensate reconstruction of the pulp is important in restoring function to the thumb. The aim of this study is to present outcomes of a sensate islanded first dorsal metacarpal artery (FDMA) flap used for the reconstruction of skin defects of the thumb. Methods: Patients who had a FDMA flap reconstruction of thumb pulp defects in the orthopaedics and traumatology clinic of affiliated hospital were included in the study. This included eight thumbs of eight patients. The range of motion, sensation and cosmetic satisfaction in the donor and recipient areas were evaluated at a minimum of 2-year follow-up. Results: There were no partial or complete flap failures. The mean static 2-point discrimination was 15 mm and the mean Semmes-Weinstein monofilament test score was 3.93. Cortical re-orientation was observed in 65% of patients. Near normal range of motion and Kapandji scores were regained in all patients. Conclusions: Excellent motion and sensory outcomes were obtained following the FDMA flap reconstruction of thumb pulp defects. The donor morbidity of the flap is minimal, and this flap can be considered as one of the primary options for reconstruction of thumb pulp defects. Level of Evidence: Level V (Therapeutic).

Reliability of Ulnar Nerve Sensation Tests in Patients with Cubital Tunnel Syndrome and Healthy Subjects.

Static two-point discrimination (2PD) and Semmes–Weinstein monofilament (SWM) tests are commonly used to evaluate sensory disorders in the hand. The aim of this study was to evaluate the reliability of 2PD and SWM tests in the ulnar nerve innervation area in patients with cubital tunnel syndrome (CuTS) and healthy individuals. This was a two-group repeated-measures inter-rater and intra-rater reliability study. Twenty-one patients with CuTS and 30 healthy adults participated. The static 2PD test was performed using a standardized Dellon discriminator, whereas the SWM test was conducted using TOUCH TEST monofilaments. Two examiners performed both tests at the hypothenar eminence and the fourth and fifth digits (ulnar nerve innervation hand territory). First, examiner A conducted three series of 2PD and SWM tests twice with a 15-min rest period (within-day intra-rater reliability). Next, examiner B repeated the same examination 5 min after (inter-rater reliability). Examiner A conducted the same examination 7 days after (between-day intra-rater reliability). For single measurements, the inter-rater reliability and within-day intra-rater reliability in the 2PD was at least 0.81 in patients with CuTS or healthy subjects. The between-days intra-rater reliability for a single measurement varied from 0.56 to 0.95 in CuTS patients and healthy subjects. The between-days intra-rater reliability for mean value from three measurements was above 0.80. The kappa for SWM was above 0.8 and the percentage of agreement was at least 90% for all sessions and trials. In conclusion, the 2PD and SWM tests are reliable for assessing sensation in the ulnar nerve innervation area of the hand in patients with CuTS and healthy subjects.

Magnetoencephalographic evaluation of repaired lip sensation in patients with cleft lip.

BackgroundCleft lip is the most common congenital anomaly worldwide. Nevertheless, lip somatosensory characteristics of patients with cleft lip after cheiloplasty have not yet been determined. The present study used magnetoencephalography to objectively evaluate the lip sensation in patients with unilateral cleft lip to establish a new objective evaluation method.MethodsParticipants were 15 patients with unilateral cleft lip after cheiloplasty (UCL group), and 30 healthy young subjects (control group). Five points of the upper and lower lips were stimulated electrically to measure somatosensory evoked magnetic fields (SEFs). The sources of the magnetic fields were modeled as single equivalent current dipoles (ECDs). ECDs located on the central sulcus by superimposition on magnetic resonance images were analyzed. Latency and intensity at 50–75 ms (cP60m) observed in the UCL group were compared with those in the control group. Thresholds of tactile stimuli in both groups were obtained using Semmes–Weinstein monofilaments for subjective sensory evaluation.ResultsNo significant difference was found in the intensity of the cP60m or subjective evaluation between the groups. However, the latency of the cP60m was significantly longer in the upper lip of the UCL group than in the control group.ConclusionsSEFs showed a difference in lip sensation between the UCL group and the control group, suggesting that longer latency might be caused by the effects of surgical scarring on the neurotransmission pathway. These results suggest SEFs as useful for the objective evaluation of lip sensations. This study might improve future surgical procedures and lip functions of patients with cleft lip.

Internet of Things (IoT) Enables Robot-Assisted Therapy as a Home Program for Training Upper Limb Functions in Chronic Stroke: A Randomized Control Crossover Study

ObjectiveTo compare the effects of using an Internet of things (IoT)-assisted tenodesis-induced-grip exoskeleton robot (TIGER) and task-specific motor training (TSMT) as home programs for the upper-limb (UL) functions of patients with chronic stroke to overturn conventional treatment modes for stroke rehabilitation. DesignA randomized 2-period crossover study. SettingA university hospital. ParticipantsEighteen chronic stroke patients were recruited and randomized to receive either the IoT-assisted TIGER first or TSMT first at the beginning of the experiment (N=18). InterventionIn addition to the standard hospital-based therapy, participants were allocated to receive a 30-minute home-based, self-administered program of either IoT-assisted TIGER first or TSMT first twice daily for 4 weeks, with the order of both treatments reversed after a 12-week washout period. The exercise mode of the TIGER training included continuous passive motion and the functional mode of gripping pegs. The TSMT involved various movement components of the wrist and hand. Main Outcome MeasuresThe outcome measures included the box and block test (BBT), the Fugl-Meyer assessment for upper extremity (FMA-UE), the motor activity log, the Semmes-Weinstein Monofilament test, the range of motion (ROM) of the wrist joint, and the modified Ashworth scale. ResultsSignificant treatment-by-time interaction effects emerged in the results for the BBT (F(1.31)=5.212 and P=.022), the FMA-UE (F(1.31)=6.807 and P=.042), and the ROM of the wrist extension (F(1.31)=8.618 and P=.009). The participants who trained at home with the IoT-assisted TIGER showed more improvement of their UL functions. ConclusionsThe IoT-assisted TIGER training has the potential for restoring the UL functions of stroke patients.

Evaluating probable predictors for fall related wrist fracture among the elderly population in a tertiary care hospital, Bhubaneswar

Wrist fractures are one among the common injuries of the elderly leading to reduced quality of life and impaired functionality, if not treated and restored adequately. Factors like asymmetry of vestibular function, decreased plantar sensation, unstable posture and functional disability have been more commonly associated with fall related wrist fractures among the geriatric population. Since wrist fractures are considered as an indicator for fracture incidence in the future specially for hip fractures, preventive measures like improving balance, function of the balance system in the inner ear and feeling in people’s feet can be timely adopted which in addition might be helpful in rehabilitation of patients with fractured wrist.To determine effect of multi sensory training (MST) on posture (muscle strength), vestibular function, vibration perception, tactile sensation and functional ability compared to wrist stabilization training (WT) among elderly with fall related wrist fractures.Experimental research design was adopted for the study among the 130 follow up cases of wrist fracture where 88 participants were randomized to Multi Sensory Training and 42 received Wrist stabilization Training. The training period was 12 weeks, with 4 supervised sessions by a physiotherapist and home exercises for both groups. Pre and post training measurements included Head Shake Test (HST), Semmes–Weinstein Monofilaments (SWM), Vibration perception Test, 10m Walk Test (10MWT), Five Times Sit to Stand Test (FTSTS), Activities Specific Balance Confidence (ABC) and Dizziness Handicap Inventory Scales (DHI). FTSTS, ABC, DHI were found to be statistically significant between the 2 groups. In contrast to wrist stabilization training, MST was more helpful in improving HST (p=0.001). Vestibular function among the cases of wrist fracture was better with Multi Sensory Training. It may be applied as a routine training intervention post fracture treatment. A robust sample size can be taken up to generalize its effectiveness.

Muscle-in-Vein Conduits for the Treatment of Symptomatic Neuroma of Sensory Digital Nerves.

Background: Considering the debilitating burden of neuroma resulting in a significant loss of function and excruciating pain, the use of muscle-in-vein conduits (MVCs) for the reconstruction of painful neuroma of sensory nerves of the fingers was assessed. Methods: We retrospectively analyzed 10 patients who underwent secondary digital nerve repair by MVCs. The recovery of sensibility was evaluated by static and moving two-point discrimination (2PDs, 2PDm) and Semmes-Weinstein monofilament testing (SWM). The minimum follow-up was set 12 months after the operation. Results: The median period between trauma and nerve repair was 13.4 weeks (IQR 53.5). After neuroma resection, defects ranged from 10–35 mm (mean 17.7 mm, SD 0.75). The successful recovery of sensibility was achieved in 90% of patients after a median follow-up of 27.0 months (IQR 31.00). The mean 2PDs and 2PDm was 8.1 mm (SD 3.52) and 5.2 mm (SD 2.27), respectively. Assessment by SWM resulted in a mean value of 3.54 (SD 0.69). Reduction in pain was achieved among all patients; eight patients reported the complete relief of neuropathic pain. There was no recurrence of neuroma in any patient. Conclusions: Muscle-in-vein conduits provide an effective treatment for painful neuroma of digital nerves, resulting in satisfactory restoration of sensory function and relief of pain.

Influence of Inferior Alveolar Nerve Exposure During Sagittal Split Osteotomy on the Rate and Timing of Baseline Sensory Recovery

Neurosensory disturbance is the most common consequence of sagittal split osteotomy (SSO). The purpose of this study is to quantitatively assess neurosensory deficiency and recovery to the preoperative status when the inferior alveolar nerve (IAN) was exposed versus unexposed during SSO. This is a single-center, prospective, cohort study of all patients undergoing bilateral SSO between August 2018 and July 2019. Patients were included in the study sample if they underwent bilateral SSO with an intact intraoperative IAN and were received follow-up assessment for at least a year. The predictor variable was the intraoperative IAN status (exposed vs unexposed). The outcomes of interest were the rate and timing of recovery to the preoperative status. The covariates were age, sex, and the magnitude and direction of surgical movements. Neurosensory function was quantitatively evaluated using the Semmes-Weinstein monofilament test at follow-up intervals of 1, 3, 6, and 12months. Descriptive statistics, bivariate statistics, Cox proportional hazards regression, and Kaplan-Meier analyses were performed. P value <.05 was considered statistically significant. Of 90 patients, 86 patients who underwent 172 SSOs were included in this study. The mean age was 22.95±3.34years (range, 17 to 30), 65 were women, and the range of surgical movements was 3 to 8.3mm of advancement and 2 to 12mm of setback. Eighty-five nerves (49.4%) were allocated to the unexposed group, and 87 (50.6%) to the exposed group, with statistically significant differences in the rate and timing of recovery (hazard ratio= 2.368; 95% confidence interval, 1.662 to 3.376; P<.001). Among those with recovered nerves, the median time to recovery was 90days in the unexposed group and 364days in the exposed group (P<.0001). IAN exposure during SSO is associated with an increased risk of neurosensory deficiency and an increased time of sensory recovery to the baseline threshold in patients aged 17 to 30years. When the IAN remained fully enclosed in the canal of the distal segment, only 11% of patients had a measurable sensory deficit 1year after surgery. In those patients with any degree of IAN exposure, 36% had a residual sensory deficit 1year after surgery.

Transcutaneous electrical nerve inhibition using medium frequency alternating current

Transcutaneous medium-frequency alternating electrical current is defined as an alternating current between 1 and 10 kHz and is capable of producing an instant, reversible block. This study aims to evaluate the efficacy of sensory perception and force production of the index and middle finger after transcutaneous medium-frequency alternating electrical current stimulation of the distal median nerve. A single-center prospective interventional cohort study was conducted in adult healthy volunteers at the Jessa Hospital, Hasselt, Belgium. Two different electrodes (PALS & 3M) were placed on the distal median nerve, which was located using a Sonosite X-Porte Ultrasound transducer, with the first electrode being placed on the skin at the level of the transverse carpal ligament and the second electrode 7 cm proximally to the first electrode. The tactile sensation was evaluated with Semmes–Weinstein monofilament test and sensation of pressure/pain was evaluated with an algometer. Peak force production was assessed with an electronic dynamometer. All measurements were performed at baseline and tMFAEC stimulation frequencies of 2 and 10 kHz in a randomized manner. Statistical analysis was performed with a one-way ANOVA with repeated measures test or a Friedman rank sum test, followed by the Wilcoxon signed rank test adjusted with Bonferroni correction. A p-value < 0.05 was considered statistically significant. From 9 to 13th of April 2021, 25 healthy volunteers were included in the Jessa Hospital, Hasselt, Belgium. A statistically significant reduction in tactile sensation during 2 kHz and 10 kHz stimulation compared to baseline was observed (2.89 ± 0.22 (PALS2); 3.35 ± 0.25 (3M2) and 2.14 ± 0.12 (PALS10); 2.38 ± 0.12 (3M10) versus − 1.75 ± 0.09 (baseline), p < 0.0001). 3M electrodes showed a tendency towards the elevation of pressure pain threshold compared to baseline. No significant difference in mean peak forces of the index and middle fingers after transcutaneous medium-frequency alternating electrical current stimulation with 2 and 10 kHz was found. This study demonstrates that transcutaneous medium-frequency alternating electrical current stimulation on the distal median nerve inhibits tactile sensory nerve activity in the index and middle finger when stimulation of 2 kHz and, to a lesser extent, 10 kHz was applied. A reduction of motor nerve activity was not observed but force production measurements may be prone to error.Trial registration: clinicaltrials.gov on 01/04/2021. NCT-Number: NCT04827173.