An update on addressing important peripheral nerve problems: challenges and potential solutions

Abstract

From time to time it is thoughtful and productive to review a medical field and reflect upon what are the major issues that need to be addressed and what is being done to do so. This review article is not meant to be all-inclusive but rather focuses on four evolving areas in the field of peripheral nerve disorders and treatments: (1) nerve surgery under ultrasound guidance using a new ultra-minimally invasive thread technique; (2) evolving magnetic resonance imaging (MRI) and ultrasound imaging techniques that are helping to both diagnose and treat a variety of peripheral nerve problems including entrapment neuropathies, traumatic nerve injuries, and masses arising from nerves; (3) promoting recovery after nerve injury using electrical stimulation; and (4) developing animal models to reproduce a severe nerve injury (neurotmetic grade in continuity) that requires a surgical intervention and repair. In each area we first describe the current challenges and then discuss new and emerging techniques and approaches. It is our hope that this article will bring added attention and resources to help better address peripheral nerve problems that remain a challenge for both patients and physicians.

Minimally invasive thread trigger digit release: a preliminary report on 34 digits of the adult hands

“…Recently, an ultrasound-guided minimally invasive procedure, the thread transecting technique, has been applied to carpal tunnel release by transecting the transverse carpal ligament with thread percutaneously looped around the structure under ultrasound guidance (Burnham et al, 2017;Guo et al 2015Guo et al , 2016Guo et al , 2017Ray et al, 2017). The technique ensures that only structures inside the loop of thread are divided.…”

Etiology Diagnosis and Management of Radial Nerve Entrapment

“…An advantage of MR imaging over the US is the higher soft-tissue contrast while reducing user variability (11). Additionally, resolving images have improved with high-resolution MR imaging, which allows the distinction between normal nerves and those with pathologies (12). In summation, more than one diagnostic test would likely be required to accurately diagnose most entrapment radial nerve entrapment syndromes.…”

“…The peripheral nerve stimulation with an implanted device is a relatively new and proven effective treatment modality (12,(25)(26)(27). This device is inserted under US guidance.…”

Effect of Local Administration of Voltage-Gated Calcium Channels Blocker (Gallopamil) Combined with Silicon Conduit on Transected Sciatic Nerve

“…Thereafter, the proximal stump gradually regrows, fostered by the neural cell surface molecule of the transmembrane glycoprotein Ll, nerve cell adhesion molecule (N-CAM), myelinassociated glycoprotein PO, and the extracellular matrix components laminin and tenascin [20]. The regenerating axons are guided by the Schwann cell processes and their growth within the Schwann cell basal lamina tubes is synchronous with the withdrawal and degeneration of the axonal remnants of the distal stump [1,20].…”

“…After an initial delay, which is necessary for the cell bodies to compensate for the retrograde effects of axonal transection, the regenerating axonal sprouts cross the site of injury, reach the distal stump, and grow down the nerve to their peripheral terminations [1]. The conduits act to guide axons sprouting from the regenerating nerve end, provide a microenvironment for diffusion of neurotrophic and neurotropic factors secreted by the injured nerve stump, as well as help protect from infiltration of fibrous tissue [2].…”