Median nerve mistaken for palmaris longus tendon: restoration of function with sensory nerve transfers.
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ABSTRACT:
SUBMITTER: Weber RV
PROVIDER: S-EPMC2526034 | biostudies-other | 2007 Mar
REPOSITORIES: biostudies-other
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Project description:Active pronation is important for many activities of daily living. Loss of median nerve function including pronation is a rare sequela of humerus fracture. Tendon transfers to restore pronation are reserved for the obstetrical brachial plexus palsy patient. Transfer of expendable motor nerves is a treatment modality that can be used to restore active pronation. Nerve transfers are advantageous in that they do not require prolonged immobilization postoperatively, avoid operating within the zone of injury, reinnervate muscles in their native location prior to degeneration of the motor end plates, and result in minimal donor deficit. We report a case of lost median nerve function after a humerus fracture. Pronation was restored with transfer of the extensor carpi radialis brevis branch of the radial nerve to the pronator teres branch of the median nerve. Anterior interosseous nerve function was restored with transfer of the supinator branch to the anterior interosseous nerve. Clinically evident motor function was seen at 4 months postoperatively and continued to improve for the following 18 months. The patient has 4+/5 pronator teres, 4+/5 flexor pollicis longus, and 4-/5 index finger flexor digitorum profundus function. The transfer of the extensor carpi radialis brevis branch of the radial nerve to the pronator teres and supinator branch of the radial nerve to the anterior interosseous nerve is a novel, previously unreported method to restore extrinsic median nerve function.
| S-EPMC2654949 | biostudies-other
Project description:BackgroundRadial nerve injuries cause profound disability, and a variety of reconstruction options exist. This study aimed to compare outcomes of tendon transfers versus nerve transfers for the management of isolated radial nerve injuries.MethodsA retrospective chart review of 30 patients with isolated radial nerve injuries treated with tendon transfers and 16 patients managed with nerve transfers was performed. Fifteen of the 16 patients treated with nerve transfer had concomitant pronator teres to extensor carpi radialis brevis tendon transfer for wrist extension. Preoperative and postoperative strength data, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and quality-of-life (QOL) scores were compared before and after surgery and compared between groups.ResultsFor the nerve transfer group, patients were significantly younger, time from injury to surgery was significantly shorter, and follow-up time was significantly longer. Both groups demonstrated significant improvements in grip and pinch strength after surgery. Postoperative grip strength was significantly higher in the nerve transfer group. Postoperative pinch strength did not differ between groups. Similarly, both groups showed an improvement in DASH and QOL scores after surgery with no significant differences between the 2 groups.ConclusionsThe nerve transfer group demonstrated greater grip strength, but both groups had improved pain, function, and satisfaction postoperatively. Patients who present early and can tolerate longer time to functional recovery would be optimal candidates for nerve transfers. Both tendon transfers and nerve transfers are good options for patients with radial nerve palsy.
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Project description:Nowadays, several techniques are available for preserving the lateral aspect of the knee after meniscectomy; meniscus transplantation is the gold standard, and meniscus scaffold implantation is an effective alternative. However, meniscus transplantation is technically difficult and has many potential complications, whereas scaffolds resorb over time. Autografts are commonly used for labroplasty in shoulder and hip surgeries. We attempted to adapt this technique to the knee, using autografts for meniscus replacement. In this report, we describe a meniscus-replacement technique, using a peroneus longus autograft, for lateral meniscus deficits. This technique significantly simplifies the procedure and is cost effective, and thus can be considered as an alternative technique for preventing osteoarthritis of the lateral aspect of the knee.
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Project description:Following peripheral nerve trauma that damages a length of the nerve, recovery of function is generally limited. This is because no material tested for bridging nerve gaps promotes good axon regeneration across the gap under conditions associated with common nerve traumas. While many materials have been tested, sensory nerve grafts remain the clinical "gold standard" technique. This is despite the significant limitations in the conditions under which they restore function. Thus, they induce reliable and good recovery only for patients < 25 years old, when gaps are <2 cm in length, and when repairs are performed <2-3 months post trauma. Repairs performed when these values are larger result in a precipitous decrease in neurological recovery. Further, when patients have more than one parameter larger than these values, there is normally no functional recovery. Clinically, there has been little progress in developing new techniques that increase the level of functional recovery following peripheral nerve injury. This paper examines the efficacies and limitations of sensory nerve grafts and various other techniques used to induce functional neurological recovery, and how these might be improved to induce more extensive functional recovery. It also discusses preliminary data from the clinical application of a novel technique that restores neurological function across long nerve gaps, when repairs are performed at long times post-trauma, and in older patients, even under all three of these conditions. Thus, it appears that function can be restored under conditions where sensory nerve grafts are not effective.
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Project description:Flexor hallucis longus tendon release for surgical treatment of functional hallux limitus-associated conditions is described. This release is obtained by arthroscopic correction of the tendon's blockage, which is located at the retrotalar pulley. The procedure restores the ability for dorsiflexion of the first toe in ankle dorsiflexion (positive stretch test result). Such movement was not possible before, causing a modified gait pattern and affecting the biomechanics of the foot and leg. This explains why the procedure creates favorable changes concerning foot dynamics by restoration not only of the normal tendon glide but also of the normal mobility of the subtalar joint.
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Project description:Hemangiomas of the median nerve are extremely rare; only 12 cases have been reported in the literature. We discuss a patient who presented with paresthesia and pain along the distribution of the left median nerve secondary to a cavernoma of the proximal part of the nerve as suspected on MRI scan. Total removal of the mass was achieved with immediate relief of the symptoms and no neurologic deficit. We conclude that despite being quite rare, the diagnosis of occult vascular lesions of peripheral nerves such as the median nerve, should be considered, especially when other common pathologies are excluded.
| S-EPMC5535331 | biostudies-other
Project description:Nerve transfer surgery involves using a working, functional nerve with an expendable or duplicated function as a donor to supply axons and restore function to an injured recipient nerve. Nerve transfers were originally popularized for the restoration of motor function in patients with peripheral nerve injuries. However, more recently, novel uses of nerve transfers have been described, including nerve transfers for sensory reinnervation, nerve transfers for spinal cord injury and stroke patients, supercharge end-to-side nerve transfers, and targeted muscle reinnervation for the prevention and treatment of postamputation neuroma pain. The uses for nerve transfers and the patient populations that can benefit from nerve transfer surgery continue to expand. Awareness about these novel uses of nerve transfers among the medical community is important in order to facilitate evaluation and treatment of these patients by peripheral nerve specialists. A lack of knowledge of these techniques continues to be a major barrier to more widespread implementation.
| S-EPMC6361052 | biostudies-literature
Project description:BackgroundPatients with upper limb pain often have a slumped sitting position and poor shoulder posture. Pain could be due to poor posture causing mechanical changes (stretch; local pressure) that in turn affect the function of major limb nerves (e.g. median nerve). This study examines (1) whether the individual components of slumped sitting (forward head position, trunk flexion and shoulder protraction) cause median nerve stretch and (2) whether shoulder protraction restricts normal nerve movements.MethodsLongitudinal nerve movement was measured using frame-by-frame cross-correlation analysis from high frequency ultrasound images during individual components of slumped sitting. The effects of protraction on nerve movement through the shoulder region were investigated by examining nerve movement in the arm in response to contralateral neck side flexion.ResultsNeither moving the head forward or trunk flexion caused significant movement of the median nerve. In contrast, 4.3 mm of movement, adding 0.7% strain, occurred in the forearm during shoulder protraction. A delay in movement at the start of protraction and straightening of the nerve trunk provided evidence of unloading with the shoulder flexed and elbow extended and the scapulothoracic joint in neutral. There was a 60% reduction in nerve movement in the arm during contralateral neck side flexion when the shoulder was protracted compared to scapulothoracic neutral.ConclusionSlumped sitting is unlikely to increase nerve strain sufficient to cause changes to nerve function. However, shoulder protraction may place the median nerve at risk of injury, since nerve movement is reduced through the shoulder region when the shoulder is protracted and other joints are moved. Both altered nerve dynamics in response to moving other joints and local changes to blood supply may adversely affect nerve function and increase the risk of developing upper quadrant pain.
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Project description:AbstractGanglion is the most common soft tissue mass in the foot and can be painful and affect comfort wearing shoes. The usual treatment of a ganglion is conservative: careful neglect, manual rupture, or aspiration. When the lesion is recurrent or painful, surgical excision is recommended. The purpose of this Technical Note is to describe the extraganglionic approach of endoscopic ganglionectomy of the extensor digitorum longus tendon. This surgery has the advantage of being minimally invasive and having better cosmetic result, with less surgical trauma to the soft tissue.Level of evidenceLevel 1: foot and ankle; Level 2: other (ganglion).
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Project description:Protein hyperdeimination and deficiency of lyso-phospholipids (LPC 18:1) has been associated with the pathology of demyelinating disease in both humans and mice. We uncovered interesting biology of LPC 18:1, in which LPC 18:1 induced optic nerve function restoration through oligodendrocyte maturation and remyelination in mouse model systems. Our in vitro studies show LPC 18:1 protection against neuron-ectopic hyperdeimination and stimulation of oligodendrocyte maturation, while in vivo investigations recorded optic nerve function improvement following optic nerve injections of LPC 18:1, in contrast with LPC 18:0. Thus, just a change in a single bond renders a dramatic alternation in biological function. The incorporation of isobaric C13-histidine in newly synthesized myelin proteins and quantitative proteome shifts are consistent with remyelination underlying restoration in optic nerve function. These results suggest that exogenous LPC 18:1 may provide a therapeutic avenue for stemming vision loss in demyelinating diseases.
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