Electrodiagnostic Evaluation of Traumatic Nerve Injuries

Carter, Gregory T.; Robinson, Lawrence R.; Chang, Victor H.; Kraft, George H.

doi:10.1016/s0749-0712(21)00497-2

Cited by 36 publications

(1 citation statement)

References 22 publications

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“…The reduction in amplitude observed in nerve conduction study indicates a decrease in the number of axons within the nerve responsible for innervating a specific muscle (Carter et al, 2000; Chung et al, 2014; Mallik, 2005; Tavee, 2019). According to the findings of our study, a reduction exceeding 80% in peak‐to‐peak amplitude in the NCS, along with the presence of R3 – R4 MURP in EMG, were more commonly observed in the lower and transverse portions than in the upper portion of the trapezius muscle following the SAN transfer procedure.…”

Section: Discussionmentioning

confidence: 99%

Functional and morphological evaluation of the trapezius muscle after spinal accessory nerve transfer to brachial plexus nerves

Simão,

Heise,

Rodrigues

et al. 2024

Microsurgery

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IntroductionThe main innervation of the trapezius muscle is provided by the spinal accessory nerve. Several studies describe the contributions of cervical plexus roots to the trapezius muscle innervation, either directly or through connections with the spinal accessory nerve. There is no adequate understanding of how the trapezius muscle is affected after using the spinal accessory nerve in nerve transfer procedures with the usual technique, preserving at least 1 branch for the upper trapezius.MethodsWe evaluated 20 patients with sequelae of traumatic brachial plexus injury who underwent surgical procedures for brachial plexus repair or free muscle transfer, which included the spinal accessory nerve transfer technique and were followed for a minimum of 1 year. The three portions trapezius muscle were evaluated by physical examination, magnetic resonance imaging (analysis of fatty degeneration) and electromyography.ResultsIn all evaluation methods, the middle and lower portions of the trapezius muscle showed more significant morphological and/or functional impairment than the upper portion, in most cases. There was a statistically significant difference in all the complementary exams results, between the affected side (with sacrifice of the nerve) versus the normal side, in the middle and lower portions of the trapezius muscle.ConclusionsPhysical examination alone is not sufficient to determine the residual functionality of the trapezius muscle. Magnetic resonance imaging and electromyography are useful tools to assess both morphological involvement of the trapezius muscle and nerve conduction impairment of the trapezius muscle, respectively. The results suggest that the middle and lower portions of the trapezius muscle are affected by previous SAN transfer and should be considered with caution for further muscle transfer procedures.

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Section: Discussionmentioning

confidence: 99%

Functional and morphological evaluation of the trapezius muscle after spinal accessory nerve transfer to brachial plexus nerves

Simão,

Heise,

Rodrigues

et al. 2024

Microsurgery

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Facial nerve regeneration through progesterone‐loaded chitosan prosthesis. A preliminary report

et al. 2003

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Biodegradable nerve guides have represented new treatment alternatives for nerve repairing. They are gradually biodegradable, exert biological effects directly to the injured nerve, and act as drug- or cell-delivery devices. Furthermore, progesterone (PROG) has been demonstrated to promote injured peripheral nerve regeneration. In this study, it was hypothesized that PROG delivered from chitosan prostheses provides better facial nerve regenerative response than chitosan prostheses with no PROG. As there are no reports on the use of the former as nerve-guide material in the regeneration of injured nerves, this is the main objective of the present work. Chitosan prostheses containing PROG were used to bridge 10-mm gaps in rabbit facial nerves. The regenerated nerves were evaluated 45 days after implantation in animals with the use of light microscopy and morphometric analysis. Gas chromatography was used in order to quantify PROG content in prosthesis prior to and after implantation in subcutaneous tissue at different periods of up to 60 days. In addition, the prosthesis walls were evaluated with histological techniques in order to assess their integrity and the surrounding tissue reaction. Chitosan prostheses allowed PROG release during the time needed for nerve regeneration. At 45 days myelinated nerve fibers were observed in both the proximal and distal stumps. This parameter and the N ratio were higher in the progesterone-treated group when compared to that of the vehicle control. Findings indicate that chitosan prostheses were useful in nerve regeneration, acting as a long-lasting PROG delivery device a faster nerve regeneration.

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Ultrastructural analysis of guided nerve regeneration using progesterone‐ and pregnenolone‐loaded chitosan prostheses

et al. 2005

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Recently, numerous guide chambers for the treatment of injured nerves made up of different biomaterials have been designed, capable of hosting living cells or carrying neurotrophic or neuroactive substances to be directly released to the injured tissue. In this study, chitosan prostheses containing neurosteroids (progesterone and pregnenolone) were used for bridging a 10-mm gap in the rabbit facial nerve. Gas chromatography was used to quantify neurosteroid content in the prostheses prior to and after subcutaneous implantation at different periods of up to 60 days. The regeneration of the nerve fibers were evaluated at 15 and 45 days after axotomy by means of ultrastructural morphometric analysis. Different nerve fibers regenerative patterns were seen depending the groups studied and the analyzed stages. At 15 days after axotomy, the newly regenerating tissue revealed Schwann cells holding nonmyelinated nerve fiber bundles in an incipient and organized regenerative pattern. At 45 days, the regenerating tissue showed myelinated nerve fibers of different sizes, shapes, and myelin sheath thickness. Although the regeneration of the nerve fibers under neurosteroid treatment showed statistically significant differences in comparison with vehicle regenerated tissue, progesterone-loaded chitosan prostheses produced the best guided nerve regeneration response. These findings indicate that chitosan prostheses allowed regeneration of nerve fibers in their lumen, and when containing neurosteroids produced a faster guided nerve regeneration acting as a long-lasting release delivery vehicle.

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Electrodiagnostic Evaluation of Traumatic Nerve Injuries

Cited by 36 publications

References 22 publications

Functional and morphological evaluation of the trapezius muscle after spinal accessory nerve transfer to brachial plexus nerves

Functional and morphological evaluation of the trapezius muscle after spinal accessory nerve transfer to brachial plexus nerves

Facial nerve regeneration through progesterone‐loaded chitosan prosthesis. A preliminary report

Ultrastructural analysis of guided nerve regeneration using progesterone‐ and pregnenolone‐loaded chitosan prostheses

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