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Nerve Injury and Rehabilitation

Works Count: 34736

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Description

This cluster of papers focuses on the surgical management, nerve transfers, muscle strength assessment, and outcomes of brachial plexus injuries, particularly related to obstetric and neonatal palsy. It covers topics such as shoulder function restoration, peripheral nerve surgery, and the impact on quality of life.

Keywords

Brachial Plexus; Nerve Transfer; Muscle Strength; Obstetric Palsy; Shoulder Function; Nerve Injury; Reconstruction; Neonatal Palsy; Peripheral Nerve Surgery; Quality of Life

Nerve Physiology

2013-07-27

Ron M.G. Menorca , Theron S. Fussell , John C. Elfar

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AN APPROACH TO OBSTETRICAL BRACHIAL PLEXUS INJURIES

1995-11-01

Howard M. Clarke , Christine Curtis

Modified neck dissection

1985-10-01

Robert M. Byers

Upper extremity pain in the postrehabilitation spinal cord injured patient.

1992-01-01

Ien Sie , R L Waters , Rodney H. Adkins +1 more

Anatomical changes in peripheral nerves compressed by a pneumatic tourniquet.

1972-12-01

J. L. Ochoa , Thomas J. Fowler , R. W. Gilliatt

Comparison of the Natural History, the Outcome of Microsurgical Repair, and the Outcome of Operative Reconstruction in Brachial Plexus Birth Palsy*

1999-05-01

Peter M. Waters

The purposes of this study were to document the natural history of brachial plexus birth palsy, in relation to the recovery of biceps function, in the first six months of … The purposes of this study were to document the natural history of brachial plexus birth palsy, in relation to the recovery of biceps function, in the first six months of life; to assess the outcome after microsurgical repair of the brachial plexus in patients who had no recovery of biceps function at six months; and to compare the results of transfer of the latissimus dorsi and teres major tendons with the results of derotation osteotomy of the humerus and to compare the results of the tendon transfers and the osteotomy with the natural history of the disorder.Sixty-six patients (sixty-seven lesions) who had brachial plexus birth palsy were seen for an initial evaluation when they were less than three months old. The time of recovery of biceps function was recorded for each month of life for six months from the date of birth. The patients were divided into groups according to the month of life during which recovery of biceps strength was noted. A physical examination and an assessment with use of the functional criteria of Mallet were performed each month. Microsurgical repair of the brachial plexus was performed in six infants who had no evidence of biceps function within the first six months of life. Another group of twenty-seven patients were referred for evaluation of chronic neuropathy after they were six months old. A transfer of the latissimus dorsi and teres major tendons to the rotator cuff was performed in nine of these patients and a derotation osteotomy of the humerus was performed in seven because of an internal rotation contracture or functional weakness of the external rotators of the shoulder.Twenty-two infants had recovery of biceps function within the first three months of life and had normal function at the time of the latest evaluation. Infants who had recovery of biceps function during the fourth, fifth, or sixth month of life later had significantly worse function, according to the criteria described by Mallet, than those who had had recovery in the first three months (p<0.005). The clinical results for the six patients who had had microsurgical repair six months after birth were significantly better (p<0.04) than those for the fifteen patients who had had recovery of biceps function in the fifth month of life. However, the results for the patients who had had repair of the brachial plexus were not found to be better than those for the eleven patients who had had recovery of biceps function in the fourth month of life. The improvement in function, as assessed with use of the Mallet criteria, after tendon transfer (p<0.001) and humeral osteotomy (p<0.0001) was significant.The present study confirms the observation of Gilbert and Tassin that it is rare for infants who have recovery of biceps function after the age of three months to have complete neurological recovery. Microsurgical repair was effective in improving function in the small subgroup of patients who had no evidence of recovery of biceps function within the first six months of life.

Preservation of Upper Limb Function Following Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Professionals

2005-01-01

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Glenohumeral Deformity Secondary to Brachial Plexus Birth Palsy

1998-05-01

Peter M. Waters , Garth R. Smith , Diego Jaramillo

Ninety-four patients who had brachial plexus birth palsy were entered into a prospective study to evaluate the association between persistent palsy, age-related musculoskeletal deformity, and functional limitations. Of these patients, … Ninety-four patients who had brachial plexus birth palsy were entered into a prospective study to evaluate the association between persistent palsy, age-related musculoskeletal deformity, and functional limitations. Of these patients, forty-two had either computerized tomography or magnetic resonance imaging to assess the presence and degree of incongruity of the glenohumeral joint, deformity of the humeral head, and hypoplasia of the glenoid as part of the preoperative planning for a reconstructive operation. Functional ability was rated with use of the classification of Mallet, on a scale of 1 to 5. The mean glenoscapular angle (the degree of retroversion of the glenoid) on the affected side was -25.7 degrees compared with -5.5 degrees on the unaffected side. Twenty-six (62 per cent) of the forty-two shoulders had evidence of posterior subluxation of the humeral head, with a mean of only 25 per cent (range, 0 to 50 per cent) of the head being intersected by the scapular line. Progressive deformity was found with increasing age (p < 0.001). The natural history of untreated brachial plexus birth palsy with residual weakness is progressive glenohumeral deformity due to persistent muscle imbalance. The status of the glenohumeral joint must be addressed when the choice between tendon transfer and humeral derotation osteotomy for reconstruction of the shoulder is considered for these patients.

Pathophysiology of Nerve Compression Syndromes

1999-11-01

David Rempel , Lars B. Dahlin , Göran Lundborg

REMPEL, DAVID M.D., M.P.H.†, SAN FRANCISCO, CALIFORNIA; DAHLIN, LARS M.D., PH.D.‡; LUNDBORG, GÖRAN M.D., PH.D.‡, MALMÖ, SWEDEN Author Information REMPEL, DAVID M.D., M.P.H.†, SAN FRANCISCO, CALIFORNIA; DAHLIN, LARS M.D., PH.D.‡; LUNDBORG, GÖRAN M.D., PH.D.‡, MALMÖ, SWEDEN Author Information

Shoulder pain in wheelchair users with tetraplegia and paraplegia

1999-04-01

Kathleen A. Curtis , George A. Drysdale , R.David Lanza +3 more

Objective: To compare the prevalence and intensity of shoulder pain experienced during daily functional activities in individuals with tetraplegia and individuals with paraplegia who use manual wheelchairs. Design: Self-report survey. … Objective: To compare the prevalence and intensity of shoulder pain experienced during daily functional activities in individuals with tetraplegia and individuals with paraplegia who use manual wheelchairs. Design: Self-report survey. Setting: General community. Participants: Fifty-five women and 140 men, 92 subjects with tetraplegia and 103 subjects with paraplegia who met inclusion criteria of 3 hours per week of manual wheelchair use and at least 1 year since onset of spinal cord injury. Main Outcome Measures: Respondents completed a demographic and medical history questionnaire and the Wheelchair User's Shoulder Pain Index (WUSPI), a measure of pain during typical daily activities. Results: More than two thirds of the sample reported shoulder pain since beginning wheelchair use, with 59% of the subjects with tetraplegia and 42% of the subjects with paraplegia reporting current pain. Performance-corrected WUSPI scores were significantly higher in subjects with tetraplegia than in subjects with paraplegia. Conclusions: Both the prevalence and intensity of shoulder pain was significantly higher in subjects with tetraplegia than in subjects with paraplegia. Efforts to monitor and prevent shoulder pain should continue after rehabilitation.

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Nerve transfer to biceps muscle using a part of ulnar nerve for C5–C6 avulsion of the brachial plexus: Anatomical study and report of four cases

1994-03-01

C. Oberlin , David Beal , Somsak Leechavengvongs +3 more

A theory of the effects of fibre size in medullated nerve

1951-09-28

W. A. H. Rushton

The Incidence of Peripheral Nerve Injury in Extremity Trauma

2008-04-15

Christopher A. Taylor , Diane W. Braza , J. Bradford Rice +1 more

To examine the incidence of peripheral nerve injury within 90 days of a limb trauma diagnosis in patients who have presented to the hospital or outpatient clinic.This study is a … To examine the incidence of peripheral nerve injury within 90 days of a limb trauma diagnosis in patients who have presented to the hospital or outpatient clinic.This study is a retrospective, descriptive study that uses the 1998 MarketScan Commercial Claims and Encounters Database (The MEDSTAT Group) to track peripheral nerve injuries in extremity trauma. We selected our sample by using ICD9 codes for limb trauma during the first 9 mos of 1998. Nerve injuries within 90 days after limb trauma were the main outcome measure. Finally, we report how the rates of trauma and accompanying nerve injuries were contrasted by gender and age group, using univariate and bivariate statistics. All data analyses were conducted using Stata 9.0 statistical software.Out of 16 million insureds in the database, 220,593 (1.4%) were diagnosed with limb trauma. Eighty-three percent of the patients were less than 55 yrs old, and 50% were male. The total incidence of nerve injuries within 90 days of upper- or lower-limb trauma was 1.64%. The type of extremity trauma with the highest incidence of nerve injury within 90 days of the diagnosis was a crush injury at 1.9%. Approximately 50% of our sample was selected because of a dislocation, which had an associated nerve injury prevalence of 1.46%.When looking at the population sampled, rates for peripheral nerve injury in people incurring limb trauma are low. Crush injuries seem to have the highest rate of associated nerve injury. Further studies are needed to observe outcomes for people with nerve damage after trauma.

Nerves and Nerve Injuries

1979-06-01

J. A. Simpson

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Chronic post‐sternotomy pain

2001-09-01

Eija Kalso , Susanna Mennander , Tiina Tasmuth +1 more

Chronic postoperative pain is a well-recognised problem. The incidence of severe incapacitating pain is about 3-5% after various types of surgery such as thoracotomy, repair of inguinal hernias and mastectomy. … Chronic postoperative pain is a well-recognised problem. The incidence of severe incapacitating pain is about 3-5% after various types of surgery such as thoracotomy, repair of inguinal hernias and mastectomy. Sternotomy causes considerable postoperative pain and patients with chronic post-sternotomy pain are often referred to pain clinics. Epidemiological studies on chronic post-sternotomy pain are scarce, however. The aim of this paper was to study the incidence and possible risk factors of chronic pain following sternotomy operations performed for coronary bypass grafting or thymectomy.Two groups of patients were studied for persistent pain following sternotomy operations. A questionnaire was sent in January 1997 to 71 patients with myasthenia gravis (MG) who had undergone a thymectomy during 1985-1996 and 720 patients who had had coronary bypass grafting (CABG) in 1994 were interviewed by letter. The patients were asked about the presence of pain and other symptoms in the chest, shoulders, arms or legs that they thought were connected to surgery. They were also asked about the quality of the pain and its evolvement with time. The patients' records were checked for details about surgery, anaesthesia and the state of the coronary disease.The response rate was 87%. The interval between the interview and surgery varied from 6 months to 12 years in the MG group and it was 2-3 years in the CABG group. In the MG group, 27% of the patients reported chronic post-sternotomy pain, which was moderate to severe in 48% of the patients. In the CABG group, 28% of the patients still had post-sternotomy pain, which was moderate to severe in 38% of patients. Of the patients who had post-sternotomy pain, one-third reported sleep disturbances due to the pain.Chronic post-sternotomy pain is an important complication that may have a significant impact on the patient's everyday life. Future studies will show whether minimising complications, improving postoperative care and starting early adequate pain management will reduce the incidence of this problem.

Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature

2001-03-01

Gregory A. Merrell , Kimberly A. Barrie , David L. Katz +1 more

Clinical Nerve Reconstruction with a Bioabsorbable Polyglycolic Acid Tube

1990-03-01

Susan Mackinnon , A. Lee Dellon

Microneurosurgical techniques to reconstruct nerve gaps with nerve grafts frequently fail to achieve excellent functional results and create donor-site morbidity. In the present study, 15 patients had gaps of 0.5 … Microneurosurgical techniques to reconstruct nerve gaps with nerve grafts frequently fail to achieve excellent functional results and create donor-site morbidity. In the present study, 15 patients had gaps of 0.5 to 3.0 cm (mean 1.7 cm) in digital nerves reconstructed by one surgeon with a bioabsorbable polyglycolic acid (PGA) tube. A final evaluation of sensibility was done by a second surgeon at a mean postoperative interval of 22.4 months (range 11 to 32 months). These were all secondary reconstructions. The evaluation included a digital nerve block with local anesthetic for the intact (not reconstructed) digital nerve. Excellent functional sensation (moving two-point discrimination less than or equal to 3 mm and/or static two-point discrimination less than or equal to 6 mm) was present in 33 percent and good functional sensation (moving two-point discrimination of 4 to 7 mm and/or static two-point discrimination of 7 to 15 mm) in 53 percent of the digital nerve reconstructions. One patient with poor sensory recovery and one with no recovery were judged as functional failures (14 percent). Absence of pain at the site of reconstruction was judged by the patient to be excellent in 40 percent, good in 33 percent, and poor in 27 percent. We conclude that reconstruction of nerve gaps of up to 3.0 cm with a bioabsorbable PGA tube gives clinical results at least comparable to the classic nerve graft technique while avoiding donor-site morbidity.

The Natural History of Obstetrical Brachil Plexus Palsy

1994-04-01

Bryan J. Michelow , Howard M. Clarke , Christine Curtis +3 more

Obstetrical brachial plexus palsy remains an unfortunate consequence of difficult childbirth. Sixty-six such patients were reviewed. Included were 28 patients (42 percent) with upper plexus involvement and 38 (58 percent) … Obstetrical brachial plexus palsy remains an unfortunate consequence of difficult childbirth. Sixty-six such patients were reviewed. Included were 28 patients (42 percent) with upper plexus involvement and 38 (58 percent) with total plexopathy. The natural history of spontaneous recovery in all of these patients has been determined using an appropriate grading mechanism. Sixty-one patients (92 percent) recovered spontaneously and five patients (8 percent) required primary brachial plexus exploration and reconstruction (median age 12 months), demonstrating that most patients do well. Additional analysis was undertaken to examine ways in which outcome might be predicted. The analysis does not consider whether or not the patient was operated upon. Good or poor recovery was determined by the spontaneous recovery observed. Discriminant analysis revealed that whereas elbow flexion at 3 months correlated well with spontaneous recovery at 12 months, when used as a single parameter it incorrectly predicted recovery in 12.8 percent of cases. Shoulder abduction was not a significant predictor of recovery. Numerous other early parameters correlated well with spontaneous recovery. When elbow flexion and elbow, wrist, thumb, and finger extension at 3 months were combined into a test score, the proportion of patients whose recovery was incorrectly predicted was reduced to 5.2 percent.

Traumatic injury to peripheral nerves

2000-06-01

Lawrence R. Robinson

This article reviews the epidemiology and classification of traumatic peripheral nerve injuries, the effects of these injuries on nerve and muscle, and how electrodiagnosis is used to help classify the … This article reviews the epidemiology and classification of traumatic peripheral nerve injuries, the effects of these injuries on nerve and muscle, and how electrodiagnosis is used to help classify the injury. Mechanisms of recovery are also reviewed. Motor and sensory nerve conduction studies, needle electromyography, and other electrophysiological methods are particularly useful for localizing peripheral nerve injuries, detecting and quantifying the degree of axon loss, and contributing toward treatment decisions as well as prognostication. © 2000 American Association of Electrodiagnostic Medicine. Published by John Wiley & Sons, Inc. Muscle Nerve 23: 863–873, 2000

The extension of cancer of the head and neck through peripheral nerves

1963-10-01

Alando J. Ballantyne , Alan B. McCarten , Michael L. Ibañez

The Inflammatory Effect of Nucleus Pulposus

1987-10-01

R McCarron , Marc W. Wimpee , Philip G. Hudkins +1 more

Homogenized autogenous nucleus pulposus was injected into the lumbar epidural space of four dogs through an indwelling catheter. After daily injections of the material over 5 to 7 days, the … Homogenized autogenous nucleus pulposus was injected into the lumbar epidural space of four dogs through an indwelling catheter. After daily injections of the material over 5 to 7 days, the dogs were killed at 5,7,14, or 21 days after the first injection. In four dogs that served as controls, normal saline was injected on an identical schedule and the dogs were killed at times identical to the experimental group. Evaluation of the dural sac, the spinal cord and its roots was performed by gross inspection and microscopic analysis. There was evidence of an inflammatory response to the nuclear material injected, but no inflammatory response occurred in the control group.

Results of Reinnervation of the Biceps and Brachialis Muscles with a Double Fascicular Transfer for Elbow Flexion

2005-09-01

Susan E. Mackinnon , Christine B. Novak , Terence M. Myckatyn +1 more

Erb's Palsy

1969-10-01

I. A. Brody , R. H. Wilkins

ERB'S description of paralysis of the upper portion of the brachial plexus is remembered mainly for its postscript. As an after-thought to his discussion, Erb noted that birth trauma is … ERB'S description of paralysis of the upper portion of the brachial plexus is remembered mainly for its postscript. As an after-thought to his discussion, Erb noted that birth trauma is one of the causes of such paralysis, and the term Erb's (or more properly Duchenne-Erb's) palsy now usually refers to this phenomenon. Wilhelm Heinrich Erb (1840 to 1921) was the foremost German neurologist of his time and the first neurologist to wield a reflex hammer.1His original account of the tendon reflexes2advanced the art of neurologic diagnosis and was a great stimulus to physiologic research. Erb also pioneered in applying electrodiagnosis and electrotherapy to neurology, and it was he who first described the "reaction of degeneration" of muscle.3Not the least of Erb's accomplishments was his successful campaign to introduce neurologic instruction into the curriculum at Heidelberg.4He thus gained a place

Sollerman Hand Function Test: A Standardised Method and its Use in Tetraplegic Patients

1995-01-01

Christer Sollerman , Arvid Ejeskär

A standardised hand function test based on seven of the eight most common hand grips is reported. The test consists of 20 activities of daily living. The test procedure and … A standardised hand function test based on seven of the eight most common hand grips is reported. The test consists of 20 activities of daily living. The test procedure and the method of scoring are described as is our evaluation of the validity and reliability of the test. Fifty-nine tetraplegic patients were evaluated using the test before reconstructive surgery to their hands. The test score correlated well with the accepted international functional classification of the patient's arm (r = 0.76, p < 0.001). The mean test score in the arms of patients lacking sensation was significantly lower than in those with tactile gnosis (O:1–3 compared with OCu:1–3, p < 0.001).

Epidemiology of Brachial Plexus Injuries in a Multitrauma Population

1997-06-01

Rajiv Midha

The purpose was to identify the prevalence, causative factors, injury types, and associated injury patterns in multitrauma patients who sustained brachial plexus injuries.A retrospective review of a prospectively collected and … The purpose was to identify the prevalence, causative factors, injury types, and associated injury patterns in multitrauma patients who sustained brachial plexus injuries.A retrospective review of a prospectively collected and computerized database and a chart review were performed.Brachial plexus injuries were identified in 54 of 4538 (1.2%) patients presenting to a regional trauma facility. Young male patients predominated. Motor vehicle accidents were the most frequent cause overall, but only 0.67% of such accidents resulted in plexus injuries. Conversely, 4.2% of motorcycle accident victims and 4.8% of snowmobile accident victims suffered brachial plexus injuries. Injuries were supraclavicular for 62% of patients and infraclavicular for 38%. Supraclavicular injuries were more likely to be severe (Sunderland Grade 3 or 4), compared with infraclavicular injuries, which were neurapraxic in 50% of cases (P < 0.01). The former therefore required surgical exploration and reconstruction more often (52 versus 17%; P < 0.05). Associated injuries included closed head injuries with loss of consciousness in 72% of patients (coma in 19%), cervical spine fractures in 13%, and clavicle, scapular, or humeral fractures and shoulder dislocations or sprains in 15 to 22%. Rib fractures were observed in 41% and were complicated by internal thoracic injuries in a similar percentage of cases. The injury severity score ranged from 5 to 59, with a mean of 24, and two patients died.Brachial plexus injuries afflict slightly more than 1% of multitrauma victims. Motorcycle and snowmobile accidents carry especially high risks, with the incidence of injury approaching 5%. Head injuries, thoracic injuries, and fractures and dislocations affecting the shoulder girdle and cervical spine are particularly common associated injuries. Supraclavicular injuries are more common, are of more severe grade, more often require surgery, and are associated with worse prognosis, compared with infraclavicular injuries.

Traumatic peripheral nerve injuries: epidemiological findings, neuropathic pain and quality of life in 158 patients

2010-06-01

P. Ciaramitaro , Mauro Mondelli , Francesco Logullo +7 more

The objectives of this study were (1) epidemiological analysis of traumatic peripheral nerve injuries; (2) assessment of neuropathic pain and quality of life in patients affected by traumatic neuropathies. All … The objectives of this study were (1) epidemiological analysis of traumatic peripheral nerve injuries; (2) assessment of neuropathic pain and quality of life in patients affected by traumatic neuropathies. All consecutive patients with a diagnosis of traumatic neuropathies from four Italian centres were enrolled. Electromyography confirmed clinical level and site diagnosis of peripheral nerve injury. All patients were evaluated by disability scales, pain screening tools, and quality of life tests. 158 consecutive patients for a total of 211 traumatic neuropathies were analysed. The brachial plexus was a frequent site of traumatic injury (36%) and the radial, ulnar, and peroneal were the most commonly involved nerves with 15% of iatrogenic injuries. Seventy‐two percent of the traumatic neuropathies were painful. Pain was present in 66% and neuropathic pain in 50% of all patients. Patients had worse quality of life scores than did the healthy Italian population. Moreover, there was a strong correlation between the quality of life and the severity of the pain, particularly neuropathic pain (Short Form‐36 [SF‐36] p < 0.005; Beck Depression Inventory [BDI] p < 0.0001). Traumatic neuropathies were more frequent in young males after road accidents, mainly in the upper limbs. Severe neuropathic pain and not only disability contributed to worsening the quality of life in patients with traumatic neuropathies.

Treatment of the Painful Neuroma by Neuroma Resection and Muscle Implantation

1986-03-01

A. Lee Dellon , Susan E. Mackinnon

The successful treatment of the painful neuroma remains an elusive surgical goal. This report evaluates one approach to the management of this problem which entails neuroma excision and placement of … The successful treatment of the painful neuroma remains an elusive surgical goal. This report evaluates one approach to the management of this problem which entails neuroma excision and placement of the proximal end of the nerve away from denervated skin, away from tension, and into a well-vascularized environment: muscle. Seventy-eight neuromas in 60 patients with a mean follow-up of 31 months (range 18 to 43 months) were evaluated. Sixty-seven percent of these patients involved Workmen's Compensation and 57 percent had had at least one previous operation to treat their pain. The results demonstrated good to excellent results in 82 percent of the treated nerves in the entire group. Factors that were predictive of a poorer outcome were (1) digital neuroma (p < 0.0005), (2) Workmen's Compensation (p < 0.01), and (3) three or more previous operations for pain (p < 0.01). Transposition of nerves into small superficial muscles or muscles with significant excursion resulted in treatment failures. The etiology and histopathology of treatment failures are reviewed. Treatment of radial sensory neuromas by transposition of the radial sensory nerve into the brachioradialis muscle when any associated injury to the lateral antebrachial cutaneous nerve was also treated, gave good to excellent relief of pain, and improved hand function in 88 percent of the patients.

A Randomized Prospective Study of Polyglycolic Acid Conduits for Digital Nerve Reconstruction in Humans

2000-10-01

Robert A. Weber , Warren C. Breidenbach , Richard E. Brown +2 more

This article reports the first randomized prospective multicenter evaluation of a bioabsorbable conduit for nerve repair. The study enrolled 98 subjects with 136 nerve transections in the hand and prospectively … This article reports the first randomized prospective multicenter evaluation of a bioabsorbable conduit for nerve repair. The study enrolled 98 subjects with 136 nerve transections in the hand and prospectively randomized the repair to two groups: standard repair, either end-to-end or with a nerve graft, or repair using a polyglycolic acid conduit. Two-point discrimination was measured by a blinded observer at 3, 6, 9, and 12 months after repair. There were 56 nerves repaired in the control group and 46 nerves repaired with a conduit available for follow-up. Three patients had a partial conduit extrusion as a result of loss of the initially crushed skin flap. The overall results showed no significant difference between the two groups as a whole. In the control group, excellent results were obtained in 43 percent of repairs, good results in 43 percent, and poor results in 14 percent. In those nerves repaired with a conduit, excellent results were obtained in 44 percent, good results in 30 percent, and poor results in 26 percent (p = 0.46). When the sensory recovery was examined with regard to length of nerve gap, however, nerves with gaps of 4 mm or less had better sensation when repaired with a conduit; the mean moving two-point discrimination was 3.7 ± 1.4 mm for polyglycolic acid tube repair and 6.1 ± 3.3 mm for end-to-end repairs (p = 0.03). All injured nerves with deficits of 8 mm or greater were reconstructed with either a nerve graft or a conduit. This subgroup also demonstrated a significant difference in favor of the polyglycolic acid tube. The mean moving two-point discrimination for the conduit was 6.8 ± 3.8 mm, with excellent results obtained in 7 of 17 nerves, whereas the mean moving two-point discrimination for the graft repair was 12.9 ± 2.4 mm, with excellent results obtained in none of the eight nerves (p < 0.001 and p = 0.06, respectively). This investigation demonstrates improved sensation when a conduit repair is used for nerve gaps of 4 mm or less, compared with end-to-end repair of digital nerves. Polyglycolic acid conduit repair also produces results superior to those of a nerve graft for larger nerve gaps and eliminates the donor-site morbidity associated with nerve-graft harvesting.

Analysis of Upper and Lower Extremity Peripheral Nerve Injuries in a Population of Patients with Multiple Injuries

1998-07-01

James E. Noble , Catherine A. Munro , Vannemreddy S. S. V. Prasad +1 more

Background The purpose of this study was to determine the prevalence, cause, severity, and patterns of associated injuries of limb peripheral nerve injuries sustained by patients with multiple injuries seen … Background The purpose of this study was to determine the prevalence, cause, severity, and patterns of associated injuries of limb peripheral nerve injuries sustained by patients with multiple injuries seen at a regional Level 1 trauma center. Methods Patients sustaining injuries to the radial, median, ulnar, sciatic, femoral, peroneal, or tibial nerves were identified using a prospectively collected computerized database, maintained by Sunnybrook Health Science Centre, and a detailed chart review was undertaken. Results From a trauma population of 5,777 patients treated between January 1, 1986, and November 30, 1996, 162 patients were identified as having an injury to at least one of the peripheral nerves of interest, yielding a prevalence of 2.8%. These 162 patients sustained a total of 200 peripheral nerve injuries, 121 of which were in the upper extremity. The mean patient age was 34.6 years (SEM +/- 1.1 year), and 83% of patients were male. The mean injury severity score was 23.1 (+/- 0.90), and the mean length of hospital stay was 28 days (+/- 1.8). Conclusions Motor vehicles crashes predominated (46%) as the cause of injury. The most frequently injured nerve was the radial nerve (58 injuries), and in the lower limb, the peroneal nerve was most commonly injured (39 injuries). Diagnosis of a peripheral nerve injury was made within 4 days of admission to Sunnybrook Health Science Centre in 78% of the cases. Surgery was required to treat 54% of patients. Head injuries were the most common associated injury, occurring in 60% of patients. Other common associated injuries included fractures and dislocations. The present report aims to aid in identification and treatment of peripheral nerve injuries.

Median and Ulnar Nerve Injuries: A Meta-Analysis of Predictors of Motor and Sensory Recovery after Modern Microsurgical Nerve Repair

2005-08-01

Aleid Ruijs , Jean-Bart Jaquet , Sandra Kalmijn +2 more

Background: The aim of this study was to quantify variables that influence outcome after median and ulnar nerve transection injuries. The authors present a meta-analysis based on individual patient data … Background: The aim of this study was to quantify variables that influence outcome after median and ulnar nerve transection injuries. The authors present a meta-analysis based on individual patient data on motor and sensory recovery after microsurgical nerve repair. Methods: From 130 studies found after literature review, 23 articles were ultimately included, giving individual data for 623 median or ulnar nerve injuries. The variables age, sex, nerve, site of injury, type of repair, use of grafts, delay between injury and repair, follow-up period, and outcome were extracted. Satisfactory motor recovery was defined as British Medical Research Council motor scale grade 4 and 5, and satisfactory sensory recovery was defined as British Medical Research Council grade 3+ and 4. For motor and sensory recovery, complete data were available for 281 and 380 nerve injuries, respectively. Results: Motor and sensory recovery were significantly associated (Spearman r = 0.62, p < 0.001). Multivariate logistic regression analysis showed that age (<16 years versus >40 years: odds ratio, 4.3; 95 percent confidence interval, 1.6 to 11.2), site (proximal versus distal: odds ratio, 0.46; 95 percent confidence interval, 0.20 to 1.10), and delay (per month: odds ratio, 0.94; 95 percent confidence interval, 0.90 to 0.98) were significant predictors of successful motor recovery. In ulnar nerve injuries, the chance of motor recovery was 71 percent lower than in median nerve injuries (odds ratio, 0.29; 95 percent confidence interval, 0.15 to 0.55). For sensory recovery, age (odds ratio, 27.0; 95 percent confidence interval, 9.4 to 77.6) and delay (per month: odds ratio, 0.92; 95 percent confidence interval, 0.87 to 0.98) were found to be significant predictors. Conclusions: In this individual patient data meta-analysis, age, site, injured nerve, and delay significantly influenced prognosis after microsurgical repair of median and ulnar nerve injuries.

Echotexture of peripheral nerves: correlation between US and histologic findings and criteria to differentiate tendons.

1995-10-01

Enzo Silvestri , Carlo Martinoli , Lorenzo E. Derchi +3 more

PURPOSE: To correlate the histologic structure and echotexture of peripheral nerves and verify if ultrasound (US) findings can be used to differentiate nerve from tendon. MATERIALS AND METHODS: In an … PURPOSE: To correlate the histologic structure and echotexture of peripheral nerves and verify if ultrasound (US) findings can be used to differentiate nerve from tendon. MATERIALS AND METHODS: In an in vitro study, the echotexture of normal peripheral nerves was correlated with the histologic findings. In an in vivo study, US was used to differentiate median nerve from flexor pollicis longus tendon in healthy volunteers (12 male and eight female subjects 7-68 years of age; mean age, 35 years). RESULTS: US examination of the peripheral nerve specimens showed hypoechoic areas separated by hyperechoic bands. The hypoechoic areas corresponded to neuronal fascicles at histologic examination. This fascicular pattern was clear in all median and ulnar nerves, 15 of 20 vagus nerves, and 19 of 20 sciatic nerves in the volunteers but not in recurrent laryngeal nerves. CONCLUSION: Peripheral nerves have a typical US pattern that correlates with histologic structure and facilitates differentiation between nerves and tendons.

Terminal axonal patterns in cat spinal cord II. The dorsal horn

1968-06-01

Madge E. Scheibel , Arnold B. Scheibel

The anatomy and physiology of nerve injury

1990-09-01

S. Sunderland

Abstract Nerves have a structure of considerable complexity with features of special relevance to nerve injury and nerve regeneration. These include variations in the cross‐sectional areas devoted to fascicular and … Abstract Nerves have a structure of considerable complexity with features of special relevance to nerve injury and nerve regeneration. These include variations in the cross‐sectional areas devoted to fascicular and epineurial tissue, the fascicular redistribution and mixing of different branch fibers brought about by fascicular plexuses, and the numbers of nerve fibers representing individual branches. The elasticity and tensile strength of nerve trunks and their capacity to resist traction deformation reside in the fascicular tissue, while the epineurium provides a protective cushion against compression. The microstructure of nerve trunks provides the basis for a classification of nerve injuries into five degrees of severity with partial and mixed types—each with a clearly defined pathology and distinguishing clinical features. Following a transection injury, changes occur in the severed axons, endoneurial tubes, fasciculi, and nerve trunk. The type of injury and the nature of these changes determine the outcome of axon regeneration.

Processed nerve allografts for peripheral nerve reconstruction: A multicenter study of utilization and outcomes in sensory, mixed, and motor nerve reconstructions

2011-11-28

Darrell Brooks , Renata V. Weber , Jerome D. Chao +7 more

Abstract Purpose: As alternatives to autograft become more conventional, clinical outcomes data on their effectiveness in restoring meaningful function is essential. In this study we report on the outcomes from … Abstract Purpose: As alternatives to autograft become more conventional, clinical outcomes data on their effectiveness in restoring meaningful function is essential. In this study we report on the outcomes from a multicenter study on processed nerve allografts (Avance® Nerve Graft, AxoGen, Inc). Patients and Methods: Twelve sites with 25 surgeons contributed data from 132 individual nerve injuries. Data was analyzed to determine the safety and efficacy of the nerve allograft. Sufficient data for efficacy analysis were reported in 76 injuries (49 sensory, 18 mixed, and 9 motor nerves). The mean age was 41 ± 17 (18–86) years. The mean graft length was 22 ± 11 (5–50) mm. Subgroup analysis was performed to determine the relationship to factors known to influence outcomes of nerve repair such as nerve type, gap length, patient age, time to repair, age of injury, and mechanism of injury. Results: Meaningful recovery was reported in 87% of the repairs reporting quantitative data. Subgroup analysis demonstrated consistency, showing no significant differences with regard to recovery outcomes between the groups ( P > 0.05 Fisher's Exact Test). No graft related adverse experiences were reported and a 5% revision rate was observed. Conclusion: Processed nerve allografts performed well and were found to be safe and effective in sensory, mixed and motor nerve defects between 5 and 50 mm. The outcomes for safety and meaningful recovery observed in this study compare favorably to those reported in the literature for nerve autograft and are higher than those reported for nerve conduits. © 2011 Wiley Periodicals, Inc. Microsurgery, 2012.

Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part II: a report of 7 cases

2003-07-01

Somsak Leechavengvongs , Kiat Witoonchart , Chairoj Uerpairojkit +1 more

Brief post-surgical electrical stimulation accelerates axon regeneration and muscle reinnervation without affecting the functional measures in carpal tunnel syndrome patients

2009-10-02

Tessa Gordon , Nasim Amirjani , David C. Edwards +1 more

The weight-bearing shoulder. The impingement syndrome in paraplegics.

1987-06-01

James C. Bayley , Thomas Cochran , C B Sledge

The cases of ninety-four patients who had complete paraplegia were studied to determine whether they had complaints about the shoulder during transfer activities. Thirty-one patients reported pain on transferring, and … The cases of ninety-four patients who had complete paraplegia were studied to determine whether they had complaints about the shoulder during transfer activities. Thirty-one patients reported pain on transferring, and twenty-three of these patients were found to have a chronic impingement syndrome with subacromial bursitis. Arthrography of the shoulder was done for each of these twenty-three patients, and fifteen were found to have a tear of the rotator cuff. Five of the thirty-one patients were found to have aseptic necrosis of the head of the humerus. We also measured the intra-articular pressure in the shoulder in five patients during different activities, including transfer from wheelchair to bed, and found that this pressure exceeded the arterial pressure by two and one-half times. We believe that this high pressure, in conjunction with abnormal distribution of stress transmitted across the subacromial area during transfer or propulsion of a wheelchair, contributes to the high rate of problems about the shoulder in paraplegics.

Evaluation and management of peripheral nerve injury

2008-05-15

William W. Campbell

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Pathophysiology of peripheral nerve injury: a brief review

2004-05-01

Mark G. Burnett , Eric L. Zager

Clinicians caring for patients with brachial plexus and other nerve injuries must possess a clear understanding of the peripheral nervous system's response to trauma. In this article, the authors briefly … Clinicians caring for patients with brachial plexus and other nerve injuries must possess a clear understanding of the peripheral nervous system's response to trauma. In this article, the authors briefly review peripheral nerve injury (PNI) types, discuss the common injury classification schemes, and describe the dynamic processes of degeneration and reinnervation that characterize the PNI response.

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Operative Nerve Repair and Reconstruction

1992-07-01

Richard H. Gelberman

Covers responses to nerve injury and the process of regeneration, and relates advanced repair, decompression, and reconstructive techniques for peripheral nerve disorders. Chapters explore the underlying principles upon which diagnosis, … Covers responses to nerve injury and the process of regeneration, and relates advanced repair, decompression, and reconstructive techniques for peripheral nerve disorders. Chapters explore the underlying principles upon which diagnosis, treatment planning and surgery are based, and complications.

The Interfascicular Nerve-Grafting of the Median and Ulnar Nerves

1972-06-01

H. Millesi , G. Meissl , A. Berger

A technique of nerve-grafting based on experimental studies is described. Complete absence of tension at the suture site is regarded as the most important factor for a successful nerve repair. … A technique of nerve-grafting based on experimental studies is described. Complete absence of tension at the suture site is regarded as the most important factor for a successful nerve repair. Nerve regeneration after grafting without tension is much better than after direct end-to-end suture under moderate tension even though the regenerating axons must cross two suture lines when grafts are used. The technique involves use of a dissecting microscope to perform an intraneural dissection of both nerve stumps to isolate the major fasciculi individually and the minor ones in groups. The scarred ends of the fasciculi are then resected, the mobilized fasciculi in each nerve stump are matched, and grafts, usually from the sural nerve, are inserted loosely with no tension to bridge the gaps between the matched fasciculi or groups of fasciculi—five or six grafts in the median nerve and usually four in the ulnar nerve. Only one very fine suture is used to fix each end of a graft and the coaption between the ends of the graft and the corresponding fasciculi is carefully adjusted using the dissecting microscope. The results using this technique in thirty-three median and thirty-two ulnar nerve lesions of different types are presented in detail.

Nerve injury and repair

1989-07-01

J. Plewes

Rationale for elective modified neck dissection

1990-02-01

H. Tideman

AGE AND OTHER FACTORS IN MOTOR RECOVERY FROM PRECENTRAL LESIONS IN MONKEYS

1936-02-29

Margaret A. Kennard

Two Case Reports

1968-11-01

Richard S. Siegel , IRA WEIDEN

COMBINED MEDIAN AND ULNAR NERVE LESIONS COMPLICATING FRACTURES OF THE DISTAL RADIUS AND ULNA: PDF Only COMBINED MEDIAN AND ULNAR NERVE LESIONS COMPLICATING FRACTURES OF THE DISTAL RADIUS AND ULNA: PDF Only

Morphology and distribution of muscle spindles in dorsal muscles of the cat neck

1975-11-01

F.J.R. Richmond , V. C. Abrahams

Silver-stained sections have been examined from the five dorsal neck muscles splenius, biventer, cervicis, complexus, rectus capitis major, and occipitoscapularis. Every serial section was examined for at least one muscle … Silver-stained sections have been examined from the five dorsal neck muscles splenius, biventer, cervicis, complexus, rectus capitis major, and occipitoscapularis. Every serial section was examined for at least one muscle of each type so that a complete description of the spindle distribution and morphology could be made. With the exception of occipitoscapularis (whose prime function is probably in scapula rotation and not in head movement), neck muscles have a remarkably high spindle density. Occipitoscapularis has a spindle density similar to that of hindleg locomotor muscles (13-19 per gram), but splenius has a density of 46-66 per gram, biventer cervicis 74-96 per gram, complexus 71-107 per gram, and rectus capitis major 48-84 per gram. Such high densities have only previously been seen in small muscles whose total spindle population is not large. Because of the relatively large size of some neck muscles, individual muscles with a spindle content of up to 254 spindles have been found.

Nerves and Nerve Injuries

1979-09-01

Ludwig G. Kempe

Peripheral Nerve Injuries.

1933-09-02

S. A. de Lange , M. de Vlieger

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor … Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal

Natural history of obstetric brachial plexus palsy: a systematic review

2004-02-01

Willem Pondaag , Martijn J. A. Malessy , J. Gert van Dijk +1 more

Giant Cervical Pseudomeningocele Following Traumatic Brachial Plexus Traction Injury: A Case Report

2025-06-25

Jun Chen , Chun Zhou , Lunshan Xu +1 more | Indian Journal of Surgery

Coronectomy Controversy: The East End's Experience of Coronectomy management and outcomes

2025-06-24

N. Chani , Steven G. Reed , E. Bailey +1 more | International Journal of Oral and Maxillofacial Surgery

Extended Sural Nerve Harvest: A Technique to Gain Additional Graft Length

2025-06-24

Elena Millesi , Lauren Gates-Tanzer , Antonia Felzen +3 more | Plastic & Reconstructive Surgery

Introduction: The sural nerve represents a widely used nerve graft for various types of peripheral nerve repair due to its simple harvest and acceptable donor site morbidity. Nevertheless, certain clinical … Introduction: The sural nerve represents a widely used nerve graft for various types of peripheral nerve repair due to its simple harvest and acceptable donor site morbidity. Nevertheless, certain clinical scenarios, such as cable grafting or multiple cross-face nerve grafts, require grafts longer than the typical 35 cm. This study aims to investigate the anatomical feasibility and clinical safety of an extended sural nerve harvest above the popliteal crease via interfascicular dissection. Methods: An anatomical study using five fresh-frozen cadaver legs was conducted, focusing on identifying the anatomic relationship of the sural nerve above the popliteal crease to its surrounding structures and nerve histopathology. Additionally, a retrospective review was performed of all patients that underwent an extended sural nerve harvest and patient outcomes, including nerve graft length and postoperative complications, were reviewed to evaluate the clinical feasibility of the extended harvest technique. Results: Anatomical dissection revealed that interfascicular dissection allowed for an additional 14.3 cm (+/- 6) of nerve length, achieving a total graft length of 49.1 cm (+/- 5). Histological analysis showed no significant differences in fascicle number or axon count along the nerve. The retrospective review included 7 adults and two pediatric patients, demonstrating that an extended sural nerve harvest was safely feasible. The maximum graft length was 55 cm, and no intraoperative complications or functional deficits were reported. Conclusion: The extended sural nerve harvest above the popliteal crease with a step-incision approach was both anatomically feasible and clinically safe, providing additional graft length without increasing donor-site morbidity.

Repairing Nerve Injury- Options and Methods

2025-06-24

Aladdin Mohana , Imad Abu El‐Naaj | International Journal of Oral and Maxillofacial Surgery

Single Patient Treatment Use of Autologous Adipose Derived Mesenchymal Stem Cells for a Sunderland Class IV Lingual Nerve Injury with Neuropathic Pain

2025-06-24

John R. Zuniga | International Journal of Oral and Maxillofacial Surgery

Glabellar and Sphenoid Implants – An Advanced Oncology Tool

2025-06-24

Vandana Gaur | International Journal of Oral and Maxillofacial Surgery

Late-onset brachial plexopathy following an implantable cardioverter defibrillator placement: Expect the unexpected

2025-06-23

Berkay Yalçınkaya , Ahmet Furkan Çolak , Alp Çetin | Neurophysiologie Clinique

Incidence of Autism Spectrum Disorder and Global Developmental Delay in Infants With Brachial Plexus Birth Injury: An Early Association With Birth Asphyxia

2025-06-23

Thomas J. McQuillan , Daniel Gabriel , Patricia E. Miller +2 more | Journal of Pediatric Orthopaedics

Autism spectrum disorder (ASD) and global developmental delay (GDD) are 2 common central nervous system (CNS) diagnoses in children. We hypothesized that the incidence of ASD and GDD is higher … Autism spectrum disorder (ASD) and global developmental delay (GDD) are 2 common central nervous system (CNS) diagnoses in children. We hypothesized that the incidence of ASD and GDD is higher among patients with brachial plexus birth injury (BPBI), and that the subgroup of patients with BPBI and CNS diagnoses would have increased rates of maternal risk factors and birth-related complications. A single institution prospective cohort of 849 patients with BPBI was used. Demographics, perinatal history, maternal factors and treatment, and patient outcomes were recorded. Charts were reviewed for concomitant diagnoses of GDD and ASD. Cohorts were compared regarding demographics and treatment data, and then age and sex-matched to analyze for risk factors. Of 834 unique patients seen for BPBI, 772 met inclusion criteria. Seventeen subjects had a diagnosis of GDD (13) or ASD (4) before the age of 5 years, an incidence of 2.2%, which is not different from the general population incidence of ASD and GDD. After age and sex-matching, a history of birth asphyxia (58% vs. 15%, P<0.05) was most associated with an increased likelihood of ASD or GDD diagnosis. Rates of shoulder dystocia and eventual surgical management did not differ between cohorts. Birth complications, especially birth asphyxia, are associated with GDD/ASD in patients with BPBI. Providers should consider that BPBI and GDD/ASD may coexist in children with a history of a complicated birth. Level IV.

Double Supinator Branch Transfer to Posterior Interosseous Nerve May Confer Superior Hand Opening Restoration Outcomes in Brachial Plexus and Spinal Cord Injury Compared to Single Branch

2025-06-23

Pavlos Texakalidis , Nikhil K. Murthy , Colin K. Franz +1 more | Operative Neurosurgery

Cervical spinal cord injury (SCI) and lower trunk brachial plexus injury (BPI) commonly result in hand paralysis. The supinator to posterior interosseous nerve (SPIN) transfer is a well-established surgical approach … Cervical spinal cord injury (SCI) and lower trunk brachial plexus injury (BPI) commonly result in hand paralysis. The supinator to posterior interosseous nerve (SPIN) transfer is a well-established surgical approach that can achieve restoration of hand opening with similar outcomes in SCI and BPI. Most often, the radial nerve has 2 branches to the supinator. Studies have reported utilization of either single or double supinator branches as donors for the SPIN transfer. The aim of this study was to study whether using one or both supinator branches can affect recovery of hand opening. A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All studies reporting outcomes of the SPIN transfer were included. A total of 16 studies with 108 patients and 152 SPIN transfers were included (132 with double and 20 with single supinator donor branches; 123 for SCI and 29 for BPI). Four of the 16 included studies reported the use of a single motor supinator branch as a donor, while the remaining 12 studies used both branches. The average time interval from injury to surgery was <12 months in each study. Finger extension (Medical Research Council ≥3/5) recovered in 65% (13/20) and 86.3% (114/132) of the single and double donor transfers (P = .016), respectively. Thumb extension restoration was achieved in 60% (12/20) and 83.3% (110/132) of the single and double branch transfers (P = .014), respectively. The median reported follow-up was more than 20 months per study. One patient in the cohort developed supination weakness; however, this patient had preexisting biceps weakness. Four patients developed temporary wrist extension weakness. Utilization of both supinator branches for the SPIN transfer might achieve superior hand opening outcomes in SCI and BPI, compared with the single supinator branch.

Corrigendum: Techniques and graft materials for repairing peripheral nerve defects

2025-06-20

Xiaodi Zou , Yanzhao Dong , Ahmad Alhaskawi +7 more | Frontiers in Neurology

Modified Dorsal Approach for Spinal Accessory Nerve (SAN) to Suprascapular Nerve (SSN) Transfer

2025-06-18

Amol Raheja , S. M. Yadav | Neurology India

Evaluation of lower trapezius function after transfer of axillary nerve to suprascapular nerve in patients with ERB’s palsy

2025-06-16

Ramin Zargarbashi , Keivan Aliyari Gharabeghlo , Seyedarad Mosalamiaghili +3 more | World Journal of Clinical Pediatrics

BACKGROUND It is expected that transfer of spinal accessory nerve to suprascapular nerve, which is widely used in the restoration of the shoulder function in brachial plexus birth injury (BPBI), … BACKGROUND It is expected that transfer of spinal accessory nerve to suprascapular nerve, which is widely used in the restoration of the shoulder function in brachial plexus birth injury (BPBI), impairs the trapezius function. AIM To hypothesize that the lower trapezius muscle remains functional after this neve transfer. METHODS In a retrospective cross-sectional study, patients with BPBI who underwent nerve transfer from accessory nerve to supraclavicular were followed for at least six months following the operation and demographic data were extracted from the database. To assess the lower trapezius function, shoulder abduction and external rotation were examined, and electromyography and nerve conduction velocity (EMG-NCV) was performed. RESULTS A total of 19 patients with a mean age of 2.69 ± 1.40 years and a mean follow-up of 10.5 months were included in the study. Shoulder abduction was disabled completely only in one patient (5.26%); 10 (52.63%) had good, 3 (15.78%) moderate, and 5 (26.31%) had poor shoulder abduction. Regarding external rotation, one (5.26%) was unable to externally rotate the shoulder; among 18 (94.73%) patients who had satisfactory results, 8 (42.10%) were evaluated to be good, 5 (26.31%) moderate, and 5 (26.31%) poor. EMG-NCV showed functional lower trapezius in all patients; its function was evaluated to be good in 11 (57.89%), moderate in 6 (31.57%), and poor in 2 (10.52%) cases. CONCLUSION This study supports the hypothesis that the lower trapezius muscle has a dual motor innervation which provides the possibility of further trapezius tendon transfer to restore a better shoulder function.

Spinal accessory nerve palsy and winged scapula caused by repetetive strain: a case report

2025-06-14

Tuğba Özüdoğru Çelik | Bozok Tıp Dergisi

Scapular winging is a rare disorder that causes functional limitation of the upper extremity. It may develop due to many pathological conditions that can cause paralysis in the serratus anterior, … Scapular winging is a rare disorder that causes functional limitation of the upper extremity. It may develop due to many pathological conditions that can cause paralysis in the serratus anterior, trapezius and rhomboid muscles (which are innervated by the long thoracic nerve, spinal accessory nerve and dorsal scapular nerve, respectively). Diagnosis is made by imaging and electrodiagnostic studies after physical examination. In this case, it is aimed to present the diagnosis and treatment stages of the patient who developed shoulder pain, muscle weakness and scapular winging, due to injury to the spinal sccessory nerve, which is the 11th cranial nerve and provides pure motor innervation to the trapezius muscle. Although scapular winging is not a condition we frequently encounter in clinical practice, it is important due to its potential for disability that may affect the quality of life.

The Superficial Inferior Epigastric Artery Fascia Flap for Nerve Reconstruction in Rabbits

2025-06-13

Sara Saffari , Alexander Y. Shin | Journal of Visualized Experiments

Postoperative complications of neck dissection for head and neck squamous cell carcinoma: a systematic review and meta-analysis

2025-06-12

Cindy Mak , Lei‐Ming Cao , Hui Luo +7 more | Oral Oncology

Pectoralis minor length index at 1 month postoperative can predict homolateral neuropathic pain 4 months after mastectomy with lymph node resection

2025-06-12

Asall Kim , Chung‐Hwi Yi , Myungki Ji +6 more | PLoS ONE

The relationship between postoperative physical changes and the development of homolateral neuropathic pain (HLNP) following mastectomy and lymph node resection remains poorly understood. In this study, we aimed to investigate … The relationship between postoperative physical changes and the development of homolateral neuropathic pain (HLNP) following mastectomy and lymph node resection remains poorly understood. In this study, we aimed to investigate whether early postoperative physical and symptom-based assessments could predict HLNP occurrence at 4 months post-surgery. Fifty-seven breast cancer survivors were included, with HLNP defined as a painDETECT Questionnaire score ≥ 13 at 4 months. Independent variables included patient demographics, physical function metrics including pectoralis minor length index (PMI), and questionnaire-based evaluations at 1 month postoperatively. Multivariate logistic regression identified systemic therapy side effects (ST) (odds ratio [OR]: 1.056; 95% confidence interval [CI]: 1.015–1.098) and PMI (OR: 0.204; 95% CI: 0.043–0.977) as significant predictors of HLNP. Receiver operating characteristic curve analysis identified cutoff values of 23.81 for ST and 9.82 for PMI. Reconstruction type and adjuvant therapy influenced the correlation between PMI and the number of resected lymph nodes, unlike external rotation metrics. Early assessment of ST and PMI facilitates HLNP risk prediction following breast cancer surgery. Multimodal interventions, including targeted physical therapy, may mitigate HLNP risk, highlighting the importance of early postoperative care.

The Impact of Brachial Plexus Birth Injury Type and Functional Level on Activity Participation and Quality of Life: Perspectives of Children and Families

2025-06-12

Merve Ekincidir , Nazan Tuğay , Engin Ramazanoğlu | SN Comprehensive Clinical Medicine

Post–Nerve Injury Pain States

2025-06-10

Jasmin Villatoro-Lopez , Rany T. Abdallah , Jennifer Tram | CRC Press eBooks

Percutaneous Peripheral Nerve Stimulation as an Ancillary Treatment Following Nerve Repair Surgery

2025-06-06

Shyam Maisuria , Antonio Mondríguez‐González , Colin K. Franz +2 more

Background and Aims: Neuropathic pain after peripheral nerve injury (PNI) severely degrades quality of life. Peripheral nerve stimulation (PN-Stim) offers a potential treatment for pain relief after PNI, although its … Background and Aims: Neuropathic pain after peripheral nerve injury (PNI) severely degrades quality of life. Peripheral nerve stimulation (PN-Stim) offers a potential treatment for pain relief after PNI, although its efficacy in managing neuropathic pain post-nerve repair surgery remains unexplored. Methods: This case series chart review analyzed 16 consecutive patients aged 18 and above who received PN-Stim implantation post-nerve repair surgery. Patients under 18 years of age, pregnant, and those with PN-Stim for off-label uses were excluded from our study. The primary outcome was pain score reduction, which was evaluated by Visual Analog Scale (VAS). The secondary outcomes included motor functional recovery and opioid usage which were evaluated by manual muscle testing (MMT) and Morphine Milligram Equivalents (MME) quantification, respectively. Statistical analyses utilized paired two-tailed T-tests and Wilcoxon sign tests, contingent on data normalcy. Results: Pain scores decreased significantly post-PN-Stim implantation (mean pre-placement: 7.35, post-placement: 2.56; p < 0.05). MMT scores showed improvement in 13 patients, with two achieving the maximum MMT score (p < 0.05). Chronic opioid usage was observed to decrease in 6 out of 7 patients who were using them (p < 0.05). No significant adverse effects were seen after implantation. Interpretation: The case series suggests that PN-Stim is a safe and effective treatment for reducing pain in patients with PNI who have undergone post-nerve repair surgery, without interfering with motor recovery. Future prospective research to explore the role of PN-Stim in pain management and its interaction with functional recovery is warranted.

Degenerated nerve grafts provide similar quality and outcome in reconstructing critical nerve defects as compared to fresh nerve grafts

2025-06-03

Philipp Tratnig-Frankl , Martin Schmoll , Udo Maierhofer +7 more | Frontiers in Cell and Developmental Biology

Brachial plexus injuries are commonly caused by stretch-traction injuries. The clinical standard is timely anatomic reconstruction with autologous nerve grafts and/or intra- or extraplexal nerve transfers. Commonly used nerve grafts … Brachial plexus injuries are commonly caused by stretch-traction injuries. The clinical standard is timely anatomic reconstruction with autologous nerve grafts and/or intra- or extraplexal nerve transfers. Commonly used nerve grafts are the sural nerves and/or grafts taken from the affected side. If the lower trunk has been affected, the latter nerves, however, are predegenerated. In this animal experiment we investigated, whether a degenerated nerve graft avails the same quality of regeneration as compared to a non-degenerated graft. In this animal study, a 2 cm lesion of the right common peroneal nerve was created, and the ipsilateral sural nerve was cut or left intact to later serve as a graft. Nerve reconstruction was carried out 3 weeks later using the fresh or degenerated graft. After 6 weeks, either a retrograde labeling of the common peroneal nerve or muscle force testing was performed. A total of 34 male SD rats, Group A (n = 13) and Group B (n = 21) were included. In Group A, the retrograde labeling of the spinal motor neurons showed an average of 66.05 (±17.03) neurons in animals with a fresh graft and 41.19 (±10.47) neurons in animals with a degenerated graft. In two animals with a fresh graft, no motor neurons could be labeled. No statistical inferiority was observed (p = 0.071). In Group B, regeneration is expressed as a recovery ratio. The fresh graft group had a mean maximum evoked contraction of 8.2 (±7.1), compared to 8.5 (±4.9) in the degenerated graft group (p = 0.462). The mean maximum twitch force was 5.2 (±3.5) and 6.4 (±4.4) respectively (p = 0.577). The mean muscle weight, comparing injured to uninjured side, was 0.32 (±0.06) in the fresh graft group and 0.32 (±0.04) in the degenerated graft group (p = 0.964). The use of predegenerated nerve grafts for critical nerve reconstruction showed no statistical inferiority as compared to the fresh grafts in any of the evaluated outcome. Overall, these results are promising, particularly in the context of critical nerve defects involving multiple nerves, where the use of a degenerated grafts often remains the only additional source of graft material.

Analysis of Penetrating Injuries to the Sciatic Nerve, Highlighting Insights From Sudan

2025-06-01

Asmaa Kamal , Momen Mohamed , A. M. Yassin +2 more | Plastic & Reconstructive Surgery Global Open

Sciatic nerves extend a considerable distance through the thigh and are near bone, which increases their risk of injury. This vulnerability can result in long-lasting morbidity and disability. Injuries caused … Sciatic nerves extend a considerable distance through the thigh and are near bone, which increases their risk of injury. This vulnerability can result in long-lasting morbidity and disability. Injuries caused by high-energy weapons can affect neural tissue through multiple pathways, and the effectiveness of subsequent interventions is often unpredictable. This is a descriptive retrospective analysis of a multicenter, cross-sectional hospital-based study focused on the evaluation and reconstruction of sciatic nerve injuries in Sudan from January 2022 to January 2024. The study encompassed all patients who had sciatic nerve injuries due to penetrating mechanisms and subsequently received reconstructive surgery. Patients with severe injuries leading to death and those with traumatic limb amputations have been excluded from the analysis. Among the 34 patients studied, a significant majority, 85.3%, were men, whereas women constituted 14.7%. The highest representation was the 20- to 30-year-old group, which accounts for 50%. The primary cause of the injuries was gunshot wounds. Sciatic nerve injuries were associated with femoral fractures in 26.5%. The predominant surgical approach used was neurolysis (41.2%), with primary repair (35.3%) and nerve graft repair (23.5%). Deep sensation was restored within 6 months following surgery, except in 2.9% who did not recover sensation. The sciatic nerve is frequently injured due to penetrating wounds in the lower limbs, leading to potentially severe disabilities. Although surgical options can be beneficial, particularly for sensory restoration and managing neuropathic pain, it is vital to engage in rehabilitation as muscle recovery progresses.

Prevalence of Neuropathic Pain after Traumatic Superficial Radial Nerve Injury: A Cross-Sectional study

2025-06-01

Romy Bosman , Mirte Langeveld , Caroline A. Hundepool +6 more | Journal of Plastic Reconstructive & Aesthetic Surgery

Developmental organization of the median nerve in fetal period

2025-06-01

Kübra Erdoğan , Mutombo Kalala A | Annals of Anatomy - Anatomischer Anzeiger

Outcome of Arthroscopic Subscapularis Release Combined with Latissmus Dorsi Tendon Transfer in Shoulder Deformity in Obstetrical Brachial Plexus Birth Palsy

2025-06-01

Ahmed Nady , Mohamed S. Khameis , Khaled Omran | The Egyptian Orthopaedic Journal

Delayed Thoracodorsal Nerve Denervation for Animation Deformity Following Latissimus Dorsi Flap Breast Reconstruction: An 11-Year Retrospective Analysis

2025-06-01

Chloe Jordan , Maurice Sosnowski , Rushabh Shah +4 more | JPRAS Open