scholarly journals Preoperative evaluation of peripheral nerve injuries: What is the place for ultrasound?

2016 ◽  
Vol 125 (3) ◽  
pp. 603-614 ◽  
Author(s):  
Francesca Toia ◽  
Andrea Gagliardo ◽  
Salvatore D'Arpa ◽  
Cesare Gagliardo ◽  
Giuseppe Gagliardo ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Imaging Modality ◽  
Preoperative Evaluation ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries ◽  
Cross Sectional ◽  
Nerve Lesions ◽  
Therapeutic Implications ◽  
Entrapment Neuropathies ◽  
Diagnostic Role

OBJECTIVE The purpose of this study was to evaluate the usefulness of ultrasound in the preoperative workup of peripheral nerve lesions and illustrate how nerve ultrasonography can be integrated in routine clinical and neurophysiological evaluation and in the management of focal peripheral nerve injuries. The diagnostic role and therapeutic implications of ultrasonography for different neuropathies are described. METHODS The authors analyzed the use of ultrasound in 119 entrapment, tumoral, posttraumatic, or postsurgical nerve injuries of limbs evaluated in 108 patients during 2013 and 2014. All patients were candidates for surgery, and in all cases the evaluation included clinical examination, electrodiagnostic studies (nerve conduction study and electromyography), and ultrasound nerve study. Ultrasound was used to explore the nerve fascicular echotexture, continuity, and surrounding tissues. The maximum cross-sectional area (CSA) and the presence of epineurial hyperechogenicity or intraneural hyper- or hypoechogenicity, of anatomical anomalies, dynamic nerve dislocations, or compressions were recorded. The concordance rate of neurophysiological and ultrasonographic data was analyzed, classifying ultrasound findings as confirming, contributive, or nonconfirming with respect to electrodiagnostic data. The correlation between maximum nerve CSA and neurophysiological severity degree in entrapment syndromes was statistically analyzed. RESULTS Ultrasonography confirmed electrodiagnostic findings in 36.1% of cases and showed a contributive role in the diagnosis and surgical planning in 53.8% of all cases; the findings were negative (“nonconfirming”) in only 10.1% of the patients. In 16% of cases, ultrasound was not only contributive, but had a key diagnostic role in the presence of doubtful electrodiagnostic findings. The contributive role differed according to etiology, being higher for tumors (100%) and for posttraumatic or postsurgical neuropathies (72.2%) than for entrapment neuropathies (43.8%). CONCLUSIONS Ultrasound is a powerful, noninvasive tool for the examination of peripheral nerve injuries, and can guide diagnosis of and surgical strategy for focal peripheral nerve injuries. It allows direct visualization of the cause and extent of nerve lesions and finds its place between electrodiagnostic tests and exploratory surgery. It can provide invaluable information, such as the presence and extent of a mass, scar compression, or neuromas. The authors recommend it as a complement to routine clinical and neurophysiological evaluation and as the first-line imaging modality for masses of suspected nerve origin.

Peripheral nerve injuries in the pediatric population: a review of the literature. Part II: entrapment neuropathies

2018 ◽  
Vol 35 (1) ◽  
pp. 37-45 ◽  
Author(s):  
Javier Robla Costales ◽  
Mariano Socolovsky ◽  
Jaime A. Sánchez Lázaro ◽  
David Robla Costales
Keyword(s):  
Peripheral Nerve ◽  
Pediatric Population ◽  
Peripheral Nerve Injuries ◽  
Review Of The Literature ◽  
Nerve Injuries ◽  
Entrapment Neuropathies

Peripheral Nerve Injuries of the Shoulder in the Athlete

1990 ◽  
Vol 9 (2) ◽  
pp. 331-342 ◽  
Author(s):  
Francis X. Mendoza ◽  
Kenneth Main
Keyword(s):  
Peripheral Nerve ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries

scholarly journals Permanent central synaptic disconnection of proprioceptors after nerve injury and regeneration. I. Loss of VGLUT1/IA synapses on motoneurons

2011 ◽  
Vol 106 (5) ◽  
pp. 2450-2470 ◽  
Author(s):  
Francisco J. Alvarez ◽  
Haley E. Titus-Mitchell ◽  
Katie L. Bullinger ◽  
Michal Kraszpulski ◽  
Paul Nardelli ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Cell Body ◽  
Peripheral Nerve Injury ◽  
Motor Coordination ◽  
Electrophysiological Study ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries ◽  
Ia Afferent ◽  
Axon Collaterals

Motor and sensory proprioceptive axons reinnervate muscles after peripheral nerve transections followed by microsurgical reattachment; nevertheless, motor coordination remains abnormal and stretch reflexes absent. We analyzed the possibility that permanent losses of central IA afferent synapses, as a consequence of peripheral nerve injury, are responsible for this deficit. VGLUT1 was used as a marker of proprioceptive synapses on rat motoneurons. After nerve injuries synapses are stripped from motoneurons, but while other excitatory and inhibitory inputs eventually recover, VGLUT1 synapses are permanently lost on the cell body (75–95% synaptic losses) and on the proximal 100 μm of dendrite (50% loss). Lost VGLUT1 synapses did not recover, even many months after muscle reinnervation. Interestingly, VGLUT1 density in more distal dendrites did not change. To investigate whether losses are due to VGLUT1 downregulation in injured IA afferents or to complete synaptic disassembly and regression of IA ventral projections, we studied the central trajectories and synaptic varicosities of axon collaterals from control and regenerated afferents with IA-like responses to stretch that were intracellularly filled with neurobiotin. VGLUT1 was present in all synaptic varicosities, identified with the synaptic marker SV2, of control and regenerated afferents. However, regenerated afferents lacked axon collaterals and synapses in lamina IX. In conjunction with the companion electrophysiological study [Bullinger KL, Nardelli P, Pinter MJ, Alvarez FJ, Cope TC. J Neurophysiol (August 10, 2011). doi:10.1152/jn.01097.2010], we conclude that peripheral nerve injuries cause a permanent retraction of IA afferent synaptic varicosities from lamina IX and disconnection with motoneurons that is not recovered after peripheral regeneration and reinnervation of muscle by sensory and motor axons.

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.

scholarly journals Use of superficial peroneal nerve graft for treating peripheral nerve injuries

2016 ◽  
Vol 51 (1) ◽  
pp. 63-69
Author(s):  
Samuel Ribak ◽  
Paulo Roberto Ferreira da Silva Filho ◽  
Alexandre Tietzmann ◽  
Helton Hiroshi Hirata ◽  
Carlos Augusto de Mattos ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Peroneal Nerve ◽  
Nerve Graft ◽  
Superficial Peroneal Nerve ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries

Peripheral Nerve Injuries in the Athlete

1997 ◽  
Vol 24 (6) ◽  
pp. 385-408 ◽  
Author(s):  
Joseph H. Feinberg ◽  
Scott F. Nadler ◽  
Lisa S. Krivickas
Keyword(s):  
Peripheral Nerve ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries
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