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American Journal of Orthopedics (Belle... Mar 2000The management of peripheral nerve injury continues to be a major clinical challenge. Despite advancements in microsurgical technique, results after nerve repair have... (Review)
Review
The management of peripheral nerve injury continues to be a major clinical challenge. Despite advancements in microsurgical technique, results after nerve repair have been unpredictable and dis appointing. The management of these nerve injuries relies on having a thorough understanding of peripheral nerve anatomy. This is the basis of the classification schemes by Seddon and Sunderland, in which the prognosis of nerve injuries varies depending on the degree of injury to their substructures. The most recent advances in the management of peripheral nerve injuries rely on the ability to manipulate the pathophysiologic processes triggered by nerve injuries and regeneration. End-to-end primary repair should be sought whenever a tension-free repair can be attained. If there is a significant nerve gap, use of nerve autograft remains the gold standard. In nerve injuries where a nerve autograft is not possible, the use of nerve allograft, as well as autogenous, biodegradable, and synthetic nerve conduits has shown promising results in experimental studies.
Topics: Humans; Neurosurgical Procedures; Peripheral Nerve Injuries; Peripheral Nerves
PubMed: 10746467
DOI: No ID Found -
Journal of the Peripheral Nervous... Jun 2005Diabetes mellitus impairs peripheral nerve regeneration. Regenerative failure likely exacerbates deficits from polyneuropathy or focal neuropathies in patients who might... (Review)
Review
Diabetes mellitus impairs peripheral nerve regeneration. Regenerative failure likely exacerbates deficits from polyneuropathy or focal neuropathies in patients who might otherwise exhibit spontaneous improvement. Some focal neuropathies, like carpal tunnel syndrome, are common, yet render ongoing disability because of their delayed recovery. Why diabetic nerves fail to regenerate is an interesting question to consider because several mechanisms likely contribute. In this review, we examine a number of these causes. These causes include microangiopathy or disease of small blood vessels, failure to provide proper metabolic support for repair, defects in the entry and actions of inflammatory cells within the injury milieu, less robust support of axons by their Schwann cells, and lack of a full repertoire of trophic factors. A number of the mechanisms that generate neuropathy in the first place also likely contribute to failed regenerative programs, but how they do so is not clear.
Topics: Animals; Diabetes Mellitus; Humans; Macrophages; Models, Biological; Nerve Fibers, Myelinated; Nerve Regeneration; Peripheral Nerves; Time Factors
PubMed: 15958126
DOI: 10.1111/j.1085-9489.2005.0010205.x -
Muscle & Nerve Jul 2023Although electromyography remains the "gold standard" for assessing and diagnosing peripheral nerve disorders, ultrasound has emerged as a useful adjunct, providing... (Meta-Analysis)
Meta-Analysis
INTRODUCTION/AIMS
Although electromyography remains the "gold standard" for assessing and diagnosing peripheral nerve disorders, ultrasound has emerged as a useful adjunct, providing valuable anatomic information. The objective of this study was to conduct a systematic review and meta-analysis evaluating the normative sonographic values for adult peripheral nerve cross-sectional area (CSA).
METHODS
Medline and Cochrane Library databases were systematically searched for healthy adult peripheral nerve CSA, excluding the median and ulnar nerves. Data were meta-analyzed, using a random-effects model, to calculate the mean nerve CSA and its 95% confidence interval (CI) for each nerve at a specific anatomical location (= group).
RESULTS
Thirty groups were identified and meta-analyzed, which comprised 16 from the upper extremity and 15 from the lower extremity. The tibial nerve (n = 2916 nerves) was reported most commonly, followed by the common fibular nerve (n = 2580 nerves) and the radial nerve (n = 2326 nerves). Means and 95% confidence interval (CIs) of nerve CSA for the largest number of combined nerves were: radial nerve assessed at the spiral groove (n = 1810; mean, 5.14 mm ; 95% CI, 4.33 to 5.96); common fibular nerve assessed at the fibular head (n = 1460; mean, 10.18 mm ; 95% CI, 8.91 to 11.45); and common fibular nerve assessed at the popliteal fossa (n = 1120; mean, 12.90 mm ; 95% CI, 9.12 to 16.68). Publication bias was suspected, but its influence on the results was minimal.
DISCUSSION
Two hundred thirty mean CSAs from 15 857 adult nerves are included in the meta-analysis. These are further categorized into 30 groups, based on anatomical location, providing a comprehensive reference for the clinician and researcher investigating adult peripheral nerve anatomy.
Topics: Median Nerve; Peripheral Nerves; Radial Nerve; Tibial Nerve; Ulnar Nerve; Ultrasonography; Humans; Adult
PubMed: 36583383
DOI: 10.1002/mus.27783 -
Microsurgery 1989A large gap in peripheral nerve will not allow effective regeneration unless a grafting conduit is used to bridge the defect. Conventionally, nerve tissue has been used... (Review)
Review
A large gap in peripheral nerve will not allow effective regeneration unless a grafting conduit is used to bridge the defect. Conventionally, nerve tissue has been used as such a conduit in nerve reconstruction; however, results from techniques using these grafts are often unsatisfactory. A number of recent investigations have indicated that nerve fibers will regenerate through a non-neural tube. The purpose of this review is: 1) to provide an overview of the various tubulation techniques previously reported for peripheral nerve gap repair; 2) to investigate new possibilities for enhancing the regenerative capacity of nerves following these tubulation techniques by drawing from technical innovations in microsurgery and recent progress in immunology and neurobiology. The interposed graft thus may perform a more positive role, not merely as a pathway for deregenerating axons, but as a source for neuronotrophic factors and neurite-promoting factors, which would nurture and guide the neurons and axons. Such modifications in graft materials may lead to clinical applications of tubulation of nerve defects that would result in an improvement in clinical results.
Topics: Humans; Nerve Fibers; Nerve Regeneration; Peripheral Nerves; Prostheses and Implants
PubMed: 2657318
DOI: 10.1002/micr.1920100112 -
Biotechnology and Applied Biochemistry Jun 2005Injuries to the nervous system are the result of mechanical, thermal, chemical or congenital pathologies and, if function is not restored, they lead to loss of muscle... (Review)
Review
Injuries to the nervous system are the result of mechanical, thermal, chemical or congenital pathologies and, if function is not restored, they lead to loss of muscle function, pain and impaired sensation. Current treatment modalities essentially coapt the two nerves ends together or place a nerve graft between the cut ends. However, clinical results have never been optimal, and therefore a quest for better options has taken place. In this review article we look at the synthetic and biomimetic options currently being tested as potential nerve grafts.
Topics: Animals; Biocompatible Materials; Culture Techniques; Humans; Models, Biological; Nerve Regeneration; Peripheral Nerve Injuries; Peripheral Nerves; Polyglycolic Acid; Schwann Cells
PubMed: 15896191
DOI: 10.1042/BA20040137 -
Der Anaesthesist May 2014Peripheral electrical nerve stimulation is one of the standard applications in peripheral regional anesthesia in addition to the ultrasound technique. Among other... (Review)
Review
Peripheral electrical nerve stimulation is one of the standard applications in peripheral regional anesthesia in addition to the ultrasound technique. Among other findings, the visualization of needle and nerve during ultrasound-guided blockade caused a change in clinical practice of peripheral nerve stimulation in the last decade. In the present article old and new aspects of principles and clinical practice of the nerve stimulation technique are presented and summarized in a total clinical concept in order to achieve safe and successful peripheral regional anesthesia using electrical peripheral nerve stimulation.
Topics: Anesthesia, Conduction; Electric Stimulation; Humans; Nerve Block; Peripheral Nerves; Safety
PubMed: 24715260
DOI: 10.1007/s00101-014-2312-0 -
Artificial Cells, Blood Substitutes,... 2010Abstract: Nerve regeneration and re-innervation are usually difficult after peripheral nerve injury. Epineurium neurorrhaphy to recover the nerve continuity was the... (Review)
Review
Abstract: Nerve regeneration and re-innervation are usually difficult after peripheral nerve injury. Epineurium neurorrhaphy to recover the nerve continuity was the traditional choice of peripheral nerve mutilation without nerve defects, whereas the functional recovery was not quite satisfactory. In this article, the authors review the literature focused on peripheral nerve injury research and possible clinical application, including introducing peripheral nerve selective regeneration theory, small gap sleeve bridging nerve methodepineurium neurorrhaphy, kinds of biological conduit, and microenvironment research between nerve stumps.
Topics: Anastomosis, Surgical; Animals; Biocompatible Materials; Cell Growth Processes; Cell Movement; Guided Tissue Regeneration; Humans; Nerve Regeneration; Neurosurgical Procedures; Peripheral Nerve Injuries; Peripheral Nerves; Recovery of Function; Tissue Scaffolds; Trauma, Nervous System
PubMed: 20064102
DOI: 10.3109/10731190903495652 -
AJR. American Journal of Roentgenology Jan 2004
Review
Topics: Humans; Peripheral Nerves; Peripheral Nervous System Diseases; Ultrasonography
PubMed: 14684524
DOI: 10.2214/ajr.182.1.1820123 -
The New England Journal of Medicine Jun 1968
Review
Topics: Adult; Child; Humans; Median Nerve; Microscopy; Peripheral Nerve Injuries; Peripheral Nerves; Peripheral Nervous System Diseases; Physical Therapy Modalities; Suture Techniques; Sutures; Transplantation, Autologous; Transplantation, Heterologous; Transplantation, Homologous
PubMed: 4297392
DOI: 10.1056/NEJM196806272782606 -
Journal of Neuropathology and... Apr 2017Saltatory conduction is the process by which action potentials are rapidly and efficiently propagated along myelinated axons. In the peripheral nervous system, saltatory... (Review)
Review
Saltatory conduction is the process by which action potentials are rapidly and efficiently propagated along myelinated axons. In the peripheral nervous system, saltatory conduction is made possible by a series of morphologically and molecularly distinct subdomains in both axons and their associated myelinating Schwann cells. This review briefly summarizes current knowledge on the molecular structure and physiology of the node of Ranvier and adjacent regions of the axoglial unit in peripheral nerve.
Topics: Animals; Axons; Humans; Nerve Fibers, Myelinated; Neural Conduction; Neurons; Peripheral Nerves; Schwann Cells
PubMed: 28340093
DOI: 10.1093/jnen/nlx013