Selective damage of large diameter peripheral nerve fibers by compression: An application of Laplace's Law

Strain, Richard E.; Olson, William H.

doi:10.1016/0014-4886(75)90237-x

Cited by 32 publications

(9 citation statements)

References 11 publications

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“…However, it has been estimated that the accuracy of EDT for diagnosing CTS is not defi nite (approximately 80-90%) [17,[24][25][26]. With respect to Laplace's law, it is believed that the principal sensory fi bres injured in compressive neuropathies are small and cannot be reliably evaluated with EDT [27]. In fact, EDT is more a diagnostic tool to evaluate large myelinated nerve fi bres rather than small nonmyelinated ones [28,29].…”

Section: Discussionmentioning

confidence: 99%

The ultrasonographic correlates of carpal tunnel syndrome in patients with normal electrodiagnostic tests

et al. 2011

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Section: Discussionmentioning

confidence: 99%

The ultrasonographic correlates of carpal tunnel syndrome in patients with normal electrodiagnostic tests

et al. 2011

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“…5 and 9, and Jose L. Ochoa, personal communication). Others, accepting the role of mechanical injury to fibers from compression, explained the selective involvement of largediameter fibers, especially at the edges of the cuff, by the expected greater effect of shear forces on cylinders of large size (19). Making the leg ischemic before and during compressing the nerve with a ligature did not appear to produce more severe conduction block or pathologic abnormality than when the nerve was similarly compressed without having made the leg ischemic (20)-further evidence that ischemia is unlikely to be responsible for the structural nerve alterations.…”

Section: Resultsmentioning

confidence: 99%

“…Whereas expression of endoneurial fluid is rapid, expression of fluid from axoplasm or of axoplasm itself is slow because of the higher viscosity of axoplasm (22) than of endoneurial fluid and the resistance to fluid movement in small-caliber cylinders (19); additional factors (e.g., presence of cytoskeletal network) may account for worsening with pressure and time. These results are not unexpected since the severity of conduction block in caudal nerve of rat is known to be longer with greater pressure and duration of compression (23).…”

Section: Resultsmentioning

confidence: 99%

Structural alterations of nerve during cuff compression.

Dyck

Lais

Giannini

et al. 1990

Proc. Natl. Acad. Sci. U.S.A.

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Whether compression nerve injury is due to ischemia, direct mechanical injury, or both remains unsettled. To assess structural changes of nerve during compression, peroneal nerves of rats were compressed at various pressures for different times, and the structural alterations were stopped by simultaneous in situ and perfusion fixation. The structural changes observed during a few minutes of compression cannot be explained by ischemic injury because the pathologic alterations characteristic of ischemia take many hours to develop and in any case are different from the ones found here. The pressure-and time-related structural changes observed in the present study under the cuffwere (i) decrease in fascicular area and increase in fiber density due to expression of endoneurial fluid; (i) compression and expression of axoplasm, sometimes to the point of fiber transection; (iii) lengthening of internodes; and (iv) obscuration of nodes of Ranvier due to cleavage and displacement of myelin and overlapping of nodes by displaced loops of myelin. At the edges of the cuff the changes were (i) increase of fascicular area probably from expressed endoneurial fluid; (ii) widening of nodal gaps, perhaps mainly from translocated axonal fluid; and (iii) disordered structure of axoplasm. We suggest that the process of paranodal demyelination and axonal transection are linked, occur during the act of compression, and are due to shear forces. The initial event is expression of endoneurial fluid, followed by compression and expression of axoplasm and cleavage and displacement oflayers of myelin. Conceivably, with prolonged cuff compression ischemic injury might be found to be superimposed on mechanical injury.In humans, nerve compression injury may follow use of a tourniquet at too high a pressure, for too long a time, or from improper application; lying in one position without moving for a long time (as may occur during anesthesia, inebriation, or coma) with a limb nerve compressed against bone by a protruding ridge or hard surface; or prolonged sitting with the legs crossed or prolonged leaning on the elbows (1, 2). Excellent recovery is expected after compression injury, whereas it is usually delayed and faulty after nerve transection. This difference in outcome is usually explained by conduction block and demyelination in the former and complete fiber degeneration and faulty regeneration in the latter (3-5).The mechanisms underlying nerve compression injury have usually been attributed to ischemia (6-8), to mechanical forces (9), or to both.In the present study the structural alterations of nerve during compression were stopped by simultaneous in situ and perfusion fixation, usually during short periods of compression. We found nodal lengthening and other acute structural changes after only a few minutes of compression, which appear to explain the paranodal demyelination and axonal degeneration that are characteristic of nerve compression injury. The structural alterations that develop during acute compression are different...

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“…The composition of the rat sciatic nerve has been relatively well studied and morphometric parameters for myelinated fibers, such as fascicle area (Podhajsky and Myers, 1993;Di Benedetto et al, 1998), fiber count (Jenq and Coggeshall, 1985a,b;Jenq et al, 1986;Schmalbruch, 1986;Rodrıguez et al, 2000;Ceballos et al, 2002;Rafiuddin Ahmed and Jayakumar, 2003;Lago et al, 2005Lago et al, , 2007Prodanov and Feirabend, 2007), fiber density (number of myelinated fibers per fascicle unit area) (De Angelis et al, 1994;Rodrıguez et al, 2000;Mazzer et al, 2008), fiber packing (the percent of the fascicular area occupied by myelinated fibers) (Koller et al, 1992), mean fiber diameter (Le Beau et al, 1988;Koller et al, 1992;De Angelis et al, 1994;Di Benedetto et al, 1998;Prodanov and Feirabend, 2007), fiber diameter distributions (Strain and Olson, 1975;Schmalbruch, 1986;Wehling et al, 1992;Rodrıguez et al, 2000;Prodanov and Feirabend, 2007;Mazzer et al, 2008), and mean g-ratio (Adhami et al, 1976;De Angelis et al, 1994;Di Benedetto et al, 1998;Rodrıguez et al, 2000;Rafiuddin Ahmed and Jayakumar, 2003;Mazzer et al, 2008) or g-ratio distributions (Mazzer et al, 2008), have been described (Table 1). It is important to recognize that such data have been collected from multiple strains and from rats of varying ages, variables whose influence on morphometric parameters have not been exami...…”

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confidence: 99%

Differences Exist in the Left and Right Sciatic Nerves of Naïve Rats and Cats

Christensen

Tresco

2015

The Anatomical Record

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The sciatic nerve of rats and cats is commonly used in experimental models of peripheral nerve injury and repair, as well as experiments involving peripheral nerve electrode implantation. In such experiments, morphometric parameters from the implanted nerve are commonly evaluated and compared to control values obtained from the contralateral nerves. However, this may not be an appropriate approach as differences may naturally exist in the structure of the two nerves owing to developmental or behavioral asymmetry. Additionally, in the cat, baseline values for standard morphometric parameters are not well established. In this study, we characterized fascicle area, fiber count, fiber density, fiber packing, mean g-ratio, and fiber diameter distributions in the rat and cat, as well as investigated the potential for naturally occurring sided differences in these parameters in both species. We also investigated whether animal age or location along the nerve influenced these parameters. We found that sided or left/right leg differences exist in some parameters in both the rat and the cat, calling into question the validity of using the contralateral nerve as a control. We also found that animal age and location along the nerve can make significant differences in the parameters tested, establishing the importance of using control nerves from age-and behaviorally matched animals whose morphometric parameters are collected and compared from the same location. Anat Rec, 298:1492Rec, 298: -1501Rec, 298: , 2015. V C 2015 Wiley Periodicals, Inc.

show abstract

Selective damage of large diameter peripheral nerve fibers by compression: An application of Laplace's Law

Cited by 32 publications

References 11 publications

The ultrasonographic correlates of carpal tunnel syndrome in patients with normal electrodiagnostic tests

The ultrasonographic correlates of carpal tunnel syndrome in patients with normal electrodiagnostic tests

Structural alterations of nerve during cuff compression.

Differences Exist in the Left and Right Sciatic Nerves of Naïve Rats and Cats

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