RESUMEN

BACKGROUND: Homolateral Imitative Synkinesis (HIS) is a rare form of associative movement between the ipsilateral upper and lower limbs. The incidence of HIS or its correlation with various movements remains uninvestigated. This study expounds on the characteristics of HIS, the frequency at which it occurs, and its relationship with movement, particularly walking. METHODS: This study included 1328 patients with acute stroke admitted to our healthcare facility between October 2019 and February 2022. We evaluated the severity of motor paralysis and sensory impairment in instances where HIS manifested, and assessed the relationship between HIS, basic activities, and gait. RESULTS: HIS was observed in 13/1328 patients. Motor paralysis was mild in all the cases. Each patient displayed a degree of sensory impairment, albeit of varying severity. HIS did not manifest during basic activities but was evident during walking movements in five instances. These patients displayed involuntary repetitive lifting of their upper limbs during the swing phase of their gait. Some individuals expressed discontent with involuntary upper-limb movements, citing them as contributors to a suboptimal gait. CONCLUSIONS: This study identified HIS as a rare syndrome, manifesting at a rate of 0.9%. Focus was more common in patients with damage to the thalamus and parietal lobe. No manifestations of the HIS occurred during basic activities, suggesting a weak correlation between the HIS and such activities. Certain patients exhibit HIS during gait, report suboptimal gait, and have an increased risk of falls, potentially influencing their gait proficiency.

Asunto(s)

Marcha , Sincinesia , Humanos , Masculino , Anciano , Persona de Mediana Edad , Sincinesia/fisiopatología , Sincinesia/diagnóstico , Sincinesia/etiología , Femenino , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/complicaciones , Índice de Severidad de la Enfermedad , Anciano de 80 o más Años , Adulto , Trastornos Neurológicos de la Marcha/fisiopatología , Trastornos Neurológicos de la Marcha/etiología , Trastornos Neurológicos de la Marcha/diagnóstico , Extremidad Superior/inervación , Estudios Retrospectivos

RESUMEN

Upper extremity amputation can lead to significant functional morbidity. The main goals after amputation are to minimize pain and maintain or improve functional status while optimizing the quality of life. Postamputation pain is common and can be addressed with regenerative peripheral nerve interface surgery or targeted muscle reinnervation surgery. Both modalities are effective in treating residual limb pain and phantom limb pain, as well as improving prosthetic use. Differences in surgical technique between the 2 approaches need to be weighed when deciding what strategy may be most appropriate for the patient.

Asunto(s)

Amputación Quirúrgica , Músculo Esquelético , Regeneración Nerviosa , Nervios Periféricos , Extremidad Superior , Humanos , Extremidad Superior/cirugía , Extremidad Superior/inervación , Regeneración Nerviosa/fisiología , Nervios Periféricos/cirugía , Músculo Esquelético/inervación , Músculo Esquelético/cirugía , Transferencia de Nervios/métodos , Miembro Fantasma

RESUMEN

Upper extremity peripheral nerve injuries present functional deficits that are amenable to management by tendon or nerve transfers. The principles of tendon and nerve transfers are discussed, with technical descriptions of preferred tendon and nerve transfers for radial, median, and ulnar nerve injuries.

Asunto(s)

Transferencia de Nervios , Traumatismos de los Nervios Periféricos , Transferencia Tendinosa , Extremidad Superior , Humanos , Traumatismos de los Nervios Periféricos/cirugía , Transferencia Tendinosa/métodos , Transferencia de Nervios/métodos , Extremidad Superior/inervación , Extremidad Superior/cirugía , Extremidad Superior/lesiones , Nervio Cubital/lesiones , Nervio Cubital/cirugía , Nervio Mediano/lesiones , Nervio Mediano/cirugía , Nervio Radial/lesiones , Nervio Radial/cirugía

RESUMEN

Peripheral nerve surgeries for compressive neuropathy in the upper extremity are generally successful. However, cases that either fail or have complications requiring revision surgery are challenging. During revision consideration, surgeons should perform a comprehensive preoperative workup to understand the etiology of the patient's symptoms and categorize symptoms as persistent, recurrent, or new in relation to the index procedure. Revision surgery often requires an open, extensile approach with additional procedures to optimize outcomes. Even with proper workup and treatment, clinical outcomes of revision surgeries are inferior compared to primary surgeries and patients should be well informed prior to undergoing such procedures.

Asunto(s)

Reoperación , Extremidad Superior , Humanos , Reoperación/métodos , Extremidad Superior/cirugía , Extremidad Superior/inervación , Procedimientos Neuroquirúrgicos/métodos , Resultado del Tratamiento , Síndromes de Compresión Nerviosa/cirugía , Síndromes de Compresión Nerviosa/etiología , Nervios Periféricos/cirugía , Complicaciones Posoperatorias/cirugía

RESUMEN

BACKGROUND: Ultrasound-guided supraclavicular block (UGSCB) is an emerging technique gaining interest amongst emergency physicians that provides regional anaesthesia to the upper limb to tolerate painful procedures. It offers an alternative to the more traditional technique of a Bier block (BB). However, the effectiveness or safety of UGSCB when performed in the emergency department (ED) is unclear. METHODS: SUPERB (SUPraclavicular block for Emergency Reduction versus Bier block) is a prospective open-label non-inferiority randomised controlled trial comparing the effectiveness of UGSCB versus BB for closed reduction of upper limb fractures and/or dislocations. Adult patients presenting with upper limb fracture and/or dislocation requiring closed reduction in ED were randomised to either UGSCB or BB. Once regional anaesthesia is obtained, closed reduction of the injured part was performed and immobilised. The primary outcome is maximal pain experienced during closed reduction measured via a visual analogue scale (VAS). Secondary outcomes include post-reduction pain, patient satisfaction, total opioid requirement in ED, ED length of stay, adverse events and regional anaesthesia failure. RESULTS: Primary outcome analysis will be performed using both the intention-to-treat and per-protocol populations. The between-group difference in maximum pain intensity will be assessed using linear regression modelling with trial group allocation (UGSCB vs BB) included as a main affect. A pre-specified non-inferiority margin of 20 mm on the VAS scale will be used to establish non-inferiority of UGSCB compared to BB. CONCLUSION: SUPERB is the first randomised controlled trial to investigate the effectiveness and safety of UGSCB in the ED. The trial has the potential to demonstrate that UGSCB is an alternative safe and effective option for the management of upper extremity emergencies in the ED.

Asunto(s)

Servicio de Urgencia en Hospital , Ultrasonografía Intervencional , Extremidad Superior , Humanos , Ultrasonografía Intervencional/métodos , Estudios Prospectivos , Extremidad Superior/inervación , Dimensión del Dolor , Bloqueo Nervioso/métodos , Bloqueo Nervioso/efectos adversos , Resultado del Tratamiento , Fracturas Óseas , Bloqueo del Plexo Braquial/métodos , Bloqueo del Plexo Braquial/efectos adversos , Estudios de Equivalencia como Asunto , Reducción Cerrada/métodos , Reducción Cerrada/efectos adversos , Luxaciones Articulares/terapia , Interpretación Estadística de Datos , Satisfacción del Paciente

RESUMEN

Advance knowledge of anatomy is a prerequisite for the peripheral nerve surgeon. This article serves to provide an outline of anatomic regions where nerve entrapment or compression can occur. Each section is subdivided into anatomic regions where the etiology, indications, and relevant and aberrant anatomy are discussed, as well as common surgical approaches to the problematic anatomic site. The purpose is to provide an overview for the peripheral nerve surgeon and offer a valuable resource to provide a better understanding and optimal care for this patient population.

Asunto(s)

Síndromes de Compresión Nerviosa , Extremidad Superior , Humanos , Síndromes de Compresión Nerviosa/cirugía , Extremidad Superior/cirugía , Extremidad Superior/inervación , Nervios Periféricos/anatomía & histología , Nervios Periféricos/cirugía

RESUMEN

INTRODUCTION: About 17-80% stroke survivors experience the deficit of upper limb function, which strongly influences their independence and quality of life. Robot-assisted training and functional electrical stimulation are commonly used interventions in the rehabilitation of hemiplegia upper extremities, while the effect of their combination remains unclear. The aim of this trial is to explore the effect of robot-assisted upper limb training combined with functional electrical stimulation, in terms of neuromuscular rehabilitation, compared with robot-assisted upper limb training alone. METHODS: Individuals (n = 60) with the first onset of stroke (more than 1 week and less than 1 year after stroke onset) will be considered in the recruitment of this single-blinded, three-arm randomized controlled trial. Participants will be allocated into three groups (robot-assisted training combined with functional electrical stimulation group, robot-assisted training group, and conventional rehabilitation therapies group) with a ratio of 1:1:1. All interventions will be executed for 45 min per session, one session per day, 5 sessions per week for 6 weeks. The neuromuscular function of the upper limb (Fugl-Meyer Assessment of upper extremity), ability of daily life (modified Barthel Index), pain (visual analogue scale), and quality of life (EQ-5D-5L) will be assessed at the baseline, at the end of this trial and after 3 months follow-up. Two-way repeated measures analysis of variance will be used to compare the outcomes if the data are normally distributed. Simple effects tests will be used for the further exploration of interaction effects by time and group. Scheirer-Ray-Hare test will be used if the data are not satisfied with normal distribution. DISCUSSION: We expect this three-arm randomized controlled trial to explore the effectiveness of robot-assisted training combined with functional electrical stimulation in improving post-stroke upper limb function compared with robot-assisted training alone. TRIAL REGISTRATION: Effect of upper limb robot on improving upper limb function after stroke, identifier: ChiCTR2300073279. Registered on 5 July 2023.

Asunto(s)

Terapia por Estimulación Eléctrica , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Recuperación de la Función , Robótica , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Extremidad Superior , Humanos , Rehabilitación de Accidente Cerebrovascular/métodos , Extremidad Superior/inervación , Método Simple Ciego , Terapia por Estimulación Eléctrica/métodos , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/terapia , Persona de Mediana Edad , Resultado del Tratamiento , Femenino , Anciano , Masculino , Adulto , Factores de Tiempo , Actividades Cotidianas , Hemiplejía/rehabilitación , Hemiplejía/etiología , Hemiplejía/fisiopatología , Terapia por Ejercicio/métodos , Terapia Combinada

RESUMEN

Pectoralis minor syndrome (PMS) and quadrilateral space syndrome (QSS) are uncommon neurovascular compression disorders affecting the upper extremity. PMS involves compression under the pectoralis minor muscle, and QSS results from compression in the quadrilateral space-both are classically observed in overhead-motion athletes. Diagnosing PMS and QSS may be challenging due to variable presentations and similarities with other, more common, upper-limb pathologies. Although there is no gold standard diagnostic, local analgesic muscle-block response in a patient with the appropriate clinical context is often all that is required for an accurate diagnosis after excluding more common etiologies. Treatment ranges from conservative physical therapy to decompressive surgery, which is reserved for refractory cases or severe, acute vascular presentations. Decompression generally yields favorable outcomes, with most patients experiencing significant relief and restored baseline function. In conclusion, PMS and QSS, although rare, can cause debilitating upper-extremity symptoms; accurate diagnosis and appropriate treatment offer excellent outcomes, alleviating pain and disability.

Asunto(s)

Descompresión Quirúrgica , Síndromes de Compresión Nerviosa , Músculos Pectorales , Extremidad Superior , Humanos , Resultado del Tratamiento , Extremidad Superior/irrigación sanguínea , Extremidad Superior/inervación , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/etiología , Síndromes de Compresión Nerviosa/fisiopatología , Síndromes de Compresión Nerviosa/cirugía , Recuperación de la Función , Masculino , Femenino , Adulto

RESUMEN

PURPOSE: Nerve transfers to restore or augment function after spinal cord injury is an expanding field. There is a paucity of information, however, on the use of nerve transfers for patients having undergone spine surgery. The incidence of neurologic deficit after spine surgery is rare but extremely debilitating. The purpose of this study was to describe the functional benefit after upper extremity nerve transfers in the setting of nerve injury after cervical spine surgery. METHODS: A single-center retrospective review of all patients who underwent nerve transfers after cervical spine surgery was completed. Patient demographics, injury features, spine surgery procedure, nerve conduction and electromyography study results, time to referral to nerve surgeon, time to surgery, surgical technique and number of nerve transfers performed, complications, postoperative muscle testing, and subjective outcomes were reviewed. RESULTS: Fourteen nerve transfers were performed in 6 patients after cervical spine surgery. Nerve transfer procedures consisted of a transfer between a median nerve branch of flexor digitorum superficialis into a biceps nerve branch, an ulnar nerve branch of flexor carpi ulnaris into a brachialis nerve branch, a radial nerve branch of triceps muscle into the axillary nerve, and the anterior interosseous nerve into the ulnar motor nerve. Average patient age was 55 years; all patients were male and underwent surgery on their left upper extremity. Average referral time was 7 months, average time to nerve transfer was 9 months, and average follow-up was 21 months. Average preoperative muscle grading was 0.9 of 5, and average postoperative muscle grading was 4.1 of 5 ( P < 0.00001). CONCLUSIONS: Upper extremity peripheral nerve transfers can significantly help patients regain muscle function from deficits secondary to cervical spine procedures. The morbidity of the nerve transfers is minimal with measurable improvements in muscle function.

Asunto(s)

Vértebras Cervicales , Transferencia de Nervios , Extremidad Superior , Humanos , Estudios Retrospectivos , Masculino , Persona de Mediana Edad , Transferencia de Nervios/métodos , Vértebras Cervicales/cirugía , Extremidad Superior/cirugía , Extremidad Superior/inervación , Adulto , Anciano , Resultado del Tratamiento , Femenino , Traumatismos de los Nervios Periféricos/etiología , Traumatismos de los Nervios Periféricos/cirugía , Recuperación de la Función , Traumatismos de la Médula Espinal

RESUMEN

Peripheral nerve injuries present a complex clinical challenge, requiring a nuanced approach in surgical management. The consequences of injury vary, with sometimes severe disability, and a risk of lifelong pain for the individual. For late management, the choice of surgical techniques available range from neurolysis and nerve grafting to tendon and nerve transfers. The choice of technique utilized demands an in-depth understanding of the anatomy, patient demographics and the time elapsed since injury for optimized outcomes. This paper focuses on injuries to the radial, median and ulnar nerves, outlining the authors' approach to these injuries.Level of evidence: IV.

Asunto(s)

Traumatismos de los Nervios Periféricos , Extremidad Superior , Humanos , Traumatismos de los Nervios Periféricos/cirugía , Extremidad Superior/inervación , Extremidad Superior/lesiones , Extremidad Superior/cirugía , Nervio Cubital/lesiones , Nervio Cubital/cirugía , Tiempo de Tratamiento , Nervio Mediano/lesiones , Nervio Mediano/cirugía , Nervio Radial/lesiones , Nervio Radial/cirugía , Procedimientos Neuroquirúrgicos/métodos

RESUMEN

Although surgical release of upper extremity nerve compression syndromes is highly effective, persistence or recurrence of symptoms and signs may occur. Thorough investigation is necessary in this situation before treatment is recommended. If the symptoms cannot be explained by other pathology than compression of the affected nerve and if conservative management has not provided improvement, reoperation may be considered. This review provides an overview of the diagnostic and surgical considerations in the revision of carpal tunnel syndrome, cubital tunnel syndrome and thoracic outlet syndrome.Level of evidence: V.

Asunto(s)

Síndrome del Túnel Carpiano , Síndrome del Túnel Cubital , Reoperación , Síndrome del Desfiladero Torácico , Humanos , Síndrome del Túnel Carpiano/cirugía , Síndrome del Túnel Cubital/cirugía , Síndrome del Túnel Cubital/diagnóstico , Síndrome del Desfiladero Torácico/cirugía , Síndrome del Desfiladero Torácico/diagnóstico , Descompresión Quirúrgica/métodos , Síndromes de Compresión Nerviosa/cirugía , Síndromes de Compresión Nerviosa/diagnóstico , Extremidad Superior/cirugía , Extremidad Superior/inervación

RESUMEN

BACKGROUND: The brachial plexus is a network of nerves located between the neck and axilla, which receives input from C5-T1. Distally, the nerves and blood vessels that supply the arm and forearm form a medial neurovascular bundle. The purpose of this study was to illustrate that a peripheral nerve dissection via a 2 × 2 inch window would allow for identification and isolation of the major nerves and blood vessels that supply the arm and forearm. METHODS: A right side formalin-fixed latex-injected cadaveric arm was transected at the proximal part of the axillary fold and included the scapular attachments. Step-by-step anatomical dissection was carried out and documented with three-dimensional digital imaging. RESULTS: A 2 × 2 inch window centered 2 inches distal to the axillary fold on the medial surface of the arm enabled access to the major neurovascular structures of the arm and forearm: the median nerve, ulnar nerve, medial antebrachial cutaneous nerve, radial nerve and triceps motor branches, musculocutaneous nerve and its biceps and brachialis branches and lateral antebrachial cutaneous nerve, basilic vein and brachial artery and vein, and profunda brachii artery. CONCLUSIONS: Our study demonstrates that the majority of the neurovascular supply in the arm and forearm can be accessed through a 2 × 2 inch area in the medial arm. Although this "key window" may not be entirely utilized in the operative setting, our comprehensive didactic description of peripheral nerve dissection in the cadaver laboratory can help in safer identification of complex anatomy encountered during surgical procedures.

Asunto(s)

Cadáver , Extremidad Superior , Humanos , Extremidad Superior/inervación , Extremidad Superior/irrigación sanguínea , Disección , Plexo Braquial/anatomía & histología , Nervio Mediano/anatomía & histología , Nervio Cubital/anatomía & histología

RESUMEN

This article reviews the recent advances or nerve-oriented surgical procedures in the treatment of the spastic upper limb. The idea to intervene on the nerve is not recent, but new trends have developed in nerve surgery over the past few years, stimulating experiments and research. Specific surgical procedures involving the nerves have been described at different levels from proximal to distal: at the cervical spinal cord and the dorsal root entry zone (rhizotomy), at the level of the roots (contralateral C7 transfer) or in the peripheral nerve, within the motor trunk (selective neurectomy) or as its branches penetrate the muscles (hyperselective neurectomy). All of these neurosurgical procedures are only effective on spasticity but do not address the other deformities, such as contractures and motor deficit. Additional procedures may have to be planned in conjunction with nerve procedures to optimize outcomes.

Asunto(s)

Espasticidad Muscular , Rizotomía , Extremidad Superior , Humanos , Espasticidad Muscular/cirugía , Espasticidad Muscular/fisiopatología , Extremidad Superior/inervación , Extremidad Superior/cirugía , Rizotomía/métodos , Procedimientos Neuroquirúrgicos/métodos , Transferencia de Nervios/métodos

RESUMEN

Selective nerve transfers are used in the setting of upper limb amputation to improve myoelectric prosthesis control. This surgical concept is referred to as targeted muscle reinnervation (TMR) and describes the rerouting of the major nerves of the arm onto the motor branches of the residual limb musculature. Aside from providing additional myosignals for prosthetic control, TMR can treat and prevent neuroma pain and possibly also phantom limb pain. This article reviews the history and current applications of TMR in upper limb amputation, with a focus on practical considerations. It further explores and identifies technological innovations to improve the man-machine interface in amputation care, particularly regarding implantable interfaces, such as muscle electrodes and osseointegration. Finally, future clinical directions and possible scientific avenues in this field are presented and critically discussed.

Asunto(s)

Miembros Artificiales , Biónica , Músculo Esquelético , Transferencia de Nervios , Extremidad Superior , Humanos , Transferencia de Nervios/métodos , Extremidad Superior/inervación , Extremidad Superior/cirugía , Músculo Esquelético/inervación , Músculo Esquelético/cirugía , Músculo Esquelético/trasplante , Amputación Quirúrgica

RESUMEN

OBJECTIVE: When considering traumatic brachial plexus and upper extremity nerve injuries, iatrogenic nerve injuries, and nontraumatic nerve injuries, brachial plexus and upper extremity nerve injuries are commonly encountered in clinical practice. Despite this, data synthesis and comparison of available studies are difficult. This is at least in part due to the lack of standardization in reporting and a lack of a core outcome set (COS). Thus, there is a need for a COS for adult brachial plexus and upper extremity nerve injuries (COS-BPUE). The objective of this study was to develop a COS-BPUE using a modified Delphi approach. METHODS: A 5-stage approach was used to develop the COS-BPUE: 1) consortium development, 2) literature review to identify potential outcome measures, 3) Delphi survey to develop consensus on outcomes for inclusion, 4) Delphi survey to develop definitions, and 5) consensus meeting to finalize the COS and definitions. The study followed the Core Outcome Set-STAndards for Development (COS-STAD) recommendations. RESULTS: The Core Outcomes in Nerve Surgery (COINS) Consortium comprised 23 participants, all neurological surgeons, representing 13 countries. The final COS-BPUE consisted of 36 data points/outcomes covering demographic, diagnostic, patient-reported outcome, motor/sensory outcome, and complication domains. Appropriate instruments, methods of testing, and definitions were set. The consensus minimum duration of follow-up was 24 months, with the consensus optimal time points for assessment being preoperatively and 3, 6, 12, and 24 months postoperatively. CONCLUSIONS: The COINS Consortium developed a consensus COS and provided definitions, methods of implementation, and time points for assessment. The COS-BPUE should serve as a minimum set of data that should be collected in all future neurosurgical studies on adult brachial plexus and upper extremity nerve injuries. Incorporation of this COS should help improve consistency in reporting, data synthesis, and comparability, and should minimize outcome reporting bias.

Asunto(s)

Plexo Braquial , Técnica Delphi , Procedimientos Neuroquirúrgicos , Traumatismos de los Nervios Periféricos , Extremidad Superior , Humanos , Plexo Braquial/lesiones , Plexo Braquial/cirugía , Extremidad Superior/inervación , Extremidad Superior/cirugía , Extremidad Superior/lesiones , Traumatismos de los Nervios Periféricos/cirugía , Procedimientos Neuroquirúrgicos/métodos , Evaluación de Resultado en la Atención de Salud , Resultado del Tratamiento , Consenso , Adulto

RESUMEN

Distal nerve transfer is a refined surgical technique involving the redirection of healthy sacrificable nerves from one part of the body to reinstate function in another area afflicted by paralysis or injury. This approach is particularly valuable when the original nerves are extensively damaged and standard repair methods, such as direct suturing or grafting, may be insufficient. As the nerve coaptation is close to the recipient muscles or skin, distal nerve transfers reduce the time to reinnervation. The harvesting of nerves for transfer should usually result in minimal or no donor morbidity, as any anticipated loss of function is compensated for by adjacent muscles or overlapping cutaneous territory. Recent years have witnessed notable progress in nerve transfer procedures, markedly enhancing the outcomes of upper limb reconstruction for conditions encompassing peripheral nerve, brachial plexus and spinal cord injuries.

Asunto(s)

Transferencia de Nervios , Traumatismos de los Nervios Periféricos , Humanos , Transferencia de Nervios/métodos , Traumatismos de los Nervios Periféricos/cirugía , Plexo Braquial/lesiones , Plexo Braquial/cirugía , Extremidad Superior/inervación , Extremidad Superior/cirugía , Extremidad Superior/lesiones

RESUMEN

Ultrasound-guided nerve blocks (UGNBs) are becoming a more common method for pain control in the emergency department. Specifically, brachial plexus blocks have shown promise for acute upper extremity injuries as well as an alternative to procedural sedation for glenohumeral reductions. Unfortunately, there is minimal discussion in the EM literature regarding phrenic nerve paralysis (a well-known complication from brachial plexus blocks). The anatomy of the brachial plexus, its relationship to the phrenic nerve, and why ultrasound-guided brachial plexus blocks can cause phrenic nerve paralysis and resultant respiratory impairment will be discussed. The focus on patient safety is paramount, and those with preexisting respiratory conditions, extremes of age or weight, spinal deformities, previous neck injuries, and anatomical variations are at greater risk. We put forth different block strategies for risk mitigation, including patient selection, volume and type of anesthetic, block location, postprocedural monitoring, and specific discharge instructions. Understanding the benefits and risks of UGNBs is critical for emergency physicians to provide effective pain control while ensuring optimal patient safety.

Asunto(s)

Bloqueo del Plexo Braquial , Humanos , Bloqueo del Plexo Braquial/métodos , Ultrasonografía Intervencional/métodos , Servicio de Urgencia en Hospital , Parálisis , Extremidad Superior/diagnóstico por imagen , Extremidad Superior/lesiones , Extremidad Superior/inervación , Dolor , Anestésicos Locales

RESUMEN

BACKGROUND: Tui Na (Chinese massage) is a relatively simple, inexpensive, and non-invasive intervention, and has been used to treat stroke patients for many years in China. Tui Na acts on specific parts of the body which are called meridians and acupoints to achieve the role of treating diseases. Yet the underlying neural mechanism associated with Tui Na is not clear due to the lack of detection methods. OBJECTIVE: Functional near-infrared spectroscopy (fNIRS) was used to explore the changes of sensorimotor cortical neural activity in patients with upper limb motor dysfunction of stroke and healthy control groups during Tui Na Hegu Point. METHODS: Ten patients with unilateral upper limb motor dysfunction after stroke and eight healthy subjects received Tui Na. fNIRS was used to record the hemodynamic data in the sensorimotor cortex and the changes in blood flow were calculated based on oxygenated hemoglobin (Oxy-Hb), the task session involved repetitive Tui Na on Hegu acupoint, using a block design [six cycles: rest (20 seconds); Tui Na (20 seconds); rest (30 seconds)]. The changes in neural activity in sensorimotor cortex could be inferred according to the principle of neurovascular coupling, and the number of activated channels in the bilateral hemisphere was used to calculate the lateralization index. RESULT: 1. For hemodynamic response induced by Hegu acupoint Tui Na, a dominant increase in the contralesional primary sensorimotor cortex during Hegu point Tui Na of the less affected arm in stroke patients was observed, as well as that in healthy controls, while this contralateral pattern was absent during Hegu point Tui Na of the affected arm in stroke patients. 2. Concerning the lateralization index in stroke patients, a significant difference was observed between lateralization index values for the affected arm and the less affected arm (P < 0.05). Wilcoxon tests showed a significant difference between lateralization index values for the affected arm in stroke patients and lateralization index values for the dominant upper limb in healthy controls (P < 0.05), and no significant difference between lateralization index values for the less affected arm in stroke patients and that in healthy controls (P = 0.36). CONCLUSION: The combination of Tui Na and fNIRS has the potential to reflect the functional status of sensorimotor neural circuits. The changes of neuroactivity in the sensorimotor cortex when Tui Na Hegu acupoint indicate that there is a certain correlation between acupoints in traditional Chinese medicine and neural circuits.

Asunto(s)

Terapia por Acupuntura , Masaje , Medicina Tradicional China , Trastornos Motores , Corteza Sensoriomotora , Accidente Cerebrovascular , Humanos , Puntos de Acupuntura , Pueblos del Este de Asia , Corteza Sensoriomotora/diagnóstico por imagen , Corteza Sensoriomotora/fisiopatología , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/terapia , Terapia por Acupuntura/métodos , Medicina Tradicional China/métodos , Extremidad Superior/inervación , Extremidad Superior/fisiopatología , Trastornos Motores/etiología , Trastornos Motores/fisiopatología , Trastornos Motores/rehabilitación , Rehabilitación de Accidente Cerebrovascular/métodos , Meridianos , Vías Nerviosas/diagnóstico por imagen , Vías Nerviosas/fisiopatología , Espectroscopía Infrarroja Corta

RESUMEN

Background: Nerve block anesthesia is a common regional anesthesia used for upper limb surgeries because of its ability to target the operative site and provision of impressive postanesthetic pain relief. This randomized, single-blinded study compared the quality of block of the perineural (PN) and perivascular (PV) techniques of axillary brachial plexus block under ultrasound guidance. Methods: Sixty-six participants were recruited into either PV or PN groups. The local anesthetic (LA) comprised 14 ml of 0.5% bupivacaine, 14 ml of 1% lidocaine, and 2 ml of dexmedetomidine (50 µg/ml). Under ultrasound guidance, 6 ml of LA was deposited around the musculocutaneous nerve for both groups. For the PV group, 24 ml was deposited dorsal to the axillary artery while 8 ml each was deposited around median, radial, and ulnar nerves for the PN group. Results: The mean total procedure time in PN group was significantly longer than in the PV group (7.82 ± 0.95 min vs. 4.79 ± 1.11 min; P = 0.001). Participants in the PN group required more needle passes (66.7% required 4 passes while 81.8% required only 2 passes in the PV group). The success rate was 100% in PN group and 93.9% in PV group (P = 0.49). Conclusion: The PV and PN techniques were comparable in terms of their success rates and total anesthesia-related times. The PN technique had higher success rate and faster block onset, but the PV provided a quicker performance time and fewer needle passes. Hence, PV technique may be preferable to PN for high-volume surgical units.

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Résumé Contexte: L'anesthésie par bloc nerveux est une anesthésie régionale courante utilisée pour les chirurgies des membres supérieurs en raison de sa capacité à cibler le site opératoire et à fournir un soulagement impressionnant de la douleur postanesthésique. Cette étude randomisée à un seul insu a comparé la qualité des techniques de blocage périneural (NP) et périvasculaire (PV) du plexus brachial axillaire sous guidage échographique. Méthodes: Soixante-six participants ont été recrutés dans les groupes PV ou PN. L'anesthésie locale (AL) comprenait 14 ml de bupivacaïne à 0,5 %, 14 ml de lidocaïne à 1 % et 2 ml de dexmedetomidine (50 µg/ml). Sous la direction des ultrasons, 6 ml de LA ont été déposés autour du nerf musculo-cutané pour les deux groupes. Pour le groupe PV, 24 ml ont été déposés en position dorsale par rapport à l'artère axillaire, tandis que 8 ml ont été déposés autour des nerfs médian, radial et ulnaire pour le groupe PN. Résultats: La durée totale moyenne de la procédure dans le groupe PN était significativement plus longue que dans le groupe PV (7,82 ± 0,95 min contre 4,79 ± 1,11 min ; P = 0,001). Les participants du groupe PN ont exigé plus de passes d'aiguille (66,7 % ont exigé 4 passes, tandis que 81,8 % n'ont exigé que 2 passes dans le groupe PV). Le taux de réussite était de 100 % dans le groupe PN et de 93,9 % dans le groupe PV (P = 0,49). Conclusion: Les techniques PV et PN étaient comparables en termes de taux de réussite et de temps total liés à l'anesthésie. La technique PN a eu un taux de succès plus élevé et un début de bloc plus rapide, mais la PV a fourni un temps de performance plus rapide et moins de passes d'aiguille. Par conséquent, la technique PV peut être préférable à la PN pour les unités chirurgicales à volume élevé. Mots-clés: Bloc nerveux, périneural, périvasculaire.

Asunto(s)

Bloqueo del Plexo Braquial , Ultrasonografía Intervencional , Humanos , Ultrasonografía Intervencional/métodos , Anestésicos Locales , Bloqueo del Plexo Braquial/métodos , Lidocaína , Extremidad Superior/cirugía , Extremidad Superior/inervación

RESUMEN

The ultrasound examination of peripheral nerves has been further developed in recent years and is recognized as an independent discipline by the German Society of Ultrasound in Medicine (DEGUM). A systematic ultrasound examination of the musculoskeletal system is not limited to the joints, muscles and bones but should also include the examination of nerves and blood vessels. Therefore, in the practice of ultrasound examination every rheumatologist should have at least a basic knowledge of the ultrasound examination of the peripheral nerves. In this article the authors present a landmark-based concept in which the three large nerves of the upper extremities can be completely visualized from proximal to distal and evaluated.

Asunto(s)

Huesos , Extremidad Superior , Humanos , Extremidad Superior/diagnóstico por imagen , Extremidad Superior/inervación