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/cirugíaRESUMEN
CASE: A 10-year-old girl presented after closed reduction of an elbow fracture dislocation. She demonstrated intact vascularity but a dense median nerve palsy. Preoperative magnetic resonance neurography (MRN) precisely mapped the median nerve entrapped within the medial epicondylar fracture. Intraoperatively, the median nerve was freed preceding reduction and fracture fixation. Postoperatively, neurological symptoms completely resolved, and she regained full elbow function. CONCLUSION: Median nerve injury can present without associated vascular injury. In this case, MRN was helpful in preoperatively illustrating the spatial relationship between the median nerve and the medial epicondyle.
Asunto(s)
Lesiones de Codo , Imagen por Resonancia Magnética , Humanos , Femenino , Niño , Imagenología Tridimensional , Fractura-Luxación/diagnóstico por imagen , Fractura-Luxación/cirugía , Neuropatía Mediana/cirugía , Neuropatía Mediana/diagnóstico por imagen , Neuropatía Mediana/etiología , Síndromes de Compresión Nerviosa/diagnóstico por imagen , Síndromes de Compresión Nerviosa/etiología , Síndromes de Compresión Nerviosa/cirugía , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/cirugía , Nervio Mediano/diagnóstico por imagen , Nervio Mediano/lesiones , Nervio Mediano/cirugía , Complicaciones Posoperatorias/diagnóstico por imagenRESUMEN
CASE: We present a case of type II (intraosseous) entrapment of the median nerve in a patient who was diagnosed based on clinical examination and magnetic resonance imaging and who was treated with medial epicondyle osteotomy, neurolysis, and transposition of the nerve to its anatomical position within a month of injury. Our patient made a complete motor and sensory recovery at 5 months with complete functionality and grip strength. CONCLUSION: Median nerve entrapment after posterolateral elbow dislocation is a rare complication with roughly 40 cases reported in the literature. This case illustrates the importance of prompt diagnosis and treatment.
Asunto(s)
Lesiones de Codo , Luxaciones Articulares , Humanos , Luxaciones Articulares/cirugía , Luxaciones Articulares/diagnóstico por imagen , Masculino , Articulación del Codo/cirugía , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/inervación , Síndromes de Compresión Nerviosa/cirugía , Síndromes de Compresión Nerviosa/etiología , Síndromes de Compresión Nerviosa/diagnóstico por imagen , Neuropatía Mediana/cirugía , Neuropatía Mediana/etiología , Niño , Imagen por Resonancia Magnética , Nervio Mediano/lesiones , Nervio Mediano/cirugía , Nervio Mediano/diagnóstico por imagenRESUMEN
Background: Bennett fractures are traditionally fixed with percutaneous K-wires from dorsal to volar, or with a volar to dorsal screw via a volar open approach. While volar to dorsal screw fixation is biomechanically advantageous, an open approach requires extensive soft tissue dissection, thus increasing morbidity. This study aims to investigate the practicality and safety of Bennett fracture fixation using a percutaneous, volar to dorsal screw, particularly with regard to the median nerve and its motor branch during wire and screw insertion. Methods: Fifteen fresh frozen forearm and hand specimens were obtained from the University of Auckland human cadaver laboratory. A guidewire is placed under image intensifier from volar to dorsal with the thumb held in traction, abduction and pronation. The wire is passed through the skin volarly under image intensifier, then the median nerve is dissected from the carpal tunnel and the motor branch of the median nerve (MBMN) is dissected from its origin to where it supplies the thenar musculature. The distance between the K-wire to the MBMN is measured. Results: In 14 of 15 specimens, the wire was superficial and radial to the carpal tunnel. The mean distance to the origin of the MBMN is 6.2 mm (95% CI 4.1-8.3) with the closest specimen 1 mm away. The mean closest distance the wire gets to any part of the MBMN is 3.7 mm (95% CI 1.6-5.8); in two specimens, the wire was through the MBMN. Conclusions: Wire placement, although done under image intensifier, is subject to significant variation in exiting location. While research has shown the thenar portal in arthroscopic thumb surgery is safe, our guidewire needs to exit further ulnar to capture the Bennett fracture fragment, placing the MBMN at risk. This cadaveric study has demonstrated the proposed technique is unsafe for use.
Asunto(s)
Tornillos Óseos , Cadáver , Fijación Interna de Fracturas , Humanos , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/efectos adversos , Tornillos Óseos/efectos adversos , Hilos Ortopédicos/efectos adversos , Fractura-Luxación/cirugía , Fractura-Luxación/diagnóstico por imagen , Nervio Mediano/lesiones , Nervio Mediano/cirugía , Fracturas Óseas/cirugíaRESUMEN
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/métodosRESUMEN
The existing report elucidates that median nerve electrical stimulation (MNS) plays a role in treating traumatic brain injury (TBI). Herein, we explored the mechanism of MNS in TBI. A TBI-induced coma model (skull was hit by a cylindrical impact hammer) was established in adult Sprague-Dawley rats. Microglia were isolated from newborn Sprague-Dawley rats and was injured by lipopolysaccharide (LPS; 10 ng/mL). Consciousness was assessed by sensory and motor functions. Brain tissue morphology was detected using hematoxylin-eosin staining assay. Ionized calcium binding adapter molecule 1, NeuN and tachykinin receptor 1 (TACR1) level were detected by immunohistochemical assay. Levels of pro-inflammatory and anti-inflammatory factors were measured by enzyme linked immune sorbent assay (ELISA). Levels of TACR1, C-C motif chemokine 7 (CCL7), phosphorylation (p)-P65 and P65 were assessed by quantitative real time polymerase chain reaction (qRT-PCR) and western blot. M1 markers (inducible nitric oxide synthase and CD86) and M2 markers (arginase-1 (Arg1) and chitinase 3-like 3 (YM1)) of microglia as well as the transfection efficiency of short hairpin TACR1 (shTACR1) were assessed by qRT-PCR. Immunofluorescence and flow cytometry assay were used to detect microglia morphology and neuron apoptosis. MNS reduced neuron injury and microglia activation in the TBI-induced rat coma model. MNS reversed the effects of TBI on levels of inflammation-related factors, M1/M2 microglia markers, TACR1, p-P65/P65 and CCL7 in rats. shTACR1 reversed the effects of LPS on inflammation-related factors, M1/M2 microglia markers, microglia activation, neuron apoptosis, p-P65/P65 value and CCL7 level. Our results revealed that MNS improved TBI by reducing TACR1 to inhibit nuclear factor-κB (NF-κB) and CCL7 activation in microglia.
Asunto(s)
Lesiones Traumáticas del Encéfalo , Nervio Mediano , Microglía , FN-kappa B , Ratas Sprague-Dawley , Animales , Lesiones Traumáticas del Encéfalo/terapia , Lesiones Traumáticas del Encéfalo/metabolismo , Lesiones Traumáticas del Encéfalo/patología , Microglía/metabolismo , Ratas , FN-kappa B/metabolismo , Nervio Mediano/lesiones , Masculino , Terapia por Estimulación Eléctrica/métodos , Modelos Animales de EnfermedadRESUMEN
Penetrating lacerations to the hand are a common cause of nerve injury and can lead to debilitating pain and numbness in the distribution of the nerve affected. Owing to an overlap in the cutaneous innervation from different sensory nerves, clinically identifying the injured nerve can be difficult. We present a novel case of isolated injury to the palmar cutaneous nerve from a penetrating knife injury which was detected using 'comparison waveform' nerve conduction studies. Using this technique, we can isolate injuries to the palmar cutaneous branch of the median nerve (PCBmdn) from the median nerve, dorsal radial sensory nerve, and lateral antebrachial cutaneous nerve. In addition, sensory nerve testing identified conduction block as the mechanism of injury, which resolved after surgery at 8 weeks postoperatively. Preoperative nerve conduction study can discern the level of nerve injury to PCBmdn only, thus eliminating the need for median and radial nerve exploration at the forearm, unnecessary incisions, pain, and scarring. The objective of this case report is to illustrate the value of preoperative comparison waveform nerve conduction study, particularly the PCBmdn, in patients presenting with neurologic deficits who have sustained penetrating lacerations to the hand.
Asunto(s)
Traumatismos de la Mano , Laceraciones , Heridas Penetrantes , Humanos , Nervio Mediano/cirugía , Nervio Mediano/lesiones , Laceraciones/cirugía , Estudios de Conducción Nerviosa , Heridas Penetrantes/cirugía , Dolor , Traumatismos de la Mano/cirugíaRESUMEN
BACKGROUND: Management of supracondylar humerus fractures (SCHF) with coexisting median nerve injury is controversial. Although many nerve injuries improve with the reduction and stabilization of the fracture, the speed and completeness of recovery are unclear. This study investigates median nerve recovery time using the serial examination. METHODS: A prospectively maintained database of SCHF-related nerve injuries referred to a tertiary hand therapy unit between 2017 and 2021 was interrogated. Factors related to the injury (vascularity, Gartland grade, open vs. closed fracture) and treatment (fixation modality, adequacy, timing of reduction, vascular and nerve intervention, and secondary procedures) were assessed.Primary outcomes were the motor recovery of Medical Research Council (MRC) grade 4 or 5 in flexor pollicis longus or flexor digitorum profundus (index) and detection of the 2.83 Semmes Weinstein monofilament.A retrospective clinical note review of all SCHF presenting during the same period was also conducted. RESULTS: Of 1096 SCHF, 74 (7%) had an associated median nerve palsy. Twenty-one patients [mean age 7 years (SD 1.6)] with SCHF-related median nerve injuries underwent serial examination. Nineteen (90%) were modified Gartland III or IV, and 10 (48%) were pulseless on presentation. The mean follow-up was 324 days.The mean motor recovery time was 120 days (SD 71). Four (27%) and 2 (13%) patients had not achieved MRC grade 4 by 6 months and 2 years, respectively. Only 50% attained MRC grade 5 at 2 years.When compared with closed reduction, those who underwent open reduction recovered motor function 80 days faster (mean 71 vs. 151 d, P =0.03) and sensory function 110 days faster (52 vs. 162, P =0.02). Fewer patients recovered after closed reduction (8 of 10) than open (5 of 5).Modified Gartland grade, vascular status, adequacy of reduction, and secondary surgery were not associated with recovery time. CONCLUSIONS: Median nerve recovery seems to occur slower than previously thought, is often incomplete, and is affected by treatment decisions (open vs. closed reduction). Retrospective reporting methods may overestimate median nerve recovery. LEVEL OF EVIDENCE: Level III-therapeutic.
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Fracturas del Húmero , Neuropatía Mediana , Traumatismos del Sistema Nervioso , Niño , Humanos , Estudios Retrospectivos , Nervio Mediano/lesiones , Húmero/cirugía , Fracturas del Húmero/complicaciones , Fracturas del Húmero/cirugía , Traumatismos del Sistema Nervioso/complicaciones , Parálisis/complicaciones , Resultado del TratamientoRESUMEN
This study aimed to investigate whether ultrasonographic inspection of the repair site of median nerve lacerations may provide useful evidence about the functional outcome in the affected hand. Forty-three patients with complete transection of the median nerve at the distal forearm were examined at a median of 40.9 months after operation by detailed ultrasonographic imaging and clinical assessment of the affected hand by the Michigan Hand Questionnaire and Rosén-Lundborg Protocol to investigate the quality of nerve healing. The continuity of individual nerve fascicles was assessed and the cross-sectional area of the enlarged nerve at the repair site was measured and compared with the contralateral median nerve at the same level. An enlargement ratio for the repair site of each nerve was calculated and compared with the numeric results obtained from the two clinical tests. A statistically significant reverse correlation was observed between nerve enlargement and the functional results of the repaired nerve.Level of evidence: IV.
Asunto(s)
Laceraciones , Nervio Mediano , Humanos , Nervio Mediano/diagnóstico por imagen , Nervio Mediano/cirugía , Nervio Mediano/lesiones , Laceraciones/diagnóstico por imagen , Laceraciones/cirugía , Mano , UltrasonografíaRESUMEN
Background: Motor branch of the ulnar nerve (MUN) injury during carpal tunnel surgery is rare and it should never be injured during carpal tunnel release (CTR). However, an iatrogenic injury of the MUN can cause catastrophic physical and mental suffering. The aim of our study is to understand the anatomy of the MUN in relation to carpal tunnel in order to prevent iatrogenic injury during CTR. Methods: We dissected 34 fresh cadaver hands and located the MUN in relation to the anatomical axis used for carpal tunnel surgery. Possible mechanisms of injury and the vulnerable area of the MUN were determined along the dissection. Results: The MUN turned towards the thumb distal to hook of hamate. It then travelled on the floor of the carpal tunnel which was formed by intrinsic hand muscles under flexor tendons. The nerve located at 29.39 ± 7.41, 35.01 ± 3.14 and 38.79 ± 4.03 mm (Mean ± SD) in the central axis of ring finger, the vertical axis of the third web-space and the central axis of middle finger respectively. The nerve's turning point, 10.9 ± 2.63 mm distal to the centre of hook of hamate where it lies just below the level of the transverse carpal ligament. Conclusions: Surgeons should be aware of the nerve's location. Surgical dissection or passing of any surgical instruments around the hook of hamate should be done with care. Level of Evidence: Level IV (Therapeutic).
Asunto(s)
Síndrome del Túnel Carpiano , Nervio Cubital , Humanos , Nervio Cubital/anatomía & histología , Nervio Mediano/lesiones , Síndrome del Túnel Carpiano/cirugía , Ligamentos Articulares/cirugía , Cadáver , Enfermedad IatrogénicaRESUMEN
We aimed to report the clinical results of volar plate removal without carpal tunnel release in patients with late-onset median neuropathy and to evaluate the relationship between plate position and median nerve symptoms. Part I. Twelve consecutive patients with late-onset median neuropathy treated with volar plate removal without carpal tunnel release were enrolled for analysis. Pre- and post-operative Tinel sign, Phalen and Ten test, subjective rating of tingling sensation, Mayo wrist score and Disabilities of the Arm, Shoulder and Hand (DASH) score were collected. Part II. 232 consecutive patients underwent volar plating for distal radius fracture. The relationships between median nerve symptoms and volar plate prominence on the Soong classification, fracture classification, gender and age were investigated. All cases except one showed complete symptom resolution at final follow-up, with negative Tinel sign and Ten test score of 10/10. Tingling was rated 0 at final follow-up. Mean Mayo wrist and DASH scores improved to 86.7 and 23.1, respectively. The incidence of the median nerve symptoms in our cohort was 5.6%. Even though the odds ratio in Soong grade 2 was 4.0957 (95% CI, 0.93-16.9) compared to the combination of grades 0 and 1, no statistically significant relationship was found between the median nerve symptoms and volar plate prominence (p > 0.05). Plate removal without carpal tunnel release adequately relieved symptoms of late-onset median neuropathy after volar plating in patients with distal radius fracture. LEVEL OF EVIDENCE: IV; Therapeutic.
Asunto(s)
Síndrome del Túnel Carpiano , Neuropatía Mediana , Placa Palmar , Fracturas del Radio , Humanos , Nervio Mediano/cirugía , Nervio Mediano/lesiones , Radio (Anatomía) , Fracturas del Radio/cirugía , Síndrome del Túnel Carpiano/cirugía , Neuropatía Mediana/cirugíaRESUMEN
PURPOSE: Carpal tunnel (CT) syndrome continues to be a commonly treated hand pathology. We aimed to evaluate several CT injection techniques for (1) spatial accuracy within the CT and (2) risk of median nerve (MN) injury. Our purpose was to evaluate for any significant differences in accuracy of needle placement within the carpal tunnel and final distance between the needle tip and the MN with each technique. METHODS: Fifteen fresh frozen cadaveric arms were used for this study. Six different injection techniques for CT injection were performed on each specimen, including palmaris longus, ulnar to flexor carpi radialis, trans-flexor carpi radialis, volar radial, volar ulnar, and direct through the palm techniques. After needle placement, a standard open CT release was performed to assess for accuracy of placement within the CT and measure needle position in relation to the MN and other anatomic structures. RESULTS: Accurate intra-CT needle placement was seen in 91% of injections. While there was no significant difference between injection techniques for distance to nearest tendon (p = 0.1531), the trans-flexor carpi radialis (tFCR), volar radial (VR), and volar ulnar (VU) techniques consistently provided the greatest intra-CT distance from needle tip to median nerve (p = 0.0019). The least incidence of intraneural needle placement was found with the tFCR and VR approaches. CONCLUSION: All six injection techniques reliably enter the CT space. The lowest risk to the MN was found with tFCR and VR techniques, and we recommend these techniques for safe and effective needle placement to avoid iatrogenic intraneural injection. LEVEL OF EVIDENCE: Level V: Cadaveric Study.
Asunto(s)
Síndrome del Túnel Carpiano , Nervio Mediano , Humanos , Nervio Mediano/diagnóstico por imagen , Nervio Mediano/lesiones , Nervio Mediano/patología , Síndrome del Túnel Carpiano/cirugía , Muñeca , Antebrazo , CadáverRESUMEN
Iatrogenic injury of the median nerve has been reported after endoscopic carpal tunnel release and corticoid injection. In 784 MR images of the wrist, the position of the median nerve in relation to the palmaris longus tendon was analysed. The ulnar edge of the median nerve was found medial to the palmaris longus tendon in 14% and 36% of patients at the proximal wrist crease and entrance of the carpal tunnel, respectively, compared with 23% and 40% of patients with carpal tunnel syndrome (88 patients). The position of the median nerve in relation to the palmaris longus tendon varies widely. It is suggested that the palmaris longus tendon may not be considered a safe landmark to locate the position of the median nerve and care should be taken when introducing an endoscopic instrument or during steroid injection for carpal tunnel syndrome.Level of evidence: IV.
Asunto(s)
Síndrome del Túnel Carpiano , Muñeca , Humanos , Nervio Mediano/lesiones , Síndrome del Túnel Carpiano/diagnóstico por imagen , Articulación de la Muñeca/diagnóstico por imagen , TendonesRESUMEN
Median nerve entrapment is a frequent disorder encountered by all clinicians at some point of their career. Affecting the distal median nerve, entrapment occurs most frequently at the level of the wrist resulting in a carpal tunnel syndrome. Median nerve entrapment may also occur proximally giving rise to the much less frequent pronator teres syndrome and even less frequent anterior interosseous nerve syndrome, which owing to the paucity of cases may prove challenging to diagnose. An unusual case of anterior interosseous syndrome precipitated by extraordinary exertion in a tetraplegic endurance athlete is presented with ancillary dynamometric, electrodiagnostic, ultrasonographic, and biochemical findings.
Asunto(s)
Síndrome del Túnel Carpiano , Neuropatía Mediana , Humanos , Neuropatía Mediana/complicaciones , Neuropatía Mediana/diagnóstico , Nervio Mediano/lesiones , Mano , MuñecaRESUMEN
BACKGROUND: To clarify the real risk of nerve injury during elbow arthroscopy, the distances of the radial and median nerves to the elbow joint were investigated using ultrasonography in patients who underwent surgery. METHODS: A total of 35 patients who underwent arthroscopic surgery of the elbow were investigated. The distances of the nerves to the capsule and bony landmarks were measured using ultrasonography. The radial nerve distances were measured at the capitellum, joint space, radial head, and radial neck levels. The median nerve distances were measured at the trochlear, joint space, and coronoid process levels. The patients were divided into 2 groups: nine patients in the hydrarthrosis (HA) group and 26 patients in the non-hydrarthrosis (non-HA) group. HA was defined as the intra-articular effusion on magnetic resonance imaging scans. RESULTS: The radial nerve ran closer to the capsule at the radial neck level in the HA group than in the non-HA group (2.0 mm vs. 5.9 mm, P < .01). In the non-HA group, the radial nerve ran closer to the radial head than in the HA group (6.3 mm vs. 8.5 mm, P = .01). The median nerve ran closer to the capsule at the trochlear level in the HA group than in the non-HA group (5.2 mm vs. 8.8 mm, P < .01). Nerves at a distance of ≤2 mm from the capsule were found in 7 patients at the radial neck of the radial nerve and in 2 patients at the trochlear region of the median nerve in the HA group. In the non-HA group, they were found in 3 patients at the radial head and in 1 patient at the joint space of the radial nerve. CONCLUSIONS: The dangerous locations for nerve injury during elbow arthroscopy vary according to hydrarthrosis, and this risk should be recognized during arthroscopic surgery.
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Articulación del Codo , Codo , Humanos , Artroscopía/efectos adversos , Artroscopía/métodos , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/cirugía , Articulación del Codo/inervación , Nervio Mediano/diagnóstico por imagen , Nervio Mediano/lesiones , Nervio Radial/diagnóstico por imagenRESUMEN
Neuropathies of the elbow represent a spectrum of disorders that involve more frequently the ulnar, radial, and median nerves. Reported multiple pathogenic factors include mechanical compression, trauma, inflammatory conditions, infections, as well as tumor-like and neoplastic processes. A thorough understanding of the anatomy of these peripheral nerves is crucial because clinical symptoms and imaging findings depend on which components of the affected nerve are involved. Correlating clinical history with the imaging manifestations of these disorders requires familiarity across all diagnostic modalities. This understanding allows for a targeted imaging work-up that can lead to a prompt and accurate diagnosis.
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Articulación del Codo , Síndromes de Compresión Nerviosa , Diagnóstico por Imagen , Articulación del Codo/diagnóstico por imagen , Humanos , Nervio Mediano/anatomía & histología , Nervio Mediano/lesiones , Síndromes de Compresión Nerviosa/diagnóstico , Nervios Periféricos , Lesiones de CodoRESUMEN
BACKGROUND: Severe peripheral nerve injury, especially the long-distance peripheral nerve defect, causes severe functional disability in patients. There is always a lack of effective repair methods for clinic, and those in practice are associated with side effects. A case study was performed to observe the regenerative outcomes of the surgical repair of long-distance peripheral nerve defects in the upper arm with chitosan-poly(glycolide-co-lactide) (PGLA) nerve grafts combined with bone marrow mononuclear cells (BMMCs). METHODS: The right upper arm of a 29-year-old woman was injured, leaving a 50-mm-long median nerve defect, an 80-mm-long ulnar nerve defect, and muscle and blood vessel disruptions. The nerve defects were repaired by implanting BMMC-containing chitosan-PGLA nerve grafts on the 40th day after injury. A series of functional assessments were carried out from 2 weeks to 66 months after surgical repair. Sensory function was assessed by the pinprick test, two-point discrimination test and Semmes-Weinstein monofilament test. Motor function was evaluated by the range of motion of the wrist joint and muscle power. Autonomic function was monitored by laser-Doppler perfusion imaging (LDPI). Tissue morphology was observed through ultrasonic investigations. RESULTS: No adverse events, such as infection, allergy, or rejection, caused by the treatment were detected during the follow-up period. Sensory and pinprick nociception in the affected thumb, index, and middle fingers gradually restored at 6th month after surgery. The monofilament tactile sensation was 0.4 g in the terminal finger pulp of the thumb and index finger, 2.0 g in the middle finger, and greater than 300 g in the ring finger and little finger at the 66th month. Motor function recovery was detected at the 5th month after surgery, when the muscle strength of the affected forearm flexors began to recover. At the 66th month after surgery, the patient's forearm flexor strength was grade 4, with 80° of palmar flexion, 85° of dorsal extension, 8° of radial deviation, 40° of ulnar deviation, 40° of anterior rotation, and 85° of posterior rotation of the affected wrist. The patient could perform holding, picking up, and some other daily activities with the affected hand. The patient's sweating function of the affected hand was close to the level of the healthy hand. LDPI showed that the skin blood flow perfusion was significantly increased, with perfusion similar to on the normal side in some areas. Neuromusculoskeletal ultrasonography showed the presence of nerve structures. CONCLUSION: These results suggest that chitosan-PGLA nerve grafts combined with BMMCs could effectively repair long-distance nerve defects and achieve good clinical results.
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Quitosano , Procedimientos de Cirugía Plástica , Adulto , Péptidos Catiónicos Antimicrobianos , Brazo/cirugía , Médula Ósea , Femenino , Humanos , Nervio Mediano/lesiones , Nervio Mediano/cirugía , Procedimientos de Cirugía Plástica/métodos , Resultado del Tratamiento , Nervio Cubital/lesiones , Nervio Cubital/cirugíaRESUMEN
We report a rare case in which a peripherally inserted central catheter (PICC) asymptomatically penetrated the median nerve. The patient was a 71-year-old man who displayed no neurological symptoms until 4 days after PICC placement. An ultrasound scan revealed that the PICC had penetrated the median nerve. He underwent surgery to remove the catheter and had no sequelae. When placing a PICC, selecting the brachial vein as a puncture site is associated with a high risk of nerve injury. Furthermore, circumspect observation is needed until withdrawal as neurological symptoms may be absent even when the catheter has punctured a nerve.
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Cateterismo Venoso Central , Cateterismo Periférico , Anciano , Cateterismo Venoso Central/efectos adversos , Cateterismo Periférico/efectos adversos , Catéteres , Humanos , Masculino , Nervio Mediano/diagnóstico por imagen , Nervio Mediano/lesiones , UltrasonografíaRESUMEN
PURPOSE: Several experimental studies have investigated the effects of hyperbaric oxygen therapy (HBOT) on peripheral nerve regeneration. However, to the best of our knowledge, clinical studies to evaluate the effects of HBOT on peripheral nerve recovery are seldom performed. The aim of our study was to investigate the efficacy of HBOT following primary nerve repair in patients with upper extremity nerve injuries. METHODS: Patients admitted to our hospital between 2015 and 2019 with ulnar and median nerve injuries were included in the study. Patients were randomized based on their application dates and divided into two different groups. Patients who received HBOT following standard epineural nerve repair were included in group 1, while patients who only underwent epineural nerve repair were included in group 2. All patients were followed up at 3, 6, and 12 months post-treatment and evaluated through electroneuromyography analysis of the traumatized nerve, injured nerve-related muscle strength, and two-point discrimination test. RESULTS: Impulse transmission of injured nerves to the end organ was faster in group 1. Further, ENMG parameters demonstrated that injured nerves of patients in group 1 recovered faster. Patients in group 1 also reached higher power score and had significantly more rapid motor recovery than patients in group 2. CONCLUSION: This prospective study of upper extremity injuries demonstrated the favorable effects of HBOT on nerve recovery both clinically and electrophysiologically following nerve repair. One HBOT session each day for 5 days after surgical treatment can decrease morbidity and facilitate recovery.
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Traumatismos del Brazo , Oxigenoterapia Hiperbárica , Humanos , Nervio Mediano/lesiones , Nervio Mediano/cirugía , Nervios Periféricos/cirugía , Estudios Prospectivos , Extremidad SuperiorRESUMEN
There is a risk of injury to the palmar cutaneous branch of the median nerve (PCBMN) during a volar approach to the carpus or the distal radius. Anatomic variations of the PCBMN increase this risk. We report an anatomic variant of the PCBMN that coursed superficial and radial to the flexor carpi radialis (FCR), reinforcing the need for meticulous subcutaneous dissection to protect the nerve during a volar approach to the distal radius. In this case, identification of the PCBMN variant warranted a modified surgical approach, ulnar to the FCR instead of radial in order to avoid iatrogenic injury. Level of Evidence: Level V (Therapeutic).