scholarly journals Surgical outcome of prognostic factors for final outcome of hand function following primary median nerve repair

2018 ◽  
Vol 5 (11) ◽  
pp. 3672
Author(s):  
S. Dhanaraju ◽  
N. Kannan
Keyword(s):  
Prognostic Factors ◽  
Median Nerve ◽  
Nerve Injury ◽  
Functional Recovery ◽  
Nerve Repair ◽  
Hand Function ◽  
Tendon Injury ◽  
Final Outcome ◽  
Nerve Injuries ◽  
Median Nerve Injury

Background: A major problem in surgery of median nerve injuries is the unpredictable final outcome, so identifying the prognostic factors for final outcome is needed in primary median nerve repair following injury. Assessing the functional recovery of hand function following median nerve repair.Methods: Total no. of patients with median nerve injury repaired in our institution was 70. All the patients assessed preoperatively by clinical examination, surgery performed immediately or within 12 hours of injury, performed under axillary block and tourniquet control, Multiple surgeons involved (about 6 surgeons). All are primarily repaired nerves, repair by 70 prolene epineural sutures, postoperative immobilization of 3 weeks.Results: Median nerve injury associated with other flexors involved patients show good functional recovery, the functional recovery deteriorate once involvement of finger flexors, particularly if all the tendons were injured. The arterial injury and repair don’t seem to influence the outcome of the hand function, but both artery involvement usually associated with all tendon injury, it shows poor outcome.Conclusions: The more distal the injury the outcome will be quicker as compared to middle 1/3 and proximal 1/3 injuries. Pure median nerve injuries sensory recovery in S4 grade about 5%, S3+ recovery of sensation is about 36%. Pure median nerve injury patients M4 motor recovery about 54%.Only median nerve injury the final outcome is good but combined median and ulnar nerve injury and associated tendon injury the outcome is poor. 

Correlation of Two-Point Discrimination and Hand Function Following Median Nerve Injury

1993 ◽  
Vol 31 (6) ◽  
pp. 495-498 ◽  
Author(s):  
Christine B. Novak ◽  
Susan E. Mackinnon ◽  
Louise Kelly
Keyword(s):  
Median Nerve ◽  
Nerve Injury ◽  
Hand Function ◽  
Median Nerve 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.

scholarly journals Immediate Tendon Transfer with Nerve Repair in Low Combined Ulnar and Median Nerve Injury

2021 ◽  
Vol 9 (5) ◽  
pp. e3597
Author(s):  
Khaled A. Reyad ◽  
Ahmed M. Behiri ◽  
Karim K. El Lamie ◽  
Mohamed A. Sayed ◽  
Hala M. Abd Elsabour Sabah
Keyword(s):  
Median Nerve ◽  
Nerve Injury ◽  
Tendon Transfer ◽  
Nerve Repair ◽  
Median Nerve Injury

Functional Outcome Following Traumatic Peripheral Nerve Injury Repair in a Tertiary Care Hospital in South India - An Observational Study

2021 ◽  
Vol 8 (25) ◽  
pp. 2197-2202
Author(s):  
Joyal Jose ◽  
Sabu Chaniveliyil Parameswaran ◽  
Aniraj Rajappan
Keyword(s):  
Observational Study ◽  
Peripheral Nerve ◽  
Functional Outcome ◽  
Median Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Nerve Repair ◽  
P Value ◽  
Nerve Injuries ◽  
Motor Outcome

BACKGROUND Peripheral nerve injuries (PNIs) often accompany trauma to limbs and is a major cause of morbidity. Various surgical techniques are described for nerve repair and various factors influence the functional outcome after repair. This study intends to assess the functional outcome following PNI repair and various factors affecting the final outcome post repair. In this study we wanted to assess the functional outcome of PNI repair done at our institute. METHODS This is a prospective observational study conducted at the Department of Plastic and Reconstructive Surgery, Government Medical College, Thiruvananthapuram, India, from September 2017 to September 2019 (24 months) in patients with a diagnosis of traumatic peripheral nerve injury. Data collected were analysed by statistical programme for social sciences (SPSS) version 20. Quantitative variables were expressed in mean & standard deviation (SD) and qualitative variables were expressed in proportions. Associations were tested by chi-square test. RESULTS A total of 100 patients were studied. Overall satisfactory sensory outcome was found to be 45.2% in median nerve and 45.5 % in ulnar nerve injuries (P value - 0.492). Overall satisfactory motor outcome was found to be 45.2 % in median nerve and 36.3 % in ulnar nerve injuries (P value - 0.391). Age < 40 years was found to be significantly associated with a good sensory and motor recovery. Diabetes mellitus was associated with a poor sensory and motor outcome compared to patients without any comorbidities. Use of nerve grafts was associated with less sensory recovery compared to primary nerve coaptation (P value - 0.496). Nerve repairs done between 4 - 7 days of injury had better sensory and motor outcome. CONCLUSIONS Traumatic peripheral nerve repair has a variable functional outcome and is dependent on various factors like age and other patient related factors, mechanism of injury and the type of nerve repair. Accurate diagnosis, attention to detail and timely intervention can improve the overall functional outcome. KEYWORDS Peripheral Nerve Injury, Nerve Repair, Functional Outcome

scholarly journals Surgical treatment of the consequences of the computed damage of the median nerve in the proximal part of the upper limb

2018 ◽  
Vol 22 (1) ◽  
pp. 133-139
Author(s):  
I.B. Tretyak ◽  
I.V. Kovalenko ◽  
A.I. Tretyakova ◽  
A.A. Gatskiy ◽  
A.N. Bazik
Keyword(s):  
Median Nerve ◽  
Nerve Injury ◽  
Functional Outcomes ◽  
Tendon Transfer ◽  
Proximal Part ◽  
Surgical Reconstruction ◽  
Anterior Surface ◽  
Nerve Injuries ◽  
Muscle Complex ◽  
Median Nerve Injury

Aim of the study – to assess the efficacy of surgical reconstruction of the combined proximal median nerve injuries, to evaluate the efficacy of the staged orthopedic reconstruction of the thumb opposition. The retrospective analysis of the reconstruction of 14 proximal median nerve injuries was conducted. 11 men and 3 women were enrolled into the study, mean age of participants was 42,3 years. In all cases proximal median nerve injury was accompanied by either axillary (4 cases) or brachial artery (10 cases) injury. 5 patients received direct repair of the median nerve. 9 patients received autologous grafting of the median nerve with mean gap between the stumps 7,5 cm. Both motor and sensory components of recovery were evaluated with MRC Scale and Seddon Scale respectively. Each patient evaluated the recovered median nerve mediated functions with Brief Michigan Hand Questionnaire. 14 cases with poor or no recovery of thenar muscles required tendon transfer (Bunne’sl transfer) to restore thumb opposition in later terms. Mean terms of recovery of the entire muscle-complex of the anterior surface of the forearm in all 14 patients with proximal median nerve injury was 12,9 months (with no reliable dependence on method of reconstruction). Mean MRC Scale score among all 14 patients was: 3,8 points for m. flexor pollicis longus, 4,4 points for mm. flexores digitorum and 4,4 points for m. flexor carpi radialis respectively. The median nerve mediated sensation recovered to 2,8 points on Seddon scale. Not a single patient showed effective recovery of the thenar muscles. Mean Brief MHQ score was 64,2 points – satisfactory recovery. 14 patients received effective thumb opposition within next 2 months post Bunnel’s tendon transfer. Mean Brief MHQ score increased to 78,2 points – good recovery. Surgical reconstruction of proximal median nerve injuries brings satisfying recovery of the entire muscle-complex of the anterior surface of the forearm, as well as the recovery to the median nerve mediated sensory component. Poor or no recovery of the thump opposition is majorly related to the distance between the site of the lesion and thenar’s motor-endplates. Bunnel’s tendon transfer dramatically increases functional outcomes at proximal median nerve injuries.

scholarly journals Evaluation of Functional Recovery in Rats After Median Nerve Resection and Autograft Repair Using Computerized Gait Analysis

2021 ◽  
Vol 14 ◽  
Author(s):  
Johannes C. Heinzel ◽  
Viola Oberhauser ◽  
Claudia Keibl ◽  
Nicole Swiadek ◽  
Gregor Längle ◽  
...  
Keyword(s):  
Gait Analysis ◽  
Nerve Regeneration ◽  
Median Nerve ◽  
Nerve Injury ◽  
Functional Recovery ◽  
Duty Cycle ◽  
Evaluation Method ◽  
Additional Tool ◽  
The Right ◽  
Median Nerve Injury

Computerized gait analysis is a common evaluation method in rat models of hind limb nerve injuries, but its use remains unpublished in models of segmental nerve injury of the forelimb. It was the aim of this work to investigate if computerized gait analysis is a feasible evaluation method in a rat model of segmental median nerve injury and autograft repair. Ten male Lewis rats underwent 7-mm resection of the right median nerve with immediate autograft repair. The left median nerve was resected without repair and served as an internal control. Animals were assessed for 12 weeks after surgery via CatWalk (CW) gait analysis every 2 weeks. Evaluation of motor recovery by means of the grasping test was performed weekly while electrophysiological measurements were performed at the end of the observation period. CW data were correlated with grasping strength at each post-operative time point. CW data were also correlated with electrophysiology using linear regression analysis. Principal component analysis was performed to identify clusters of outcome metrics. Recovery of motor function was observable 4 weeks after surgery, but grasping strength was significantly reduced (p &lt; 0.01) compared to baseline values until post-operative week 6. In terms of sensory recovery, the pain-related parameter Duty Cycle showed significant (p &lt; 0.05) recovery starting from post-operative week 8. The Print Area of the right paw was significantly (p &lt; 0.05) increased compared to the left side starting from post-operative week 10. Various parameters of gait correlated significantly (p &lt; 0.05) with mean and maximum grasping strength. However, only Stand Index showed a significant correlation with compound muscle action potential (CMAP) amplitude (p &lt; 0.05). With this work, we prove that computerized gait analysis is a valid and feasible method to evaluate functional recovery after autograft repair of the rat median nerve. We were able to identify parameters such as Print Area, Duty Cycle, and Stand Index, which allow assessment of nerve regeneration. The course of these parameters following nerve resection without repair was also assessed. Additionally, external paw rotation was identified as a valid parameter to evaluate motor reinnervation. In summary, computerized gait analysis is a valuable additional tool to study nerve regeneration in rats with median nerve injury.

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