Clinical and user-friendly classification of traumatic digital nerve injuries of hand

Incidence of nerve injury following acupuncture treatments in Taiwan

OBJECTIVE

Acupuncture, a widely employed traditional therapeutic modality known for its efficacy in pain alleviation and diverse condition management, may inadvertently result in mechanical nerve injury due to its invasive nature. This research aimed to ascertain the incidence of nerve injuries post-acupuncture, identify associated risk factors, and map the distribution of nerve injury sites.

METHODS

A case-control study nested in the National Health Insurance Research Database (NHIRD) 2000-2018 two million cohort was conducted. Patients previously diagnosed with nerve injury, surgery, or degeneration before acupuncture were excluded. Cases were defined as patients receiving acupuncture and seeking medical attention for nerve injury (ICD9-CM code 950-957) within 14 days post-procedure, while control groups comprised patients undergoing acupuncture without subsequent adverse events. Invasive treatments prior to adverse events and adverse events occurring more than 14 days post-acupuncture were excluded. To ensure case-control comparability, factors such as age, gender, socioeconomic status, and medical facility environment were controlled using propensity score matching.

RESULTS

The study encompassed 14,507,847 acupuncture treatments administered to 886,753 patients, with 8361 instances of post-acupuncture nerve injury identified, representing an incidence rate of approximately 5.76 per 10,000 procedures. Age emerged as a significant risk factor, with the adjusted odds ratios escalating with age. Several comorbidities including diabetes, hypothyroidism, liver cirrhosis, chronic kidney disease, herpes zoster, hepatitis virus, rheumatoid arthritis, systemic lupus erythematosus, dementia, and cerebrovascular accidents were associated with an elevated risk of nerve injury post-acupuncture.

CONCLUSION

This study underscores the importance of meticulous patient profiling and cautious therapeutic approach in acupuncture, considering the evident influence of various demographic, systemic, and treatment-related factors on the incidence of nerve injuries.

Sensory Nerve Conduction Study with Inching Test in Palmar Digital Neuropathy

Mild palmar digital neuropathy may be underestimated because selective nerve conduction studies (NCS) of the palmar digital nerve are challenging. We herein report two cases of palmar digital neuropathy. We performed sensory NCS in each finger using the standard approach. Both cases showed a decrease in the amplitude of sensory nerve action potential (SNAP) in the localized finger. Furthermore, the sensory nerve inching test identified the lesion site. When performing NCS in patients with finger sensory impairment, we recommend recording the SNAP in each finger using standard NCS at the wrist, as well as sensory nerve inching testing.

Magnetic Resonance Imaging of the Digital Nerves of the Hand: Anatomy and Spectrum of Pathology

Digital nerves are intrinsic to the sensory and motor function of the hand. These nerves represent the terminal ramifications of the ulnar, median, and radial nerves and are located distal to the carpal tunnel and Guyon canal. With magnetic resonance imaging, traumatic and nontraumatic abnormalities of the digital nerves can be shown with high contrast as well as high spatial resolution. Digital nerve abnormalities are most commonly posttraumatic in nature; however, infection, inflammatory, vascular malformations, and neoplasms can rarely occur. Magnetic resonance imaging is playing an increasing role in the assessment of peripheral nerve injury throughout the body, and in the hand, which can accurately identify the extent and character of digital nerve abnormalities before operative intervention.

The impact of flexor tendon rehabilitation restrictions on individuals' independence with daily activities: implications for hand therapists

STUDY DESIGN

Descriptive, grounded theory.

PURPOSE

This study identified activity limitations which individuals with flexor tendon lacerations experience post-repair and explored methods they used to support participation in life roles. The role of hand therapy during the period of restricted hand use is discussed.

METHODS

Standardized interviews with 19 individuals 6-12 months after flexor tendon repair (FTR) were recorded and thematic analysis was performed. Descriptive and nonparametric statistics were used to analyze quantitative data generated through these interviews.

RESULTS

Patients struggled to fulfill life roles during the period of restricted hand use following FTR. Most participants asked other individuals for assistance; however, 59% of the participants removed their injured fingers from the orthosis in order to use their hand to perform activities. All of the participants' hand therapists instructed them in orthotic wear and activity restrictions and most addressed pain management, but few addressed how to perform meaningful activities and participate in life roles during the period of restricted hand use. Participants who did receive these types of interventions perceived that they were very useful.

CONCLUSIONS

During the phase of restricted hand use following FTR, it is important for hand therapists to address activity performance and participation in meaningful life roles, in addition to ensuring the integrity and function of the healing tendon. This can include instruction in one-handed methods, use of adaptive equipment, and exploration of accommodations needed at work.

LEVEL OF EVIDENCE

III.