Hand therapy after peripheral nerve injury

2021 ◽  
pp. 283-288
Author(s):  
Birgitta Rosén ◽  
Christina Jerosch-Herold
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Tissue Injury ◽  
Hand Function ◽  
Cognitive Capacity ◽  
Cold Sensitivity ◽  
Post Traumatic Stress ◽  
Hand Rehabilitation ◽  
Functional Consequences ◽  
Type Of Injury

Injury to the peripheral nerve affects the whole length of the neuron and is not just localized to the site of injury, making a nerve injury different from other types of tissue injury in the body. Moreover, a nerve injury has immediate functional consequences for the brain in terms of rapid cortical functional reorganization. Lifelong limitations of hand function with loss of sensibility, muscle weakness, prehensile problems, pain, and cold sensitivity are common. Recovery can take years in adults, especially of tactile discrimination, but often remains incomplete and quality of life may be significantly affected. Numerous factors influence the outcome: age, type of injury, timing of surgery, and cognitive capacity. In addition, education, sex, and post-traumatic stress have proved to be prognostic factors. The timing of hand rehabilitation including sensory and motor re-education are also important contributors to the final outcome.

scholarly journals Psychological consequences of traumatic upper limb peripheral nerve injury: A systematic review

Hand Therapy ◽  
2016 ◽  
Vol 22 (1) ◽  
pp. 35-45 ◽  
Author(s):  
Caroline Miller ◽  
Aimie L Peek ◽  
Dominic Power ◽  
Nicola R Heneghan
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Upper Limb ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Peripheral Nerve Injury ◽  
Stress Disorder ◽  
Psychological Consequences ◽  
Post Traumatic Stress ◽  
Post Traumatic

Introduction Traumatic upper limb peripheral nerve injuries significantly impact individuals’ function and ability to return to work. Patients with peripheral nerve injury experience ongoing psychological impairments for which they are not routinely treated. The aim of this review was to investigate the psychological consequences of traumatic upper limb peripheral nerve injury. Methods A systematic review of MEDLINE, Embase, PsycINFO, CINAHL, AMED, BNI, the Cochrane libraries and grey literature up to October 2015 was undertaken. Two reviewers independently assessed methodological quality in accordance with Cochrane Collaboration recommendations. Eligibility criteria comprised: adults or adolescents with traumatic upper limb peripheral nerve injury using any measurement of psychological well-being. Results Six studies ( n = 245) met the inclusion criteria. Methodological quality varied widely. Evidence of post-traumatic stress disorder at one month, which decreased over time, was reported in three studies. Two studies found a statistically significant correlation between the early presence of post-traumatic stress disorder and reduction in function at 12 or more months. Limited information was available on anxiety, depression and mental quality of life. Combined nerve injuries (in two studies) had significantly higher levels of post-traumatic stress disorder, at one month, compared to those with an isolated nerve injury. Conclusion There is some evidence of early post-traumatic stress disorder following traumatic upper limb peripheral nerve injury, which may have an impact on functional outcome. However, high-quality studies using prospective cohorts are required to further evaluate the psychological aspects associated with this traumatic injury.

FLEXOR TENDON AND PERIPHERAL NERVE REPAIR

Hand Surgery ◽  
2002 ◽  
Vol 07 (01) ◽  
pp. 83-100 ◽  
Author(s):  
Judith A. Bell Krotoski
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Flexor Tendon ◽  
Nerve Repair ◽  
Hand Function ◽  
Tendon Injury ◽  
Finger Movement ◽  
Flexor Tendon Injury ◽  
Direct Injury

Any restoration of hand function following tendon and nerve injury has to include the repair or replacement of the hand's ability to perform a great many tasks. It is hard at first to appreciate fully the loss that occurs with flexor tendon injury. With loss of flexor tendons operating at the fingers or thumb, they cannot be fully closed and the hand is impaired for grasp and release as it interfaces with objects. But, sensibility can also be compromised from tendon injury even without direct injury to nerve, as object recognition in the absence of vision requires finger movement. When peripheral nerve injury is combined with flexor tendon injury, sensibility is directly impaired. There is a loss in the sense of finger or thumb position, pain, temperature, and touch/pressure recognition, in addition to the tendon injury.

Changes in Muscle Cytoarchitecture after Peripheral Nerve Injury and Repair

1998 ◽  
Vol 23 (3) ◽  
pp. 365-369 ◽  
Author(s):  
A-J. CARTER ◽  
F. KRISTMUNDSDOTTIR ◽  
J. GILMOUR ◽  
M. A. GLASBY
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Muscle Fibre ◽  
Peripheral Nerve Injury ◽  
Surgical Techniques ◽  
Cell Loss ◽  
Crush Injury ◽  
Injury And Repair ◽  
Type Of Injury

The aim of this study was to assess the changes which occurred in the rat in target muscles after the injury and repair of a specific peripheral nerve, using several clinically-appropriate surgical techniques. There were alterations in the size, shape, morphology and cytochemical architecture of the fibres of the target muscles. These changes were marked when transection and repair of the nerve was compared with the less-severe crush injury. The method of repair did not correlate significantly with the occurrence of changes in muscle cytoarchitecture. The results suggest that the extent of cell loss and the changes in muscle fibre architecture were influenced by the type of injury, rather than by the method of repair.

scholarly journals The Thermal Sensitivity Test in Evaluating Outcome after Peripheral Nerve Injury

2015 ◽  
Vol 2015 ◽  
pp. 1-9
Author(s):  
Marcin Ceynowa ◽  
Tomasz Mazurek ◽  
Rafał Pankowski ◽  
Marek Rocławski ◽  
Mariusz Treder
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Thermal Sensitivity ◽  
Hand Function ◽  
Cold Intolerance ◽  
Measuring Device ◽  
Knowing That ◽  
Functional Scores ◽  
Temperature Sense

The purpose of this study was to evaluate the ability to discriminate temperatures in patients following peripheral nerve injury. Knowing that temperature sensibility is mediated by different receptors, the scores were compared to other functional hand scores in order to determine whether the ability to discriminate temperatures is restored to a different extent compared with other commonly evaluated hand function modalities. The test was performed using the NTE-2 device (Physitemp Instruments Inc., 154 Huron Avenue, Clifton, New Jersey, USA). Out of 57 patients, 27 had normal thermal discrimination scores, and 9 could not tell the temperatures apart in the differences set on the measuring device. Overall, patients with better thermal discrimination had also better hand function as evaluated with different methods. However, some patients who did regain the ability to differentiate temperatures correctly did not have any measurable return of hand function in other tests. Thermal discrimination scores correlated similarly with different functional scores, except for vibration sensibility, which did not show any significant correlation. The development and severity of cold intolerance seem to be unrelated to temperature sense.

The correlation of cognitive capacity with recovery of hand sensibility after peripheral nerve injury of upper extremity

2011 ◽  
Vol 29 (4) ◽  
pp. 373-379 ◽  
Author(s):  
M. MahmoudAliloo ◽  
A. Bakhshipour ◽  
T. Hashemi ◽  
A.R. Roofigari ◽  
Roghieh Hassan-Zadeh
Keyword(s):  
Peripheral Nerve ◽  
Upper Extremity ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Cognitive Capacity

scholarly journals Supplementary motor area deactivation impacts the recovery of hand function from severe peripheral nerve injury

2016 ◽  
Vol 11 (4) ◽  
pp. 670 ◽  
Author(s):  
Yu-dong Gu ◽  
Ye-chen Lu ◽  
Han-qiu Liu ◽  
Xu-yun Hua ◽  
Yun-dong Shen ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Supplementary Motor Area ◽  
Hand Function ◽  
Motor Area

Human motor endplate remodeling after traumatic nerve injury

2020 ◽  
pp. 1-8
Author(s):  
Ranjan Gupta ◽  
Justin P. Chan ◽  
Jennifer Uong ◽  
Winnie A. Palispis ◽  
David J. Wright ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Surgical Intervention ◽  
Linear Regression Analysis ◽  
Motor Endplate ◽  
Nerve Injuries ◽  
Denervated Muscle ◽  
Sequence Of Events ◽  
Human Motor ◽  
Denervated Muscles

OBJECTIVECurrent management of traumatic peripheral nerve injuries is variable with operative decisions based on assumptions that irreversible degeneration of the human motor endplate (MEP) follows prolonged denervation and precludes reinnervation. However, the mechanism and time course of MEP changes after human peripheral nerve injury have not been investigated. Consequently, there are no objective measures by which to determine the probability of spontaneous recovery and the optimal timing of surgical intervention. To improve guidance for such decisions, the aim of this study was to characterize morphological changes at the human MEP following traumatic nerve injury.METHODSA prospective cohort (here analyzed retrospectively) of 18 patients with traumatic brachial plexus and axillary nerve injuries underwent biopsy of denervated muscles from the upper extremity from 3 days to 6 years after injury. Muscle specimens were processed for H & E staining and immunohistochemistry, with visualization via confocal and two-photon excitation microscopy.RESULTSImmunohistochemical analysis demonstrated varying degrees of fragmentation and acetylcholine receptor dispersion in denervated muscles. Comparison of denervated muscles at different times postinjury revealed progressively increasing degeneration. Linear regression analysis of 3D reconstructions revealed significant linear decreases in MEP volume (R = −0.92, R2 = 0.85, p = 0.001) and surface area (R = −0.75, R2 = 0.56, p = 0.032) as deltoid muscle denervation time increased. Surprisingly, innervated and structurally intact MEPs persisted in denervated muscle specimens from multiple patients 6 or more months after nerve injury, including 2 patients who had presented > 3 years after nerve injury.CONCLUSIONSThis study details novel and critically important data about the morphology and temporal sequence of events involved in human MEP degradation after traumatic nerve injuries. Surprisingly, human MEPs not only persisted, but also retained their structures beyond the assumed 6-month window for therapeutic surgical intervention based on previous clinical studies. Preoperative muscle biopsy in patients being considered for nerve transfer may be a useful prognostic tool to determine MEP viability in denervated muscle, with surviving MEPs also being targets for adjuvant therapy.

Sign in / Sign up

Export Citation Format

Share Document