RESUMEN
INTRODUCTION: Upper limb spasticity is a surgical challenge, both in diminishing agonists spasticity and reconstructing antagonist function. Brachioradialis (BR) is often involved in elbow flexors spasticity. Finger extension is often impaired in spastic patients. This study aims to demonstrate the feasibility of BR motor branch to posterior interosseous nerve (PIN) during BR selective neurectomies, and to describe fascicles topography inside the radial nerve to facilitate PIN dissection. MATERIAL AND METHOD: Ten upper limbs from 10 fresh frozen anatomical specimens were dissected. Motor branches to the BR, wrist extensors, supinator, PIN and radial sensory branch were identified. BR to PIN transfer was realized and its feasibility was studies (donor length, tensionless suture). RESULTS: BR to PIN transfer was achievable in 9 out of 10 cases. The position of the sensory branch of the radial nerve was inferior or medial in all cases. The position of the PIN was lateral in 90% of the cases. CONCLUSION: BR to PIN nerve transfer is achievable in most cases (90%). The lateral topography of the PIN and the inferomedial topography of the sensory branch in most cases allows for an easier intraoperative finding of the PIN when stimulation is not possible. LEVEL: IV, feasibility study.
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Cadáver , Estudios de Factibilidad , Dedos , Espasticidad Muscular , Transferencia de Nervios , Nervio Radial , Humanos , Nervio Radial/cirugía , Nervio Radial/anatomía & histología , Transferencia de Nervios/métodos , Espasticidad Muscular/cirugía , Dedos/inervación , Dedos/cirugía , Codo/inervación , Codo/cirugía , Masculino , FemeninoRESUMEN
Sensory feedback provides critical interactive information for the effective use of hand prostheses. Non-invasive neural interfaces allow convenient access to the sensory system, but they communicate a limited amount of sensory information. This study examined a novel approach that leverages a direct and natural sensory afferent pathway, and enables an evoked tactile sensation (ETS) of multiple digits in the projected finger map (PFM) of participants with forearm amputation non-invasively. A bidirectional prosthetic interface was constructed by integrating the non-invasive ETS-based feedback system into a commercial prosthetic hand. The pressure information of five fingers was encoded linearly by the pulse width modulation range of the buzz sensation. We showed that simultaneous perception of multiple digits allowed participants with forearm amputation to identify object length and compliance by using information about contact patterns and force intensity. The ETS enhanced the grasp-and-transport performance of participants with and without prior experience of prosthetic use. The functional test of transport-and-identification further revealed improved execution in classifying object size and compliance using ETS-based feedback. Results demonstrated that the ETS is capable of communicating somatotopically compatible information to participants efficiently, and improves sensory discrimination and closed-loop prosthetic control. This non-invasive sensory interface may establish a viable way to restore sensory ability for prosthetic users who experience the phenomenon of PFM.
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Miembros Artificiales , Retroalimentación Sensorial , Dedos , Diseño de Prótesis , Tacto , Estimulación Eléctrica Transcutánea del Nervio , Humanos , Masculino , Estimulación Eléctrica Transcutánea del Nervio/métodos , Adulto , Retroalimentación Sensorial/fisiología , Dedos/fisiología , Dedos/inervación , Femenino , Tacto/fisiología , Fuerza de la Mano/fisiología , Antebrazo/inervación , Amputados , Adulto Joven , Percepción del Tacto/fisiología , Desempeño Psicomotor/fisiología , ManoRESUMEN
Distal nerve transfers can restore precise motor control in tetraplegic patients. When nerve transfers are not successful, tendon transfers may be used for subsequent reconstruction. In this case, an extensor carpi radialis brevis (ECRB) tendon transfer was used to restore thumb and finger flexion following an unsuccessful ECRB to anterior interosseous nerve transfer in a young tetraplegic patient. Twelve months following tendon transfer, the patient demonstrated functional grip and pinch strength and was using both hands for daily activities. Level of Evidence: Level V (Therapeutic).
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Transferencia de Nervios , Cuadriplejía , Transferencia Tendinosa , Pulgar , Humanos , Transferencia Tendinosa/métodos , Cuadriplejía/cirugía , Cuadriplejía/fisiopatología , Pulgar/inervación , Pulgar/cirugía , Masculino , Transferencia de Nervios/métodos , Rango del Movimiento Articular , Fuerza de la Mano/fisiología , Dedos/cirugía , Dedos/inervaciónRESUMEN
BACKGROUND: This work aimed to investigate the change in fingerprint depth and the recovery rule of fingerprint biological recognition function after repairing finger abdominal defects and rebuilding fingerprint with a free flap. METHOD: From April 2018 to March 2023, we collected a total of 43 cases of repairing finger pulp defects using the free flap of the fibular side of the great toe with the digital nerve. After surgery, irregular follow-up visits were conducted to observe fingerprint clarity, perform the ninhydrin test or detect visible sweating with the naked eye. We recorded fingerprint clarity, nail shape, two-point discrimination, cold perception, warm perception and fingerprint recognition using smartphones. The reconstruction process of the repaired finger was recorded to understand the changes in various observation indicators and their relationship with the depth of the fingerprint. The correlation between fingerprint depth and neural repair was determined, and the process of fingerprint biological recognition function repair was elucidated. RESULT: All flaps survived, and we observed various manifestations in different stages of nerve recovery. The reconstructed fingerprint had a clear fuzzy process, and the depth changes of the fingerprint were consistent with the changes in the biological recognition function curve. CONCLUSION: The free flap with the digital nerve is used to repair finger pulp defects. The reconstructed fingerprint has a biological recognition function, and the depth of the fingerprint is correlated with the process of nerve repair. The fingerprint morphology has a dynamic recovery process, and it can reach a stable state after 6-8 months.
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Traumatismos de los Dedos , Colgajos Tisulares Libres , Traumatismos de los Tejidos Blandos , Humanos , Masculino , Femenino , Adulto , Colgajos Tisulares Libres/trasplante , Colgajos Tisulares Libres/inervación , Persona de Mediana Edad , Traumatismos de los Dedos/cirugía , Traumatismos de los Tejidos Blandos/cirugía , Adulto Joven , Recuperación de la Función , Procedimientos de Cirugía Plástica/métodos , Dedos del Pie/cirugía , Dedos del Pie/inervación , Dedos/inervación , Dedos/cirugía , Resultado del Tratamiento , Peroné/trasplante , Peroné/cirugía , Adolescente , AncianoRESUMEN
Awareness of unique path of the superficial branch of the radial nerve and its unusual sensory distribution can help avoid potential diagnostic confusion. We present a unique case encountered during a routine dissection of a Central European male cadaver. An unusual course of the superficial branch of the radial nerve was found in the right forearm, where the superficial branch of the radial nerve originated from the radial nerve distally, within the supinator canal, emerged between the extensor digitorum and abductor pollicis longus muscles and supplied the second and a radial half of the third digit, featuring communications with the lateral antebrachial cutaneous nerve and the dorsal branch of the ulnar nerve. Due to dorsal emerging of the superficial branch of the radial nerve the dorsal aspect of the thumb was innervated by the lateral antebrachial cutaneous nerve. To our best knowledge such variation of the superficial branch of the radial nerve has never been reported before. This variation dramatically changes aetiology and manifestation of possible entrapment syndromes which clinicians should be aware of.
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Variación Anatómica , Cadáver , Dedos , Antebrazo , Músculo Esquelético , Nervio Radial , Humanos , Nervio Radial/anatomía & histología , Nervio Radial/anomalías , Masculino , Músculo Esquelético/inervación , Músculo Esquelético/anomalías , Dedos/inervación , Antebrazo/inervación , Antebrazo/anomalías , DisecciónRESUMEN
BACKGROUND: Finger nerve injuries have a significant impact on hand function and can result in reduced sensation, pain and impaired coordination. The socioeconomic implications of these injuries include decreased workplace productivity, reduced earning potential, and financial burdens associated with long-term medical treatment and rehabilitation. However, there is a lack of comprehensive literature regarding the incidence, mechanisms, and associated injuries of finger nerve lesions. METHODS: A retrospective analysis was conducted on patients treated at our institution from January 2012 to July 2020. Cases of peripheral finger nerve lesions were identified using the digital hospital information system and ICD-10 Classification. Exclusion criteria included injuries to the median nerve at the carpal tunnel level or superficial branch of the radial nerve. Data were collected using a pseudonymized approach, and statistical analyses were performed using SPSS Statistics (Version 27). RESULTS: A total of 2089 finger nerve lesions were analyzed, with a majority of cases occurring in men. Most injuries97.4 % were caused by trauma, predominantly cut/tear injuries. Isolated finger nerve injuries were more common than multiple nerve injuries, with the index finger being the most frequently affected. Concomitant tendon and vascular injuries were observed in a significant proportion51.7 % of cases. Surgical management included direct nerve coaptation, interposition grafting and neurolysis. DISCUSSION: Finger nerve injuries are the most prevalent type of nerve injury, often resulting from small lacerations. These injuries have substantial societal costs and can lead to prolonged sick leave. Understanding the epidemiology and etiology of finger nerve injuries is crucial for implementing effective preventive measures. Accompanying tendon injuries and the anatomical location of the nerve lesions can impact sensory recovery and treatment outcomes. Proper management of peripheral finger nerve lesions is essential for optimizing functional outcomes and minimizing the impact on daily activities. Treatment options should be tailored to the severity and underlying cause of the nerve injury.
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Traumatismos de los Dedos , Traumatismos de los Nervios Periféricos , Humanos , Masculino , Femenino , Estudios Retrospectivos , Traumatismos de los Dedos/cirugía , Traumatismos de los Dedos/epidemiología , Adulto , Persona de Mediana Edad , Dedos/inervación , Dedos/cirugía , Adulto Joven , Adolescente , Incidencia , AncianoRESUMEN
Hand-arm vibration injury is a well-known occupational disorder that affects many workers globally. The diagnosis is based mainly on quantitative psychophysical tests and medical history. Typical manifestations of hand-arm vibration injury entail episodes of finger blanching, Raynaud's phenomenon (RP) and sensorineural symptoms from affected nerve fibres and mechanoreceptors in the skin. Differences in serum levels of 17 different biomarkers between 92 patients with hand-arm vibration injury and 51 controls were analysed. Patients with hand-arm vibration injury entailing RP and sensorineural manifestations showed elevated levels of biomarkers associated with endothelial injury or dysfunction, inflammation, vaso- or neuroprotective compensatory, or apoptotic mechanisms: intercellular adhesion molecule-1 (ICAM-1), monocyte chemoattractant protein-1 (MCP-1); thrombomodulin (TM), heat shock protein 27 (HSP27); von Willebrand factor, calcitonin gene-related peptide (CGRP) and caspase-3. This study adds important knowledge on pathophysiological mechanisms that can contribute to the implementation of a more objective method for diagnosis of hand-arm vibration injury.
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Traumatismos del Brazo , Traumatismos de la Mano , Enfermedades Profesionales , Enfermedad de Raynaud , Humanos , Vibración , Mano , Dedos/inervación , BiomarcadoresRESUMEN
During object manipulation, humans adjust the grip force to friction, such that slippery objects are squeezed more firmly than sticky ones. This essential mechanism to keep a stable grasp relies on feedback from tactile afferents innervating the fingertips, that are sensitive to local skin strains. To test if this feedback originates from the skin-object interface, we asked participants to perform a grip-lift task with an instrumented object able to monitor skin strains at the contact through transparent plates of different frictions. We observed that, following an unbeknown change in plate across trials, participants adapted their grip force to friction. After switching from high to low friction, we found a significant increase in strain inside the contact arising ~100 ms before the modulation of grip force, suggesting that differences in strain patterns before lift-off are used by the nervous system to quickly adjust the force to the frictional properties of manipulated objects.
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Dedos , Tacto , Humanos , Fricción , Dedos/inervación , Dedos/fisiología , Tacto/fisiología , Piel , Fuerza de la Mano/fisiologíaRESUMEN
CASES: We present 2 cases of median nerve reconstruction using distal nerve transfers after resection of unusual benign median nerve tumors. Critical sensation was restored in case 1 by transferring the fourth common digital nerve to first web digital nerves. Thumb opposition was regained by transferring the abductor digiti minimi ulnar motor nerve branch to the recurrent median motor nerve branch. Critical sensation was restored in case 2 by transferring the long finger ulnar digital nerve to the index finger radial digital nerve. CONCLUSION: Distal nerve transfers, even with short grafts, are reliable median nerve deficit treatments, sparing the need for larger autologous nerve grafts and late tendon opponensplasties.
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Nervio Mediano , Transferencia de Nervios , Humanos , Nervio Mediano/cirugía , Dedos/cirugía , Dedos/inervación , Nervio Cubital/cirugía , Nervio Radial/cirugíaRESUMEN
This systematic review with a meta-analysis aimed to identify the altered brain structure and function in carpal tunnel syndrome (CTS) by summarizing the literature about magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), and magnetoencephalography (MEG) outcomes compared to healthy controls (HC). CTS is the most common nerve entrapment in the arm associated with altered peripheral and central nociceptive system. PRISMA guidelines were used to report the outcomes. Six databases were searched for relevant literature (Web of Science, Scopus, PubMed, Sage, EBSCO host, and Cochrane). Eligible studies comparing MRI, fMRI, and MEG findings in people with CTS (present for at least 2 months) and HC through the following parameters: (1) interdigit cortical separation distance, (2) white and grey matter changes, (3) peak latency of M20 wave and recovery function of N20 from the somatosensory cortex (SI), and (4) surface area of activated digit cortical representation. The results from different studies were pooled and a meta-analysis was done. From 17 included, there was a significant reduction of interdigit cortical separation distance of index-middle and index-little fingers in the CTS (SMD = - 0.869, 95% CI (- 1.325, - 0.413), p-value = 0.000) and (SMD = - 0.79, 95% CI (- 1.217, - 0.364), p-value = 0.000), respectively. Middle-little fingers interdigit separation showed no difference (SMD = - 0.2, 95% CI (- 0.903, 1.309), p-value = 0.718). There is evidence supporting the altered brain structure and function in CTS as evidenced by reduction of interdigit cortical separation distance, and excessive blurring and disinhibition of SI, with low resting state functional connectivity. Thus, centrally directed therapeutic approaches might complement peripheral treatments.
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Síndrome del Túnel Carpiano , Humanos , Síndrome del Túnel Carpiano/diagnóstico por imagen , Síndrome del Túnel Carpiano/patología , Mapeo Encefálico , Imagen por Resonancia Magnética/métodos , Dedos/inervación , Corteza SomatosensorialRESUMEN
PURPOSE AND METHOD: The purpose of this study was to determine the changes in the Blood Oxygen Level Dependent signal of Primary somatosensory area (S1) and Brodmann area 3 (BA3) per finger and phalanx in comparison to the activation voxel when 250 Hz vibratory stimulation with high sensitivity for the Pacinian corpuscle was given to the four fingers and three phalanges. RESULTS: The result of analyzing the activation voxel showed a significant difference for S1 per finger and phalanx, but for BA3, no significant difference was observed despite a similar trend to S1. In contrast, the activation intensity (BOLD) displayed a significant difference for S1 per finger and phalanx and for BA3, where the activation voxel had no significant variation. In addition, while the result of S1 did not indicate whether the index or the little fingers had the highest sensitivity based on the BOLD signal per finger, the result of BA3 marked the strongest BOLD signal for the little finger as a response to 250 Hz vibratory stimulation. The activation intensity per phalanx was the highest for the intermediate phalanx for S1 and BA3, which was in line with a previous study comparing the activation voxel. CONCLUSIONS: The method based on the intensity of the nerve activation is presumed to have high sensitivity as the signal intensity is monitored within a specific, defined area. Thus, for the extraction of brain activation patterns of micro-domains, such as BA3, monitoring the BOLD signal that reflects the nerve activation intensity more sensitively is likely to be advantageous.
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Imagen por Resonancia Magnética , Corteza Somatosensorial , Corteza Somatosensorial/fisiología , Imagen por Resonancia Magnética/métodos , Dedos/inervación , Mapeo Encefálico/métodosRESUMEN
A 60-year-old woman presented functional deficit of the index finger flexor digitorum profundus (FDP) tendon after shoulder arthroscopic rotator cuff repair. As no recovery was observed for 10 months, we conducted an operative exploration of the median nerve and the anterior interosseous nerve, followed by an external neurolysis. The patient recovered FDP function 4.5 months after the second operation. In a patient with persistent isolated FDP dysfunction after shoulder arthroscopy, operative exploration and external neurolysis could facilitate functional recovery. Level of Evidence: Level V (Therapeutic).
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Artroscopía , Hombro , Femenino , Humanos , Persona de Mediana Edad , Artroscopía/efectos adversos , Dedos/inervación , Músculo Esquelético , Tendones/cirugía , Tendones/fisiologíaRESUMEN
BACKGROUND: The functional deficits that develop after a peripheral nerve injury mean a considerable reduction in the quality of life for the affected patients. However, interventions on the injured nerve are not always possible or effective. In this case, secondary procedures, e.g. tendon transfers, are a feasible option for functional reconstruction. OBJECTIVES: An overview of the most common secondary surgical procedures for functional reconstruction after peripheral nerve injuries. METHODS: Presentation and discussion of the most common secondary surgical procedures with emphasis on tendon transfers. Illustration of the primary functions that need to be reconstructed depending on the respective nerve lesion. RESULTS: The basic principle of secondary surgical procedures after nerve injuries is the transposition of a healthy tendomuscular unit to replace a lost function following a loss of muscle or tendon or if an intervention on the nerve is not promising. For example, by transferring flexor forearm muscles, wrist, finger and thumb extension can be reconstructed after radial nerve injury. By transposing the tibialis posterior muscle, dorsiflexion in the talocrural joint can be restored to enable the affected patient to walk safely without an orthosis. CONCLUSIONS: Secondary surgical procedures are a valuable option for functional reconstruction after nerve injury.
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Enfermedades del Sistema Nervioso Periférico , Calidad de Vida , Humanos , Nervio Radial/lesiones , Nervio Radial/cirugía , Dedos/inervación , Transferencia Tendinosa/métodosRESUMEN
OBJECTIVE: To explore a surgical method for the reconstruction of volar soft tissue defect and sensory and vascular repair in middle and far phalangeal digits. METHODS: From January 2016 to January 2020, a total of 14 patients , 9 males and 5 females, ages ranging from 22 to 69 years old, and with volar soft tissue defects in the middle and distal digits 2 to 4, underwent surgical reconstruction using the V-Y shaped flap with digital artery and nerve at the metacarpophalangeal joint. The defect area was (2.0~2.5) cm×(1.5 ~2.0) cm. The procedure involved the harvest of a V-Y shaped flap with the digital artery and nerve from the metacarpophalangeal joint. Flap design, dissection of blood vessels and nerves, and anastomosis with the digital artery and nerve were performed according to a standardized protocol., Functional exercise of affected finger was initiated 3 weeks postoperatively. Subsequent assessments were conducted to evaluate finger pulp sensation, shape and other relevant parameters. According to the upper extremity functional evaluation standard set up by Hand Surgery Branch of Chinese Medical Association, the surgical outcomes were evaluated. RESULTS: All 14 cases demonstrated successful tissue transplantation, , with immediate recovery of sensation observed in 10 cases with distal finger pulp defects. Four patients with middle phalangeal defects experienced gradual sensory recovery within 2 to 3 months postoperatively. Thirteen patients were followed up for a mean duration of (8.8 ± 4.49) months, during which satisfactory outcomes were observed. The average two-point resolution of the finger pulp was 4-6mm, and sensory function evaluation yielded a score of S3 or above. Patients exhibited realistic finger shape, normal skin color and temperature, good wear resistance, and cold resistance. Furthermore, finger joint function was essentially normal. CONCLUSION: The V-Y shaped flap with digital artery and nerve at the metacarpophalangeal joint offers a suitable solution for repairing the defect of the middle or distal phalangeal finger. This technique is characterized by its simplicity, low risk, and favorable outcomes, including restored finger shape, blood supply and sensation. Moreover, high patient satisfaction was achieved.
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Traumatismos de los Dedos , Articulación Metacarpofalángica , Traumatismos de los Tejidos Blandos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Traumatismos de los Dedos/cirugía , Dedos/irrigación sanguínea , Dedos/inervación , Dedos/cirugía , Articulación Metacarpofalángica/cirugía , Procedimientos de Cirugía Plástica , Trasplante de Piel , Traumatismos de los Tejidos Blandos/cirugía , Resultado del Tratamiento , Arteria Cubital/cirugíaRESUMEN
SUMMARY: Neuralgic amyotrophy (NA) is a disease affecting peripheral nerves. Treatment has historically been conservative, as the natural course of the disease was thought to be self-limiting. Recent work has demonstrated that as many as two-thirds of people with NA have persistent pain, fatigue, or weakness. At the authors' center, supercharged end-to-side (SETS) nerve transfers are commonly performed in patients with NA to optimize motor recovery while allowing for native axonal regrowth. The authors describe the technique and clinical outcomes of patients with NA affecting the anterior interosseous nerve (AIN) who were treated with SETS nerve transfer from extensor carpi radialis brevis to AIN. Ten patients (90% male; mean age, 51.3 ± 9.7 years) underwent extensor carpi radialis brevis-to-AIN transfer at a mean period of 6.4 ± 1.4 months after onset of symptoms. Mean postoperative follow-up duration was 14.8 ± 3.2 months. Before surgery, all patients demonstrated clinically significant weakness in the flexor pollicis longus (FPL), flexor digitorum profundus muscle to the index finger (FDP2), or both. FPL strength improved from a median Medical Research Council (MRC) grade of 1.5 to 4 ( P = 0.011) and FDP2 strength improved from a median MRC grade of 1 to 5 ( P = 0.016). A postoperative MRC grade of 4 or greater was achieved in nine of 10 (90%) FPL and 10 of 10 (100%) FDP muscles. This is the first report of SETS nerve transfer for the treatment of NA. The outcomes of this work suggest that SETS nerve transfers may be an option to optimize motor outcomes in patients with NA. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
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Neuritis del Plexo Braquial , Transferencia de Nervios , Humanos , Masculino , Adulto , Persona de Mediana Edad , Femenino , Transferencia de Nervios/métodos , Neuritis del Plexo Braquial/cirugía , Nervios Periféricos/cirugía , Extremidad Superior/cirugía , Dedos/inervaciónRESUMEN
We present a patient with Pacinian corpuscle hypertrophy and hyperplasia in the hand and discuss the diagnosis and treatment of this rare condition. A 46-year-old woman presented with radiating pain of the left middle finger. A strong Tinel-like sign was elicited between the index and middle fingers. The patient frequently used mobile phone, with the corner of the phone consistently applying pressure on the palm. The surgery was carried out under the microscope and two enlarged cystic lesions under the epineurium were found in the proper digital nerve. Histologic examination revealed hypertrophied Pacinian corpuscle with normal structure. Postoperatively, her symptoms gradually improved. Preoperative diagnosis of this disease is very difficult. Hand surgeons should keep this disease in mind preoperatively. In our case, we would not have been able to identify multiple hypertrophic Pacinian corpuscles without the microscope. An operating microscope is recommended in a surgery of this nature. Level of Evidence: Level V (Therapeutic).
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Mano , Microcirugia , Corpúsculos de Pacini , Nervios Periféricos , Enfermedades del Sistema Nervioso Periférico , Femenino , Humanos , Persona de Mediana Edad , Dedos/inervación , Dedos/cirugía , Mano/inervación , Mano/cirugía , Hiperplasia/cirugía , Neuroma/cirugía , Corpúsculos de Pacini/patología , Corpúsculos de Pacini/cirugía , Enfermedades del Sistema Nervioso Periférico/etiología , Enfermedades del Sistema Nervioso Periférico/cirugía , Hipertrofia/cirugía , Nervios Periféricos/cirugíaRESUMEN
In this study, we examined the prognostic factors affecting outcomes following nerve grafting in high radial nerve injuries. Thirty-three patients with radial nerve injuries at a level distal to the first branch to the triceps and proximal to the posterior interosseous nerve were retrospectively studied. After a follow-up of at least 1 year, 24 patients (73%) obtained M3+ wrist extension, 16 (48%) obtained M3+ finger extension and only ten (30%) obtained M3+ thumb extension. Univariate, multivariate and receiver operating characteristic analyses showed that a delay in the repair of less than 6 months, a defect length of less than 5 cm or when grafted with three or more donor nerve cables achieved better recovery. Number of cables used was related to muscle strength recovery but not time to reinnervation. Nerve grafting for high radial nerve injury achieved relatively good wrist extension but poor thumb extension and is affected by certain prognostic factors. Level of evidence: IV.
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Transferencia de Nervios , Nervio Radial , Humanos , Nervio Radial/cirugía , Nervio Radial/lesiones , Estudios Retrospectivos , Pronóstico , Procedimientos Neuroquirúrgicos , Dedos/inervaciónRESUMEN
PURPOSE: Muscle-in-vein conduits provide an alternative for bridging digital nerve defects when tension-free suture is not possible. Low donor site morbidity and absence of additional costs are favorable advantages compared with autografts or conduits. METHODS: We retrospectively reviewed 37 patients with 43 defects of proper palmar digital nerves. Primary repair by muscle-in-vein conduits was performed in 22 cases, whereas 21 cases underwent secondary reconstruction. Recovery of sensibility was assessed using static and moving 2-point discrimination and Semmes-Weinstein monofilament testing. Results were compared with the contralateral side serving as a control. Outcome data were stratified according to international guidelines and evaluated for differences in terms of age, gap length, time of reconstruction, and concomitant injuries. RESULTS: The median gap length was 20 mm (range, 9-60 mm). After a median follow-up of 25.0 months (interquartile range, 29.0 months), the median static and moving 2-point discrimination were 7.0 mm and 5.0 mm (interquartile range, 3.0 mm), respectively. The evaluation with Semmes-Weinstein monofilament revealed a median reduction of sensibility of 2 levels compared with the contralateral side. According to the American Society for Surgery of the Hand guidelines, 81.4% of the results were classified as excellent or good, whereas fair and poor results were noted in 9.3% of the cases each. The modified Highet and Sander's criteria rated complete clinical recovery in 13 cases; 23 results were regarded as S3+. CONCLUSIONS: Muscle-in-vein conduits can be considered for primary and secondary reconstruction of digital nerves. Successful sensory recovery in terms of measurable 2-point discrimination was achieved in 91% of all cases. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
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Dedos , Traumatismos de los Nervios Periféricos , Humanos , Estudios de Seguimiento , Dedos/cirugía , Dedos/inervación , Estudios Retrospectivos , Traumatismos de los Nervios Periféricos/cirugía , Resultado del Tratamiento , MúsculosRESUMEN
Background: There are numerous options available for restoration of wrist and finger extension following radial nerve palsy. The aim of this study is to conduct a systematic review of the effectiveness of nerve transfer for radial nerve palsy. Methods: Electronic literature research of PubMed, Cochrane, Scopus and Lilacs database was conducted in June 2021 using the terms 'Distal nerve transfer' AND 'Radial nerve injury' 'Radial nerve palsy' OR 'Radial nerve paresis' OR 'Median nerve transfer' OR 'wrist extensor' OR 'finger extension' OR 'thumb extension' OR 'wrist motion'. The data extracted included the study details, demographic data, procedure performed and final functional outcome according to the muscle research council scale. Results: A total of 92.59% and 56.52% had satisfactory outcome following distal nerve transfer of median nerve to restore wrist and finger extension respectively. No significant correlation was found between time to injury duration and satisfactory outcomes. Conclusions: Outcomes of nerve transfers are comparable to tendon transfers. Multi-centric studies are needed to compare the results amongst various surgical procedures described. Level of Evidence: Level III (Therapeutic).
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Transferencia de Nervios , Neuropatía Radial , Humanos , Muñeca/cirugía , Transferencia de Nervios/métodos , Dedos/cirugía , Dedos/inervación , Articulación de la Muñeca/fisiología , Neuropatía Radial/cirugía , Parálisis/cirugíaRESUMEN
Running our fingers across a textured surface gives rise to two types of skin deformations, each transduced by different tactile nerve fibers. Coarse features produce large-scale skin deformations whose spatial configuration is reflected in the spatial pattern of activation of some tactile fibers. Scanning a finely textured surface elicits vibrations in the skin, which in turn evoked temporally patterned responses in other fibers. These two neural codes-spatial and temporal-drive a spectrum of neural response properties in somatosensory cortex: At one extreme, neurons are sensitive to spatial patterns and encode coarse features; at the other extreme, neurons are sensitive to vibrations and encode fine features. While the texture responses of nerve fibers are dependent on scanning speed, those of cortical neurons are less so, giving rise to a speed invariant texture percept. Neurons in high-level somatosensory cortices combine information about texture with information about task variables.