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Physical Medicine and Rehabilitation... Aug 2016Ultrasound guidance allows real-time visualization of the needle in peripheral nerve procedures, improving accuracy and safety. Sonographic visualization of the... (Review)
Review
Ultrasound guidance allows real-time visualization of the needle in peripheral nerve procedures, improving accuracy and safety. Sonographic visualization of the peripheral nerve and surrounding anatomy can provide valuable information for diagnostic purposes and procedure enhancement. Common procedures discussed are the suprascapular nerve at the suprascapular notch, deep branch of the radial nerve at the supinator, median nerve at the pronator teres and carpal tunnel, lateral cutaneous nerve of the thigh, superficial fibular nerve at the leg, tibial nerve at the ankle, and interdigital neuroma. For each procedure, the indications, relevant anatomy, preprocedural scanning technique, and injection procedure itself are detailed.
Topics: Adrenal Cortex Hormones; Anesthetics, Local; Forefoot, Human; Humans; Median Nerve; Musculoskeletal Pain; Nerve Block; Neuroma; Peripheral Nerves; Radial Nerve; Shoulder Pain; Tibial Nerve; Ultrasonography, Interventional
PubMed: 27468673
DOI: 10.1016/j.pmr.2016.04.006 -
The Journal of Hand Surgery Apr 2023Intraoperative neuromonitoring is a valuable surgical resource that can assist in decision-making during peripheral nerve surgery using real-time electrophysiologic... (Review)
Review
Intraoperative neuromonitoring is a valuable surgical resource that can assist in decision-making during peripheral nerve surgery using real-time electrophysiologic data. By stimulating a nerve and recording action potentials from a point on the nerve ("nerve action potential") or from a muscle ("triggered electromyography"), nerve lesions can be localized and the extent of nerve damage evaluated. The purpose of this article is to provide an overview of the role, indications, and techniques of intraoperative neuromonitoring of peripheral nerve injuries.
Topics: Humans; Action Potentials; Electromyography; Intraoperative Complications; Monitoring, Intraoperative; Neurosurgical Procedures; Peripheral Nerve Injuries; Peripheral Nerves
PubMed: 36623946
DOI: 10.1016/j.jhsa.2022.11.022 -
The Journal of Hand Surgery... Mar 2017Lymphoma involvement of peripheral nerves is rare and it may mimic benign neurogenic tumors or neuropraxic injury. This study presents three patterns of presentations in...
Lymphoma involvement of peripheral nerves is rare and it may mimic benign neurogenic tumors or neuropraxic injury. This study presents three patterns of presentations in four patients with neurolymphomatous involvement of their peripheral nerves. We reviewed the clinical records of four patients who underwent exploratory brachial plexus surgery (n = 1), pronator tunnel decompression (n = 1) and peripheral nerve exploration (n = 2) and subsequently found to have neurolymphomatosis (NL). Histological diagnoses were diffuse large B-cell lymphoma (n = 3) and NK/T-cell lymphoma (n = 1). NL lacks pathognomonic clinical and imaging features that aid clinicians in diagnosis. Apart from a history of lymphoma, and high clinical index of suspicion, PET-CT scans appear to be a helpful adjunct in detecting high metabolic lesions occuring in situ or systemically. Intra-operative frozen section is helpful to detect round blue cells, before final cytological diagnosis.
Topics: Aged; Brachial Plexus; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Neurolymphomatosis; Positron Emission Tomography Computed Tomography; Sciatic Nerve; Ulnar Nerve
PubMed: 28205463
DOI: 10.1142/S0218810417720042 -
F1000Research 2019Magnetic resonance imaging (MRI) has been used extensively in revealing pathological changes in the central nervous system. However, to date, MRI is very much... (Review)
Review
Magnetic resonance imaging (MRI) has been used extensively in revealing pathological changes in the central nervous system. However, to date, MRI is very much underutilized in evaluating the peripheral nervous system (PNS). This underutilization is generally due to two perceived weaknesses in MRI: first, the need for very high resolution to image the small structures within the peripheral nerves to visualize morphological changes; second, the lack of normative data in MRI of the PNS and this makes reliable interpretation of the data difficult. This article reviews current state-of-the-art capabilities in MRI of human peripheral nerves. It aims to identify areas where progress has been made and those that still require further improvement. In particular, with many new therapies on the horizon, this review addresses how MRI can be used to provide non-invasive and objective biomarkers in the evaluation of peripheral neuropathies. Although a number of techniques are available in diagnosing and tracking pathologies in the PNS, those techniques typically target the distal peripheral nerves, and distal nerves may be completely degenerated during the patient's first clinic visit. These techniques may also not be able to access the proximal nerves deeply embedded in the tissue. Peripheral nerve MRI would be an alternative to circumvent these problems. In order to address the pressing clinical needs, this review closes with a clinical protocol at 3T that will allow high-resolution, high-contrast, quantitative MRI of the proximal peripheral nerves.
Topics: Humans; Magnetic Resonance Imaging; Peripheral Nerves; Peripheral Nervous System Diseases
PubMed: 31700612
DOI: 10.12688/f1000research.19695.1 -
Seminars in Neurology Oct 2019Peripheral nerve disorders may be the presenting manifestation of a systemic infection, and early recognition of these syndromes is essential for prompt diagnosis and... (Review)
Review
Peripheral nerve disorders may be the presenting manifestation of a systemic infection, and early recognition of these syndromes is essential for prompt diagnosis and treatment. Mechanisms associated with infectious disorders of the peripheral nerve are often complex and multiple, with secondary inflammation, direct infectious invasion of nerves, and toxicities of antimicrobial medications playing a role. Here, we provide a complete review of the most common infectious pathogens that can affect the peripheral nerves.
Topics: Communicable Diseases; Herpes Zoster; Humans; Inflammation; Peripheral Nerves; Peripheral Nervous System Diseases
PubMed: 31639846
DOI: 10.1055/s-0039-1688995 -
Annals of Plastic Surgery Aug 2023Peripheral nerve injury is a common injury disease. Understanding of the mechanisms of periphery nerve repair and regeneration after injury is an essential prerequisite...
Peripheral nerve injury is a common injury disease. Understanding of the mechanisms of periphery nerve repair and regeneration after injury is an essential prerequisite for treating related diseases. Although the biological mechanisms of peripheral nerve injury and regeneration have been studied comprehensively, the clinical treatment methods are still limited. The bottlenecks of the treatments are the shortage of donor nerves and the limited surgical precision. Apart from the knowledge regarding the fundamental characteristics and physical processes of peripheral nerve injury, numerous studies have found that Schwann cells, growth factors, and extracellular matrix are main factors affecting the repair and regeneration process of injured nerves. At present, the therapeutical methods of the disease include microsurgery, autologous nerve transplantation, allograft nerve transplantation and tissue engineering technology. Tissue engineering technology, which combines seed cells, neurotrophic factors, and scaffold materials together, is promising for treating the patients with long-gapped and large nerve damage. With the development of neuron science and technology, the treatment of peripheral nerve injury diseases will continue being improved.
Topics: Humans; Peripheral Nerve Injuries; Schwann Cells; Tissue Engineering; Nerve Growth Factors; Transplantation, Autologous; Nerve Regeneration; Peripheral Nerves
PubMed: 36880740
DOI: 10.1097/SAP.0000000000003480 -
Neurological Research Sep 2023
Topics: Humans; Peripheral Nerve Injuries; Neurosurgical Procedures; Peripheral Nerves
PubMed: 37559232
DOI: 10.1080/01616412.2023.2184035 -
European Journal of Orthopaedic Surgery... Feb 2019The injuries of the peripheral nerves are relatively frequent. Some of them may lead to defects which cannot be repaired with direct end-to-end repair without tension.... (Review)
Review
The injuries of the peripheral nerves are relatively frequent. Some of them may lead to defects which cannot be repaired with direct end-to-end repair without tension. These injuries may cause function loss to the patient, and they consist a challenge for the treating microsurgeon. Autologous nerve grafts remain the gold standard for bridging the peripheral nerve defects. Nevertheless, there are selected cases where alternative types of nerve reconstruction can be performed in order to cover the peripheral nerve defects. In all these types of reconstruction, the basic principles of microsurgery are necessary and the surgeon should be aware of them in order to achieve a successful reconstruction. The purpose of the present review was to present the most current data concerning the surgical options available for bridging such defects.
Topics: Allografts; Autografts; Humans; Nerve Transfer; Peripheral Nerve Injuries; Peripheral Nerves; Plastic Surgery Procedures; Suture Techniques
PubMed: 30483968
DOI: 10.1007/s00590-018-2344-2 -
Current Pain and Headache Reports Aug 2019Peripheral nerve blocks are effective and safe modalities for perioperative analgesia. But it remains unclear what blocks are adequate for ambulatory surgeries, as well... (Review)
Review
PURPOSE OF REVIEW
Peripheral nerve blocks are effective and safe modalities for perioperative analgesia. But it remains unclear what blocks are adequate for ambulatory surgeries, as well as the proper patient management before and after discharge.
RECENT FINDINGS
Emerging nerve blocks have sparked interests due to ease to perform under ultrasound guidance and lower risks of adverse events. Some of these novel blocks are particularly suitable for ambulatory procedures, including but not limited to motor-sparing lower extremity nerve blocks and phrenic-sparing nerve blocks for shoulder surgeries. The adoption of peripheral nerve block into outpatient surgery is a multidisciplinary effort that encompasses appropriate patient choice, careful selection of nerve blocks that minimize potential adverse events after discharge, and proper patient follow-up until block effects resolve.
Topics: Ambulatory Surgical Procedures; Anesthesia, Conduction; Humans; Nerve Block; Outpatients; Peripheral Nerves; Ultrasonography, Interventional
PubMed: 31372836
DOI: 10.1007/s11916-019-0809-6 -
Development (Cambridge, England) Nov 2019During the development of the peripheral nervous system, axons and myelinating Schwann cells form a unique symbiotic unit, which is realized by a finely tuned network of... (Review)
Review
During the development of the peripheral nervous system, axons and myelinating Schwann cells form a unique symbiotic unit, which is realized by a finely tuned network of molecular signals and reciprocal interactions. The importance of this complex interplay becomes evident after injury or in diseases in which aspects of axo-glial interaction are perturbed. This Review focuses on the specific interdependence of axons and Schwann cells in peripheral nerve development that enables axonal outgrowth, Schwann cell lineage progression, radial sorting and, finally, formation and maintenance of the myelin sheath.
Topics: Animals; Axons; Cell Differentiation; Cell Lineage; Cell Separation; Gene Expression Regulation, Developmental; Mice; Myelin Sheath; Nerve Regeneration; Neuroglia; Peripheral Nerves; Peripheral Nervous System; Rats; Schwann Cells; Signal Transduction
PubMed: 31719044
DOI: 10.1242/dev.151704