Types Of Peripheral Nerve Injuries Research Articles

Assessment, management, and rehabilitation of traumatic peripheral nerve injuries for non-surgeons.

Electrodiagnostic evaluation is often requested for persons with peripheral nerve injuries and plays an important role in their diagnosis, prognosis, and management. Peripheral nerve injuries are common and can have devastating effects on patients' physical, psychological, and socioeconomic well-being; alongside surgeons, electrodiagnostic medicine specialists serve a central function in ensuring patients receive optimal treatment for these injuries. Surgical intervention-nerve grafting, nerve transfers, and tendon transfers-often plays a critical role in the management of these injuries and the restoration of patients' function. Increasingly, nerve transfers are becoming the standard of care for some types of peripheral nerve injury due to two significant advantages: first, they shorten the time to reinnervation of denervated muscles; and second, they confer greater specificity in directing motor and sensory axons toward their respective targets. As the indications for, and use of, nerve transfers expand, so too does the role of the electrodiagnostic medicine specialist in establishing or confirming the diagnosis, determining the injury's prognosis, recommending treatment, aiding in surgical planning, and supporting rehabilitation. Having a working knowledge of nerve and/or tendon transfer options allows the electrodiagnostic medicine specialist to not only arrive at the diagnosis and prognosticate, but also to clarify which nerves and/or muscles might be suitable donors, such as confirming whether the branch to supinator could be a nerve transfer donor to restore distal posterior interosseous nerve function. Moreover, post-operative testing can determine if nerve transfer reinnervation is occurring and progress patients' rehabilitation and/or direct surgeons to consider tendon transfers.

Assessment, patient selection, and rehabilitation of nerve transfers.

Peripheral nerve injuries are common and can have a devastating effect on physical, psychological, and socioeconomic wellbeing. Peripheral nerve transfers have become the standard of care for many types of peripheral nerve injury due to their superior outcomes relative to conventional techniques. As the indications for, and use of, nerve transfers expand, the importance of pre-operative assessment and post-operative optimization increases. There are two principal advantages of nerve transfers: (1) their ability to shorten the time to reinnervation of muscles undergoing denervation because of peripheral nerve injury; and (2) their specificity in ensuring proximal motor and sensory axons are directed towards appropriate motor and sensory targets. Compared to conventional nerve grafting, nerve transfers offer opportunities to reinnervate muscles affected by cervical spinal cord injury and to augment natural reinnervation potential for very proximal injuries. This article provides a narrative review of the current scientific knowledge and clinical understanding of nerve transfers including peripheral nerve injury assessment and pre- and post-operative electrodiagnostic testing, adjuvant therapies, and post-operative rehabilitation for optimizing nerve transfer outcomes.

Exosomes combined with biosynthesized cellulose conduits improve peripheral nerve regeneration

Peripheral nerve injury is one of the more common forms of peripheral nerve disorders, and the most severe type of peripheral nerve injury is a defect with a gap. Biosynthetic cellulose membrane (BCM) is a commonly used material for repair and ligation of nerve defects with gaps. Meanwhile, exosomes from mesenchymal stem cells can promote cell growth and proliferation. We envision combining exosomes with BCMs to leverage the advantages of both to promote repair of peripheral nerve injury. Prepared exosomes were added to BCMs to form exosome-loaded BCMs (EXO-BCM) that were used for nerve repair in a rat model of sciatic nerve defects with gaps. We evaluated the repair activity using a pawprint experiment, measurement and statistical analyses of sciatica function index and thermal latency of paw withdrawal, and quantitation of the number and diameter of regenerated nerve fibers. Results indicated that EXO-BCM produced comprehensive and durable repair of peripheral nerve defects that were similar to those for autologous nerve transplantation, the gold standard for nerve defect repair. EXO-BCM is not predicted to cause donor site morbidity to the patient, in contrast to autologous nerve transplantation. Together these results indicate that an approach using EXO-BCM represents a promising alternative to autologous nerve transplantation, and could have broad applications for repair of nerve defects.

A period of transient synaptic density unbalancing in the motor cortex after peripheral nerve injury and the involvement of microglial cells

Some types of peripheral nerve injury lead to limb deafferentation, which leads to remodeling of body representation areas in different parts of the brain, such as in the primary motor cortex and primary sensory cortex. This plasticity is a consequence of several cellular events, such as the emergence and elimination of synapses in these areas. Beside neurons, microglial cells are intimately involved in synapse plasticity, especially in synaptic pruning. In this study, we investigated the transient changes in synaptic density in the primary motor and sensory cortex after different types of peripheral nerve injury, as well as the behavior of microglial cells in each scenario. Male C57/B6 mice were divided into a control group (no injury), sciatic-crush group, and sciatic-transection group, and treated with PBS or minocycline daily for different time points. Both types of sciatic lesion led to a significant decrease of synaptophysin and PSD-95 positive puncta counts compared to control animals 4 days after lesion (DAL), which recovered at 7 DAL and was sustained until 14 DAL. The changes in synaptic puncta density were concomitant with changes in the density and morphology of microglial cells, which were significantly more ramified in the primary motor cortex of injured animals at 1 and 4 DAL. Although the decreased synaptic puncta density overlapped with an increased number of microglial cells, the number of lysosomes per microglial cell did not increase on day 4 after lesion. Surprisingly, daily administration of minocycline increased microglial cell number and PSD-95 positive puncta density by 14 DAL. Taken together, we found evidence for transient changes in synaptic density in the primary motor, related to peripheral injury with possible participation of microglia in this plasticity process.

Leupeptin accelerates recovery after sciatic transection and repair, but not crush injuries in rats.

We aimed to explore previously reported discrepancies in success with leupeptin by comparing outcomes of two types of injury: transection and crush. Male rats were randomized into vehicle and leupeptin treatment groups (n = 6/transection group; n = 10/crush group). Leupeptin (12 mg/kg) was administered via intramuscular injection into the gastrocnemius muscle twice a week for the duration of the study. Rats were monitored on a weekly basis for electromyographic function and gait for 8 weeks. A total of 83.3% of the rats that were treated with leupeptin began to recover electromyographic activity 1 week after transection, versus 0% that were treated with leupeptin after crush (P < 0.0001). Rats that were treated with leupeptin also had less functional debilitation, as indicated by a greater sciatic functional index at five of the eight time-points after transection versus one of eight after crush (P ≤ 0.05). Leupeptin aids in the rate of recovery after transection and repair but not crush injuries. These findings suggest there may be differences in pathology and recovery associated with these two types of peripheral nerve injury.

Ultrasound examination of peripheral nerve injuries in patients with limb injuries in the early post-traumatic or postoperative periods

Introduction. In the early hours and days after traumatic or surgical event it is essential to determine type of peripheral nerve injury accurately.Objective. To assess performance of diagnostic ultrasound (US) in patients with traumatic and intraoperative nerve injuries during the early hours and days after trauma or surgery.Materials and methods. 106 patients with clinical signs of extremity nerve injuries were included into the study. A total of 113 limb nerves were investigated with US.Results. US sensitivity in the detection of complete nerve rupture was 100% (95% CI: 39,8-100%), specificity — 99,0% (94,7100,0%); for nerve compression with the bone sensitivity was 100% (66,4-100%), specificity — 100% (96,3-100%); for nerve compression with fixation devices sensitivity was 100% (66,4-100%), specificity — 100% (15,8-100%) и 100% (88,4-100%).Conclusion. Nerve US is a reliable method for the evaluation of extremity nerve injury, the method can be recommended for use in the early hours and days after trauma or surgery.

Treatment Process for Neuropathy Involving Science-Based Clinical Research and Medical Technology Combinations

we will demonstrate the ability of multiple and specific alternative medical technologies used in combination that support the body’s natural ability to repair peripheral nerves in neuropathy patients. This paper looks to review currently known biological foundations for the regenerative effects of Low-Level Laser Therapy, Pulsed Electromagnetic Field Therapy, Infrared and Near Infrared Therapy, and Nutritional Protocols to demonstrate the significant potential to repair peripheral nerve injuries. There is favorable evidence to expand functional recovery in diverse types of peripheral nerve injuries. The conclusion from this study indicates using a specific combination of technologies that scientifically enhances the body’s ability to repair nerves is more effective in helping patients with neuropathies than the normal standard of care.

Sensory neuron-associated macrophages as novel modulators of neuropathic pain.

The peripheral nervous system comprises an infinity of neural networks that act in the communication between the central nervous system and the most diverse tissues of the body. Along with the extension of the primary sensory neurons (axons and cell bodies), a population of resident macrophages has been described. These newly called sensory neuron–associated macrophages (sNAMs) seem to play an essential role in physiological and pathophysiological processes, including infection, autoimmunity, nerve degeneration/regeneration, and chronic neuropathic pain. After different types of peripheral nerve injury, there is an increase in the number and activation of sNAMs in the sciatic nerve and sensory ganglia. The activation of sNAMs and their participation in neuropathic pain development depends on the stimulation of pattern recognition receptors such as Toll-like receptors and Nod-like receptors, chemokines/cytokines, and microRNAs. On activation, sNAMs trigger the production of critical inflammatory mediators such as proinflammatory cytokines (eg, TNF and IL-1β) and reactive oxygen species that can act in the amplification of primary sensory neurons sensitization. On the other hand, there is evidence that sNAMs can produce antinociceptive mediators (eg, IL-10) that counteract neuropathic pain development. This review will present the cellular and molecular mechanisms behind the participation of sNAMs in peripheral nerve injury–induced neuropathic pain development. Understanding how sNAMs are activated and responding to nerve injury can help set novel targets for the control of neuropathic pain.

FREQUENCY OF PERIPHERAL NERVE INJURIES IN ATHLETES OF CERTAIN SPORTS CLUBS IN THE CITY OF ZADAR

Peripheral nerves in athletes are susceptible to injury due to an increase in physiological requirements in the training process to neurological structures and to the soft tissues that protect them. The training process is conditioned by the rank and level of competition and its implementation largely depends on the education of professional staff. Common mechanisms of injury are pressure, sprain, strain, ischemia, and sports injury. Seddon's original system of dividing nerve injuries based on neurophysiological changes is most widely used in medicine. The initial stage of nerve injury is neuropraxia, the second stage is axonal degeneration, and the third stage is nerve cutting. Peripheral nerve injuries are more common in the upper extremities than in the lower extremities. They have specifics related to a particular sport, in this case, football and basketball, and often have a biomechanical component in the making. Early detection allows an appropriate rehabilitation program to be initiated and biomechanics changed before the nerve injury becomes permanent. Recognizing nerve injury requires an understanding of peripheral neuroanatomy, knowledge of common nerve injury sites, and awareness of the types of peripheral nerve injuries that are common and specific to a particular sport. Rehabilitation programs in the field of kinesiology can be read through FMS protocols. Electrodiagnostic tests (electromyography), somatosensory evoked potentials, magnetic resonance imaging, and ultrasound are used to diagnose peripheral nerve injuries. Proximal peripheral nerve injuries have a slightly poorer prognosis in terms of neurological recovery in athletes. The survey determined the frequency of injuries in the subjects and that there is a misunderstanding among the athletes themselves, which is a peripheral nerve injury. The survey also found that peripheral nerve injuries occur due to acute injuries, while chronic injuries are excessive, resulting in damage to muscles and joints, and rarely as a result of inappropriate sports equipment. Athletes' knowledge of what constitutes a peripheral nerve injury itself and how this type of injury should be given more importance in further general prevention has also been established.

Restoration of motor innervation by the «end-to-side» neurorraphia: experimental modeling and clinical and instrumental control of reinnervation

The high probability of permanent loss of professional fitness and a significant risk of disability of the injured as a result of limb injuries with peripheral nerve damage contribute to both the continuous improvement of surgical techniques on the peripheral nerves, and the implementation of experimental and anatomical studies aimed at developing new ways to restore the lost innervation. Various types of peripheral nerve injuries are observed in peace and wartime victims in 2-6% and 9.8% of cases, respectively. The high degree of disability of patients with the consequences of peripheral nerve injuries requires improvement of diagnostic and reconstructive plastic approaches in this category of patients. A promising method of restoration of the distal part of the crossed nerve with extensive defects of the nerve trunk is its connection with the lateral surface of the intact donor nerve by the end-to-side neurorraphia. The lack of unambiguous views on the nature of reinnervation in this case, even in the presence of single publications on the positive outcomes of such interventions allow us to use this method only in the absence of the possibility of using autonerval transplants to replace extensive defects of peripheral nerves.&#x0D; The purpose of the study: in experiments on laboratory animals to determine the features of modeling trauma of nerve trunks in relation to the development of the main stages of recovery of lost innervation by connecting peripheral nerves by the end-to-side neurorraphia and to determine the range of simple and demonstrative methods of clinical and instrumental control of the functional state of the restored peripheral nerves in a long-term experiment on laboratory animals.&#x0D; Methods. A comprehensive experimental surgical and clinical-instrumental study was performed on 61 laboratory animals (Chinchilla rabbits of both sexes, phenotypically healthy individuals). In the experimental operating room under intravenous anesthesia, modeling of peripheral nerve defect was performed by resection of the total peroneal nerve with a length of 1 cm at the level of the middle third of the thigh. In animals of the studied group (n=39) to restore innervation, the "end-to-side" neurorraphia of the distal portion of the crossed common peroneal nerve with a specially formed defect of the perineural membrane on the lateral surface of the tibial nerve was performed. In the comparison group (n=22) no replacement of the defect of the common peroneal nerve was performed. The follow-up period after experimental interventions ranged from 1 to 290 days. Morphofunctional state of restored nerve trunks was determined by clinical, radiological and electrophysiological methods.&#x0D; Research results. Performing unilateral resections of the common peroneal nerve in laboratory animals (rabbits) with subsequent restoration of the distal portion of the crossed nerve by connecting it by the end-to-side neurorraphia with a nearby intact donor nerve allows to obtain reproducible in the experiment positive results of tissue reinnervation. Indirect assessment of the functional state of the restored nerves is possible using simple and accessible clinical tests, for example, the amplitude of the abduction of the toes of experimental animals in the study of the unconditional reflex of preparation for landing characterizes the conductivity of the common peroneal nerve. When performing experimental studies with multi-stage reconstructive plastic interventions on the peripheral nerves of laboratory animals, the inclusion of radiological methods in the complex of diagnostic measures allows performing in vivo visualization of the surgical intervention area, the restored nerve trunk, as well as the tissues innervated by its branches, which makes it possible to adjust the plan of subsequent morphological studies.&#x0D; Conclusions &#x0D; &#x0D; Performing resection of the common peroneal nerve of laboratory animals (rabbits) at the level of the middle third of the femur as a model of peripheral nerve injury allows to practice the technique of restoration of the distal section of the crossed nerve by connecting it with the adjacent intact donor nerve of the end-to-side neurorraphia.&#x0D; Performing a simple test with the initiation of an unconditional reflex of preparation for landing allows us to qualitatively assess the functional state of the common peroneal nerve in experimental animals.&#x0D; &#x0D; 3. The inclusion of radiological research methods in the program of comprehensive assessment of the peripheral nerves allows to perform their visualization in vivo with the definition of the main morphological characteristics of the restored in experimental reconstructive plastic interventions of nerve trunks.

Motion Browser: Visualizing and Understanding Complex Upper Limb Movement Under Obstetrical Brachial Plexus Injuries.

The brachial plexus is a complex network of peripheral nerves that enables sensing from and control of the movements of the arms and hand. Nowadays, the coordination between the muscles to generate simple movements is still not well understood, hindering the knowledge of how to best treat patients with this type of peripheral nerve injury. To acquire enough information for medical data analysis, physicians conduct motion analysis assessments with patients to produce a rich dataset of electromyographic signals from multiple muscles recorded with joint movements during real-world tasks. However, tools for the analysis and visualization of the data in a succinct and interpretable manner are currently not available. Without the ability to integrate, compare, and compute multiple data sources in one platform, physicians can only compute simple statistical values to describe patient's behavior vaguely, which limits the possibility to answer clinical questions and generate hypotheses for research. To address this challenge, we have developed MOTION BROWSER, an interactive visual analytics system which provides an efficient framework to extract and compare muscle activity patterns from the patient's limbs and coordinated views to help users analyze muscle signals, motion data, and video information to address different tasks. The system was developed as a result of a collaborative endeavor between computer scientists and orthopedic surgery and rehabilitation physicians. We present case studies showing physicians can utilize the information displayed to understand how individuals coordinate their muscles to initiate appropriate treatment and generate new hypotheses for future research.

Electromyographic Biofeedback in Motor Function Recovery After Peripheral Nerve Injury: An Integrative Review of the Literature.

Electromyographic biofeedback (EMG-BF) has been applied to treat different types of peripheral nerve injuries (PNI). However, despite the clinical practice widespread use its evidence is controversial. With the objective of summarize the available evidence on the electromyographic biofeedback effectiveness and efficacy to help motor function recovery after PNI an integrative review was performed. A secondary objective was to identify the conceptual framework and strategies of EMG-BF intervention, and the quality of technical description of EMG-BF procedures. To conduct this integrative review a systematic search of the literature was performed between October 2013 and July 2018, in PUBMED, ISI and COCHRANE databases for EMG-BF original studies in PNI patients of any etiology, in English, Portuguese, Spanish or French, published after 1990. Exclusion criteria were poor description of EMG-BF treatment, associated treatment that could impair EMG-BF effect, inclusion of non-PNI individuals and case studies design. The PEDro scale was used to evaluate study quality of randomized clinical trials (RCTs) included. This resulted in 71 potential articles enrolled to full reading, although only nine matched the inclusion criteria. PNI included facial paralysis, acute sciatic inflammation and carpal tunnel syndrome. The average quality score of the included RCTs was five, corresponding to low methodological quality. Due to the small number of included articles, low qualitystudies and heterogeneity of interventions, outcomes and population we concluded that there is limited evidence of EMG-BF effectiveness and efficacy for motor function recovery in PNI patients.

End-to-side neurorrhaphy: expectations and reality

An increasing number of injuries with damage of peripheral nerves, including a substantial number of injuries with extensive defects of large nerve trunks, requires improvement in approach to surgical treatment of patients. High-energy impact injuries in peacetime and wartime often lead to persistent violations of musculoskeletal apparatus, a significant part of which is due to injuries of peripheral nerves. During peacetime, various types of peripheral nerve injuries occur in 2-6% of trauma patients. In today’s armed conflicts, various types of peripheral nerve injuries occur in nearly 80% of neurosurgical patients and are mostly of combined injury. Improvements in surgical methods of recovery of lost innervation due to an injury are directly associated with the development of fundamental understanding of the nature of occurring degenerative and regenerative processes in damaged nerve fiber. Nerve suture is only the creation of appropriate conditions that contribute to regeneration of nerve fibers and recovery of lost functions. When extensive defects of nerve trunks exist, connection of distal part damaged nerve with side surface of the intact nerve is the alternative to traditional replacement of extensive defects with nerve grafts. Positive outcomes of such interventions that were seen during tests on laboratory animals led to trials of this method on patients and resulted in a number of positive outcomes as well. Despite the fact that the question of morphological substantiation of reinnervation processes of the distal portion of a damaged nerve is the cause of heated disputes among scientists, some surgeons make attempts to define a set of specific conditions needed to justify the use of end-to-side neurorrhaphy.

The effects on peripheral nerve damage of the application of local and systemic erythropoietin

To investigate the histopathological and biochemical effects of topical and systemic administrations of erythropoietin (EPO) on crush and transection type peripheral nerve injuries in an experimental rat model. 128 male Wistar-Albino rats were allocated to 8 groups according to the route of administration of EPO (local/systemic) and type of peripheral nerve injury (crush/transection). groups were compared with respect to histopathological examination and number of axons as well as levels of IL-1β, IL-6, and IL-10. Groups receiving EPO either locally or intraperitoneally revealed less scar tissue formation index, lower number of inflammatory cells, reduced number of perineural fibroblasts and increased number of axons (p < 0.001 for all). Levels of IL-1β and IL-6 were lower and IL-10 levels were higher in groups receiving EPO locally or intraperitoneally (p < 0.001). Iatrogenic nerve injury has remained an area with few therapeutic options. Our results indicated that local and systemic applications of EPO might have a promising potential therapeutic agent for crush or transection type of peripheral nerve injuries. Dose, route of administration and indications should be elucidated in further prospective, randomized, controlled trials (Tab. 3, Fig. 4, Ref. 32).

Proteomic analysis of the dorsal spinal cord in the mouse model of spared nerve injury-induced neuropathic pain.

Peripheral nerve injury often causes neuropathic pain and is associated with changes in the expression of numerous proteins in the dorsal horn of the spinal cord. To date, proteomic analysis method has been used to simultaneously analyze hundreds or thousands of proteins differentially expressed in the dorsal horn of the spinal cord in rats or dorsal root ganglion of rats with certain type of peripheral nerve injury. However, a proteomic study using a mouse model of neuropathic pain could be attempted because of abundant protein database and the availability of transgenic mice. In this study, whole proteins were extracted from the ipsilateral dorsal half of the 4th–6th lumbar spinal cord in a mouse model of spared nerve injury (SNI)-induced neuropathic pain. In-gel digests of the proteins size-separated on a polyacrylamide gel were subjected to reverse-phase liquid-chromatography coupled with electrospray ionization ion trap tandem mass spectrometry (MS/MS). After identifying proteins, the data were analyzed with subtractive proteomics usingProtAn, an in-house analytic program. Consequently, 15 downregulated and 35 upregulated proteins were identified in SNI mice. The identified proteins may contribute to the maintenance of neuropathic pain, and may provide new or valuable information in the discovery of new therapeutic targets for neuropathic pain.

The effect of Riluzole on functional recovery of locomotion in the rat sciatic nerve crush model.

Peripheral nerve injury (PNI) is common disorder that represents more than 3% of all traumatic injury cases. One type of PNI, sciatic nerve injury, leads to considerable motoneuron dysfunction. Because Riluzole is clinically approved for the treatment of motoneuron disease, we evaluated whether Riluzole treatment could enhance the nerve regeneration process and improve functional outcome after sciatic nerve crush in rats. In acute treatment groups, a single dose of Riluzole (6 and 8mg/kg) was administered intra-peritoneally 15min after the crush nerve injury. In the chronic treatment groups, animals were treated with Riluzole (4 and 6mg/kg/d) for 8days. Sciatic functional index (SFI) was evaluated for 9weeks after injury. Furthermore, electrophysiological and morphometric evaluations were performed at the 9th week following injury. Acute and chronic administrations of Riluzole immediately after sciatic nerve crush result in significantly delayed regeneration and reduced motor function outcome. These findings suggest that early administration of even a single dose of Riluzole after sciatic nerve crush injury can delay motor function recovery. This effect may not depend on its anti-nociceptive activity.

Aligned carbon nanotube containing scaffolds for neural tissue regeneration.

Neuropathologies include the deterioration and damage of the nervous system, especially neurons present in the brain, spinal cord and peripheral nervous system. Damage or alternations in neurons makes their structure and functionality abnormal. Every year over 90,000 people get affected by neurodegenerative diseases in the USA. Among all the neurological pathologies, the spinal cord injuries alone influence 10,000 people in the USA every year. Millions of cases of neurodegenerative pathologies are registered worldwide. Without proper treatment and cure to these cases, the toll for patients suffering from neurode-generative disease is expected to reach at least 12 million in the USA 30 years from now (John, 2015).

NEURONAL APOPTOSIS AND INTERVENTION STRATEGIES

Following distal nerve injury significant sensory neuronal cell death occurs in the dorsal root ganglia, while after a more proximal injury, such as brachial plexus injury, a sizeable proportion of spinal motoneurons also undergo cell death. This phenomenon has been undervalued for a long time, but it has a significant role in the lack of functional recuperation, as neuronal cells cannot divide and be replaced, hence the resulting nerve regeneration is usually suboptimal. It is now accepted that this cell death is due to apoptosis, as indicated by analysis of specific genes involved in the apoptotic signalling cascade. Immediate nerve repair, either by direct suturing or nerve grafting, gives a degree of neuroprotection, but this approach does not fully prevent neuronal cell death and importantly it is not always possible. Our work has shown that pharmacological intervention using either acetyl-L-carnitine (ALCAR) or N-acetyl-cysteine (NAC) give complete neuroprotection in different types of peripheral nerve injury. Both compounds are clinically safe and experimental work has defined the best dose, timing after injury and duration of administration. The efficacy of neuroprotection of ALCAR and NAC can be monitored non-invasively using MRI, as demonstrated experimentally and more recently by clinical studies of the volume of dorsal root ganglia. Translation to patients of this pharmacological intervention requires further work, but the available results indicate that this approach will help to secure a better functional outcome following peripheral nerve injury and repair.

Reasons and diagnostic errors in cases of the peripheral nerves of extremities injuring

Trauma of peripheral nerves of extremities takes leading place in disability cases (28-75%). The risk zones for injuring the nerves of upper extremity are shoulder and forearm, and of lower extremity are lower third of the thigh and the upper third of the tibia.The aim of research: to analyze and identify the causes of diagnostic errors and complications in injuries of peripheral nerves of the extremities.Material and methods:Results of clinico-neurological and electrodiagnostical studying of 72 patients with injuries of upper and lower extremities are presented in the article. Patients were treated in 2010-2013 in traumatology department of Dnepropetrovsk state clinical hospital № 16.The author distinguishes three forms of disturbance of the integrity of the neural trunk and five periods of their clinical course: neurotmesis - complete or partial break patterns of nerves, was diagnosed in 43 patients (59,7%); aksonotmesis - break part of axial cylinder, while maintaining the integrity of the epineurium - in 19 patients (26,4%) and neuropraxia - fine-grained lesions without violating the integrity of the axle of cylinders in 10 patients (13.9%). The types of peripheral nerve injuries of extremities were divided into 2 groups: primary and secondary (iatrogenic).ResultsThe study showed that the most frequently pain from the injured nerves of the upper limb radiated at shoulder level, median and ulnar - at the level of the forearm. Diagnostic and therapeutic errors were detected at all stages of medical care, the author noted the insufficient assessment of neurological risk, in the pre-hospital and hospital stages, especially in cases of combined injuries. It is necessary to conduct more thorough clinical, radiological and electrophysiological assessment in the presence of small stab and cut wounds of the extremities.Lack of the special tools and equipment, insufficient qualification of surgeons in matters of anatomical and topographical relationships between nerves, tendons and blood vessels in the soft tissues, as well as divergent views in the specialized literature, about terms of surgical and conservative treatment, about indications for them, leave the problem of peripheral nerve injuries is very topical issue of modern medicine.ConclusionsTrauma of peripheral nerves of extremities takes the leading place in permanent disability (28-75%) and occurs in 1,5 - 3,5 % of the total traumatism.Currently, the diagnosis and treatment of peripheral nerves of extremity has no generally accepted standardized system for assessing the level, degree and nature of the injury.In our opinion, the distribution of patients in our study into groups by the etiology and levels of damage the peripheral nerves, helped to clarify and to objectify the reasons for their traumatization, and find errors on the stages of diagnosis and treatment.Most commonly of the radial nerve trunks (45,8%), and on the forearm - the median and ulnar nerves (15,3%) are damaged.

The Correlation between Calcium Intensity and Histopathological Changes in Brachial Plexus Nerve Injuries

After nerve injury, an influx of calcium exceeds the homeostatic capacity, which damages peripheral nerves. Previous studies identified that following nerve crush, function improves as calcium levels normalize. Electrophysiological analysis was performed to measure the compound muscle action potential of 15 patients' damaged nerves. These samples were evaluated for calcium level and also stained with a Luxol fast blue and neurofilament antibodies to evaluate the myelin sheath and neurofilaments of the nerves. Based on the Sunderland scale, we identified three exclusive types of peripheral nerve injury groups. There was a correlation between histopathological damage and calcium levels of 0.81 (p < 0.005). The average relative fluorescence units (RFUs) was 235.28 ± 19, which corresponds to 5.3 × 10⁻⁷ M of calcium, five times the normal value. Our study shows promising clinical implications via faster pathology results by the RFU technique. This approach of calcium staining, though still in clinical trials, offers significant clinical application, allowing physicians to get the clinically diagnostic nerve injury degree faster and will also facilitate better strategies for further treatment or future surgeries.