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Bula-Oyola E, Belda-Lois JM, Porcar-Seder R, Page Á. Effectiveness of electrophysical modalities in the sensorimotor rehabilitation of radial, ulnar, and median neuropathies: A meta-analysis. PLoS One 2021; 16:e0248484. [PMID: 33735212 PMCID: PMC7971482 DOI: 10.1371/journal.pone.0248484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 02/26/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION People with ulnar, radial or median nerve injuries can present significant impairment of their sensory and motor functions. The prescribed treatment for these conditions often includes electrophysical therapies, whose effectiveness in improving symptoms and function is a source of debate. Therefore, this systematic review aims to provide an integrative overview of the efficacy of these modalities in sensorimotor rehabilitation compared to placebo, manual therapy, or between them. METHODS We conducted a systematic review according to PRISMA guidelines. We perform a literature review in the following databases: Biomed Central, Ebscohost, Lilacs, Ovid, PEDro, Sage, Scopus, Science Direct, Semantic Scholar, Taylor & Francis, and Web of Science, for the period 1980-2020. We include studies that discussed the sensorimotor rehabilitation of people with non-degenerative ulnar, radial, or median nerve injury. We assessed the quality of the included studies using the Risk of Bias Tool described in the Cochrane Handbook of Systematic Reviews of Interventions and the risk of bias across studies with the GRADE approach described in the GRADE Handbook. RESULTS Thirty-eight studies were included in the systematic review and 34 in the meta-analysis. The overall quality of evidence was rated as low or very low according to GRADE criteria. Low-level laser therapy and ultrasound showed favourable results in improving symptom severity and functional status compared to manual therapy. In addition, the low level laser showed improvements in pinch strength compared to placebo and pain (VAS) compared to manual therapy. Splints showed superior results to electrophysical modalities. The clinical significance of the results was assessed by effect size estimation and comparison with the minimum clinically important difference (MCID). CONCLUSIONS We found favourable results in pain relief, improvement of symptoms, functional status, and neurophysiological parameters for some electrophysical modalities, mainly when applied with a splint. Our results coincide with those obtained in some meta-analyses. However, none of these can be considered clinically significant. TRIAL REGISTRATION PROSPERO registration number CRD42020168792; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=168792.
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Affiliation(s)
- Ena Bula-Oyola
- Universitat Politècnica de València, Valencia, Spain
- Departamento de Diseño, Universidad del Norte, Barranquilla, Colombia
| | - Juan-Manuel Belda-Lois
- Instituto Universitario de Ingeniería Mecánica y Biomecánica, Universitat Politècnica de València, Valencia, Spain
- Grupo de Tecnología Sanitaria del IBV, CIBER de Bioingeniería, Biomateriales y Nanomedicina, Valencia, Spain
| | - Rosa Porcar-Seder
- Instituto Universitario de Ingeniería Mecánica y Biomecánica, Universitat Politècnica de València, Valencia, Spain
| | - Álvaro Page
- Instituto Universitario de Ingeniería Mecánica y Biomecánica, Universitat Politècnica de València, Valencia, Spain
- Departamento de Física Aplicada, Universitat Politècnica de València, Valencia, Spain
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Saranteas T, Koliantzaki I, Savvidou O, Tsoumpa M, Eustathiou G, Kontogeorgakos V, Souvatzoglou R. Acute pain management in trauma: anatomy, ultrasound-guided peripheral nerve blocks and special considerations. Minerva Anestesiol 2019; 85:763-773. [DOI: 10.23736/s0375-9393.19.13145-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Nerve Diameter in the Hand: A Cadaveric Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2155. [PMID: 31044121 PMCID: PMC6467622 DOI: 10.1097/gox.0000000000002155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/19/2018] [Indexed: 11/26/2022]
Abstract
Background Nerve injuries in the hand are common and often pose a challenge for the upper extremity surgeon. A range of reconstructive options exist for nerve repair, but proper matching of nerve diameter is important for many of these techniques. The purposes of this study were to (1) describe the nerve diameters of the hand and their relative differences and (2) investigate whether there is a relationship between nerve diameter and external hand dimensions or body mass index. Methods We utilized 18 freshly frozen cadaveric hands from adult donors aged 20-86 of both sexes for this study. Two independent observers measured each nerve diameter to the nearest 0.1 mm using a digital caliper. Results Using the flexor zones as boundaries, a total of 33 nerve measurements were performed for each cadaveric hand. Nerve diameter increased from the distal to the proximal flexor zones. The internal common digital nerves in flexor zone 3 were larger than the external digital nerves. The median nerve was found to be nearly 2 times larger than the ulnar nerve at 2 locations within the wrist. There was a positive correlation between body mass index, hand span, hand width, and nerve diameter at several measured locations. Conclusions This study provides reference values for nerve diameters of the hand and wrist and describes their relative differences. It is important for surgeons to be aware of these differences and to consider this information as we advance our efforts to reconstruct the hand and develop technologies for nerve repair.
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Reichert P, Kiełbowicz Z, Kuryszko J, Bocheńska A. Gait analysis after neurorrhaphy in the brachial plexus. Pol J Vet Sci 2015; 18:367-70. [PMID: 26172187 DOI: 10.1515/pjvs-2015-0047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The gait is a form of human and animal locomotion on land by using limbs. The study assessed functional recovery after end to side and side to side neurorrhaphy the ventral branches of the C5 and C6 spinal nerves to the C7 spinal nerve on the rabbit brachial plexus. Gait statistical analysis showed significant differences between the control group versus the end-to-side and side to side neurorrhaphy groups, in opposite to the comparison between the two experimentals groups. Gait analysis results corresponded with the histomorphometric results. The results indicate the potential use of gait analysis for the assessment of the recovery of nerve function.
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Martins RS, Bastos D, Siqueira MG, Heise CO, Teixeira MJ. Traumatic injuries of peripheral nerves: a review with emphasis on surgical indication. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:811-4. [DOI: 10.1590/0004-282x20130127] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 05/27/2013] [Indexed: 12/12/2022]
Abstract
Traumatic peripheral nerve injury is a dramatic condition present in many of the injuries to the upper and lower extremities. An understanding of its physiopathology and selection of a suitable time for surgery are necessary for proper treatment of this challenging disorder. This article reviews the physiopathology of traumatic peripheral nerve injury, considers the most used classification, and discusses the main aspects of surgical timing and treatment of such a condition.
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Affiliation(s)
- Roberto Sergio Martins
- University of Sao Paulo School of Medicine, Brazil; Hospital do Servidor Publico do Estado de Sao Paulo, Brazil
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Godinho MJ, Teh L, Pollett MA, Goodman D, Hodgetts SI, Sweetman I, Walters M, Verhaagen J, Plant GW, Harvey AR. Immunohistochemical, ultrastructural and functional analysis of axonal regeneration through peripheral nerve grafts containing Schwann cells expressing BDNF, CNTF or NT3. PLoS One 2013; 8:e69987. [PMID: 23950907 PMCID: PMC3739754 DOI: 10.1371/journal.pone.0069987] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 06/14/2013] [Indexed: 01/13/2023] Open
Abstract
We used morphological, immunohistochemical and functional assessments to determine the impact of genetically-modified peripheral nerve (PN) grafts on axonal regeneration after injury. Grafts were assembled from acellular nerve sheaths repopulated ex vivo with Schwann cells (SCs) modified to express brain-derived neurotrophic factor (BDNF), a secretable form of ciliary neurotrophic factor (CNTF), or neurotrophin-3 (NT3). Grafts were used to repair unilateral 1 cm defects in rat peroneal nerves and 10 weeks later outcomes were compared to normal nerves and various controls: autografts, acellular grafts and grafts with unmodified SCs. The number of regenerated βIII-Tubulin positive axons was similar in all grafts with the exception of CNTF, which contained the fewest immunostained axons. There were significantly lower fiber counts in acellular, untransduced SC and NT3 groups using a PanNF antibody, suggesting a paucity of large caliber axons. In addition, NT3 grafts contained the greatest number of sensory fibres, identified with either IB4 or CGRP markers. Examination of semi- and ultra-thin sections revealed heterogeneous graft morphologies, particularly in BDNF and NT3 grafts in which the fascicular organization was pronounced. Unmyelinated axons were loosely organized in numerous Remak bundles in NT3 grafts, while the BDNF graft group displayed the lowest ratio of umyelinated to myelinated axons. Gait analysis revealed that stance width was increased in rats with CNTF and NT3 grafts, and step length involving the injured left hindlimb was significantly greater in NT3 grafted rats, suggesting enhanced sensory sensitivity in these animals. In summary, the selective expression of BDNF, CNTF or NT3 by genetically modified SCs had differential effects on PN graft morphology, the number and type of regenerating axons, myelination, and locomotor function.
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Affiliation(s)
- Maria João Godinho
- School of Anatomy, Physiology and Human Biology, The University of Western Australia, Crawley, Western Australia, Australia
| | - Lip Teh
- Cranio-Maxillo-Facial Unit, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Margaret A. Pollett
- School of Anatomy, Physiology and Human Biology, The University of Western Australia, Crawley, Western Australia, Australia
| | - Douglas Goodman
- School of Veterinary and Biomedical Sciences, Murdoch University, Murdoch, Western Australia, Australia
| | - Stuart I. Hodgetts
- School of Anatomy, Physiology and Human Biology, The University of Western Australia, Crawley, Western Australia, Australia
| | - Iain Sweetman
- School of Anatomy, Physiology and Human Biology, The University of Western Australia, Crawley, Western Australia, Australia
| | - Mark Walters
- Cranio-Maxillo-Facial Unit, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Joost Verhaagen
- Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Giles W. Plant
- School of Anatomy, Physiology and Human Biology, The University of Western Australia, Crawley, Western Australia, Australia
| | - Alan R. Harvey
- School of Anatomy, Physiology and Human Biology, The University of Western Australia, Crawley, Western Australia, Australia
- * E-mail:
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Gomes LEA, Dalmarco EM, André ES. The brain-derived neurotrophic factor, nerve growth factor, neurotrophin-3, and induced nitric oxide synthase expressions after low-level laser therapy in an axonotmesis experimental model. Photomed Laser Surg 2012; 30:642-7. [PMID: 23003120 DOI: 10.1089/pho.2012.3242] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND DATA A robust body of evidence has shown that low-level laser therapy (LLLT) improves peripheral nerve regeneration. However, the biochemical background triggered in this process is not yet fully understood. OBJECTIVE The purpose of this study was to evaluate the mRNA expression of neurotrophic factors (brain-derived neurotrophic factor [BDNF], nerve growth factor [NGF], and neurotrophin-3, [NT-3]) and also an inflammatory marker (induced nitric oxide synthase [iNOS]) in an axonotmesis experimental model after low-level laser therapy. METHODS Thirty-six adult male Wistar rats (250-350 g) were subjected to right sciatic nerve crush injury, and 24 h later, the animals in the three different experimental groups (n=18) were irradiated on a daily basis with helium-neon laser (collimated HeNe laser, continuous emission, wavelength: 632.8 nm, power density: 0.5 mW/cm(2), irradiation time: 20 sec, energy density: 10 J/cm(2)) during 7, 14, and 21 consecutive days, respectively. The control group (n=18) underwent the same procedures, but with the equipment turned off. At the end of the experiments, animals were killed with an overdose of anesthesia to remove samples from the sciatic nerve lesion epicenter to determine the mRNA expression of BDNF, NGF, NT-3 and iNOS enzyme. RESULTS Comparisons between groups showed that HeNe laser increased the mRNA expression of both BDNF and NGF factors after 14 days of LLLT, with peak expression at the 21st day. Increase in NT-3 mRNA expression was not observed. In addition, HeNe laser produced iNOS expression reduction, which played an important role in the inflammatory process. CONCLUSIONS The reported data could have a relevant practical value because LLLT is a noninvasive procedure, and have revealed significant increase in neurotrophic factor expressions and inflammatory process reduction, opening the possibility of using LLLT as an important aid to nerve regeneration process.
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Affiliation(s)
- Lessandra Esper Abdala Gomes
- 1 Laboratório de Fisioterapia Neurológica Experimental (LFNE), Departamento de Fisioterapia, Universidade Regional de Blumenau (FURB) , Blumenau, Brazil
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Liu Y, Lao J, Gao K, Gu Y, Xin Z. Outcome of nerve transfers for traumatic complete brachial plexus avulsion: results of 28 patients by DASH and NRS questionnaires. J Hand Surg Eur Vol 2012; 37:413-21. [PMID: 22067298 DOI: 10.1177/1753193411425330] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The objective of this study was to evaluate outcomes of patients who suffered complete brachial plexus avulsion before and after nerve transfers by assessing upper extremity function and pain using the DASH and NRS questionnaires. Patients who underwent nerve transfers improved their DASH and NRS scores compared with before surgery. Although individually there was no correlation with improved scores, the triple combination of rehabilitation exercises, electrical stimulation therapy and neurotrophic drugs postoperatively correlated positively with improved functional outcomes. This study suggested a positive effect of the passage of time and nerve transfers in total brachial plexus avulsions from patients' self assessments.
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Affiliation(s)
- Y Liu
- Department of Hand Surgery, Shanghai Huashan Hospital, Shanghai, China
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Martins RS, Teodoro WR, Simplício H, Capellozi VL, Siqueira MG, Yoshinari NH, Pereira Plese JP, Teixeira MJ. Influence of Suture on Peripheral Nerve Regeneration and Collagen Production at the Site of Neurorrhaphy: An Experimental Study. Neurosurgery 2011; 68:765-72; discussion 772. [DOI: 10.1227/neu.0b013e3182077332] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Roberto Sergio Martins
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, São Paulo University School of Medicine and Hospital do Servidor Público do Estado
| | - Walcy Rosolio Teodoro
- Division of Rheumatology, São Paulo University School of Medicine, São Paulo, Brazil
| | - Hougelle Simplício
- Department of Neurosurgery, São Paulo University School of Medicine, São Paulo, Brazil
| | - Vera Luiza Capellozi
- Departament of Pathology, São Paulo University School of Medicine, São Paulo, Brazil
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Merolli A, Marceddu S, Rocchi L, Catalano F. In vivo study of ethyl-2-cyanoacrylate applied in direct contact with nerves regenerating in a novel nerve-guide. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2010; 21:1979-1987. [PMID: 20300954 DOI: 10.1007/s10856-010-4036-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Accepted: 02/22/2010] [Indexed: 05/29/2023]
Abstract
Stitch suture is still the most recommended method to hold a nerve-guide in place but stitch suture is a well known cause of local inflammatory response. Glues of several kinds have been proposed as an alternative but they are not easy to apply in a real surgical setting. In 2006 authors developed a new concept of nerve-guide termed "NeuroBox" which is double-halved, not-degradable and rigid, and allows the use of cyanoacrylic glues. In this study, Authors analyzed histologically the nerve-glue interface. Wistar rats were used as animal model. In group 1, animals were implanted a NeuroBox to promote the regeneration of an experimentally produced 4 mm gap in the sciatic nerve. In group 2, the gap was left without repair ("sham-operated" group). Group 3 was assembled by harvesting 10 contralateral intact nerves to document the normal anatomy. Semi-thin sections for visible light microscopy and ultra-thin sections for Transmission Electron Microscopy were analyzed. Results showed that application of ethyl-2-cyanoacrylate directly to the epineurium produced no significative insult to the underlining nerve fibers nor impaired nerve regeneration. No regeneration occurred in the "sham-operated" group.
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Affiliation(s)
- A Merolli
- Orthopaedics and Hand Surgery Unit, The Catholic University School of Medicine in Rome, Complesso "Columbus", via Moscati 31, 00168 Rome, Italy.
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Abstract
Nerve injuries extend from simple nerve compression lesions to complete nerve injuries and severe lacerations of the nerve trunks. A specific problem is brachial plexus injuries where nerve roots can be ruptured, or even avulsed from the spinal cord, by traction. An early and correct diagnosis of a nerve injury is important. A thorough knowledge of the anatomy of the peripheral nerve trunk as well as of basic neurobiological alterations in neurons and Schwann cells induced by the injury are crucial for the surgeon in making adequate decisions on how to repair and reconstruct nerves. The technique of peripheral nerve repair includes four important steps (preparation of nerve end, approximation, coaptation and maintenance). Nerves are usually repaired primarily with sutures applied in the different tissue components, but various tubes are available. Nerve grafts and nerve transfers are alternatives when the injury induces a nerve defect. Timing of nerve repair is essential. An early repair is preferable since it is advantageous for neurobiological reasons. Postoperative rehabilitation, utilising the patients' own coping strategies, with evaluation of outcome are additional important steps in treatment of peripheral nerve injuries. in the rehabilitation phase adequate handling of pain, allodynia and cold intolerance are emphasised.
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Affiliation(s)
- L B Dahlin
- Department of Hand Surgery, Malmö University Hospital, Malmö, Sweden.
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Merolli A, Rocchi L, Catalano F, Planell J, Engel E, Martinez E, Sbernardori MC, Marceddu S, Tranquilli Leali P. In vivo regeneration of rat sciatic nerve in a double-halved stitch-less guide: A pilot-study. Microsurgery 2009; 29:310-8. [DOI: 10.1002/micr.20622] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Dahlin L, Johansson F, Lindwall C, Kanje M. Chapter 28 Future Perspective in Peripheral Nerve Reconstruction. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009; 87:507-30. [DOI: 10.1016/s0074-7742(09)87028-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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