Axonal and extracellular matrix responses to experimental chronic nerve entrapment

Prinz, Rafael Augusto Dantas; Nakamura‐Pereira, Marcos; De-Ary-Pires, Bernardo; Fernandes, Daniel S.; Fabião-Gomes, Bárbara Daphne Souza Valle; Martínez, Ana Maria Blanco; Ary-Pires, Ricardo de; Pires-Neto, Mário Ary

doi:10.1016/j.brainres.2005.02.085

Cited by 14 publications

(10 citation statements)

References 64 publications

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“…It has been shown experimentally that chronic nerve compression leads to endoneurial oedema, perineurial and endoneurial thickening and to other ultrastructural changes (Prinz et al, 2005), with consequent nerve enlargement. In CTS, the swelling of the nerve at the tunnel inlet has been very early recognized as a consistent sign of compression within the tunnel (Buchberger et al, 1991) and has become the mainstay for the ultrasonographic diagnosis of CTS (Cartwright et al, 2012;Tai et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

The significance of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome

Csillik

Bereczki

Bora³

et al. 2016

Clinical Neurophysiology

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). The sponsor had no direct involvement in the collection, analysis and interpretation of data and in the preparation of the manuscript. 2 HIGHLIGHTS Median nerve enlargement in CTS is significantly greater at the tunnel outlet than at the inlet  It is postulated that pressure progressively increases from proximal to distal within the tunnel  The addition of outlet measurements increases diagnostic sensitivity and accuracy of CTS 3 ABSTRACT Objective: A retrospective study to investigate the utility of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome (CTS).Methods: 118 hands of 87 patients with electrophysiologically confirmed CTS and 44 control hands of 23 subjects were assessed. Cross-sectional areas (CSA) of the median nerve were measured at the tunnel inlet, outlet, and forearm. Longitudinal diameters (LAPD) were measured at the inlet, proximal tunnel, distal tunnel, and outlet.Results: CSA at the outlet (median: 18 mm 2 ) and its palm-to-forearm-ratio (median: 2.7) were significantly larger than CSA at the inlet (median: 15 mm 2 ) and its wrist-to-forearm-ratio (median: 2.2) (p <0.001). 27% of the hands showed enlargement only at the outlet versus 13% only at the inlet.LAPD jump was significantly greater, suggesting relief of higher pressure, at the outlet / distal tunnel versus inlet / proximal tunnel (p <0.001). Conclusion:Median nerve enlargement in CTS is greater at the tunnel outlet than at the inlet. We postulate that this is explained by the progressive increase of pressure within the tunnel from proximal to distal.Significance: The addition of outlet measurements to inlet measurements increased sensitivity and accuracy of the ultrasonographic diagnosis of CTS by 15% and 10%, respectively.

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Section: Discussionmentioning

confidence: 99%

The significance of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome

Csillik

Bereczki

Bora³

et al. 2016

Clinical Neurophysiology

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“…The biologic response to nerve compression consists of a cascade of pathologic changes, to include thickening of the walls of endoneurial and perineurial microvessels; thickening of the endoneurium because of edema; an increase in the amount of connective tissue; and later, thickening of the epineurium and perineurium due to fibrosis and edema. 18,19 Correlating with these pathologic changes, abnormal ultrasound findings in compressive neuropathies include an increased cross-sectional area, loss of normal echotexture, and increased nerve vascularity. In a 2011 systemic review, 20 the authors found 7 of 11 clinical trials of HRS in UNE suitable for further analysis.…”

Section: Utility Of Short Segment Studies Has Been Validatedmentioning

confidence: 99%

Ulnar neuropathy at the elbow

2015

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Ulnar neuropathy at the elbow (UNE) is the second most frequent compression neuropathy. While other diagnostic imaging tools are emerging to assist in the diagnosis of UNE, electrodiagnosis remains the gold standard. However, the electrodiagnostic approach to UNE presents unique challenges limiting its diagnostic accuracy. We review advances in 5 areas relevant to the diagnosis of UNE: technologic advancements with modern EMG machines have allowed for reconsideration of the question of experimental error and lesion detection; how temperature effects can lead to misdiagnosis; the effect of body mass index on the electrodiagnosis of UNE; the validation of short segment studies; and the emerging role of high-resolution sonography as a diagnostic tool.

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“…More than 120 years ago, Renaut himself thought they may act as ‘supportive and protective cushions’ for the nerve ( Renaut, 1881; 1899 ) , yet their precise function remains unknown. They may represent a secondary reaction to trauma because mechanical factors have been linked with their development ( Neary et al, 1975; Ortman et al, 1983; Mackinnon et al, 1986; Prinz et al, 2003; 2005 ) .…”

Section: Introductionmentioning

confidence: 99%

Immunohistochemical characterization of Renaut bodies in superficial digital nerves: further evidence supporting their perineurial cell origin

Piña‐Oviedo

Valle

Baquera-Heredia

et al. 2009

J Peripheral Nervous Sys

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Renaut bodies are well-demarcated cylindrical (circular in cross section) hyaline structures attached to the inner layer of the perineurium that can be found in normal and pathological nerves of various animals and humans. They are composed of spidery fibroblasts and perineurial cells immersed in an extracellular matrix that contains randomly oriented collagen fibers and elastin precursors but not axons or Schwann cells. Frequently, they are associated with thickened subperineurial capillaries. As Renaut bodies are mainly located at sites of nerve compression, it is hypothesized they may act as 'protective cushions' for endoneurial components, and that they may be formed as a secondary reaction to trauma. Herein, we report the presence of Renaut bodies within numerous small dermal nerve trunks in an amputated finger. By immunohistochemistry, Renaut bodies expressed markers identical to those of perineurial cells (epithelial membrane antigen, Glut-1, and claudin-1), supporting the concept of a closely associated perineurial but not endoneurial origin. In addition, expression of hypoxia-inducible factor 1 alpha (which has been shown to increase Glut-1 transcription), neurofibromatosis 1 gene related product and NF-2, were also detected in these peripheral nerve structures.

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Axonal and extracellular matrix responses to experimental chronic nerve entrapment

Cited by 14 publications

References 64 publications

The significance of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome

The significance of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome

Ulnar neuropathy at the elbow

Immunohistochemical characterization of Renaut bodies in superficial digital nerves: further evidence supporting their perineurial cell origin

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