Clemastine improves electrophysiologic and histomorphometric changes through promoting myelin repair in a murine model of compression neuropathy

Compression neuropathies are common and debilitating conditions that result in variable functional recovery after surgical decompression. Recent drug repurposing studies have verified that clemastine promotes functional recovery through enhancement of myelin repair in demyelinating disease. We investigated the utility of clemastine as a treatment for compression neuropathy using a validated murine model of compression neuropathy encircling the compression tube around the sciatic nerve. Mice received PBS or clemastine solution for 6 weeks of compression phase. Mice taken surgical decompression received PBS or clemastine solution for 2 weeks of decompression phase. Electrodiagnostic, histomorphometric, and Western immunoblotting analyses were performed to verify the effects of clemastine. During the compression phase, mice treated with clemastine had significantly decreased latency and increased amplitude compared to untreated mice that received PBS. Histomorphometric analyses revealed that mice treated with clemastine had significantly higher proportions of myelinated axons, thicker myelin, and a lower G-ratio. The expression levels of myelin proteins, including myelin protein zero and myelin associated glycoprotein, were higher in mice treated with clemastine. However, the electrophysiologic and histomorphometric improvements were observed regardless of clemastine treatment in mice taken surgical decompression. Mice treated with clemastine during compression of the sciatic nerve demonstrated that clemastine treatment attenuated electrophysiologic and histomorphometric changes caused by compression through promoting myelin repair.

Effectiveness of the Influence of Physical Therapy on the Indicators of the Neurological and Functional Status of the Hand in People with Compression Neuropathy of the Median Nerve as a Postimmobilization Complication of Fractures of the Distal Forearm Bo

The social inconsistency of patients with hand injuries is due to the limitation of the possibilities of professional and labor activity (reduced qualifications, limited opportunities for training and retraining, inability to work in their specialty), which justifies the search for new methods of their rehabilitation. The purpose of the study was to determine the effectiveness of physical therapy on the indicators of the neurological and functional status of the hand in patients with compression neuropathy of the median nerve as a postimmobilization complication of fractures of the distal forearm bones. Material and methods. The study involved 56 people with postimmobilization contractures of the wrist joint, complicated by compression neuropathy of the median nerve, as a result of fracture of the bones of the distal forearm. They were divided into two groups: the control group (they practiced according to the principles of polyclinic rehabilitation with a predominance of passive means like manual techniques, preformed physical factors) and the main group (they were engaged in a developed physical therapy program based on the principles of International Classification of Functioning, Disability and Health with a predominance of active means like functional training; massage; warm wet compress combined with post-isometric muscle relaxation, posture treatment; kinesiological taping). The effectiveness of the program was assessed by the presence and degree of pain (VAS and DN4), goniometry results, signs of median nerve irritation (Phalen, Hoffmann-Tinel, Durkan), French Arm Test, ABILIHAND, DASH, Boston carpal tunnel questionnaire. Results and discussion. After the rehabilitation intervention, all examined patients showed a decrease in the intensity of pain at rest and during movement (according to VAS). Signs of compression neuropathy of the median nerve decreased (pain intensity according to the DN4 questionnaire, the prevalence of specific symptoms, the results of a quantitative assessment of the Boston carpal tunnel questionnaire). There was an improvement in the functioning of the upper limb according to the ABILIHAND, DASH, French Arm Test scales. For all the studied parameters, the patients of both groups showed a statistically significantly better result compared to the initial data (p <0.05). However, the patients of the main group showed a better result than the patients of the control group (p <0.05). Conclusion. The developed program of physical therapy with the predominant using of active rehabilitation means revealed a statistically significant better effect on the indicators of the neurological and functional status of the hand in persons with compression neuropathy of the median nerve as a postimmobilization complication of fractures of the distal forearm bones

Prophylaxis and treatment of acute and chronic postoperative inguinal pain (CPIP)—association of pain with compression neuropathy†

Can open inguinal hernia repair (OIHR) and tailored neurectomy (TN) be effective for prophylaxis of chronic postoperative inguinal hernia repair (CPIP) (I) and treatment of CPIP (II)? Patients with symptomatic primary inguinal hernia (I group 1) and secondary hernia with CPIP (II, groups 2–5) were investigated for postoperative complications and nerve damage. About, 98% of patients with OIHR with TN reported preoperative pain (I group 1, n = 388, recurrence rate 1%). There were 73 cases (II) of CPIP after laparoscopic inguinal hernia repair (LIHR) (group 2, n = 22), OIHR (group 3, n = 37), LIHR followed by OIHR/LIHR (group 4, n = 5) and OIHR followed by LIHR/OIHR (group 5, n = 9). The results were as follows: preoperative pain: 33–100%, recurrence rate 0–11% (II, groups 2–5), nerve damage 92–100% and persistent CPIP: n = 1 after trocar perforation of inguinal nerve elsewhere. OIHR is effective to avoid CPIP with compression neuropathy. This is the largest series of histological nerve damage in CPIP.

Compression Neuropathy of the Ulnar Nerve due to the Accessory Abductor Digiti Minimi at Guyon’s Canal: A Case Report

Guyon’s canal syndrome is a compression neuropathy of the ulnar nerve that occurs at the wrist. Compression can be caused by many conditions, such as benign tumors, repeated occupational trauma, vascular lesions, fractures of the carpal bones, rheumatoid arthritis and anomalous hypothenar muscle at Guyon's canal. Here, the authors report a case of compression neuropathy of the ulnar nerve by the accessory abductor digiti minimi muscle (AADM), one of the anomalous hypothenar muscles, at Guyon's canal. The case report is accompanied by a literature review.