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Acta Cirurgica Brasileira 2021To evaluate the influence of mesenchymal stem cells from adipose tissue in the end-to-side neurorrhaphy, focusing in the nerve regeneration and the muscle reinnervation...
PURPOSE
To evaluate the influence of mesenchymal stem cells from adipose tissue in the end-to-side neurorrhaphy, focusing in the nerve regeneration and the muscle reinnervation in acute trauma.
METHODS
140 animals were randomly divided in seven groups: control, denervated, end-to-side neurorrhaphy between distal stump of common peroneal nerve and tibial nerve (ESN), ESN wrapped in fascia, ESN wrapped in fascia and platelet gel, ESN wrapped in platelet gel, ESN wrapped in fascia and platelet gel within stem cells (without culture) removed from the adipose tissue. Mass measurements of the animal and of cranial tibial muscles, electromyography, walking track analysis tests and histological examinations of the nerves and muscles after 180 days was performed.
RESULTS
In the groups where the ESN was performed, the results were always better when compared to the denervated group, showing reinnervation in all ESN groups. The most sensitive methods were walking track and histological analysis. Only the group with stem cells showed values similar to the control group, as well as the functional indices of peroneal nerve and the number of nerve fibers in the peroneal nerve.
CONCLUSIONS
Stem cells were effective in ESN according with the functional index of the peroneal nerve, evaluated by walking track analysis and the number of nerve fibers in the peroneal nerve.
Topics: Animals; Muscle, Skeletal; Nerve Regeneration; Neurosurgical Procedures; Peroneal Nerve; Rats; Stem Cells; Tibial Nerve
PubMed: 33503220
DOI: 10.1590/ACB351207 -
Neurologia Medico-chirurgica Aug 2023Impingement of the common peroneal nerve, a branch of the L5 nerve root, causes common peroneal nerve entrapment neuropathy (CPNE). Although there are cases of CPNE...
Impingement of the common peroneal nerve, a branch of the L5 nerve root, causes common peroneal nerve entrapment neuropathy (CPNE). Although there are cases of CPNE associated with L5 radiculopathy, surgical intervention's effectiveness remains to be elucidated. This retrospective case-control study aimed to evaluate the efficacy of surgery in patients with CPNE associated with L5 radiculopathy. Twenty-two patients (25 limbs) with surgically treated CPNE between 2015 and 2022 were retrospectively reviewed. The limbs were classified into two groups: group R (limbs of CPNE associated with L5 radiculopathy) and group O (limbs of CPNE without L5 radiculopathy). The durations from onset to surgery, the nerve conduction studies (NCSs), and postoperative improvement rates for motor weakness, pain, and dysesthesia were compared between the groups. Group R included 15 limbs (13 patients), and group O included 10 limbs (9 patients). There were no significant differences in the duration from onset to surgery or abnormal findings of NCS between the two groups. The postoperative improvement rates were 88% and 100% (p = 0.62) for muscle weakness, 87% and 80% (p = 0.53) for pain, and 71% and 56% (p = 0.37) for dysesthesia in group R and group O, respectively, without significant differences between groups. CPNE associated with L5 radiculopathy is common, and the results of the present study showed that the surgical outcomes in such cases were satisfactory and comparable to those in CPNE without L5 radiculopathy.
Topics: Humans; Radiculopathy; Retrospective Studies; Case-Control Studies; Peroneal Neuropathies; Paresthesia; Treatment Outcome; Pain; Peroneal Nerve; Nerve Compression Syndromes
PubMed: 37286483
DOI: 10.2176/jns-nmc.2022-0313 -
Journal of Rehabilitation Medicine Aug 2023Impaired ankle dorsiflexion in hemiparesis may be treated with ankle-foot orthosis or functional electrical stimulation. Semi-implanted selective functional electrical... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Impaired ankle dorsiflexion in hemiparesis may be treated with ankle-foot orthosis or functional electrical stimulation. Semi-implanted selective functional electrical stimulation uses independent stimulations of deep and superficial peroneal nerves. The aim of this study was to compare gait kinematics using ankle-foot orthosis or semi-implanted selective functional electrical stimulation over 6 months in hemiparesis.
METHODS
Subjects with chronic hemiparesis, randomized into ankle-foot orthosis or semi-implanted selective functional electrical stimulation groups, underwent comfortable gait analysis without and with device OFF and ON, before, and 3 and 6 months after treatment onset. The effects of condition, visit and group on gait kinematics (analysis of variance; ANOVA) were analysed.
RESULTS
A total of 27 subjects were included (ankle-foot orthosis, n = 13; semi-implanted selective functional electrical stimulation, n = 14). The only between-group difference in changes from OFF to ON conditions was a deteriorated ankle dorsiflexion speed with ankle-foot orthosis at month 6 (condition*group, p = 0.04; ankle-foot orthosis, -60%, p = 0.02; semi-implanted selective functional electrical stimulation, non significant). Both groups pooled, from OFF to ON gait speed (+ 0.07 m/s; + 10%), cadence (+ 4%), step length (+ 6%) and peak ankle dorsiflexion (+ 6°) increased, and peak ankle inversion (-5°) and peak knee flexion (-2°) decreased (p < 0.001); finally, peak knee flexion in the OFF condition increased (+ 2°, p = 0.03).
CONCLUSION
Semi-implanted selective functional electrical stimulation and ankle-foot orthosis similarly impacted gait kinematics in chronic hemiparesis after 6 months of use. Ankle dorsiflexion speed in swing deteriorated markedly with ankle-foot orthosis.
Topics: Humans; Ankle; Foot Orthoses; Peroneal Nerve; Biomechanical Phenomena; Treatment Outcome; Gait; Paresis; Gait Disorders, Neurologic
PubMed: 37548420
DOI: 10.2340/jrm.v55.7130 -
Journal of Acupuncture and Meridian... Aug 2014Acupuncture has been practiced in China for over 2000 years to treat a variety of diseases based on the "meridian theory" as described in the Yellow Emperor's Classic of... (Review)
Review
Acupuncture has been practiced in China for over 2000 years to treat a variety of diseases based on the "meridian theory" as described in the Yellow Emperor's Classic of Internal Medicine. To this date, the meridian theory continues to be an important guide for traditional Chinese medicine practitioners to diagnose and treat patients. Although the meridians have not been identified reliably as actual anatomical structures, they appear to serve as a road map to identify the location of various acupoints. Research has shown that acupoints overlie major neuronal bundles. The meridians extensively studied in the cardiovascular realm are the pericardial meridians (P) 5, 6, which overlie the deep median nerve. Meridians involved with gastrointestinal processes are (St) 36, 37, which overlie the deep peroneal nerve. Acupuncture needles, either manipulated manually or stimulated using a low current and frequency, have been documented to be a neurophysiological basis for modulating the activity of peripheral and central neural pathways. This review describes our current understanding of acupoints and meridians from a physiological aspect.
Topics: Acupuncture; Acupuncture Points; Acupuncture Therapy; Humans; Median Nerve; Medicine, Chinese Traditional; Meridians; Neural Pathways; Peroneal Nerve
PubMed: 25151452
DOI: 10.1016/j.jams.2014.02.007 -
European Journal of Vascular and... Aug 2016
Commentary on 'Lateral Fasciectomy Sparing the Superficial Peroneal Nerve with Simultaneous Mesh Graft in Non-Healing Lateral Ulcers of Diverse Vascular Origins: Surgical Technique, Short- and Long-term Results from 44 Legs'.
Topics: Fascia; Fasciotomy; Humans; Leg; Peroneal Nerve; Ulcer
PubMed: 27321550
DOI: 10.1016/j.ejvs.2016.05.017 -
Human Vaccines & Immunotherapeutics Dec 2023
Topics: Humans; Ganglion Cysts; Peroneal Nerve; COVID-19; Magnetic Resonance Imaging
PubMed: 37941376
DOI: 10.1080/21645515.2023.2278357 -
Journal of Neurophysiology Feb 2022Motor responses in one leg to sensory stimulation of the contralateral leg have been named "crossed reflexes" and are extensively investigated in cats and humans....
Motor responses in one leg to sensory stimulation of the contralateral leg have been named "crossed reflexes" and are extensively investigated in cats and humans. Despite this effort, a circuit-level understanding of the crossed reflexes has remained missing. In mice, advances in molecular genetics enabled insights into the "commissural spinal circuitry" that ensures coordinated leg movements during locomotion. Despite some common features between the commissural spinal circuitry and the circuit for the crossed reflexes, the degree to which they overlap has remained obscure. Here, we describe excitatory crossed reflex responses elicited by electrically stimulating the common peroneal nerve that mainly innervates ankle flexor muscles and the skin on anterolateral aspect of the hind leg. Stimulation of the peroneal nerve with low current intensity evoked low-amplitude motor responses in the contralateral flexor and extensor muscles. At higher current strengths, stimulation of the same nerve evoked stronger and more synchronous responses in the same contralateral muscles. In addition to the excitatory crossed reflex pathway indicated by muscle activation, we demonstrate the presence of an inhibitory crossed reflex pathway, which was modulated when the motor pools were active during walking. The results are compared with the crossed reflex responses initiated by stimulating proprioceptors from extensor muscles and cutaneous afferents from the posterior part of the leg. We anticipate that these findings will be essential for future research combining the in vivo experiments presented here with mouse genetics to understand crossed reflex pathways at the network level in vivo. Insights into the mechanisms of crossed reflexes are essential for understanding coordinated leg movements that maintain stable locomotion. Advances in mouse genetics allow for the selective manipulation of spinal interneurons and provide opportunities to understand crossed reflexes. Crossed reflexes in mice, however, are poorly described. Here, we describe crossed reflex responses in mice initiated by stimulation of the common peroneal nerve, which serves as a starting point for investigating crossed reflexes at the cellular level.
Topics: Animals; Behavior, Animal; Electric Stimulation; Feedback, Sensory; Hindlimb; Locomotion; Mice; Muscle, Skeletal; Peroneal Nerve; Reflex
PubMed: 34986055
DOI: 10.1152/jn.00385.2021 -
PloS One 2014The peroneal nerve anatomy of the rabbit distal hindlimb is similar to humans, but reports of distal peroneal nerve conduction studies were not identified with a...
The peroneal nerve anatomy of the rabbit distal hindlimb is similar to humans, but reports of distal peroneal nerve conduction studies were not identified with a literature search. Distal sensorimotor recordings may be useful for studying rabbit models of length-dependent peripheral neuropathy. Surface electrodes were adhered to the dorsal rabbit foot overlying the extensor digitorum brevis muscle and the superficial peroneal nerve. The deep and superficial peroneal nerves were stimulated above the ankle and the common peroneal nerve was stimulated at the knee. The nerve conduction studies were repeated twice with a one-week intertest interval to determine measurement variability. Intravenous vincristine was used to produce a peripheral neuropathy. Repeat recordings measured the response to vincristine. A compound muscle action potential and a sensory nerve action potential were evoked in all rabbits. The compound muscle action potential mean amplitude was 0.29 mV (SD ± 0.12) and the fibula head to ankle mean motor conduction velocity was 46.5 m/s (SD ± 2.9). The sensory nerve action potential mean amplitude was 22.8 μV (SD ± 2.8) and the distal sensory conduction velocity was 38.8 m/s (SD ± 2.2). Sensorimotor latencies and velocities were least variable between two test sessions (coefficient of variation = 2.6-5.9%), sensory potential amplitudes were intermediate (coefficient of variation = 11.1%) and compound potential amplitudes were the most variable (coefficient of variation = 19.3%). Vincristine abolished compound muscle action potentials and reduced sensory nerve action potential amplitudes by 42-57% while having little effect on velocity. Rabbit distal hindlimb nerve conduction studies are feasible with surface recordings and stimulation. The evoked distal sensory potentials have amplitudes, configurations and recording techniques that are similar to humans and may be valuable for measuring large sensory fiber function in chronic models of peripheral neuropathies.
Topics: Action Potentials; Animals; Disease Models, Animal; Evoked Potentials; Female; Hindlimb; Neural Conduction; Peripheral Nervous System Diseases; Peroneal Nerve; Rabbits
PubMed: 24658286
DOI: 10.1371/journal.pone.0092694 -
International Journal of Molecular... Jan 2021Thousands of people worldwide suffer from peripheral nerve injuries and must deal daily with the resulting physiological and functional deficits. Recent advances in this...
Thousands of people worldwide suffer from peripheral nerve injuries and must deal daily with the resulting physiological and functional deficits. Recent advances in this field are still insufficient to guarantee adequate outcomes, and the development of new and compelling therapeutic options require the use of valid preclinical models that effectively replicate the characteristics and challenges associated with these injuries in humans. In this study, we established a sheep model for common peroneal nerve injuries that can be applied in preclinical research with the advantages associated with the use of large animal models. The anatomy of the common peroneal nerve and topographically related nerves, the functional consequences of its injury and a neurological examination directed at this nerve have been described. Furthermore, the surgical protocol for accessing the common peroneal nerve, the induction of different types of nerve damage and the application of possible therapeutic options were described. Finally, a preliminary morphological and stereological study was carried out to establish control values for the healthy common peroneal nerves regarding this animal model and to identify preliminary differences between therapeutic methods. This study allowed to define the described lateral incision as the best to access the common peroneal nerve, besides establishing 12 and 24 weeks as the minimum periods to study lesions of axonotmesis and neurotmesis, respectively, in this specie. The post-mortem evaluation of the harvested nerves allowed to register stereological values for healthy common peroneal nerves to be used as controls in future studies, and to establish preliminary values associated with the therapeutic performance of the different applied options, although limited by a small sample size, thus requiring further validation studies. Finally, this study demonstrated that the sheep is a valid model of peripheral nerve injury to be used in pre-clinical and translational works and to evaluate the efficacy and safety of nerve injury therapeutic options before its clinical application in humans and veterinary patients.
Topics: Animals; Disease Models, Animal; Female; Hindlimb; Humans; Peripheral Nerve Injuries; Peroneal Nerve; Sheep
PubMed: 33573310
DOI: 10.3390/ijms22031401 -
Foot & Ankle International Sep 2021Anatomic and clinical studies show many variants of the superficial peroneal nerve (SPN) course and branching within the compartments and at the suprafascial layer. The...
BACKGROUND
Anatomic and clinical studies show many variants of the superficial peroneal nerve (SPN) course and branching within the compartments and at the suprafascial layer. The anatomy of the transition zone from the compartment to the subcutaneous layer has been occasionally described in the literature, mainly in studies reporting the intraseptal SPN variant in 6.6% to 13.6% of patients affected by the SPN entrapment syndrome. Despite the little evidence available, the knowledge of the transition zone is relevant to avoid iatrogenic lesions to the SPN during fasciotomy, open approaches to the leg and ankle, and SPN decompression. Our anatomic study aimed to describe the SPN transition site and to evaluate the occurrence of a peroneal tunnel and of an intraseptal SPN variant.
METHODS
According to the institutional ethics committee requirements, 15 fresh-frozen lower limbs were dissected to study the SPN course and its branching, focusing on the transition site to the suprafascial layer.
RESULTS
The SPN was located in the anterior compartment in 2 cases and in the lateral in 13. An intraseptal tunnel was present in 10 legs (66%), at a mean distance of 10.67 cm from the lateral malleolus. Its mean length was 2.63 cm. The tunnel allowed the passage of the main SPN in 8 cases and of its branches in two. In the remaining 5 legs (33%), the SPN pierced a crural fascia window.
CONCLUSION
In our sample a higher rate than expected of intraseptal SPN variants was found.
CLINICAL RELEVANCE
The knowledge of the anatomy of the SPN course and intraseptal variant is relevant to avoid iatrogenic lesions during operative dissection. Further studies are needed to evaluate the effective prevalence of an intraseptal tunnel, independently from the SPN entrapment syndrome, and how to avoid associated iatrogenic complications.
Topics: Ankle; Cadaver; Fasciotomy; Humans; Leg; Peroneal Nerve
PubMed: 34151593
DOI: 10.1177/10711007211002508