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International Journal of Molecular... Jan 2022Peripheral nerve injuries (PNI) can have several etiologies, such as trauma and iatrogenic interventions, that can lead to the loss of structure and/or function... (Review)
Review
Peripheral nerve injuries (PNI) can have several etiologies, such as trauma and iatrogenic interventions, that can lead to the loss of structure and/or function impairment. These changes can cause partial or complete loss of motor and sensory functions, physical disability, and neuropathic pain, which in turn can affect the quality of life. This review aims to revisit the concepts associated with the PNI and the anatomy of the peripheral nerve is detailed to explain the different types of injury. Then, some of the available therapeutic strategies are explained, including surgical methods, pharmacological therapies, and the use of cell-based therapies alone or in combination with biomaterials in the form of tube guides. Nevertheless, even with the various available treatments, it is difficult to achieve a perfect outcome with complete functional recovery. This review aims to enhance the importance of new therapies, especially in severe lesions, to overcome limitations and achieve better outcomes. The urge for new approaches and the understanding of the different methods to evaluate nerve regeneration is fundamental from a One Health perspective. In vitro models followed by in vivo models are very important to be able to translate the achievements to human medicine.
Topics: Animals; Biomarkers; Clinical Studies as Topic; Combined Modality Therapy; Disease Management; Disease Models, Animal; Disease Susceptibility; Humans; Peripheral Nerve Injuries; Peripheral Nerves; Treatment Outcome
PubMed: 35055104
DOI: 10.3390/ijms23020918 -
Neurology India 2019Peripheral nerve injuries are a heterogeneous and distinct group of disorders that are secondary to various causes commonly including motor vehicle accidents, falls,... (Review)
Review
Peripheral nerve injuries are a heterogeneous and distinct group of disorders that are secondary to various causes commonly including motor vehicle accidents, falls, industrial accidents, household accidents, and penetrating trauma. The earliest classification of nerve injuries was given by Seddon and Sunderland, which holds true till date and is commonly used. Neuropraxia, axonotmesis, and neurotmesis are the three main types of nerve injuries. The electrophysiological studies including nerve conduction studies (NCS) and electromyography (EMG) play a key role and are now considered an extension of the clinical examination in patients with peripheral nerve injuries. The electrophysiological results should be interpreted in the light of clinical examination. These studies help in localizing the site of lesion, determine the type and severity of lesion, and help in prognosticating. In neuropraxia, the compound muscle action potential (CMAP) and sensory nerve action potential (SNAP) are elicitable on stimulating the nerve distal to the site of the lesion but demonstrate conduction block on proximal stimulation. The electrodiagnostic findings in axonotmesis and neurotmesis are similar. After few days of injury, Wallerian degeneration sets in with failure to record CMAP and SNAP. Intraoperative technique involves recording from the peripheral nerves during the intraoperative period and has proved useful in the surgical management of nerve injuries and helps in identifying the injured nerve, to determine whether the nerve is in continuity and in localizing the site of lesion. Intraoperative monitoring also helps in identifying the nerve close to an ongoing surgery so that surgical damage to the nerve can be prevented.
Topics: Action Potentials; Electrodiagnosis; Electromyography; Humans; Intraoperative Neurophysiological Monitoring; Neural Conduction; Neurosurgical Procedures; Peripheral Nerve Injuries; Peripheral Nerves; Prognosis
PubMed: 31857526
DOI: 10.4103/0028-3886.273626 -
Neurosurgical Review Apr 2020Brachial plexus injuries are among the rarest but at the same time the most severe complications of shoulder dislocation. The symptoms range from transient weakening or... (Review)
Review
Brachial plexus injuries are among the rarest but at the same time the most severe complications of shoulder dislocation. The symptoms range from transient weakening or tingling sensation of the upper limb to total permanent paralysis of the limb associated with chronic pain and disability. Conflicting opinions exist as to whether these injuries should be treated operatively and if so when surgery should be performed. In this review, available literature dedicated to neurological complications of shoulder dislocation has been analysed and management algorithm has been proposed. Neurological complications were found in 5.4-55% of all dislocations, with the two most commonly affected patient groups being elderly women sustaining dislocation as a result of a simple fall and young men after high-energy injuries, often multitrauma victims. Infraclavicular part of the brachial plexus was most often affected. Neurapraxia or axonotmesis predominated, and complete nerve disruption was observed in less than 3% of the patients. Shoulder dislocation caused injury to multiple nerves more often than mononeuropathies. The axillary nerve was most commonly affected, both as a single nerve and in combination with other nerves. Older patient age, higher energy of the initial trauma and longer period from dislocation to its reduction have been postulated as risk factors. Brachial plexus injury resolved spontaneously in the majority of the patients. Operative treatment was required in 13-18% of the patients in different studies. Patients with suspected neurological complications require systematic control. Surgery should be performed within 3-6 months from the injury when no signs of recovery are present.
Topics: Brachial Plexus; Brachial Plexus Neuropathies; Humans; Neurosurgical Procedures; Shoulder Dislocation; Treatment Outcome
PubMed: 29961154
DOI: 10.1007/s10143-018-1001-x -
BioMed Research International 2014Unlike other tissues in the body, peripheral nerve regeneration is slow and usually incomplete. Less than half of patients who undergo nerve repair after injury regain... (Review)
Review
Unlike other tissues in the body, peripheral nerve regeneration is slow and usually incomplete. Less than half of patients who undergo nerve repair after injury regain good to excellent motor or sensory function and current surgical techniques are similar to those described by Sunderland more than 60 years ago. Our increasing knowledge about nerve physiology and regeneration far outweighs our surgical abilities to reconstruct damaged nerves and successfully regenerate motor and sensory function. It is technically possible to reconstruct nerves at the fascicular level but not at the level of individual axons. Recent surgical options including nerve transfers demonstrate promise in improving outcomes for proximal nerve injuries and experimental molecular and bioengineering strategies are being developed to overcome biological roadblocks limiting patient recovery.
Topics: Animals; Humans; Nerve Regeneration; Peripheral Nerve Injuries; Peripheral Nerves; Plastic Surgery Procedures; Recovery of Function; Translational Research, Biomedical
PubMed: 25276813
DOI: 10.1155/2014/698256 -
PloS One 2022Maxillofacial trauma can be limited to superficial lacerations, abrasions, and facial bone fractures. The objective of this study was to determine the etiology, pattern,...
INTRODUCTION
Maxillofacial trauma can be limited to superficial lacerations, abrasions, and facial bone fractures. The objective of this study was to determine the etiology, pattern, and predictors of soft tissue and bony injuries.
MATERIALS AND METHODS
This study was conducted in the department of maxillofacial surgery Lady Reading hospital Pakistan from Jan 2019 to June 2021. The nonprobability consecutive sampling technique was used for the selection of patients. All patients were assessed clinically and radiologically. The neurosensory examination was done for any altered sensation, anesthesia, or paresthesia. Motor nerve function was also assessed clinically. Data were analyzed using SPSS version 26. The etiology and pattern of maxillofacial trauma were stratified among age and genders using the chi-square test to see effect modifiers. Tests for regression analysis were also applied. P≤0.05 was considered significant.
RESULTS
A total of 253 patients meeting inclusion criteria were included in this study. The majority of these patients were males, 223 (88.1%), while only 30 (11.9%) were females. The mean age for the group was 25.4 ± 12.6 years. RTAs were the most common causes of trauma (63.6%) followed by assault (15.0%), falls (11.5%), FAIs (5.9%), and sports (0.4%). The most vulnerable skeletal part was the mandible (22.9%) followed by Zygoma (7.1%), significantly predicted by RTAs. Soft tissue laceration analysis showed a high frequency of multiple lacerations (38%) significantly predicted by FAIs. The frequency of trigeminal nerve injury was 5.5% (14 patients) and that of the facial nerve was 1.6% (4 patients). The strongest association of nerve injury was with firearm injury (47%), followed by road traffic accidents and sports injuries.
CONCLUSION
Road traffic accident was the most common etiological factor and mandible fracture was commonly predicted by RTA. Trigeminal nerve injuries were common, frequency of nerve injuries was highly associated with mandible fracture and was predicted by FAI.
Topics: Adolescent; Adult; Causality; Child; Female; Firearms; Humans; Lacerations; Male; Mandibular Fractures; Maxillofacial Injuries; Trigeminal Nerve Injuries; Wounds, Gunshot; Young Adult
PubMed: 36174089
DOI: 10.1371/journal.pone.0275515 -
Pediatric Clinics of North America Dec 1993Although significant birth injury accounts for few neonatal deaths and stillborns in the United States, it still occasionally and unavoidably occurs. This article... (Review)
Review
Although significant birth injury accounts for few neonatal deaths and stillborns in the United States, it still occasionally and unavoidably occurs. This article reviews soft tissue, peripheral nerve, intrathoracic, and intra-abdominal injury.
Topics: Abdominal Injuries; Birth Injuries; Connective Tissue; Humans; Infant, Newborn; Peripheral Nerve Injuries
PubMed: 8255629
DOI: 10.1016/s0031-3955(16)38665-5 -
Journal of Plastic, Reconstructive &... May 2023Peripheral nerve injury (PNI) is a significant health problem that confers lifelong impact on those injured. Current interventions are purely surgical; however, outcomes...
UNLABELLED
Peripheral nerve injury (PNI) is a significant health problem that confers lifelong impact on those injured. Current interventions are purely surgical; however, outcomes remain poor. There is a lack of high-quality epidemiological data that is needed to identify populations involved, current healthcare demands, and ensure resources are distributed to the greatest effect, to reduce the injury burden.
METHODS
Anonymized hospital episode statistical (HES) data on admitted patient care was obtained from NHS Digital for all National Health Service (NHS) patients sustaining PNI of all body regions between 2005 and 2020. Total numbers of finished consultant episodes (FCEs) or FCEs/100,000 population were used to demonstrate changes in demographic variables, anatomical locations of injury, mechanisms of injury, speciality, and main operation.
RESULTS
There was a mean national incidence of 11.2 (95% CI 10.9, 11.6) events per 100,000 population per year. Males were at least twice as likely (p < 0.0001) to sustain a PNI. Upper limb nerves at or distal to the wrist were most commonly injured. Knife injuries increased (p < 0.0001), whereas glass injuries decreased (p < 0.0001). Plastic surgeons increasingly managed PNI (p = 0.002) as opposed to orthopaedic surgeons (p = 0.006) or neurosurgeons (p = 0.001). There was an increase in neurosynthesis (p = 0.022) and graft procedures (p < 0.0001) during the study period.
DISCUSSION
PNI is a significant national healthcare problem predominantly affecting distal, upper limb nerves of men of working age. Injury prevention strategies, improved targeted funding and rehabilitation pathways are needed to reduce the injury burden and improve patient care.
Topics: Male; Humans; Peripheral Nerve Injuries; Incidence; State Medicine; Peripheral Nerves; Upper Extremity
PubMed: 36996504
DOI: 10.1016/j.bjps.2023.02.017 -
International Journal of Molecular... Dec 2022Introduction-Recovery from peripheral nerve injuries is poor even though injured peripheral axons can regenerate. Novel therapeutic approaches are needed. The most...
Introduction-Recovery from peripheral nerve injuries is poor even though injured peripheral axons can regenerate. Novel therapeutic approaches are needed. The most successful preclinical experimental treatments have relied on increasing the activity of the regenerating axons, but the approaches taken are not applicable to many nerve-injured patients. Bioluminescent optogenetics (BL-OG) is a novel method of increasing the excitation of neurons that might be similar to that found with activity-dependent experimental therapies. We investigated the use of BL-OG as an approach to promoting axon regeneration following peripheral nerve injury. Methods-BL-OG uses luminopsins, light-sensing ion channels (opsins) fused with a light-emitting luciferase. When exposed to a luciferase substrate, such as coelenterazine (CTZ), luminopsins expressed in neurons generate bioluminescence and produce excitation through their opsin component. Adeno-associated viral vectors encoding either an excitatory luminopsin (eLMO3) or a mutated form (R115A) that can generate bioluminescence but not excite neurons were injected into mouse sciatic nerves. After retrograde transport and viral transduction, nerves were cut and repaired by simple end-to-end anastomosis, and mice were treated with a single dose of CTZ. Results-Four weeks after nerve injury, compound muscle action potentials (M waves) recorded in response to sciatic nerve stimulation were more than fourfold larger in mice expressing the excitatory luminopsin than in controls expressing the mutant luminopsin. The number of motor and sensory neurons retrogradely labeled from reinnervated muscles in mice expressing eLMO3 was significantly greater than the number in mice expressing the R115A luminopsin and not significantly different from those in intact mice. When viral injection was delayed so that luminopsin expression was induced after nerve injury, a clinically relevant scenario, evoked M waves recorded from reinnervated muscles were significantly larger after injury in eLMO3-expressing mice. Conclusions-Treatment of peripheral nerve injuries using BL-OG has significant potential to enhance axon regeneration and promote functional recovery.
Topics: Mice; Animals; Axons; Peripheral Nerve Injuries; Optogenetics; Nerve Regeneration; Neurons; Sciatic Nerve
PubMed: 36555724
DOI: 10.3390/ijms232416084 -
Toxins Jul 2020Botulinum neurotoxins (BoNTs) are toxins produced by the bacteria , the causing agent for botulism, in different serotypes, seven of which (A-G) are well characterized,... (Review)
Review
Botulinum neurotoxins (BoNTs) are toxins produced by the bacteria , the causing agent for botulism, in different serotypes, seven of which (A-G) are well characterized, while others, such as H or FA, are still debated. BoNTs exert their action by blocking SNARE (soluble N-ethylmale-imide-sensitive factor-attachment protein receptors) complex formation and vesicle release from the neuronal terminal through the specific cleavage of SNARE proteins. The action of BoNTs at the neuromuscular junction has been extensively investigated and knowledge gained in this field has set the foundation for the use of these toxins in a variety of human pathologies characterized by excessive muscle contractions. In parallel, BoNTs became a cosmetic drug due to its power to ward off facial wrinkles following the activity of the mimic muscles. Successively, BoNTs became therapeutic agents that have proven to be successful in the treatment of different neurological disorders, with new indications emerging or being approved each year. In particular, BoNT/A became the treatment of excellence not only for muscle hyperactivity conditions, such as dystonia and spasticity, but also to reduce pain in a series of painful states, such as neuropathic pain, lumbar and myofascial pain, and to treat various dysfunctions of the urinary bladder. This review summarizes recent experimental findings on the potential efficacy of BoNTs in favoring nerve regeneration after traumatic injury in the peripheral nervous system, such as the injury of peripheral nerves, like sciatic nerve, and in the central nervous system, such as spinal cord injury.
Topics: Animals; Botulinum Toxins; Brain Injuries; Central Nervous System Agents; Humans; Nerve Regeneration; Peripheral Nerve Injuries; Peripheral Nervous System Agents; Recovery of Function; Spinal Cord Injuries; Spinal Cord Regeneration
PubMed: 32630737
DOI: 10.3390/toxins12070434 -
Hand Clinics May 2017Heterotopic ossification (HO) presents a substantial barrier to rehabilitation for patients with severe burns or trauma. Although surgical excision is a mainstay of... (Review)
Review
Heterotopic ossification (HO) presents a substantial barrier to rehabilitation for patients with severe burns or trauma. Although surgical excision is a mainstay of management for this condition, this is unable to address the chronic sequelae of HO, including chronic pain, joint contractures, nerve dysfunction, and open wounds. Current therapeutic modalities are aimed at excision and the prevention of recurrence using nonsteroidal antiinflammatory drugs (NSAIDs) or radiation therapy. Research is now focused on identifying alternative strategies to prevent the initial occurrence of HO through NSAIDs and novel inhibitors of the bone morphogenetic protein signaling pathway.
Topics: Arm Injuries; Burns; Contracture; Elbow Joint; Humans; Joint Dislocations; Ossification, Heterotopic; Range of Motion, Articular
PubMed: 28363301
DOI: 10.1016/j.hcl.2016.12.013