Revision Peripheral Nerve Surgery of the Upper Extremity

2021 ◽  
Vol 35 (02) ◽  
pp. 119-129
Author(s):  
Rami P. Dibbs ◽  
Kausar Ali ◽  
Shayan M. Sarrami ◽  
John C. Koshy
Keyword(s):  
Peripheral Nerve ◽  
Upper Extremity ◽  
Preoperative Evaluation ◽  
Surgical Techniques ◽  
Nerve Compression ◽  
Nerve Injuries ◽  
Muscle Flaps ◽  
Traumatic Injuries ◽  
Ulnar Nerve Compression ◽  
Advantages And Disadvantages

AbstractPeripheral nerve injuries of the upper extremity can result from a wide array of etiologies, with the two most common being compression neuropathy and traumatic injuries. These types of injuries are common and can be psychologically, functionally, and financially devastating to the patient. A detailed preoperative evaluation is imperative for appropriate management. Traumatic injuries can typically be treated with local burial techniques, targeted muscle reinnervation, and regenerative peripheral nerve interfaces. Median nerve compression is frequently managed with complete release of the antebrachial fascia/transverse carpal ligament and/or use of flap coverage such as the hypothenar fat pad flap and local muscle flaps. Ulnar nerve compression is commonly managed via submuscular transposition, subcutaneous transposition, neurolysis, and nerve wrapping. In this review, we discuss the preoperative evaluation, surgical techniques, and advantages and disadvantages of each treatment modality for patients with compressive and traumatic upper extremity nerve injuries.

Peripheral nerve injuries due to osteochondromas: analysis of 20 cases and review of the literature

2014 ◽  
Vol 120 (5) ◽  
pp. 1105-1112 ◽  
Author(s):  
Selçuk Göçmen ◽  
Ali Kıvanç Topuz ◽  
Cem Atabey ◽  
Hakan Şimşek ◽  
Kenan Keklikçi ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Nerve Compression ◽  
Radiographic Evaluation ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries ◽  
En Bloc ◽  
Duration Of Symptoms ◽  
Nerve Decompression

Object Nerve compressions due to osteochondromas are extremely rare. The aim of this retrospective study was to investigate the mechanisms, diagnostic evaluations, and treatment of nerve lesions due to osteochondromas, and to review the literature. Methods The authors retrospectively reviewed their clinic data archive from 1998 through 2008, and 20 patients who were operated on due to peripheral nerve injuries caused by osseous growth were enrolled in the study. Patients' age, duration of symptoms, localizations, intraoperative findings, and modified British Medical Research Council (MRC) and electromyography data obtained from hospital records were evaluated. The literature on this topic available in PubMed was also reviewed. All 20 patients underwent surgery, which consisted of tumor excision performed by orthopedic surgeons and nerve decompression performed by neurosurgeons. Results There were 17 men and 3 women included in the study, with a mean age of 21 years (range 18–25 years). Three patients had multiple hereditary exostoses, and 17 had a solitary exostosis. All of the patients underwent en bloc resection. The most common lesion site was the distal femur (45%). The peroneal and posterior tibial nerves were the structures that were affected the most frequently. The mean follow-up was 3.9 years (range 2–7 years). After the surgery, all patients (100%) experienced good sensory recovery (modified MRC Grade S4 or S5). Conclusions To the authors' knowledge, no large series have reported peripheral nerve compression due to exostoses. The authors have several recommendations as a result of their findings. First, all patients with peripheral nerve compression due to an osteochondroma should undergo surgery. Second, preoperative electromyographic examinations and radiographic evaluation, consisting of MRI and CT to provide optimal information about the lesion, are crucially important. Third, immediate treatment is mandatory to regain the best possible recovery. And fourth, performing nerve decompression first and en bloc resection of osteochondroma consecutively in a multidisciplinary fashion is strongly recommended to avoid peripheral nerve injury.

Chronic neuropathic pain after traumatic peripheral nerve injuries in the upper extremity: prevalence, demographic and surgical determinants, impact on health and on pain medication

2019 ◽  
Vol 20 (1) ◽  
pp. 95-108
Author(s):  
Adriana Miclescu ◽  
Antje Straatmann ◽  
Panagiota Gkatziani ◽  
Stephen Butler ◽  
Rolf Karlsten ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Peripheral Nerve ◽  
Upper Extremity ◽  
Nerve Injury ◽  
Persistent Pain ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries ◽  
Chronic Neuropathic Pain ◽  
Younger Age

AbstractBackground and aimsAside from the long term side effects of a nerve injury in the upper extremity with devastating consequences there is often the problem of chronic neuropathic pain. The studies concerning the prevalence of persistent pain of neuropathic origin after peripheral nerve injuries are sparse. The prevalence and risk factors associated with chronic neuropathic pain after nerve injuries in the upper extremity were assessed.MethodsA standardized data collection template was employed prospectively and retrospectively for all patients with traumatic nerve injuries accepted at the Hand Surgery Department, Uppsala, Sweden between 2010 and 2018. The template included demographic data, pain diagnosis, type of injured nerve, level of injury, date of the lesion and repair, type of procedure, reoperation, time since the procedure, S-LANSS questionnaire (Self report-Leeds Assessment of Neuropathic Symptoms and Signs), RAND-36 (Item short form health survey), QuickDASH (Disability of Shoulder, Arm and Hand) and additional questionnaires concerned medication, pain intensity were sent to 1,051 patients with nerve injuries. Partial proportional odds models were used to investigate the association between persistent pain and potential predictors.ResultsMore than half of the patients undergoing a surgical procedure developed persistent pain. Prevalence of neuropathic pain was 73% of the patients with pain (S-LANSS ≥ 12 or more). Multivariate analysis indicated that injury of a major nerve OR 1.6 (p = 0.013), years from surgery OR 0.91 (p = 0.01), younger age OR 0.7 (p < 0.001), were the main factors for predicting pain after surgery. The type of the nerve injured was the strongest predictor for chronic pain with major nerves associated with more pain (p = 0.019).ConclusionsA high prevalence of chronic pain and neuropathic pain with a negative impact on quality of life and disability were found in patients after traumatic nerve injury. Major nerve injury, younger age and less time from surgery were predictors for chronic pain.

Ultrasonographic evaluation of the iatrogenic peripheral nerve injuries in upper extremity

2010 ◽  
Vol 73 (2) ◽  
pp. 234-240 ◽  
Author(s):  
Nuri Karabay ◽  
Tulgar Toros ◽  
Yalçın Ademoğlu ◽  
Sait Ada
Keyword(s):  
Peripheral Nerve ◽  
Upper Extremity ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries

Primary Repair of Upper Extremity Peripheral Nerve Injuries: An NSQIP Analysis From 2010 to 2016

Hand ◽  
2021 ◽  
pp. 155894472110447
Author(s):  
Ryan Brennan ◽  
Jordan Carter ◽  
Gilberto Gonzalez ◽  
Fernando A. Herrera
Keyword(s):  
Peripheral Nerve ◽  
Upper Extremity ◽  
Complication Rate ◽  
Primary Repair ◽  
Nerve Repair ◽  
Multiple Injury ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries ◽  
Improvement Program ◽  
Injury Group

Background To identify the rate of 30-day complications after primary repair of upper extremity peripheral nerve injuries, associated diagnoses, and postoperative complication rate. Methods The American College of Surgeons National Surgical Quality Improvement Program database was reviewed from 2010 to 2016. Current Procedural Terminology codes consistent with primary nerve repair of the upper extremity were identified and included in the analysis. Patient demographics, comorbidities, type of procedure (elective/emergent), wound class, operative time, and 30-day complications were recorded. Patients with isolated upper extremity nerve injuries (isolated) were compared with those with peripheral nerve injuries in addition to bone, tendon, or soft tissue injuries (multiple). Results In all, 785 patients were identified as having upper extremity nerve repairs (0.16%). Of them, 64% were men and 36% were women; the average patient age was 40 years. The most common indication for surgery was injury to the digits (54% of cases). Thirty-day adverse events occurred in 3% of all cases. Isolated nerve injury occurred in 43% of patients, whereas 57% had additional injuries. The multiple injury group had a significantly higher complication rate compared with the isolated group (1% vs 4.5%) ( P = .007). Repair of tendon at forearm or wrist was the most common concurrent procedure performed. Conclusions Thirty-day complications among upper extremity peripheral nerve injuries are low, accounting for 3% of cases. Return to the operating room accounted for nearly half of all complications. Patients in the multiple injury group accounted for more than half of these and had a significantly higher complication rate compared with patients with isolated nerve injuries.

scholarly journals Ultrasound examination of peripheral nerve injuries in patients with limb injuries in the early post-traumatic or postoperative periods

2021 ◽  
Vol 11 (4) ◽  
pp. 87-95
Author(s):  
I. I. Mazhorova ◽  
E. Yu. Trofimova ◽  
L. T. Khamidova ◽  
R. S. Titov ◽  
Yu. A. Bogolyubsky ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Ultrasound Examination ◽  
Clinical Signs ◽  
Nerve Compression ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries ◽  
Fixation Devices ◽  
Limb Injuries ◽  
Post Traumatic

Introduction. In the early hours and days after traumatic or surgical event it is essential to determine type of peripheral nerve injury accurately.Objective. To assess performance of diagnostic ultrasound (US) in patients with traumatic and intraoperative nerve injuries during the early hours and days after trauma or surgery.Materials and methods. 106 patients with clinical signs of extremity nerve injuries were included into the study. A total of 113 limb nerves were investigated with US.Results. US sensitivity in the detection of complete nerve rupture was 100% (95% CI: 39,8-100%), specificity — 99,0% (94,7100,0%); for nerve compression with the bone sensitivity was 100% (66,4-100%), specificity — 100% (96,3-100%); for nerve compression with fixation devices sensitivity was 100% (66,4-100%), specificity — 100% (15,8-100%) и 100% (88,4-100%).Conclusion. Nerve US is a reliable method for the evaluation of extremity nerve injury, the method can be recommended for use in the early hours and days after trauma or surgery.

scholarly journals Acute and long-term costs of 268 peripheral nerve injuries in the upper extremity

PLoS ONE ◽  
2020 ◽  
Vol 15 (4) ◽  
pp. e0229530 ◽  
Author(s):  
Konstantin D. Bergmeister ◽  
Luisa Große-Hartlage ◽  
Simeon C. Daeschler ◽  
Patrick Rhodius ◽  
Arne Böcker ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Upper Extremity ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries
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