Personal clinical and neurophysiological experience in the surgically treated carpal tunnel syndrome]

In 18 cases of carpal tunnel syndrome treated by surgical decompression of the median nerve, a neurophysiological control was performed before and after surgery. In all cases improvement or disappearance of the pain was observed; improvement in motor function was less constant. Control of the median nerve conduction showed that in all cases with preoperative distal latency less than 6 msec. there was a normalization of the nerve conduction after only 3 months. In cases of distal latency over 6 msec, and especially in those with complete motor conduction block, the latency remain within patological limits even 15 months after surgery. This may be explained either by a slower conduction of the regenerated fibres or by a persistent myelinic and axonal damage of the nerve.     

Carpal tunnel syndrome: Neurographical parameters in different stages of median nerve compression

In a series of 47 cases and 55 hands operated upon for carpal tunnel syndrome, the pre-operative electrodiagnostic findings have been compared retrospectively with the morphological findings within the carpal tunnel during operation. As a main result there was no significant correlation between the degree of electrophysiological changes and the degree of median nerve compression. Only the lack of any motor or sensory response seems to indicate a more severe median nerve compression. In about 20% of cases with operatively proven marked median nerve compression, both distal motor latency and motor nerve conduction velocity were well within normal limits and would not have led to the diagnosis of a carpal tunnel syndrome in these cases. The diagnosis, therefore, cannot be made on the basis of electrodiagnostic pathological values only of distal motor latency and motor nerve conduction velocity, but has to take into account as well the sensory nerve conduction velocity as well as the clinical picture and neurological findings.     

Experimental and clinical study of the effect of naftidrofuryl on the recovery from peripheral nerve lesions

After primary repair of lesions of nerves and vessels, patients who were administered a vasoactive drug, naftidrofuryl, postoperatively, had a better functional recovery than untreated patients. Evidence for the favourable effect of the drug on nerve regeneration was first obtained from experiments in the rat. The sciatic nerve was transected and repaired with standard microsurgical techniques. Results were evaluated by electromyography and histology. Data indicated that treated animals had better motor responses and distal latency than untreated rats. Fibre counts showed a greater number of nerve fibres in the distal stump of treated animals. The clinical study was undertaken in cases of carpal tunnel syndrome with muscle atrophy. Assessment was performed by electrophysiology: motor and sensory conduction was studied. Data showed that all treated patients recovered totally or partially from the thenar atrophy they presented before operation, whereas thenar atrophy persisted in 37% of the patients receiving placebo. In conclusion, naftidrofuryl has an experimentally and clinically favourable effect on nerve regeneration and on muscle trophicity, but the mechanism of action of this drug is not known.     

The sensory-motor bridge neurorraphy: an anatomic study of feasibility between sensory branch of the musculocutaneous nerve and deep branch of the radial nerve

Introduction: Restoring elbow flexion remains the first step in the management of total palsy of the brachial plexus. Non avulsed upper roots may be grafted on the musculocutaneous nerve. When this nerve is entirely grafted, some motor fibres regenerate within the sensory fibres quota. Aiming potential utilization of these lost motor fibres, we attempted suturing the sensory branch of the musculocutaneous nerve onto the deep branch of the radial nerve. The objective of our study was to assess the anatomic feasibility of such direct suturing of the terminal sensory branch of the musculocutaneous nerve onto the deep branch of the radial nerve. Methods: The study was carried out with 10 upper limbs from fresh cadavers. The sensory branch of the musculocutaneous muscle was dissected right to its division. The motor branch of the radial nerve was identified and dissected as proximally as possible into the radial nerve. Then, the distance separating the two nerves was measured so as to assess whether direct neurorraphy of the two branches was feasible. Results: The excessive distance between the two branches averaged 6 mm (1–13 mm). Thus, direct neurorraphy of the sensory branch of the musculocutaneous nerve and the deep branch of the radial nerve was possible. Conclusions: When the whole musculocutaneous nerve is grafted, some of its motor fibres are lost amongst the sensory fibres (cutaneous lateral antebrachial nerve). By suturing this sensory branch onto the deep branch of the radial nerve, “lost” fibres may be retrieved, resulting in restoration of digital extension. © 2011 Wiley‐Liss, Inc. Microsurgery, 2011.     

SENSORY RECOVERY AFTER HAND REIMPLANTATION: A CLINICAL,MORPHOLOGICAL, AND NEUROPHYSIOLOGICAL STUDY IN HUMANS

Despite fairly good return of motor function, patients who have amputated hands reimplanted demonstrate poor sensory recovery and severe cold intolerance, two variables that are difficult to quantify reliably. In this study we wanted to find out if there is a correlation between morphological findings of sensory and sympathetic reinnervation and clinical and neurophysiological variables. Skin was biopsied from the reimplanted and corresponding area in the normal hands of eight patients who had sustained a hand amputation and subsequent reimplantation. The sections were immunostained using markers for both sensory and sympathetic nerve fibres. Comparison between the reimplanted and normal sides in each individual showed a mean loss of sensory immunoreactive nerve fibres of 30%, and for sympathetic immunoreactivity the loss was 60%. There was measurable two-point discrimination in the injured hand only in patients below the age of 40 years, corresponding to the better recovery of mechanical thresholds evaluated neurophysiologically for this age group. These results confirm the extensive loss of sensory nerve fibres after nerve injury, probably correlated to loss of sensory neurons. We have also shown that it is possible to correlate the results of clinical and neurophysiological evaluation with morphological results of skin reinnervation specific to the repaired nerve, and so improve the possibility for the quantification of sensory recovery.     

Sensory recovery after hand reimplantation: a clinical, morphological, and neurophysiological study in humans.

Despite fairly good return of motor function, patients who have amputated hands reimplanted demonstrate poor sensory recovery and severe cold intolerance, two variables that are difficult to quantify reliably. In this study we wanted to find out if there is a correlation between morphological findings of sensory and sympathetic reinnervation and clinical and neurophysiological variables. Skin was biopsied from the reimplanted and corresponding area in the normal hands of eight patients who had sustained a hand amputation and subsequent reimplantation. The sections were immunostained using markers for both sensory and sympathetic nerve fibres. Comparison between the reimplanted and normal sides in each individual showed a mean loss of sensory immunoreactive nerve fibres of 30%, and for sympathetic immunoreactivity the loss was 60%. There was measurable two-point discrimination in the injured hand only in patients below the age of 40 years, corresponding to the better recovery of mechanical thresholds evaluated neurophysiologically for this age group. These results confirm the extensive loss of sensory nerve fibres after nerve injury, probably correlated to loss of sensory neurons. We have also shown that it is possible to correlate the results of clinical and neurophysiological evaluation with morphological results of skin reinnervation specific to the repaired nerve, and so improve the possibility for the quantification of sensory recovery.     

Value of electrodiagnostic tests in carpal tunnel syndrome

Eighty-five patients who were treated surgically for carpal tunnel syndrome were reviewed by a prospective study to assess the relationship between electrodiagnostic tests and clinical outcome. Before surgery all patients completed a self-administered questionnaire, and an electrophysiological examination was done to assess distal motor latency, sensory and motor amplitudes, and sensory nerve conduction velocity. After 6 months follow-up all these tests were repeated. There was significant correlation between improvement in sensory nerve conduction velocity and clinical improvement at follow-up.     

肘管综合征的成因和神经学检查

肘管综合征是常见的周围神经嵌压症之一。我院1990年12月—1995年12月共收治该症22例,均经严格的神经学检查和病因学分析后确诊,治疗全部行尺神经前移术。术后随访20例,平均随访2年5月,12例恢复正常,6例明显好转,2例较差。作者认为,当手部感觉改变和运动障碍为单纯尺神经损伤引起,肌电图提示尺神经传导速度在肘管部减慢,肘管内或外可找到神经受损原因,肘管综合征即可确诊;当肌电提示尺神经传导在肘管部减慢,而肘管内或外找不到神经受损原因,应高度疑诊肘管综合征。     

Enhancement of motor nerve regeneration by nerve growth factor.

The sciatic nerves of adult Wistar rats were severed bilaterally. Each nerve was sutured into a silicone tube used as a conduit, leaving a 5 mm gap in length between the nerve ends. Nerve growth factor in a saline solution vehicle was injected into the silicone chamber on the right side and normal saline solution (control) on the left. Six weeks after surgery, electrophysiological studies were performed. The motor nerve conduction velocities (MNCV) were significantly increased in the NGF-treated nerves. In one rat, the MNCV on the NGF-treated side was 66.6 m/s, in the range of normal nerves. There was no significant difference between the two sides in the amplitudes of evoked muscle action potentials. There are apparently no reports on the effect of NGF on motor neuron regeneration in vitro. In this study, NGF was found to enhance motor nerve regeneration.     

Rehabilitation of conversion paralysis

Three patients referred for rehabilitation of brachial plexus lesions and two referred with leg weakness associated with sciatica were found to have conversion paralysis. The diagnosis was made by demonstrating normal motor nerve conduction to the clinically weak muscles. The weakness was treated by intensive physical rehabilitation with complete and sustained recovery in all cases.     

Mononeuropathy of the deep motor palmar branch of the ulnar nerve: report of two unusual cases

Abstract Two female patients with lesions of the deep motor branch of the ulnar nerve are presented. In the first, a 40-year-old woman, the lesion was provoked by the stereotyped professional activity (screwing lids). In the second, aged 50 years, the nerve was damaged by a strike from a tennis ball. In both patients, we observed atrophy of the dorsal interosseous muscle. Hypothenar muscles and sensitivity were spared. Motor and sensory conduction velocities of the ulnar nerve were normal. Both patients recovered well in a few months.     

Ultrasound-guided peripheral regional blockade in patients with Charcot-Marie-Tooth disease: a review of three cases

PURPOSE: To describe the clinical presentation of three patients with Charcot-Marie-Tooth disease, who underwent uneventful upper limb surgery following successful peripheral nerve blockade, and to review the anesthetic implications in patients with Charcot-Marie-Tooth disease.Clinical features: In three patients with Charcot-Marie-Tooth disease presenting for surgery of the upper limb, the motor response, following nerve stimulation, was suboptimal. However, ultrasound guidance was effective in visualizing the needle-nerve interaction, and local anesthetic was injected around the nerves. Good block ensued and surgery proceeded in all patients without complications. No exacerbation of the neurological condition was observed in any patient.Conclusions: Charcot-Marie-Tooth disease is a demyelinating, hereditary, motor and sensory neuropathy characterized by abnormalities of nerve conduction. Regional anesthesia of the upper limb is feasible in these patients, and these cases show that ultrasound guidance makes peripheral nerve block possible in patients for whom traditional methods of nerve localization fail.     

腰椎间盘突出症神经根损害的肌电图检查分析

目的 探讨神经电生理检查对腰椎间盘突出症患者神经根功能损害的诊断价值。方法 2003年1月至2007年12月临床确诊为腰椎间盘突出症48例,男33例,女15例;年龄23-65岁,平均47.6岁;病史1周-1年;发病部位：L_4-5 29例,L_5-S_1 8例,L_4-5并L_5-S_1 11例。对所有患者进行周围神经传导、F波、H反射及肌电图（electromyography,EMG）,观察电生理检查对神经根受损程度和定位的准确性。结果 48例患者的周围神经感觉传导均正常;周围神经运动传导检查除5例表现为复合肌肉动作电位（compound muscle action potential,CMAP）波幅降低外,其余基本正常。F波异常3例,H反射异常12例。病程超过2周的40例患者的相应神经根前支支配肌肉的EMG出现异常表现,其中15例腰部椎旁肌EMG异常。结论 神经电生理检查可了解腰椎间盘突出症患者的神经根定位和神经功能状态,是辅助诊断腰椎间盘突出症的重要方法和判断神经损害程度的客观指标。     

Outcomes of cubital tunnel surgery among patients with absent sensory nerve conduction

OBJECTIVE: To report the outcomes of cubital tunnel surgery for patients with absent ulnar sensory nerve conduction. METHODS: The charts of 34 patients who exhibited clinical symptoms of ulnar nerve entrapment at the elbow and who had electromyography-confirmed prolonged motor nerve conduction across the cubital tunnel in association with absent sensory nerve conduction were reviewed. The mean age was 63 years, and the mean symptom duration was 17 months. Four patients had bilateral symptoms. Surgery was performed for 38 limbs, i.e., neurolysis for 21 limbs and subcutaneous transposition for 17 limbs. Fifteen limbs demonstrated associated ulnar nerve-related motor weakness. The mean postoperative follow-up period was 4 years (range, 3 mo to 11 yr). RESULTS: Sensory symptoms (i.e., pain, paresthesia, and two-point discrimination) improved in 20 limbs (53%), and muscle strength improved in 2 limbs (13%). Improvements in sensory symptoms were not related to patient age, symptom duration, cause, severity of prolonged motor nerve conduction, select psychological factors, associated medical diseases, associated cervical pathological conditions, or type of surgery. Improvements in sensory symptoms were significantly decreased among patients who had experienced cervical disease for more than 1 year and patients with bilateral symptoms. CONCLUSION: Patients with cubital tunnel syndrome who have absent sensory nerve conduction seem to experience less improvement of sensory symptoms after surgery, compared with all patients with cubital tunnel syndrome described in the literature. Bilateral symptoms and delayed surgery secondary to associated cervical spine disease seem to be significant negative factors for postoperative improvement of sensory symptoms. Sensory symptoms improved similarly among patients who underwent neurolysis or subcutaneous transposition     

Effect of erythropoietin therapy on polyneuropathy in predialytic patients

BACKGROUND: Peripheral neuropathy commonly develops in patients with advanced chronic renal failure. The uremic neuropathy is often subclinical and detectable only by electrophysiological studies. Receptors to erythropoietin (EPO) have been described on non-hematopoietic cells including neuronal cells. METHODS: In order to evaluate the effect of five months' EPO therapy on polyneuropathy in predialytic patients, nerve conduction studies (NCS) were done in 46 anemic predialytic patients without neurological complaints. In 22 (twelve non-diabetic and ten diabetic) neuropathy was detected and these patients were included in the study. After five months of subcutaneous EPO therapy NCSs were repeated. RESULTS: Hemoglobin increased significantly (p=0.0001) with no significant increase in plasma creatinine. Motor nerve conduction velocity (MNCV) and compound muscle action potentials (CMAP) of the ulnar nerve were normal before EPO therapy and at the end of the study. MNCV of the median, peroneal and tibial nerves improved significantly (p<0.05). CMAP of the median nerve rose significantly, to the normal range (p=0.01). Sensory nerve conduction velocity (SNCV ) and sensory nerve action potentials (SNAP) were reduced in all sensory nerves and did not improve. The improvement in non-diabetic patients was better than in diabetic patients. No significant correlation was found between the increase in hemoglobin and the improvement in MNCV. CONCLUSIONS: Subcutaneous EPO therapy improved motor polyneuropathy in uremic patients, especially non-diabetic individuals. The improvement in MNCV may reflect remyelination. This non-hematopoietic effect may be related to some direct action through EPO receptors on peripheral neuronal cells.     

Motor evoked potentials enable differentiation between motor and sensory branches of peripheral nerves in animal experiments

Differentiation between motor and sensory fascicles is frequently necessary in reconstructive peripheral nerve surgery. The goal of this experimental study was to verify if centrally motor evoked potentials (MEP) could be implemented to differentiate sensory from motor fascicles, despite the well-known intermingling between nerve fascicles along their course to their distant periphery. This new procedure would enable surgeons to use MEP for placing nerve grafts at corresponding fascicles in the proximal and distal stumps without the need to use time-consuming staining. In ten sheep, both ulnar nerves were exposed at the terminal bifurcation between the last sensory and motor branch. Animals were then relaxed to avoid volume conduction. On central stimulation, the evoked nerve compound action potentials were simultaneously recorded from both terminal branches. In all cases, neurogenic motor nerve action potentials were recorded only from the terminal motor branch. The conclusion was that MEPs can be used for intraoperative differentiation between sensory and motor nerves. Further studies are necessary to develop this method for in situ measurements on intact nerve trunks.     

慢性肾脏病血清镁离子、钙离子水平与周围神经功能的相关性研究

目的 研究慢性肾脏病(chronic kidney disease,CKD)患者血清Ca2+和Mg2+水平及其与周围神经功能的相关性.方法 选取2011年10月至2019年10月中国人民解放军联勤保障部队第961医院收治的CKD患者300例为样本进行横断面研究,根据肾小球滤过率分为1～5期,比较各期血清Ca2+和Mg2...     

Vesicourethral function in diabetic patients: association of abnormal nerve conduction velocity with vesicourethral dysfunction.

This study was undertaken to examine diabetic vesicourethral dysfunction in association with nerve conduction velocity. Uroflowmetry, water cystometry, International Prostate Symptom Score (IPSS), and nerve conduction velocity were analyzed in 29 diabetic patients (21 men and eight women; a mean age, 58.0 years). Nerve conduction velocity was measured for sensory nerve conduction velocity (SCV) of the sural nerve and motor nerve conduction velocity (MCV) of the peroneal nerve. Normal voiding was defined as continuous flow at the normal flow rate and residual urine <50 mL. Results of uroflowmetry and cystometry were compared with those of nerve conduction velocity. Eleven of 29 patients (38%) had voiding dysfunction. A vesical denervation supersensitivity test was negative in all patients. The mean IPSS was not significant different between patients with or without voiding dysfunction. Incidence of bladder volume at first desire to void >300 mL and maximum bladder capacity >500 mL were significantly higher in patients with abnormal SCV than those with normal SCV (P < 0.03 and 0.001, respectively). Eleven of 16 patients with abnormal MCV showed voiding dysfunction, whereas all patients with normal MCV showed normal voiding (P < 0.001). These results suggest that lower urinary tract symptoms alone cannot predict diabetic vesicourethral dysfunction and that diabetic vesicourethral dysfunction is highly correlated with abnormal nerve conduction velocity. Neurourol. Urodynam. 18:639-645, 1999.     

Increased risk of median nerve dysfunction in floor cleaners: a controlled clinical and neurophysiological study.

We studied median nerve involvement in a group of asymptomatic handworkers at risk for carpal tunnel syndrome, and we evaluated damage to thin and thick nerve fibres in the distribution area of the median nerve. Considering floor cleaners as workers at high risk of developing cumulative traumatic disorders in the wrist, we included 42 cleaners and 41 controls. We assessed nerve conduction studies, vibration threshold, and temperature and pain thresholds of the median nerve. The cleaners had significantly impaired motor nerve conduction velocity (p = 0.006), longer sensory distal latency (p = 0.01), lower sensory amplitude (p = 0.0005), and increased difference in heat and cold threshold of the median nerve (p = 0.0002). Increased temperature threshold was associated with prolonged sensory distal latency of the median nerve in the cleaners. In conclusion, impaired neurophysiological variables in the median nerve in floor cleaners compared with controls confirm the hypothesis that those workers are at risk of developing median nerve dysfunction. Sensory nerves seem to be more susceptible to injury than motor branches.     

Effects of magnitude and duration of compression on spinal nerve root conduction.

Spinal nerve root compression occurs commonly in conditions such as herniated nucleus pulposus, spinal stenosis, and trauma. However, the pathophysiology of the symptoms and signs related to spinal nerve root compression is poorly understood. The purpose of the present study was to assess and compare effects of various pressures and durations of acute compression on spinal nerve root conduction in the pig cauda equina. Efferent conduction (compound motor action potentials) and afferent conduction (compound nerve action potentials) were monitored during compression for 2 or 4 hours with compression pressures of 0 (sham), 50, 100, or 200 mm Hg. Recovery from compression was monitored for 1.5 hours. No significant deficits in spinal nerve root conduction were observed with 0 or 50 mm Hg compression, compared to significant conduction deficits induced by 100 and 200 mm Hg compression. Three-way analysis of variance demonstrated significant effects of compression pressure and duration on conduction at the end of compression and recovery, with a significant difference between efferent and afferent conduction at the end of the recovery period. These observations suggest an interaction between biomechanical and microvascular mechanisms in the production of nerve root conduction deficits. Such information may relate to the motor and sensory dysfunction in clinical conditions associated with spinal nerve root compression.