Static Two-point Discrimination Test Research Articles

Treatment by collagen conduit of painful post-traumatic neuromas of the sensitive digital nerve: A retrospective study of 10 cases

Objectives The purpose of this retrospective study was to report the results of surgery in painful post-traumatic neuromas of the digital nerves treated by collagen conduits after excision of the neuromas, when two stumps were available. Methods We retrospectively reviewed all patients operated on for painful neuroma in our institution and having undergone repair with collagen conduits. Their files were retrieved by a coding file (CCAM version 10). Ten patients involving nine digital nerves and one common digital nerve were included. Primary outcome data points were static two-point discrimination, Semmes-Weinstein monofilament testing, Quick-Dash outcome survey scores, Cold Intolerance Symptom Severity (CISS) score and recurrence of pain at final follow-up. We set up a minimum follow-up period of 6 months after surgery. Results The patients’ average age was 30 years. The average follow-up duration was 11.8 months. Five patients had excellent or good results (50%) at static two-point discrimination testing. Semmes-Weinstein monofilament testing results were full, diminished light touch or diminished protective sensation in nine digits (80%). The average Quick-Dash survey score was 19.3. The average CISS score was 27.8. There was no recurrence of pain. Conclusions Our findings indicate that collagen conduit is an effective treatment for post-traumatic painful neuromas of digital nerves and common digital nerves.

Successful replantation in ten-digit amputation

Amputations involving ten digits are very rare because of different lengths of the digits. A 34-year-old man working in a printing house presented one hour after guillotine amputation involving all ten digits. Surgery was initiated 80 minutes after admission and took seven hours. Under axillary anesthesia, the operation was performed by two teams each consisting of two microsurgeons and two assistants. Replantation was completed without the use of any skin graft or flap. Fingertip examination showed poor arterial circulation in the second, third, and fourth digits of the left hand after 24 hours of replantation and surgical exploration was performed, during which anastomosis of the ulnar digital artery of the second digit was re-established and a Y-shaped vein graft was placed at the level of the third web to restore revascularization of the third and fourth digits. However, these interventions did not prevent the development of necrosis in the distal segment of the fourth digit which resulted in dry gangrene that required amputation. After 38 months of replantation, radiographic examination showed complete union in all fingers without malunion or damage to the joint surface and about 8 degrees of medial angulation in the proximal phalanx of the fourth digit of the right hand. The patient did not have difficulty in performing daily activities and had a considerably good pinching. Losses of active range of motion of the metacarpophalangeal and interphalangeal joints were within the rage of 10 to 30 degrees in both hands. In the assessment of sensation, static and dynamic two-point discrimination test results were 6.1 mm and 4.0 mm, respectively.

Reconstruction of finger pulp defects using homodigital dorsal middle phalangeal neurovascular advancement flap

Eighteen finger pulp defects were reconstructed using a homodigital dorsal middle phalangeal neurovascular island flap procedure based on a single neurovascular pedicle preserving the length of the finger. All flaps survived and achieved adequate functional and cosmetic results. The mean follow-up time was 22 months. The mean value of static two-point discrimination test of the healed flaps was 7 mm and the mean value of moving two-point discrimination test was 5 mm. Range of motion was considered satisfactory in all reconstructed fingers except one, in which a 20 degree extension deficit at the proximal interphalangeal joint was observed. This flap represents a useful alternative for reconstruction of the fingers with large pulp defects.

Evaluation of deformity and hand function in cerebral palsy patients

BackgroundA cross-sectional study was performed to describe the upper limb deformity and function in cerebral palsy patients and to determine the correlation of deformity, spasticity, motor control, and sensation to hand function in the said population.Materials and methodsThirty patients satisfying our inclusion criteria underwent physical, sensory, and functional assessment using a standard protocol. Physical assessment included documentation of the degree of spasticity, deformity and muscle control. Sensation was tested using static two-point discrimination test and stereognosis test. Melbourne Assessment of the Unilateral Upper Limb Function Test (MAULF), Functional Hand Grip Test (FHGT), and Functional Independence Measure for children (WeeFIM) were used to evaluate hand function. Deformity, spasticity, motor control, and sensation were analyzed for correlation with hand function using Pearson Correlation analysis. A p-value of less than 0.05 was considered statistically significant.ResultsFunctional deficits of the hand increased with increasing severity of deformity and spasticity. Tetraplegics were most affected by spasticity, deformity, poor motor control, sensory and functional deficits. Triplegics, followed by diplegics had more functional upper limbs in terms of the MAULF and FHGT scores. Unilaterally affected patients (triplegics and hemiplegics) scored better in performance of activities of daily living. The MAULF and FHGT had a stronger correlation to deformity, spasticity and motor control compared to the WeeFIM.ConclusionThe degree of deformity, spasticity, sensory deficit, and motor control affected the hand function of a cerebral palsy patient significantly. The MAULF and FHGT more accurately represents hand function deficit in cerebral palsy patients.

LONG TERM FOLLOW-UP AFTER FINGER REPLANTATION

The aim of this retrospective study was to assess objective and subjective aspects of the long-term results of finger replantations and revascularisations. Forty patients with 59 successfully replanted or revascularised fingers, who had a mean age of 38 years, were followed-up over an average of 3.5 years. The assessment included: the profile of the blood flow in the digital arteries of replanted fingers with Doppler ultrasound, active range of motion, total grip strength, pinch grip, static two-point discrimination test and Semmes-Weinstein monofilament testing. The dexterity of the hand was evaluated subjectively with the Carlsson's questionnaire and cold intolerance with a modified McCabe's questionnaire. Statistical analysis was performed and a statistically significant correlation was found between the Carlsson's functional score, active range of motion and total grip strength. In 28 fingers (74%), blood flow in the digital arteries showed an undisturbed profile, while ten fingers showed mild stenosis or impaired microcirculation.

Repairing a 35‐mm‐long median nerve defect with a chitosan/PGA artificial nerve graft in the human: A case study

We have developed a chitosan/polyglycolic acid (PGA) artificial nerve graft which was previously used for bridge implantation of dog sciatic nerves across 30-mm long defects. Here we describe a clinical trial of this graft for repairing a 35-mm-long median nerve defect at elbow of a human patient. During the 3-year follow-up period, functional recovery of the injured median nerve was assessed by pinch gauge test, hydraulic hand dynamometry, static two-point discrimination and touch test with monofilaments, in couple with electrophysiological examinations. The motor and sensory function of the median nerve demonstrated an ongoing recovery postimplantation, reaching M4 and S3+ levels during the follow-up period. The results indicate that the chitosan/PGA artificial nerve graft could be used for surgical repair of larger defects in major peripheral nerves at a higher level in the human.

Comparison of Blind and Sighted Subjects' Volar Tactile Sensation Using Static and Moving Two-Point Discrimination Tests

The volar tactile sensations of the blind and the sighted subjects were measured using two tests : static two-point discrimination test (s2PD) and moving two-point discrimination test (m2PD). Twelve blind subjects (age range 19-72 years, mean 36 years; one female; mean Braille reading experience 27 years) and ten sighted subjects (age range 21-24 years, mean 22 years) participated in this study. The volar side of the right hand of subjects was divided into 29 areas each, according to the location of finger joints and the innervation regions of peripheral and peripheral nerves. The s2PD thresholds of blind subjects were significantly shorter than that of sighted subjects at 19 areas on the volar side of hand. However, there was no difference between the m2PD thresholds of blind subjects and sighted subjects at all 29 areas. In addition, the m2PD thresholds of blind subjects were significantly shorter than the s2PD thresholds of them at only two areas. So, blind subjects have superior tactile sensation on the volar side of hand for both static and moving stimuli.

Finger-level avulsion-type injuries

Fifty-nine avulsed fingers were managed between May 1986-December 2004. Of 59 cases, 39 (66%) were treated with microsurgical techniques, and the remaining 20 cases (34%) were treated in the conventional manner. Follow-up time varied between 9-18 years. All cases were classified according to the Kay-Wolff classification. Replantation was done in 26 fingers, and revascularization in 13 fingers. The survival rate was 100% in the revascularization cases, and 80.7% in the replantation cases. The total active range of motion was more than 90 degrees in the interphalangeal joints in 48% of cases, and sensory recovery was good in 38% of cases (between 4-10 mm, static two-point discrimination test). Although the data show that avulsion injuries can be treated successfully by microsurgical techniques, functional results are not as successful. However, the decision for surgery at times is determined by nonmedical factors such as the patient's age, occupation, economic situation, and level of motivation.

Notre expérience de dix sutures latéroterminales de nerfs sensitifs de la main

Ten traumatic nerve defects at the palm or digit level were treated by end-to-side (ETS) neurorrhaphy. The technique included removal of an epineurial window on the donor nerve and coaptation of the sharply cut distal end of the injured nerve by epineurial stitches under microscope magnification. At final follow-up, the static two-point discrimination test scored at an average of 9.1 (range, 6–12) mm on the repaired nerve, compared to an average of 4.6 (range, 4–6) mm on the contralateral uninjured control side. The moving two-point discrimination test scored at an average of 7 (range, 4–10) mm on the repaired nerve compared to an average of 2.6 (range, 2–4) mm on the control side. This short series showed ETS neurorrhaphies are effective and give comparable results with those of nerve grafts or vein conduits, but worse than direct repairs.

Sensorial donor site morbidity after saphenous neurocutaneous flap

Neurocutaneous flaps based on the arterial network around the superficial sensory nerves are popular in soft tissue coverage of the lower extremities, and are usually preferred in reconstruction of the lower leg and foot. Although sacrifice of sensory cutaneous nerves is mentioned as one of their major disadvantages to our knowledge the morbidity in the foot and at the donor site has not been properly investigated. We investigated sensorial morbidity in the foot and at the donor site caused by raising a saphenous neurocutaneous flap in 14 patients by using static two-point discrimination test, Semmes-Weinstein monofilament test, vibration test, and by measuring somatosensory evoked potentials in the twelfth postoperative month. Our results suggest that sensory recovery is good and protective sensation is gained in most patients.

Measurement of Tactile Sensation on Human Hand by Static and Moving Two-point Discrimination Tests

Tactile sensation of the human hand was measured using two methods : static two-point discrimination test (s2PD) and moving two-point discrimination test (m2PD). The volar side of the right hand of ten subjects (21-24 year old men) was divided into 29 areas each, according to the location of finger joints and the innervation regions of peripheral and peripheral nerves. The shortest threshold of s2PD was measured in the 2nd distal phalanx, which value was 1.4 mm±0.5 mm, and the shortest threshold of m2PD was also measured in the 2nd distal phalanx, which value was 0.7 mm±0.5 mm. In all 29 areas, the threshold of m2PD was significantly (P<0.01) shorter than that of s2PD. That is, the dynamic stimulus allows generating much response of mechanoreceptive afferent units than the static stimulus. The strong correlation (r=0.95) was found between the threshold of s2PD and that of m2PD on the volar side of human hand.

Postural stability in the elderly: a comparison between fallers and non-fallers

the identification of specific risk factors for falls in community-dwelling elderly persons is required to identify older people at risk of falling. the aim of the study was to determine the ability of various biomechanical measures of postural stability to identify fallers in the elderly population. 19 subjects (78.4 +/- 1.3 years old) who reported having fallen unexpectedly at least twice in the last 6 months, and 124 non-fallers (77.8 +/- 0.53 years old) participated in the study. Balance measurements were made in the upright position in six different conditions using a force platform, and the Limits of Stability Test was carried out. Static two-point discrimination (TPD) testing to the underside of the first toe was made to evaluate the innervation density of the slowly adapting receptors. Finally, maximal isometric lower limb strength was measured in major muscle groups. Repeated measures analysis of variance tests were performed to assess the mean differences between the two groups (fallers and non-fallers). The level of significance was set to 0.05. results suggest that control of balance in narrow base stance may be an important tool in identifying elderly fallers. The findings show an increase in mediolateral sway in narrow base stance in older people who experienced recurrent falls. Also, TPD appears to be impaired in elderly fallers (14.93 +/- 1.1 mm versus 12.98 +/- 0.3 mm). simple and safe laboratory quantitative tests were able to differentiate between elderly fallers and elderly individuals who did not fall, suggesting a possible clinical application as a preliminary screening tool for predicting future risk of falling.

End-to-side neurorrhaphy for defects of palmar sensory digital nerves

Ten traumatic nerve defects at the palm or digit level were treated by end-to-side (ETS) neurorrhaphy. The technique included removal of an epineurial window on the donor nerve and coaptation of the sharply cut distal end of the injured nerve by epineurial stitches under microscopic magnification. At final follow-up, the static two-point discrimination test (2 pd) scored at an average of 9.1 mm (range, 6–12 mm) on the repaired nerve, compared to an average of 4.6 mm (range, 4–6 mm) on the contralateral uninjured control side. Moving 2 pd scored at an average of 7 mm (range, 4–9 mm) on the repaired nerve compared to an average of 2.6 mm (range, 2–4 mm) on the control side. This short series showed that ETS neurorrhaphies are effective and give comparable results with those of nerve grafts or vein conduits.

Effects of Regular Walking on Postural Stability in the Elderly

Background: Both age and lack of physical activity may be responsible for poor health and poor balance control. Conversely, physical activity may modulate postural control in elderly people. Objective: An observational study was performed in older adults to explore whether walking on a regular basis might prove to be beneficial not only to the cardiovascular system but also to maintaining a good balance. Methods: Twenty-two healthy older subjects walking on a regular basis (DW group) and 121 healthy control older subjects who did not walk regularly (NW group) were studied. The subjects included in the study were free from major gait and postural disorders. An instrumented force platform was used to measure the time-varying displacements of the center of pressure under eight static conditions and postural limit tests. An isometric test was performed to evaluate lower limb muscle strength, and a static two-point discrimination test evaluated the innervation density of the slowly adapting receptors of the sole of the first toe. Results: The DW group had a significantly better (p < 0.05) postural stability under static conditions than the NW group. There were no significant differences in postural limit tests and in two-point discrimination between the groups. The DW group had significantly higher values of ankle plantar flexor and knee extensor strengths, while there were no significant differences in ankle dorsiflexors and knee flexors. None of the DW group reported experiencing a fall during the previous 6 months compared with 16% in the NW group who reported at least two falls during the last half year. Conclusions: Walking on a regular basis in old age may have the potential to modulate stability. It was found that healthy older subjects, who walked on a regular basis since their retirement, have better postural control, especially in their static balance, than those who do not. The laboratory results were accompanied by the important finding that although older subjects who walk on a regular basis walked much more than nonwalkers, they did not suffer from falls.

Sensory recovery after reconstruction of defects of long fingertips using the pedicled V flap

The pedicled V-flap technique was used to repair varying degrees of injury to the fingertip in 29 patients. The technique is described, together with the results of static two-point discrimination tests 1 month and 3 months after surgery. The sensation in the flaps reached near-normal levels after 3 months in all patients. Although statistically significant, the difference in the results at 1 month and 3 months postoperatively was minimal.

下顎枝矢状分割法術後の知覚障害に関する臨床的研究

Sagittal splitting ramus osteotomy (SSRO) is the most common orthodontic procedure used to correct mandibular deformation. However there is a postoperative risk of neurosensory disturbance (NSD) of the mental nerve.A total of 84 patients underwent preoperative and postoperative bilateral examinations (total: 168 examinations). Subjective symptoms were assessed by interview, and constant-touch was evaluated by tactile-threshold tests with the use of a Semmes-Weinstein pressure aesthesiometer (SW test) and by static two-point discrimination tests (2 PD). Dynamic-touch was examined by vibratory sensibility tests.No significant differences were observed as compared with the preoperative scores on the SW test after 4 weeks. Furthermore, no change in the mean preoperative value on the 2 PD test was observed at the 8th postoperative week. A significant difference was detected between the preoperative score on the vibratory sensation test and the score after 24 weeks. Dynamic-touch assessment suggested that recovery was slow as compared with constant-touch recovery. The majority of patients scored 1.65 (the smallest sensible filament) on the SW test, and 83.2% of these patients showed an improvement in symptoms. A significant difference was noted between symptoms and the dispersion of vibratory sensibility test scores. The vibratory sensibility test could detect sensation recovery by slow regeneration of nerves, but the probability of not detecting sensation was high when only the SW test was used.Sensibility occurs via the function of various sensory units. Thus, a combination of tests should be performed to assess sensiblity associated with perceptual disorders.

The reverse digital artery island flap: clinical experience in 120 fingers.

Fingertip injuries represent the most common type of injuries seen in the upper extremity. Their management is functionally and aesthetically important but at the same time very controversial. The aim of this study is to report usefulness and postoperative results of reverse digital artery island flaps for fingertip reconstruction. From July of 1984 to December of 1995, 120 fingers in 110 patients with defects of the distal phalanx were reconstructed by reverse digital artery island flaps at Korea University Guro Hospital. We reviewed the medical records of our cases and analyzed them in several aspects. In 21 cases, neurorrhaphy was performed to improve sensibility. In the majority of the cases, the defect was covered primarily, whereas in 27 cases it was covered secondarily after composite graft, replantation, and so on. All the flaps survived except for one. Long-term follow-up for more than 6 months was possible in 44 fingers in 41 patients. Light touch and temperature sensation could be detected in all the evaluated flaps. The mean values of the static two-point discrimination test in sensate and insensate flaps were 6.2 and 10.2 mm, respectively. The reverse digital artery island flap is a safe and reliable procedure with a high survival rate and therefore is an excellent choice for coverage of fingertip defects.

Une augmentation importante de la sensibilité superficielle, de nombreuses années après une lésion neurologique périphérique, par stimulation vibratoire transcutanée

A patient with sensory changes in the territory of the ulnar nerve due to a partial nerve lesion 19 years previously, was treated by Transcutaneous Vibratory Stimulation. The effectiveness of this treatment was verified by subjective criteria and by the following tests: Moving and Static Two-Point discrimination Test, Light-touch-Deep-pressure (Semmes-Weinstein) Test, Ninhydrin sweat Test and Wrinkle Test. These tests document both a marked improvement in superficial sensitivity and partial regulation of sympathetic nervous system function.

Evaluation of functional sensation in the hand

The ability to predict hand function based upon the degree of sensory impairment is required in determining disability rating, evaluating patients for reconstructive surgery, measuring end results of nerve repairs, and following peripheral neuropathies. The present study evaluated the ability of four tests of sensibility to predict hand function. It was found that the moving two-point discrimination test best correlated with the patient's ability to identify objects with the fingertips, p less than 0.001. The time required for object recognition correlated best with the static two-point discrimination test, p less than 0.001. This study also suggests that the most precise prediction of functional sensation in the hand requires the combined use of both these tests.