Nerves and Nerve Injuries

Sunderland, Sidney; Smith, James W.

doi:10.1097/00006534-196912000-00013

Cited by 307 publications

(542 citation statements)

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“…The individual fascicles are embedded in the epineurium and surrounded by the perineurium. In addition to its protective mechanical function, the high degree of vascularization of this mantle contributes to the metabolism of the peripheral nerve [29,41,42]. Several authors [9,25] have described deformations of the nerve fascicle and their occurrence in the range of an exerted pressure of 30-50 mmHg, which is consistent with our observations.…”

Section: Discussionsupporting

confidence: 91%

Topographic relations between the neural and ligamentous structures of the lumbosacral junction: in-vitro investigation

2001

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Section: Discussionsupporting

confidence: 91%

Topographic relations between the neural and ligamentous structures of the lumbosacral junction: in-vitro investigation

2001

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“…With increasing tension, cross-sectional area is reduced, leading to increased intrafascicular pressure and disrupted perfusion. Increasing strain further caused disruption of the microarchitecture, most notably of the perineurium, which leads to protein leak into the fascicles and resultant fibrosis, irreversibly hindering nerve function [28,40].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Operative Technique on Ulnar Nerve Strain following Surgery for Cubital Tunnel Syndrome

Mitchell

Dunn

Kusnezov

et al. 2015

Hand (New York, N,Y.)

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Background The aim of this study is to compare the amount of strain on the ulnar nerve based on elbow position after in situ release, subcutaneous transposition, submuscular transposition, and medial epicondylectomy. Methods Six matched cadaver upper extremity pairs underwent ulnar nerve decompression, transposition in a sequential fashion, while five elbows underwent medial epicondylectomy. A differential variable reluctance transducer (DVRT) was placed in the ulnar nerve. An in situ release, a subcutaneous transposition, and a submuscular transposition were performed sequentially with the strain being measured after each procedure in neutral, full elbow flexion, and extension positions. The strain was then averaged and compared for each procedure. Five cadavers underwent medial epicondylectomy and were similarly tested. Results After the in situ release, there was no statistically significant change in strain in either flexion or extension. After a subcutaneous transposition, there was a statistically significant decrease in strain in full elbow flexion but not in extension. Similarly after a submuscular transposition, there was a statistically significant decrease in strain in full flexion but not in extension. There was not a statistically significant change in strain with medial epicondylectomy.Conclusion An in situ release of the ulnar nerve at the elbow may relieve pressure on the nerve but does not address the problem of strain which may be the underlying pathology in many cases of ulnar neuropathy at the elbow (UNE). Transposition of the ulnar nerve anterior to the medial epicondyle addresses the problem of strain on the ulnar nerve. In addition, it does not create an increased strain on the ulnar nerve with elbow extension.

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“…In these cases, there is Wallerian degeneration of the axons beginning at the node of Ranvier immediately proximal to the site of injury, often in the geniculate ganglion, and proceeding distally. 7 While the neuronal cell bodies usually remain viable, the axons must resprout, each one extending multiple growth cones and attempting to reestablish continuity with its target muscle. The large number of growth cones, travelling down a nerve trunk designed for only 7,000 fibers, often will result in misrouting and multiply terminal axons.…”

Section: Discussionmentioning

confidence: 99%