Transfer of Sensory Nerves in Hand Surgery

1984 ◽  
Vol 9 (1) ◽  
pp. 46-49 ◽  
Author(s):  
P. BEDESCHI ◽  
L. CELLI ◽  
A. BALLI
Keyword(s):  
Median Nerve ◽  
Ulnar Nerve ◽  
Radial Nerve ◽  
Surgical Techniques ◽  
Hand Surgery ◽  
Sensory Nerves ◽  
Dorsal Rami

The transfer of sensitive dorsal rami of the ulnar nerve (two cases) and of two sensitive dorsal rami of the radial nerve (five cases) was accomplished in order to restore the sensitivity of the first three finger tips in patients suffering from serious and longstanding inveterate lesions of the median nerve. The Authors describe the two surgical techniques in detail and, according to the satisfactory results obtained, specify the indications and advantages of this operation.

scholarly journals Topographical, anatomical and neurosurgical aspects of "end-to-side" nerve repair

2021 ◽  
Vol 23 (1) ◽  
pp. 121-128
Author(s):  
A. Y. Nisht ◽  
Nikolay F. Fomin ◽  
Vladimir P. Orlov
Keyword(s):  
Median Nerve ◽  
Ulnar Nerve ◽  
Lateral Surface ◽  
Peripheral Nerves ◽  
Radial Nerve ◽  
Surgical Techniques ◽  
Nerve Fibers ◽  
Individual Variability ◽  
Motor Branch ◽  
Deep Branch

The article presents the results of a comprehensive anatomical and experimental study of individual variability in the structure and topography of motor branches of peripheral nerves in relation to the justification of methods for selective reinnervation of tissues by the "end-to-side" neurorrhaphy. It was found that relatively longer branches of peripheral nerves with a small number of connecting inter-arm collaterals characteristic of narrow and long limbs create conditions for less traumatic mobilization of motor branches. In cases with relatively wide and short extremities mobilization of peripheral nerves is complicated by the presence of a large number of collateral branches and intra-trunk connections, which are often damaged when separate bundles that make up the mobilized branches of the donor or recipient nerve are isolated from the main nerve trunk. It has been shown that potential recipient nerves should be motor branches of peripheral nerves, the preservation of which is of fundamental importance for the function of the corresponding segment of the limb. To create conditions conducive to selective reinnervation of functionally significant muscle groups of the upper limb, we have developed, justified from anatomical positions, and tested in an experiment on anatomical material methods for connecting the distal motor branches of peripheral nerves by the "end-to-side" neurorrhaphy. The main idea of accelerated recovery of the thumb opposition in injuries of the median nerve is to reinnervate the muscles of the elevation of the I finger due to nerve fibers that are part of the deep branch of the ulnar nerve. For this purpose, surgical techniques have been developed for connecting the recurrent motor branch of the damaged median nerve mobilized at the level of the wrist with the edges of a surgically formed perineurium defect on the lateral surface of the bundles that make up the deep branch of the ulnar nerve. In another clinical situation, in patients with radial nerve injuries, for the muscle reinnervation, а method is proposed for neurotisation of the deep motor branch of the radial nerve by the end-to-side suture to the lateral surface of the median nerve. We assume that performing the "end-to-side" nerve suture at the level of the base of the hand in the cases of proximal damage to the median nerve will reduce the time of reinnervation of the muscles of the thumb elevation by 400450 days. Transposition of the deep branch of the damaged at the proximal level radial nerve with "end-to-side" neurorrhaphy to the median nerve by 250300 days (based on the total length of the shoulder and forearm, which is about 50 cm and the rate of regeneration of nerve fibers 1 mm per day). Accordingly, with higher injuries (brachial plexus), the gain in the time of reinnervation of the distal segments will be even greater. In our opinion, the results can be used as a basis for further clinical research on the development of methods for selective tissue reinnervation in cases with isolated injuries of the peripheral nerves.

Peripheral Nervous SystemUpper Extremity

2013 ◽  
Author(s):  
Adam Fisch
Keyword(s):  
Nervous System ◽  
Brachial Plexus ◽  
Median Nerve ◽  
Peripheral Nervous System ◽  
Ulnar Nerve ◽  
Radial Nerve ◽  
Upper Extremities ◽  
Cervical Plexus

Chapter 3 discusses how to draw the peripheral nervous system (upper extremities), including the brachial plexus, median nerve, ulnar nerve, radial nerve, and the cervical plexus.

Emergence of Radial Nerve Dominance in Median Nerve Cortex After Median Nerve Transection in an Adult Squirrel Monkey

1997 ◽  
Vol 77 (1) ◽  
pp. 522-526 ◽  
Author(s):  
C. E. Schroeder ◽  
S. Seto ◽  
P. E. Garraghty
Keyword(s):  
Median Nerve ◽  
Squirrel Monkey ◽  
Ulnar Nerve ◽  
Action Potentials ◽  
Radial Nerve ◽  
Current Source ◽  
Short Latency ◽  
Nerve Transection ◽  
A Site ◽  
Stimulation Of

Schroeder, C. E., S. Seto, and P. E. Garraghty. Emergence of radial nerve dominance in median nerve cortex after median nerve transection in an adult squirrel monkey. J. Neurophysiol. 77: 522–526, 1997. Throughout the glabrous representation in Area 3b, electrical stimulation of the dominant (median or ulnar) input produces robust, short-latency excitation, evident as a net extracellular “sink” in the Lamina 4 current source density (CSD) accompanied by action potentials. Stimulation of the collocated nondominant (radial nerve) input produces a subtle short-latency response in the Lamina 4 CSD unaccompanied by action potentials and followed by a clear excitatory response 12–15 ms later. Laminar response profiles for both inputs have a “feedforward” pattern, with initial activation in Lamina 4, followed by extragranular laminae. Such corepresentation of nondominant radial nerve inputs with the dominant (median or ulnar nerve) inputs in the glabrous hand surface representation provides a likely mechanism for reorganization after median nerve section in adult primates. To investigate this, we conducted repeated recordings using an implanted linear multi-electrode array straddling the cortical laminae at a site in “median nerve cortex” (i.e., at a site with a cutaneous receptive field on the volar surface of D2 and thus with its dominant afferent input conveyed by the median nerve) in an adult squirrel monkey. We characterized the baseline responses to median, radial, and ulnar nerve stimulation. We then cut the median nerve and semi-chronically monitored radial nerve, ulnar nerve and median nerve (proximal stump) evoked responses. The radial nerve response in median nerve cortex changed progressively during the weeks after median nerve transection, ultimately assuming the characteristics of the dominant nerve profile. During this time, median, and ulnar nerve profiles displayed little or no change.

Transfer of Sensory Branches of Radial Nerve in Hand Surgery

1993 ◽  
Vol 18 (3) ◽  
pp. 409-409
Author(s):  
R. Matloubi
Keyword(s):  
Radial Nerve ◽  
Surgical Techniques ◽  
Hand Surgery ◽  
War Injuries ◽  
Irreparable Damage

Transfer of sensory branches of the radial nerve to sensory branches of the ulnar or median nerves has been carried out to restore sensitivity to the digits in patients suffering from severe, longstanding and irreparable damage to the median or ulnar nerves, due to war injuries. The author describes the two surgical techniques in detail and reports the results obtained.

Restoration of Elbow Flexion in Traumatic Upper Brachial Plexus Palsy in Adults: Outcome with Intraplexus Distal Nerve Transfers in 78 Patients

2018 ◽  
Vol 37 (04) ◽  
pp. 285-290
Author(s):  
Mario Siqueira ◽  
Roberto Martins ◽  
Wilson Faglioni Junior ◽  
Luciano Foroni ◽  
Carlos Heise
Keyword(s):  
Brachial Plexus ◽  
Median Nerve ◽  
Ulnar Nerve ◽  
Traumatic Injury ◽  
Surgical Techniques ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Nerve Transfers ◽  
Significant Difference ◽  
Distal Nerve

Objective To present the functional outcomes of distal nerve transfer techniques for restoration of elbow flexion after upper brachial plexus injury. Method The files of 78 adult patients with C5, C6, ± C7 lesions were reviewed. The attempt to restore elbow flexion was made by intraplexus distal nerve transfers using a fascicle of the ulnar nerve (group A, n = 43), or a fascicle of the median nerve (group B, n = 16) or a combination of both (group C, n = 19). The result of the treatment was defined based on the British Medical Research Council grading system: muscle strength < M3 was considered a poor result. Results The global incidence of good/excellent results with these nerve transfers was 80.7%, and for different surgical techniques (groups A, B, C), it was 86%, 56.2% and 100% respectively. Patients submitted to ulnar nerve transfer or double transfer (ulnar + median fascicles transfer) had a better outcome than those submitted to median nerve transfer alone (p < 0.05). There was no significant difference between the outcome of ulnar transfer and double transfer. Conclusion In cases of traumatic injury of the upper brachial plexus, good and excelent results in the restoration of elbow flexion can be obtained using distal nerve transfers.

Susceptibility of the Superficial Sensory Branch of the Radial Nerve to Form Painful Neuromas

1984 ◽  
Vol 9 (1) ◽  
pp. 42-45 ◽  
Author(s):  
A. LEE DELLON ◽  
SUSAN E. MACKINNON
Keyword(s):  
Median Nerve ◽  
Ulnar Nerve ◽  
Radial Nerve ◽  
Palmar Cutaneous Branch ◽  
Cutaneous Branch ◽  
Distal Fixation ◽  
Extensor Carpi Radialis

The superficial sensory branch of the radial nerve appears prone to develop painful neuromas out of proportion to its likelihood for injury. Based on cadaver dissections and intraoperative observations, an anatomical mechanism for this “predisposition” is suggested. Exit of this nerve beneath dense fascia and the tendons of brachioradialis and extensor carpi radialis longus provide a proximal tethering against which tension develops as the distal fixation point (neuroma) is pulled through the long excursion of wrist are of motion. This long excursion and proximal tethering are not present anatomically for the dorsal cutaneous branch of the ulnar nerve nor the palmar cutaneous branch of the median nerve.

scholarly journals Ipsilateral radial nerve, median nerve, and ulnar nerve injury caused by crush syndrome due to alcohol intoxication

Medicine ◽  
2019 ◽  
Vol 98 (38) ◽  
pp. e17227
Author(s):  
Yuan-Wei Zhang ◽  
Cheng Ju ◽  
Xue-Lei Ke ◽  
Xin Xiao ◽  
Yan Xiao ◽  
...  
Keyword(s):  
Median Nerve ◽  
Nerve Injury ◽  
Ulnar Nerve ◽  
Radial Nerve ◽  
Alcohol Intoxication ◽  
Crush Syndrome ◽  
Ulnar Nerve Injury

Transfer of Sensory Branches of Radial Nerve in Hand Surgery

1988 ◽  
Vol 13 (1) ◽  
pp. 92-95
Author(s):  
R. MATLOUBI
Keyword(s):  
Radial Nerve ◽  
Surgical Techniques ◽  
Hand Surgery ◽  
War Injuries ◽  
Irreparable Damage

Transfer of sensory branches of the radial nerve to sensory branches of the ulnar or median nerves has been carried out to restore sensitivity to the digits in patients suffering from severe, longstanding and irreparable damage to the median or ulnar nerves, due to war injuries. The author describes the two surgical techniques in detail and reports the results obtained.

Nerve Transfer to the Median Nerve Using Parts of the Ulnar and Radial Nerves in the Rabbit – Effects on Motor Recovery of the Median Nerve and Donor Nerve Morbidity

2000 ◽  
Vol 25 (4) ◽  
pp. 329-335 ◽  
Author(s):  
B. S. LUTZ ◽  
D. C. C. CHUANG ◽  
S. S. CHUANG ◽  
J. C. HSU ◽  
S. F. MA ◽  
...  
Keyword(s):  
Muscle Contraction ◽  
Median Nerve ◽  
Ulnar Nerve ◽  
Radial Nerve ◽  
Muscle Power ◽  
Donor Site ◽  
Nerve Transfer ◽  
Donor Site Morbidity ◽  
Motor Recovery ◽  
Contraction Force

In this study, motor re-innervation of the median nerve by transfer of one-third, one-half, and two-thirds of either the agonistic ulnar nerve or the antagonistic radial nerve was investigated in both extremities of 20 rabbits. Recipient median nerve: Muscle contraction force of the flexor digitorum sublimus muscle after a one-third and a one-half of the ulnar nerve transfer achieved an average of 75 and 97% muscle power respectively as compared to conventional end-to-end neurorrhaphy. Muscle contraction force after one-third or one-half of the radial nerve transfer was significantly lower (36%). Donor nerves: Extensor carpi radialis muscle or flexor carpi ulnaris muscle contraction force 6 months postoperatively demonstrated a significant decrease after a one-half ulnar nerve and a two-thirds ulnar or radial nerve transfer, but not after a one-third transfer of either radial or ulnar nerves. Histologically, the number of axons in the re-innervated median nerve and both donor nerves distal to the coaptation site seemed to follow variable patterns. It was concluded that in the rabbit use of one-third of the agonistic ulnar nerve for re-innervation of the median nerve results in useful motor recovery with negligible donor site morbidity. Clinically, this technique may offer an alternative option for proximal nerve injuries or for free functioning muscle transplantations.

scholarly journals Asymptomatic Neuropathy in Recently Diagnosed Diabetic Patients: Electrophysiological Evaluation

2014 ◽  
Vol 30 (1) ◽  
pp. 16-22
Author(s):  
Abu Saleh Md Badrul Hasan ◽  
Biplob Kumar Roy ◽  
Kazi Giasuddin Ahmed ◽  
Md Rafiqul Islam ◽  
AKM Anwaullah ◽  
...  
Keyword(s):  
Diabetic Neuropathy ◽  
Median Nerve ◽  
Ulnar Nerve ◽  
Nerve Conduction ◽  
Motor Nerve ◽  
Sensory Nerves ◽  
Case Group ◽  
Diabetic Patients ◽  
Significant Difference ◽  
And Control

Aim & background: As significant electrophysiological changes are found in asymptomatic neuropathy in diabetes mellitus and electrophysiological studies of nerve conduction velocity are our most sensitive tools to quantify early abnormalities, therefore, we tried to find out status of asymptomatic peripheral nerve dysfunction in recently diagnosed diabetic patients in Bangladesh perspective. Method :This study was carried out at BSMMU and BIRDEM during November 2005 and April 2006. The study included 60 subjects, 30 recently diagnosed diabetic subjects (14 male, 16 female). None had neuropathic symptoms or signs. All cases were selected randomly diagnosed by ADA criteria accepted by WHO. Thirty healthy controls with mean age comparable to that of diabetic subject were selected from the friends of the subjects and patients attending neurology outdoor of BSMMU. Result:Findings (mean±SD) were (case and control, respectively): Tibial nerve, DML 4.05±0.81 and 3.84±0.70 msec (P>0.10), CMAP 16.90±5.14 and 19.49±4.73 mV (P<0.05), MCV 45.43±4.55 and 48.24±4.72 m/ s (P<0.05), and F latency 45.09±12.43 and 42.50±8.93 msec (P>0.10); peroneal nerve, DML 4.12±1.10 and 4.03±0.67 msec (P>0.50), CMAP 5.80±2.89 and 6.97±1.79 mV (P>0.05), MCV 43.10±8.89 and 48.27±3.56 m/s (P<0.01), and F latency 50.27±10.81 and 41.32±3.05 msec (P<0.001); median nerve, DML 3.57±0.46 and 3.55±0.52 msec (P>0.50), CMAP 16.33±4.24 and 17.84±3.73 mV (P>0.10) and MCV 55.16±5.33 and 57.70±4.33 m/s (P<0.05), and F latency 25.08±5.28 and 24.39±4.83 msec (P>0.50); and ulnar nerve DML 2.57±0.33 an 3.17±0.61 msec (P<0.001), CMAP 14.65±3.32 and 17.29±6.83 mV (P>0.05), MCV 55.74±5.00 and 58.50±5.13 m/s (P<0.05), F latency 25.09±5.35 and 25.82±3.33 msec (P>0.50); sural nerve, DSL 2.46±0.68 and 3.12±0.45 msec (P<0.001), SNAP 19.44±10.25 and 25.32±7.88 ìV (P<0.05), SCV 49.95±10.22 and 52.46±3.96 m/s (P>0.10); median nerve, DSL 2.52±0.39 and 2.77±0.49 msec (P<0.05), SNAP 30.23±12.79 and 31.69±11.02 ìV (P>0.50), and SCV 56.90±6.77 and 57.41±5.85 m/s (P>0.50); and ulnar nerve, DSL 2.03±0.39 and 2.48±0.49 msec (P<0.001), SNAP 29.30±14.36 and 30.72±10.76 ìV (P>0.50), and SCV 60.96±8.38 and 57.93±7.15 m/s (P>0.10). Mean (±SD) HbA1c was significantly high (P<0.001) in case group (7.10±0.80%) compared to control (5.51±0.65%). Mean (±SD) SGPT showed no significant difference between case (36.10±13.02 u/L) and control (36.20±7.94 u/L). Similarly, mean (±SD) total cholesterol also showed no significant difference between case (201.57±37.56 mg/dl) and control (191.00±17.17 mg/dl). Conclusion: Motor nerve conduction parameters are affected more than sensory nerves and F-wave latencies are more frequently and early involved in these subjects. Abnormalities on nerve conduction was started in the feet rather than the hands.Clinical spectrum of diabetic neuropathy is variable and may be asymptomatic, but once established as polyneuropathy, it is irreversible and may finally be disabling. Early detection of diabetic neuropathy is one of the major goals in the management of diabetes since timely intervention may substantially reduce mortality and morbidity. Bangladesh Journal of Neuroscience 2014; Vol. 30 (1): 16-22

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