RESUMEN
This study investigates the impact of the anatomical separation point of the dorsal ulnar cutaneous nerve (DUCN) on nerve conduction studies (NCS). Involving 25 subjects with DUCN NCS findings, it utilizes ultrasound to mark the DUCN's divergence from the ulnar nerve. NCS was performed at four points relative to the separation point. The findings indicate the maximal amplitudes occurred 2 cm distal to the separation point. The study suggests it is ideal when the stimulation is performed between the seperation point and 2 cm distal to it.
Asunto(s)
Conducción Nerviosa , Nervio Cubital , Ultrasonografía , Humanos , Nervio Cubital/diagnóstico por imagen , Nervio Cubital/fisiología , Conducción Nerviosa/fisiología , Ultrasonografía/métodos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Adulto Joven , Anciano , Estudios de Conducción NerviosaRESUMEN
OBJECTIVE: We assessed microvessel flow within peripheral nerves using nerve sonography in patients with peripheral neuropathy. METHODS: This study included consecutive patients with peripheral neuropathy who were admitted to our hospital. The patients were divided into two groups: inflammatory neuropathies for immune-mediated neuropathies, such as Guillain - Barré syndrome and chronic inflammatory demyelinating polyneuropathy, and the rest were defined as non-inflammatory neuropathies. We assessed nerve size and intraneural blood flow at four sites on each median and ulnar nerve. Blood flow was evaluated using color Doppler imaging, advanced dynamic flow (ADF), and superb microvascular imaging (SMI) techniques. RESULTS: Thirty-nine patients (median age, 60.0 years; 20 male) were enrolled in this study. An increase in intraneural blood flow was observed in five patients when evaluated by color Doppler, five patients by ADF, and 13 patients by SMI. An overall analysis of the three methods showed that intraneural blood flow was significantly higher in patients with inflammatory neuropathy than in those with non-inflammatory neuropathy (54.2% vs. 0%, p = 0.0005). CONCLUSIONS: Intraneural hypervascularization is more frequent in patients with inflammatory neuropathy than in those with non-inflammatory neuropathy. SIGNIFICANCE: Evaluation of microvessel flow within peripheral nerves may contribute to the diagnosis of peripheral neuropathy.
Asunto(s)
Microvasos , Enfermedades del Sistema Nervioso Periférico , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Microvasos/diagnóstico por imagen , Microvasos/fisiopatología , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Enfermedades del Sistema Nervioso Periférico/diagnóstico por imagen , Adulto , Ultrasonografía/métodos , Ultrasonografía Doppler en Color/métodos , Nervio Mediano/diagnóstico por imagen , Nervio Mediano/fisiopatología , Nervio Cubital/diagnóstico por imagen , Nervio Cubital/fisiopatología , Anciano de 80 o más AñosRESUMEN
BACKGROUND AND OBJECTIVES: Cubital tunnel syndrome is the second most common nerve entrapment, and understanding the anatomy is crucial for the success of the nerve release. During ulnar nerve release for cubital tunnel syndrome, a motor branch is frequently encountered crossing anteriorly over the ulnar nerve from its medial/ulnar side proximally to the lateral/radial side distally. Little has been noted about this crossing branch in the literature. In this anatomic study, we sought to characterize this branch further and discuss its potential significance in cubital tunnel release. METHODS: We performed a cadaveric dissection of 48 elbow specimens as if performing a cubital tunnel release. We assessed for the presence of the crossing motor branch of the ulnar nerve and measured the distance from the medial epicondyle to the branch takeoff and to its target of innervation. RESULTS: Of our 48 specimens, 34 (71%) were noted to have a crossing motor branch at the area of compression by the deep flexor carpi ulnaris muscle fascia (common aponeurosis). On average, the distance from the medial epicondyle to the branch origin from the ulnar nerve was 18.2 mm and to the target muscle innervation was 28.4 mm. CONCLUSION: Identifying this branch is important for performing a cubital tunnel release, and awareness of this anatomy during ulnar nerve decompression procedures may help avoid injury to this motor branch.
Asunto(s)
Cadáver , Síndrome del Túnel Cubital , Codo , Nervio Cubital , Humanos , Nervio Cubital/anatomía & histología , Síndrome del Túnel Cubital/cirugía , Codo/inervación , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Persona de Mediana Edad , Descompresión Quirúrgica/métodosRESUMEN
BACKGROUND: Symptomatic idiopathic ulnar nerve instability (IUNI) in the elbow is an uncommon condition characterized by symptoms of ulnar neuritis resulting from frictional injury to the ulnar nerve from repetitive subluxation out of the cubital tunnel. This study reports the 1-year clinical outcomes after treatment of IUNI with anterior transposition of the ulnar nerve. METHODS: This is a retrospective case study of five patients. Ulnar nerve instability was diagnosed clinically based on the presence of ulnar neuritis symptoms in combination with a positive "ulnar nerve push past" test. Electromyography (EMG) was performed on all patients. After failure of nonsurgical treatment, five patients underwent anterior subcutaneous transposition of the ulnar nerve at the elbow. Clinical outcome scores and time to resolution of symptoms were recorded at a minimum follow-up of 12 months. RESULTS: The mean age of the patients at the time of surgery was 37.8 years (range: 18 to 57 years). The mean duration of symptoms prior to surgery was 15.7 ± 4.9 months. All five patients reported neuritis symptoms in the distribution of ulnar nerve in the hand and had ulnar nerve instability in the cubital tunnel on clinical examination. All patients were symptom free within 6 months after anterior transposition of the ulnar nerve.
Asunto(s)
Electromiografía , Nervio Cubital , Neuropatías Cubitales , Humanos , Adulto , Persona de Mediana Edad , Nervio Cubital/cirugía , Nervio Cubital/fisiopatología , Estudios Retrospectivos , Masculino , Resultado del Tratamiento , Femenino , Adulto Joven , Adolescente , Neuropatías Cubitales/cirugía , Neuropatías Cubitales/etiología , Neuropatías Cubitales/diagnóstico , Neuropatías Cubitales/fisiopatología , Recuperación de la Función , Factores de Tiempo , Articulación del Codo/cirugía , Articulación del Codo/fisiopatología , Síndrome del Túnel Cubital/cirugía , Síndrome del Túnel Cubital/diagnóstico , Síndrome del Túnel Cubital/fisiopatología , Síndrome del Túnel Cubital/etiología , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Neuroquirúrgicos/efectos adversosAsunto(s)
Fibrosis , Pulgar , Humanos , Pulgar/inervación , Masculino , Adulto , Nervio Cubital , Femenino , Persona de Mediana EdadRESUMEN
BACKGROUND: Recurrent ulnar nerve compression after primary anterior subcutaneous transposition is relatively rare, and revision surgery is challenging. This study retrospectively evaluated the clinical outcomes of revision anterior subcutaneous transposition for recurrent ulnar nerve compression. METHODS: Eight patients who underwent revision anterior subcutaneous transposition for recurrent ulnar nerve compression were enrolled in this study. The outcomes were based on preoperative and postoperative symptoms, physical examination findings, and electromyographic evaluation. RESULTS: Ulnar nerve enlargement was preoperatively found in all patients with a mean cross sectional area of 0.15 cm2 (range, 0.14-0.18 cm2). Intraoperative findings showed that recurrent compression occurred in three areas, including the medial intermuscular septum (n = 5), the medial epicondyle (n = 6) and nerve entrance to forearm fascia (n = 1). Post-operation, significant improvements were observed in ring/little finger numbness (from severe to mild, p = 0.031), grip strength (from 48.00% to 80.38% of the intact side, p < 0.001) and McGowan grade (from Grade III to Grade I, p = 0.049). Postoperative electromyography test also showed significant improvement in motor nerve conduction at elbow (velocity, 23.30 ± 9.598 vs. 35.30 ± 9.367, p = 0.012; amplitude, 3.40 ± 3.703 vs. 5.65 ± 2.056, p = 0.007) and sensory nerve conduction at wrist (velocity, 27.04 ± 22.450 vs. 36.45 ± 18.099, p = 0.139; amplitude, 1.44 ± 1.600 vs. 4.00 ± 2.642, p = 0.011). Seven of the eight patients reported satisfaction with the postoperative results. CONCLUSIONS: Revision anterior subcutaneous transposition was an effective treatment for recurrent ulnar nerve compression from prior failed procedures.
Asunto(s)
Reoperación , Síndromes de Compresión del Nervio Cubital , Humanos , Masculino , Femenino , Reoperación/métodos , Persona de Mediana Edad , Adulto , Estudios Retrospectivos , Síndromes de Compresión del Nervio Cubital/cirugía , Nervio Cubital/cirugía , Anciano , Resultado del Tratamiento , Descompresión Quirúrgica/métodos , RecurrenciaRESUMEN
BACKGROUND: The complex anatomy of peripheral nerves has been traditionally investigated through histological microsections, with inherent limitations. We aimed to compare three-dimensional (3D) reconstructions of median and ulnar nerves acquired with tomographic high-resolution ultrasound (HRUS) and magnetic resonance microscopy (MRM) and assess their capacity to depict intraneural anatomy. METHODS: Three fresh-frozen human upper extremity specimens were prepared for HRUS imaging by submersion in a water medium. The median and ulnar nerves were pierced with sutures to improve orientation during imaging. Peripheral nerve 3D HRUS scanning was performed on the mid-upper arm using a broadband linear probe (10-22 MHz) equipped with a tomographic 3D HRUS system. Following excision, nerves were cut into 16-mm segments and loaded into the MRM probe of a 9.4-T system (scanning time 27 h). Fascicle and nerve counting was performed to estimate the nerve volume, fascicle volume, fascicle count, and number of interfascicular connections. HRUS reconstructions employed artificial intelligence-based algorithms, while MRM reconstructions were generated using an open-source imaging software 3D slicer. RESULTS: Compared to MRM, 3D HRUS underestimated nerve volume by up to 22% and volume of all fascicles by up to 11%. Additionally, 3D HRUS depicted 6-60% fewer fascicles compared to MRM and visualized approximately half as many interfascicular connections. CONCLUSION: MRM demonstrated a more detailed fascicular depiction compared to 3D HRUS, with a greater capacity for visualizing smaller fascicles. While 3D HRUS reconstructions can offer supplementary data in peripheral nerve assessment, their limitations in depicting interfascicular connections and small fascicles within clusters necessitate cautious interpretation. CLINICAL RELEVANCE STATEMENT: Although 3D HRUS reconstructions can offer supplementary data in peripheral nerve assessment, even in intraoperative settings, their limitations in depicting interfascicular branches and small fascicles within clusters require cautious interpretation. KEY POINTS: 3D HRUS was limited in visualizing nerve interfascicular connections. MRM demonstrated better nerve fascicle depiction than 3D HRUS. MRM depicted more nerve interfascicular connections than 3D HRUS.
Asunto(s)
Imagenología Tridimensional , Imagen por Resonancia Magnética , Nervio Mediano , Nervio Cubital , Ultrasonografía , Humanos , Imagenología Tridimensional/métodos , Ultrasonografía/métodos , Nervio Mediano/diagnóstico por imagen , Nervio Mediano/anatomía & histología , Imagen por Resonancia Magnética/métodos , Nervio Cubital/diagnóstico por imagen , Nervio Cubital/anatomía & histología , Cadáver , Masculino , Microscopía/métodos , FemeninoRESUMEN
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/cirugíaRESUMEN
Ulnar nerve originates from the lower trunk as a branch from anterior division, continuing as a branch from medial cord of the brachial plexus. It receives fibres from anterior rami of cervical nerve root 8 and the first thoracic nerve root. Ulnar nerve injury accounts for being the most common vessel of upper limb that results in hospitalisation. Knowing the variability in the anatomical pattern of ulnar nerve and its communication with various branches of nerves in the vicinity can have implications. The current narrative review comprised literature search on Google, Google Scholar and PubMed databases for articles published between 2015 and 2023 on the subject. The insight and understanding of the related ulnar nerve anatomy is likely to be of prodigious help to anatomists, surgeons, physicians and radiologists in preventing unexpected outcomes in the future.
Asunto(s)
Nervio Cubital , Humanos , Nervio Cubital/anatomía & histología , Plexo Braquial/anatomía & histologíaRESUMEN
Elbow arthroscopy is a useful tool that can be applied in a variety of surgical indications. However, performing the procedure safely demands a thorough understanding of the proximity of neurovascular structures around the elbow. Although nerve injuries in elbow arthroscopy are rare, complications can further be avoided by adhering to a set of principles designed to protect the surrounding neurovascular structures. Before making portals, the surgeon should palpate and mark the ulnar nerve to confirm its location in the groove. Next, the joint should be insufflated with fluid to distend the joint capsule and increase the distance between instruments and the anterior neurovascular structures. Anterior portals ideally should be made proximal to the medial and lateral epicondyles, thereby increasing distance from the median and radial nerve, respectively. Once in the joint, it is critical to stay oriented by maintaining instruments and the articular surfaces in the same view. Special caution should be exercised when in proximity to the capsule in the posteromedial gutter to protect the ulnar nerve. Similarly, the anterior inferior capsule should be approached with caution, as its violation puts branches of the radial nerve, specifically the posterior interosseous nerve, at risk. Elbow arthroscopy can be safely performed with proper knowledge and application of anatomy around the elbow when making portals and understanding at-risk areas beyond the capsule when working within the joint.
Asunto(s)
Artroscopía , Articulación del Codo , Traumatismos de los Nervios Periféricos , Humanos , Artroscopía/métodos , Articulación del Codo/cirugía , Traumatismos de los Nervios Periféricos/prevención & control , Traumatismos de los Nervios Periféricos/etiología , Nervio Cubital/lesiones , Nervio Radial/lesiones , Nervio Radial/anatomía & histologíaRESUMEN
The distinct and specialized movements performed in different sports disciplines may significantly influence nerve performance, potentially affecting nerve responses and the overall function within the respective athletic activities. The purpose of this study is to find the effect of forearm supination and pronation across the elbow joint on ulnar and median nerve conduction velocity (NCV) in throwers, archers, and non-athletes. A total of 34 participants both male and females were recruited with a body mass index (BMI) between 18.5 and 24.9 kg/m2. Nerve conduction study (NeuroStim NS2 EMG/NCV/EP System) was used for measuring ulnar and median NCV across the elbow joint at different angles with the forearm in supination and pronation. Repeated measure analysis of variance (RMANOVA) revealed that there are statistically significant differences in mean values of forearm positions, angles, nerves and groups (p < .05). This study illuminates distinctive NCV variations across diverse athletic groups during forearm supination and pronation movements. Pronation consistently exhibited faster ulnar NCV compared to the median nerve across throwers, archers, and non-athletes, while in supination specific joint positions revealed notable differences within sports groups and nerve function.
Asunto(s)
Antebrazo , Nervio Mediano , Conducción Nerviosa , Pronación , Supinación , Nervio Cubital , Humanos , Masculino , Supinación/fisiología , Pronación/fisiología , Femenino , Antebrazo/fisiología , Conducción Nerviosa/fisiología , Nervio Mediano/fisiología , Nervio Cubital/fisiología , Adulto Joven , Adulto , Electromiografía , AtletasRESUMEN
Heterotopic ossification (HO) is characterized by the formation of pathological bone within the soft tissues. HO predominantly affects elbow joints and may be accompanied by tardy ulnar nerve palsy. This study aimed to explore the clinical and functional outcomes of patients with tardy ulnar nerve palsy caused by HO following surgical treatment, with a review of the relevant literature. A retrospective study was conducted on 4 patients with tardy ulnar nerve palsy caused by HO, who underwent anterior subcutaneous ulnar nerve transposition between 2015 and 2020. The patients were followed up for more than 1 year and the cause of HO was also identified. Clinical and functional outcomes were evaluating using the grip strength and pinch strength, visual analog scale (VAS) pain score and Quick disabilities of the arm, shoulder and hand (DASH) score. The causes of HO were repetitive micro-trauma in 1 case and excessive physical or rehabilitation therapy in 3 cases. The average follow-up period was 15.6 months (range; 12-21 months). The grip strength increased from an average of 14kg to 26.5kg. The pinch strength increased from an average of 1.5 kg to 3.63 kg. The Quick DASH score decreased from an average of 55.6 to 6.15. The VAS score for pain decreased from an average of 7 to 0.25. Rapid surgical treatment, including removal of the heterotopic bone and ulnar nerve anterior transposition, might improve outcomes in patients with tardy ulnar nerve palsy caused by HO.
Asunto(s)
Osificación Heterotópica , Humanos , Osificación Heterotópica/cirugía , Masculino , Estudios Retrospectivos , Femenino , Persona de Mediana Edad , Adulto , Neuropatías Cubitales/cirugía , Neuropatías Cubitales/etiología , Fuerza de la Mano , Articulación del Codo/cirugía , Articulación del Codo/fisiopatología , Nervio Cubital/cirugía , Resultado del Tratamiento , Dimensión del Dolor , AncianoRESUMEN
OBJECTIVE: MScanFit motor unit number estimation (MUNE) is a sensitive method for detecting motor unit loss and has demonstrated high reproducibility in various settings. In this study, our aim was to assess the outputs of this method when the nerve conduction distance is increased. METHODS: MScanFit recordings were obtained from the abductor digiti minimi muscle of 20 healthy volunteers. To evaluate the effect of nerve conduction distance, the ulnar nerve was stimulated from the wrist and elbow respectively. Reproducibility of MUNE, compound muscle action potential (CMAP), and other motor unit parameters were assessed using intraclass correlation coefficients (ICCs). RESULTS: Motor unit numbers obtained from stimulation at the wrist and elbow did not significantly differ and exhibited strong consistency in the ICC test (120.3 ± 23.7 vs. 118.5 ± 27.9, p > 0.05, ICC: 0.88). Similar repeatability values were noted for other parameters. However, the Largest Unit (%) displayed notable variability between the two regions and exhibited a negative correlation with nerve conduction distance. CONCLUSION: Our findings indicate that MScanFit can consistently calculate motor unit numbers and most of its outputs without substantial influence from nerve conduction distance. Exploring MScanFit's capabilities in various settings could enhance our understanding of its strengths and limitations for extensive use in clinical practice.
Asunto(s)
Potenciales de Acción , Neuronas Motoras , Músculo Esquelético , Conducción Nerviosa , Nervio Cubital , Humanos , Conducción Nerviosa/fisiología , Adulto , Masculino , Femenino , Neuronas Motoras/fisiología , Potenciales de Acción/fisiología , Nervio Cubital/fisiología , Músculo Esquelético/fisiología , Músculo Esquelético/inervación , Electromiografía/métodos , Reproducibilidad de los Resultados , Adulto Joven , Persona de Mediana EdadRESUMEN
BACKGROUND: High ulnar nerve injuries is known to have unfavorable motor outcomes compared to other peripheral nerve injuries in the upper extremity. Functional muscle recovery after peripheral nerve injury depends on the time to motor end plate reinnervation and the number of motor axons that successfully reach the target muscle. The purpose of this study is to assess the functional recovery, and complications following performing supercharge end-to-side (SETS) anastomosis for proximal ulnar nerve injuries. Our study focuses on the role of SETS in the recovery process of high ulnar nerve injury. PATIENT AND METHODS: This study is a prospective, single-arm, open-label, case series. The original proximal nerve pathology was dealt with according to the cause of injury, then SETS was performed distally. The follow-up period was 18 months. We compared the neurological findings before and after the procedure. A new test was used to show the effect of SETS on recovery by performing a Lidocaine proximal ulnar nerve block test. RESULTS: Recovery of the motor function of the ulnar nerve was evident in 33 (86.8%) patients. The mean time to intrinsic muscle recovery was 6.85 months ± 1.3, only 11.14% of patients restored protective sensation to the palm and finger and 86.8% showed sensory level at the wrist level at the end of the follow-up period. Lidocaine block test was performed on 35 recovered patients and showed no change in intrinsic hand function in 31 patients. CONCLUSION: SETS exhibit a remarkable role in the treatment of high ulnar nerve damage. SETS transfer can act as a nerve transfer that can supply intrinsic muscles by its fibers and allows for proximal nerve regeneration. We believe that this technique improves recovery of hand motor function and allows recovery of sensory fibers when combined with treating the proximal lesion. TRIAL REGISTRATION: Approved by Research Ethics Committee of Faculty of Medicine- Cairo University on 01/09/2021 with code number: MD-215-2021.
Asunto(s)
Transferencia de Nervios , Recuperación de la Función , Nervio Cubital , Humanos , Estudios Prospectivos , Nervio Cubital/lesiones , Nervio Cubital/cirugía , Adulto , Masculino , Femenino , Transferencia de Nervios/métodos , Persona de Mediana Edad , Adulto Joven , Traumatismos de los Nervios Periféricos/cirugía , Traumatismos de los Nervios Periféricos/etiología , Traumatismos de los Nervios Periféricos/fisiopatología , Resultado del Tratamiento , Estudios de Seguimiento , Regeneración Nerviosa/fisiología , AdolescenteRESUMEN
INTRODUCTION/AIMS: Leprosy is the most common treatable peripheral neuropathy worldwide. The detection of peripheral nerve impairment is essential for its diagnosis and treatment, in order to prevent stigmatizing deformities and disabilities. This study was performed to identify neural thickening through multisegmental ultrasound (US). METHODS: We assessed US measurements of cross-sectional areas (CSAs) of ulnar, median and tibial nerves at two points (in the osteofibrous tunnel and proximal to the tunnel), and also of the common fibular nerve at the fibular head level in 53 leprosy patients (LP), and compared with those of 53 healthy volunteers (HV), as well as among different clinical forms of leprosy. RESULTS: US evaluation detected neural thickening in 71.1% (38/53) of LP and a mean number of 3.6 enlarged nerves per patient. The ulnar and tibial were the most frequently affected nerves. All nerves showed significantly higher measurements in LP compared with HV, and also greater asymmetry, with significantly higher values for ulnar and tibial nerves. We found significant CSAs differences between tunnel and pre-tunnel points for ulnar and tibial nerves, with maximum values proximal to the tunnel. All clinical forms of leprosy evaluated showed neural enlargement through US. DISCUSSION: Our findings support the role of multisegmental US as a useful method for diagnosing leprosy neuropathy, revealing that asymmetry, regional and non-uniform thickening are characteristics of the disease. Furthermore, we observed that neural involvement is common in different clinical forms of leprosy, reinforcing the importance of including US evaluation of peripheral nerves in the investigation of all leprosy patients.
Asunto(s)
Lepra , Enfermedades del Sistema Nervioso Periférico , Ultrasonografía , Humanos , Lepra/diagnóstico por imagen , Lepra/diagnóstico , Masculino , Femenino , Ultrasonografía/métodos , Adulto , Persona de Mediana Edad , Enfermedades del Sistema Nervioso Periférico/diagnóstico por imagen , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Anciano , Nervio Tibial/diagnóstico por imagen , Adulto Joven , Nervio Cubital/diagnóstico por imagen , Nervio Cubital/patología , Estudios de Casos y Controles , Nervio Mediano/diagnóstico por imagenRESUMEN
Diabetes mellitus (DM) is a risk factor for the development of ulnar nerve entrapment (UNE). Differences in surgical outcomes for UNE between patients with and without DM have been reported, but studies on presurgical management are scarce. This study aimed to evaluate the presurgical management of UNE in patients with (DM diagnosis < 2 years of UNE diagnosis) and without DM regarding the level of care for diagnosis and the proportion that proceeds to surgery. Data from 6600 patients with UNE between 2004 and 2019 were included from the Skåne Health Care Register (SHR) and cross-linked with data from the Swedish National Diabetes Register (NDR). The group with UNE and DM was compared to the group with UNE without DM and prevalence ratios were calculated using Cox regression analysis. Patients with DM more often got their first UNE diagnosis in secondary care than in primary care (643/667, 96% vs. 5361/5786; 93%). Patients with and without DM, regardless of the type of DM, presence of retinopathy, or HbA1c levels, were surgically treated for UNE to the same extent (258/667, 39% of patients with DM vs. 2131/5786, 37% of patients without DM). The proportion of surgically treated was significantly lower among patients diagnosed with UNE in primary care compared to secondary care (59/449, 13% vs. 2330/5786, 38%). Men were more often surgically treated than women (1228/3191, 38% vs.1161/3262 36%). Patients with UNE and DM are surgically treated to the same extent as patients with UNE but without DM and are more likely to be diagnosed in specialized care.
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Síndromes de Compresión del Nervio Cubital , Humanos , Masculino , Femenino , Persona de Mediana Edad , Síndromes de Compresión del Nervio Cubital/cirugía , Síndromes de Compresión del Nervio Cubital/etiología , Anciano , Suecia/epidemiología , Diabetes Mellitus/cirugía , Adulto , Sistema de Registros , Nervio Cubital/cirugía , Factores de RiesgoRESUMEN
BACKGROUND: Traumatic peripheral nerve injury, with an annual incidence reported to be approximately 13-23 per 100,000 people, is a serious clinical condition that can often lead to significant functional impairment and permanent disability. Although nerve transfer has become increasingly popular in the treatment of brachial plexus injuries, satisfactory results cannot be obtained even with total nerve root transfer, especially after serious injuries. To overcome this problem, we hypothesize that the application of stem cells in conjunction with nerve transfer procedures may be a viable alternative to more aggressive treatments that do not result in adequate improvement. Similarly, some preliminary studies have shown that adipose stem cells combined with acellular nerve allograft provide promising results in the repair of brachial plexus injury. The purpose of this study was to assess the efficacy of combining adipose-derived stem cells with nerve transfer procedure in a rat brachial plexus injury model. METHODS: Twenty female Wistar rats weighing 300-350 g and aged 8-10 weeks were randomly divided into two groups: a nerve transfer group (NT group) and a nerve transfer combined adipose stem cell group (NT and ASC group). The upper brachial plexus injury model was established by gently avulsing the C5-C6 roots from the spinal cord with microforceps. A nerve transfer from the ulnar nerve to the musculocutaneous nerve (Oberlin procedure) was performed with or without seeded allogeneic adipose tissue-derived stem cells. Adipose tissue-derived stem cells at a rate of 2 × 106 cells were injected locally to the surface of the nerve transfer area with a 23-gauge needle. Immunohistochemistry (S100 and PGP 9.5 antibodies) and electrophysiological data were used to evaluate the effect of nerve repair 12 weeks after surgery. RESULTS: The mean latency was significantly longer in the NT group (2.0 ± 0.0 ms, 95% CI: 1.96-2.06) than in the NT and ASC group (1.7 ± 0.0 ms, 95% CI: 1.7-1.7) (p < .001). The mean peak value was higher in the NT group (1.7 ± 0.0 mV, 95% CI: 1.7-1.7) than in the NT and ASC group (1.7 ± 0.3 mV, 95% CI: 1.6-1.9) with no significant difference (p = .61). Although S100 and PGP 9.5 positive areas were observed in higher amounts in the NT and ASC group compared to the NT group, the differences were not statistically significant (p = .26 and .08, respectively). CONCLUSIONS: This study conducted on rats provides preliminary evidence that adipose-derived stem cells may have a positive effect on nerve transfer for the treatment of brachial plexus injury. Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings.
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Tejido Adiposo , Plexo Braquial , Modelos Animales de Enfermedad , Nervio Musculocutáneo , Regeneración Nerviosa , Transferencia de Nervios , Ratas Wistar , Nervio Cubital , Animales , Ratas , Transferencia de Nervios/métodos , Femenino , Regeneración Nerviosa/fisiología , Plexo Braquial/lesiones , Plexo Braquial/cirugía , Nervio Musculocutáneo/cirugía , Tejido Adiposo/citología , Tejido Adiposo/trasplante , Nervio Cubital/lesiones , Nervio Cubital/cirugía , Nervio Cubital/trasplante , Trasplante de Células Madre/métodos , Distribución Aleatoria , Neuropatías del Plexo Braquial/cirugía , Traumatismos de los Nervios Periféricos/cirugíaRESUMEN
Total supported abduction, or TSA, is a position for ultrasound evaluations and guided interventions of the upper extremity. It provides optimal access to the medial arm through the volar wrist and palmar hand for diagnostic evaluations of the median and ulnar nerves as well as procedures including injections for carpal tunnel syndrome, ulnar neuropathy at the elbow, and stenosing tenosynovitis. It enables ease of both ipsilateral and bilateral evaluations/interventions without the need for significant positional changes by the patient or physician. Incorporation of TSA may enhance clinical efficiency by reducing the amount of time, materials, and space required to provide such services.
Asunto(s)
Ultrasonografía , Extremidad Superior , Humanos , Extremidad Superior/diagnóstico por imagen , Ultrasonografía/métodos , Posicionamiento del Paciente/métodos , Síndrome del Túnel Carpiano/diagnóstico por imagen , Nervio Cubital/diagnóstico por imagenRESUMEN
Objective: To test the new method of iMAX (the minimum stimulus current that elicits the maximum compound muscle action potential amplitude) electrodiagnosis, verify the feasibility of this method in evaluating the excitability of peripheral motor axons, and preliminarily explore the clinical application value. Methods: This study was a cross-sectional study. A total of 50 healthy subjects were recruited from the outpatient department of Peking University Third Hospital from June 2022 to March 2023, including 25 males and 25 females, aged 25-68 (48±8) years. Eleven patients with Charcot-Marie-Pain-1A (CMT1A), 7 males and 4 females, aged 19-55 (41±13) years and 21 patients with diabetic peripheral neuropathy (DPN), 10 males and 11 females, aged 28-79 (53±16) years were enrolled in this study. iMAX of bilateral median nerves, ulnar nerves and peroneal nerves were detected in all patients. Repeatable motor responses with minimum motor threshold and amplitude of at least 0.1 mV and the minimum stimulus current intensity, at which the maximum compound muscle action potential amplitude is elicited, were measured respectively [1 mA increment is called (iUP) and, 0.1 mA adjustment is called (iMAX)].Comparison of the parameters: the parameters of threshold, iUP and iMAX were compared among different age groups, genders and sides, body mass index(BMI) values and detection time , as well as between CMT1A patients, DPN patients and healthy subjects. Results: In healthy subjects, the threshold, iUP value and iMAX value were (1.8±0.7) mA, (4.4±1.2) mA, and (4.2±1.3) mA respectively; ulnar nerve (3.1±1.6) mA, (6.8±3.2) mA, (6.4±3.2) mA; peroneal nerve (3.7±2.0) mA, (7.8±2.8) mA, (7.4±2.9) mA. There were statistically significant differences in threshold, iUP value and iMAX value among different age groups (all P<0.001).With the increase of age, there was a trend of increasing threshold, iUP, and iMAX values in different nerves, and the differences are statistically significant (all P<0.001). There were no significant differences in gender, side and detection time threshold, iUP value and iMAX value (all P>0.05). The parameters of healthy subjects with high BMI value were higher than those of healthy subjects with low BMI value(all P<0.05). Compared with the healthy subjects, the parameters of 11 CMT1A patients were significantly increased (all P<0.05), and the parameters of 21 DPN patients were slightly increased (P<0.05). Conclusion: The new iMAX method reflects the excitability of motor axons and early axonal dysfunction, which is an important supplement to the traditional nerve conduction, and can be used to monitor motor axon excitability disorders.
Asunto(s)
Potenciales de Acción , Electrodiagnóstico , Humanos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Estudios Transversales , Anciano , Electrodiagnóstico/métodos , Neuronas Motoras/fisiología , Nervio Mediano/fisiopatología , Conducción Nerviosa , Nervio Cubital , Neuropatías Diabéticas/diagnóstico , Neuropatías Diabéticas/fisiopatología , Nervios Periféricos/fisiopatología , Estimulación Eléctrica , ElectromiografíaRESUMEN
INTRODUCTION/AIMS: The current diagnosis of ulnar neuropathy at the elbow (UNE) relies mainly on the clinical presentation and nerve electrodiagnostic (EDX) testing, which can be uncomfortable and yield false negatives. The aim of this study was to investigate the diagnostic value of conventional ultrasound, shear wave elastography (SWE), and superb microvascular imaging (SMI) in diagnosing UNE. METHODS: We enrolled 40 patients (48 elbows) with UNE and 48 healthy volunteers (48 elbows). The patients were categorized as having mild, moderate or severe UNE based on the findings of EDX testing. The cross-sectional area (CSA) was measured using conventional ultrasound. Ulnar nerve (UN) shear wave velocity (SWV) and SMI were performed in a longitudinal plane. RESULTS: Based on the EDX findings, UNE severity was graded as mild in 4, moderate in 10, and severe in 34. The patient group showed increased ulnar nerve CSA and stiffness at the site of maximal enlargement (CSA mean at the site of max enlargement [CSAmax] and SWV mean at the site of max enlargement [SWVmax]), ulnar nerve CSA ratio, and stiffness ratio (elbow-to-upper arm), compared with the control group (p < .001). Furthermore, the severe UNE group showed higher ulnar nerve CSAmax and SWVmax compared with the mild and moderate UNE groups (p < .001). The cutoff values for diagnosis of UNE were 9.5 mm2 for CSAmax, 3.06 m/s for SWVmax, 2.00 for CSA ratio, 1.36 for stiffness ratio, and grade 1 for SMI. DISCUSSION: Our findings suggest that SWE and SMI are valuable diagnostic tools for the diagnosis and assessment of severity of UNE.