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Le LTT, Pham NC, Trinh XT, Nguyen NG, Nguyen VL, Nam SY, Heo CY. Supercritical Carbon Dioxide Decellularization of Porcine Nerve Matrix for Regenerative Medicine. Tissue Eng Part A 2024. [PMID: 38205627 DOI: 10.1089/ten.tea.2023.0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
Tissue engineering scaffolds are often made from the decellularization of tissues. The decellularization of tissues caused by prolonged contact with aqueous detergents might harm the microstructure and leave cytotoxic residues. In this research, we developed a new technique to use supercritical carbon dioxide (Sc-CO2)-based decellularization for porcine nerve tissue. The effect of decellularization was analyzed by histological examination, including Hematoxylin and Eosin, Masson's Trichrome staining, and 4',6-diamidino-2-phenylindole staining. Moreover, biochemical analysis of the decellularized tissues was also performed by measuring DNA content, amount of collagen, and glycosaminoglycans (GAGs) after decellularization. The results showed that the tissue structure was preserved, cells were removed, and the essential components of extracellular matrix, such as collagen fibers, elastin fibers, and GAG fibers, remained after decellularization. In addition, the DNA content was decreased compared with native tissue, and the concentration of collagen and GAGs in the decellularized nerve tissue was the same as in native tissue. The in vivo experiment in the rat model showed that after 6 months of decellularized nerve implantation, the sciatic function index was confirmed to recover in decellularized nerve. Morphological analysis displayed a range of infiltrated cells in the decellularized nerve, similar to that in native tissue, and the number of Schwann cells that play essential for motor function and sensory in the decellularized nerve was confirmed. These findings indicate that tissue decellularization using Sc-CO2 has been successfully used in tissue engineering.
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Affiliation(s)
- Linh Thi Thuy Le
- Department of Biomedical Science, College of Medicine, Seoul National University, Seoul, Republic of Korea
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ngoc Chien Pham
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Medical Device Development, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Xuan-Tung Trinh
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ngan Giang Nguyen
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Korean Institute of Nonclinical Study Center, Seongnam, Republic of Korea
| | - Van Long Nguyen
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sun-Young Nam
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chan-Yeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Korean Institute of Nonclinical Study Center, Seongnam, Republic of Korea
- Department of Medical Device Development, College of Medicine, Seoul National University, Seoul, Republic of Korea
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Demyanenko SV, Kalyuzhnaya YN, Bachurin SS, Khaitin AM, Kunitsyna AE, Batalshchikova SA, Evgen'ev MB, Garbuz DG. Exogenous Hsp70 exerts neuroprotective effects in peripheral nerve rupture model. Exp Neurol 2024; 373:114670. [PMID: 38158007 DOI: 10.1016/j.expneurol.2023.114670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/08/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
Hsp70 is the main molecular chaperone responsible for cellular proteostasis under normal conditions and for restoring the conformation or utilization of proteins damaged by stress. Increased expression of endogenous Hsp70 or administration of exogenous Hsp70 is known to exert neuroprotective effects in models of many neurodegenerative diseases. In this study, we have investigated the effect of exogenous Hsp70 on recovery from peripheral nerve injury in a model of sciatic nerve transection in rats. It was shown that recombinant Hsp70 after being added to the conduit connecting the ends of the nerve at the site of its extended severance, migrates along the nerve into the spinal ganglion and is retained there at least three days. In animals with the addition of recombinant Hsp70 to the conduit, a decrease in apoptosis in the spinal ganglion cells after nerve rupture, an increase in the level of PTEN-induced kinase 1 (PINK1), an increase in markers of nerve tissue regeneration and a decrease in functional deficit were observed compared to control animals. The obtained data indicate the possibility of using recombinant Hsp70 preparations to accelerate the recovery of patients after neurotrauma.
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Affiliation(s)
- Svetlana V Demyanenko
- Laboratory «Molecular Neurobiology», Academy of Biology and Biotechnology, Southern Federal University, 344090 Rostov-on-Don, Russia; Department of General and Clinical Biochemistry no. 2, Rostov State Medical University, Rostov-on-Don, Russia
| | - Yuliya N Kalyuzhnaya
- Laboratory «Molecular Neurobiology», Academy of Biology and Biotechnology, Southern Federal University, 344090 Rostov-on-Don, Russia
| | - Stanislav S Bachurin
- Department of General and Clinical Biochemistry no. 2, Rostov State Medical University, Rostov-on-Don, Russia
| | - Andrey M Khaitin
- Laboratory «Molecular Neurobiology», Academy of Biology and Biotechnology, Southern Federal University, 344090 Rostov-on-Don, Russia
| | - Anastasia E Kunitsyna
- Laboratory «Molecular Neurobiology», Academy of Biology and Biotechnology, Southern Federal University, 344090 Rostov-on-Don, Russia
| | - Svetlana A Batalshchikova
- Laboratory «Molecular Neurobiology», Academy of Biology and Biotechnology, Southern Federal University, 344090 Rostov-on-Don, Russia
| | - Michael B Evgen'ev
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
| | - David G Garbuz
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia.
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Eren T, Kuru CA, Harput G, Leblebicioglu G. Case-based report of graded motor imagery experience in traumatic brachial plexus injury: The art of moving without moving. J Hand Ther 2024; 37:161-169. [PMID: 37586989 DOI: 10.1016/j.jht.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND We reported a 24-year-old woman who sustained multiple upper limb injuries after a traffic accident in March 2017. She sustained a C7-T1 brachial plexus injury and radial nerve injury on the left side diagnosed in November 2017. The patient underwent radial nerve reconstruction. The patient began her comprehensive therapy program in January 2018. PURPOSE To describe the use of graded motor imagery (GMI) and outcomes after traumatic brachial plexus palsy. We presented changes in electromyographic (EMG) activity of target muscles during task execution and functional status following 10-session GMI therapy. STUDY DESIGN Case report. METHODS The program included 4 sessions of motor imagery and 6 sessions of a combination of motor imagery and mirror therapy. RESULTS The patient successfully participated in the program with reported improvements in EMG activity, functional status, emotional well-being, and body awareness. CONCLUSIONS GMI therapy appears to have peripheral motor effects, including altered surface EMG activity and contributes to a favorable outcome in the functional level of the affected arm. An improved emotional state and awareness of the affected hand could have a positive effect on function. Future long-term randomized controlled trials are needed to investigate the cumulative peripheral effects of treatment of graded motor imagery and the effects of variables mediating its effects on functional performance in patients with nerve injury.
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Affiliation(s)
- Tuba Eren
- Beykent University, Faculty of Health Sciences, Istanbul, Turkey
| | - Cigdem Ayhan Kuru
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey.
| | - Gulcan Harput
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
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Nicksic PJ, Donnelly DT, Zeng W, Seitz AJ, Poore SO, Suminski AJ, Dingle AM. Trigeminal or peripheral nerve stimulation improves functional outcomes of nerve recovery in a rodent forelimb gap repair model. J Plast Reconstr Aesthet Surg 2024; 88:57-65. [PMID: 37952438 DOI: 10.1016/j.bjps.2023.10.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/10/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND The hypothesis of this study was that trigeminal nerve stimulation (TNS) or peripheral nerve stimulation (PNS) could improve functional outcomes of peripheral nerve injury in a rat forelimb model when compared to control rats not receiving electrical stimulation (ES). While PNS is known to improve outcomes after nerve surgery, the role of TNS has not been explored. METHODS Lewis rats were trained to perform a reach and grasp task before receiving a 2 mm gap repair of the ulnar and median nerves and randomized into four treatment groups: (1) sham injury, (2) nerve injury with sham ES, (3) nerve injury with PNS, and (4) nerve injury with TNS. Functional motor (median pull force and percent success in motor task) and sensory metrics (forelimb paw withdrawal thresholds) were collected both pre-injury and throughout rehabilitation. Nerves stained using Gomori's trichrome were assessed quantitatively and qualitatively. RESULTS The sham ES group did not recover their pre-injury baseline functional outcomes. In contrast, the TNS and PNS groups fully recovered following injury, with no difference in functional outcomes between the pre-injury baseline and the final week of rehabilitation (P > 0.05, all). Histomorphology results demonstrated no quantitative difference, but qualitative differences in architecture were evident. CONCLUSIONS Electrical stimulation of the trigeminal nerve or the injured nerve improved the functional outcomes of nerve regeneration in rodents. Histomorphology results of nerves from the TNS group support the proposed central mechanisms. This is an important step in translating this therapy as an adjunct, non-invasive treatment for high, mixed nerve injuries in humans.
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Affiliation(s)
- Peter J Nicksic
- University of Wisconsin, Division of Plastic and Reconstructive Surgery, Madison, WI, United States
| | - D'Andrea T Donnelly
- University of Wisconsin, Division of Plastic and Reconstructive Surgery, Madison, WI, United States
| | - Weifeng Zeng
- University of Wisconsin, Division of Plastic and Reconstructive Surgery, Madison, WI, United States
| | - Allison J Seitz
- University of Wisconsin, Division of Plastic and Reconstructive Surgery, Madison, WI, United States
| | - Samuel O Poore
- University of Wisconsin, Division of Plastic and Reconstructive Surgery, Madison, WI, United States
| | - Aaron J Suminski
- University of Wisconsin, Department of Neurological Surgery, Madison, WI, United States; Wisconsin Institute for Translational Neuroengineering, Madison, WI, United States
| | - Aaron M Dingle
- University of Wisconsin, Division of Plastic and Reconstructive Surgery, Madison, WI, United States.
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McGill LS, Hughes AJ, Carroll CP, Bediako SM. Illness Intrusiveness in Adults with Sickle Cell Disease: The Role of Fatigue. J Clin Psychol Med Settings 2023; 30:866-875. [PMID: 36881316 DOI: 10.1007/s10880-023-09950-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/08/2023]
Abstract
Chronic illness experiences often interfere with daily functioning (a concept known as illness intrusiveness) and health-related quality of life (HRQoL). However, less is known about the role of specific symptoms in predicting illness intrusiveness in sickle cell disease (SCD). This exploratory study examined associations between common SCD-related symptoms (i.e., pain, fatigue, depression, and anxiety), illness intrusiveness, and HRQoL among adults with SCD (n = 60). Illness intrusiveness significantly correlated with fatigue severity (r = .39, p = .002), depression severity (r = .45, p < .001), anxiety severity (r = .41, p = .001), physical HRQoL (r = - .53, p < .001), and mental HRQoL (r = - .44, p < .001). Multiple regression revealed a significant overall model, (R2 = .28, F(4, 55) = 5.21, p = .001), with fatigue, but not pain, depression, or anxiety, significantly predicting illness intrusiveness (β = .29, p = .036). Results suggest that fatigue may be a primary factor contributing to illness intrusiveness-a determinant of HRQoL-in individuals with SCD. Given the limited sample size, larger confirmatory studies are warranted.
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Affiliation(s)
- Lakeya S McGill
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, 600 N Wolfe St, Phipps 174, Baltimore, MD, 21287, USA.
| | - Abbey J Hughes
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, 600 N Wolfe St, Phipps 174, Baltimore, MD, 21287, USA
| | - C Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Shawn M Bediako
- Center for the Advancement of Science Leadership and Culture, Howard Hughes Medical Institute, Chevy Chase, MD, USA
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Sonohata M, Doi A, Uchihashi K, Hashimoto A, Kii S, Inoue T, Mawatari M. Short-Term Collagen Nerve Wrapping Facilitates Motor and Sensory Recovery from Nerve Degeneration in a Sciatic Nerve Injury Rat Model. J Pain Res 2023; 16:1683-1695. [PMID: 37234570 PMCID: PMC10208243 DOI: 10.2147/jpr.s401126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Purpose This study used a sciatic nerve injury rat model to investigate the short-term effects of a polyglycolic acid (PGA)-collagen tube for nerve injury in continuity. Materials and Methods Sixteen female Wistar rats (6-8 weeks) were used, and the left sciatic nerve was crushed with a Sugita aneurysm clip. Sciatic nerve model rats were randomly categorized into two groups (n = 8; control group, n = 8; nerve wrapping group). Then, we measured four sensory thresholds, magnetically stimulated the lumbar region to induce motor-evoked potentials (MEPs), and evaluated the sciatic nerve histopathologically. Results In the sensory thresholds, there were significant differences for the main effect in 250 and 2000 Hz stimulation (p = 0.048 and 0.006, respectively). Further, a significant difference was observed with 2000 Hz stimulation at 1 week (p = 0.003). In the heat stimulation, there were significant differences for the main effect in both weeks and groups (p = 0.0002 and 0.0185, respectively). The post-hoc test showed a significant difference between groups only in 2W (p = 0.0283). Three weeks after the surgery, both 2nd and 3rd MEPs waves-related latencies in the nerve wrapping group were significantly shorter than those in the control group (p = 0.0207 and 0.0271, respectively). Histological evaluation of the sciatic nerve revealed considerable differences in the number of axons between the two groups (p = 0.0352). Conclusion The short-term PGA-collagen tube nerve wrapping facilitated motor and sensory recovery from nerve degeneration in the sciatic nerve injury rat model.
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Affiliation(s)
- Motoki Sonohata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
- Department of Orthopaedic Surgery, Saga Central Hospital, Saga, Japan
| | - Atsushi Doi
- Department of Rehabilitation, Kumamoto Health Science University, Kumamoto, Japan
| | - Kazuyoshi Uchihashi
- Department of Surgical Pathology, National Hospital Organization Saga Hospital, Saga, Japan
| | - Akira Hashimoto
- Department of Orthopaedic Surgery, Saga Central Hospital, Saga, Japan
| | - Sakumo Kii
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Takao Inoue
- Organization of Research Initiatives, Yamaguchi University, Yamaguchi, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
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John A, Rossettie S, Rafael J, Cox CT, Ducic I, Mackay BJ. Patient-Reported Outcomes and Provocative Testing in Peripheral Nerve Injury and Recovery. J Brachial Plex Peripher Nerve Inj 2023; 18:e10-e20. [PMID: 37089516 PMCID: PMC10121318 DOI: 10.1055/s-0043-1764352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 02/03/2023] [Indexed: 04/25/2023] Open
Abstract
Background Peripheral nerve function is often difficult to assess given the highly variable presentation and subjective patient experience of nerve injury. If nerve assessment is incomplete or inaccurate, inappropriate diagnosis and subsequent treatment may result in permanent dysfunction. Objective As our understanding of nerve repair and generation evolves, so have tools for evaluating peripheral nerve function, recovery, and nerve-related impact on the quality of life. Provocative testing is often used in the clinic to identify peripheral nerve dysfunction. Patient-reported outcome forms provide insights regarding the effect of nerve dysfunction on daily activities and quality of life. Methods We performed a review of the literature using a comprehensive combination of keywords and search algorithms to determine the clinical utility of different provocative tests and patient-reported outcomes measures in a variety of contexts, both pre- and postoperatively. Results This review may serve as a valuable resource for surgeons determining the appropriate provocative testing tools and patient-reported outcomes forms to monitor nerve function both pre- and postoperatively. Conclusion As treatments for peripheral nerve injury and dysfunction continue to improve, identifying the most appropriate measures of success may ultimately lead to improved patient outcomes.
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Affiliation(s)
- Albin John
- Texas Tech University Health Sciences Center, Lubbock, Texas
- Address for correspondence Albin John, MBA Department of Orthopaedic SurgeryTexas Tech University Health Sciences Center, 3601 4th Street, Mail Stop 9436, Lubbock 79430TX
| | | | - John Rafael
- Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Cameron T. Cox
- Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Ivica Ducic
- Washington Nerve Institute, McLean, Virginia
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High Median Nerve Paralysis: Is the Hand of Benediction or Preacher's Hand A Correct Sign? Plast Reconstr Surg Glob Open 2022; 10:e4598. [PMID: 36320624 PMCID: PMC9616636 DOI: 10.1097/gox.0000000000004598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 08/23/2022] [Indexed: 11/26/2022]
Abstract
UNLABELLED High median nerve injuries are commonly presented in textbooks as adopting the typical posture of hand of benediction or preacher's hand. This study aimed to show that the hand of benediction or preacher's hand is incorrectly associated with a high median nerve paralysis. METHODS A retrospective review of four cases with a high median nerve injury is presented. Diagnosis of a high median nerve injury was performed by means of intraoperative findings, electrodiagnostic studies, or ultrasound imaging. None of the patients presented in this study had a hand of benediction on physical examination despite the presence of a high median nerve lesion. RESULTS All four patients with high median nerve injuries showed a similar hand posture when attempting to make a fist. Firstly, the index finger still flexed at the metacarpophalangeal joint because of the ulnar innervated interossei muscles. Secondly the thumb is completely abducted at the carpometocarpal joint and extended at the interphalangeal joint. Lastly, middle finger flexion is possible due to dual innervation of its flexor digitorum profundus by the ulnar nerve as well as due to the quadriga phenomenon. CONCLUSIONS The clinical appearance of a high median nerve palsy is different from the classical hand of benediction or preacher's hand posture pointing finger. We have shown that this incorrect association can result in delayed referral of patients with high median nerve injuries.
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Padovano WM, Dengler J, Patterson MM, Yee A, Snyder-Warwick AK, Wood MD, Moore AM, Mackinnon SE. Incidence of Nerve Injury After Extremity Trauma in the United States. Hand (N Y) 2022; 17:615-623. [PMID: 33084377 PMCID: PMC9274890 DOI: 10.1177/1558944720963895] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Traumatic peripheral nerve injuries cause chronic pain, disability, and long-term reductions in quality of life. However, their incidence after extremity trauma remains poorly understood. METHODS The IBM® MarketScan® Commercial Database from 2010 to 2015 was used to identify patients aged 18 to 64 who presented to emergency departments for upper and/or lower extremity traumas. Cumulative incidences were calculated for nerve injuries diagnosed within 2 years of trauma. Cox regression models were developed to evaluate the associations between upper extremity nerve injury and chronic pain, disability, and use of physical therapy or occupational therapy. RESULTS The final cohort consisted of 1 230 362 patients with employer-sponsored health plans. Nerve injuries were diagnosed in 2.6% of upper extremity trauma patients and 1.2% of lower extremity trauma patients. Only 9% and 38% of nerve injuries were diagnosed by the time of emergency department and hospital discharge, respectively. Patients with nerve injuries were more likely to be diagnosed with chronic pain (hazard ratio [HR]: 5.9, 95% confidence interval [CI], 4.3-8.2), use physical therapy services (HR: 10.7, 95% CI, 8.8-13.1), and use occupational therapy services (HR: 19.2, 95% CI, 15.4-24.0) more than 90 days after injury. CONCLUSIONS The incidence of nerve injury in this national cohort was higher than previously reported. A minority of injuries were diagnosed by emergency department or hospital discharge. These findings may improve practitioner awareness and inform public health interventions for injury prevention.
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Affiliation(s)
| | - Jana Dengler
- Washington University School of Medicine, St. Louis, MO, USA
| | | | - Andrew Yee
- Washington University School of Medicine, St. Louis, MO, USA
| | | | - Matthew D. Wood
- Washington University School of Medicine, St. Louis, MO, USA
| | - Amy M. Moore
- Washington University School of Medicine, St. Louis, MO, USA
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John AA, Rossettie S, Rafael J, Cox CT, Ducic I, Mackay BJ. Clinical Assessment of Pain and Sensory Function in Peripheral Nerve Injury and Recovery: A Systematic Review of Literature. Arch Plast Surg 2022; 49:427-439. [PMID: 35832158 PMCID: PMC9142258 DOI: 10.1055/s-0042-1748658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Peripheral nerve injuries (PNIs) often present with variable symptoms, making them difficult to diagnose, treat, and monitor. When neurologic compromise is inadequately assessed, suboptimal treatment decisions can result in lasting functional deficits. There are many available tools for evaluating pain and functional status of peripheral nerves. However, the literature lacks a detailed, comprehensive view of the data comparing the clinical utility of these modalities, and there is no consensus on the optimal algorithm for sensory and pain assessment in PNIs. We performed a systematic review of the literature focused on clinical data, evaluating pain and sensory assessment methods in peripheral nerves. We searched through multiple databases, including PubMed/Medline, Embase, and Google Scholar, to identify studies that assessed assessment tools and explored their advantages and disadvantages. A total of 66 studies were selected that assessed various tools used to assess patient's pain and sensory recovery after a PNI. This review may serve as a guide to select the most appropriate assessment tools for monitoring nerve pain and/or sensory function both pre- and postoperatively. As the surgeons work to improve treatments for PNI and dysfunction, identifying the most appropriate existing measures of success and future directions for improved algorithms could lead to improved patient outcomes.
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Affiliation(s)
- Albin A. John
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Stephen Rossettie
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - John Rafael
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Cameron T. Cox
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Ivica Ducic
- Washington Nerve Institute, McLean, Virginia
| | - Brendan J. Mackay
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
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A Concept Analysis of Illness Intrusiveness in Chronic Disease: Application of the Hybrid Model Method. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105900. [PMID: 35627435 PMCID: PMC9141028 DOI: 10.3390/ijerph19105900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 11/17/2022]
Abstract
This study clarifies the concept of illness intrusiveness in patients with a chronic disease using the hybrid model method. To clarify the dimension, attributes, and definition of illness intrusiveness in chronic disease, three phases of analysis were conducted. In the theoretical phase, a working definition was devised through a systematic review. In the fieldwork phase, individual in-depth interviews were conducted with nine participants with chronic diseases. In the final analytic phase, the results were integrated through comparison and review. There are four domains and eleven attributes of illness intrusiveness in chronic disease. The domains include physical, psychological, social/contextual, and spiritual. The physical domain consists of four attributes: pain, fatigue, physical malfunction, and change of body image. The psychological domain consists of three attributes: psychological weakness, uncertainty, and stigma. The social/contextual domain is made up of three attributes: withdrawal of role play, limit of daily life, and burden of changing health habits. Finally, the spiritual domain had one attribute: unstable spiritual state. Thus, based on the study findings, it is necessary to develop a suitable illness intrusiveness in chronic disease assessment scale to assess chronic disease patients.
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12
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Van der Gucht E, Dams L, Bernar K, De Vrieze T, Haenen V, De Groef A, Godderis L, Morlion B, Meeus M, Devoogdt N. The Dutch language version of the Pain Disability Index (PDI-DLV): psychometric properties in breast cancer patients. Physiother Theory Pract 2022:1-15. [PMID: 35378054 DOI: 10.1080/09593985.2022.2059036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pain after breast cancer surgery is a common and disabling problem. A reliable and valid questionnaire to assess pain-related disability is the Pain Disability Index (0-70). However, properties of the Dutch version (PDI-DLV) have never been investigated in this population. OBJECTIVE To assess psychometric properties of the PDI-DLV after breast cancer surgery. METHODS For reliability, relative and absolute reliability were calculated with a one-week test-retest interval, as well as internal consistency. Moreover, content and construct validity were examined to evaluate validity. RESULTS One hundred twenty-three women were included. Relative reliability was good (intraclass correlation coefficient = 0.80). Standard error of measurement and minimal detectable change (absolute reliability) were 5.57 and 15.45 points, respectively. The mean difference between two measurements was -1.98 points, with 95% limits of agreement equal to 13.19 and -17.15. The within-subjects coefficient of variation was 59%. Internal consistency was confirmed (α = 0.87). The PDI-DLV was scored as understandable and complete (content validity). Construct validity was supported by confirmation of more than 75% of the tested hypotheses and of the one-factor model. CONCLUSION The PDI-DLV is a valid questionnaire to assess pain-related disability 1 year after breast cancer surgery. Although absolute reliability is disputable, its good relative reliability allows evaluating changes between subjects.
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Affiliation(s)
- Elien Van der Gucht
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Movant, University of Antwerp, Belgium Campus Drie Eiken, Wilrijk, Belgium.,Pain in Motion International Research Group, Brussel, Belgium
| | - Lore Dams
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Movant, University of Antwerp, Belgium Campus Drie Eiken, Wilrijk, Belgium.,Pain in Motion International Research Group, Brussel, Belgium
| | - Koen Bernar
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium.,The Leuven Centre for Algology and Pain Management, University Hospitals Leuven, Leuven, Belgium
| | - Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium
| | - Vincent Haenen
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Movant, University of Antwerp, Belgium Campus Drie Eiken, Wilrijk, Belgium
| | - An De Groef
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Movant, University of Antwerp, Belgium Campus Drie Eiken, Wilrijk, Belgium.,Pain in Motion International Research Group, Brussel, Belgium
| | - Lode Godderis
- Department of Public Health and Primary Care, Centre for Environment and Health, University of Leuven, Leuven Belgium.,External Service for Prevention and Protection at Work, IDEWE, Leuven, Belgium
| | - Bart Morlion
- The Leuven Centre for Algology and Pain Management, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, Section Anaesthesiology & Algology, University of Leuven, Leuven, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Movant, University of Antwerp, Belgium Campus Drie Eiken, Wilrijk, Belgium.,Pain in Motion International Research Group, Brussel, Belgium.,Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium.,Department of Vascular Surgery and Department of Physical Medicine and Rehabilitation, Center for Lymphedema, Uz Leuven - University Hospitals Leuven, Leuven, Belgium
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13
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Roh J, Schellhardt L, Keane GC, Hunter DA, Moore AM, Snyder-Warwick AK, Mackinnon SE, Wood MD. Short-Duration, Pulsatile, Electrical Stimulation Therapy Accelerates Axon Regeneration and Recovery following Tibial Nerve Injury and Repair in Rats. Plast Reconstr Surg 2022; 149:681e-690e. [PMID: 35139047 PMCID: PMC8969122 DOI: 10.1097/prs.0000000000008924] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Repair of nerve injuries can fail to achieve adequate functional recovery. Electrical stimulation applied at the time of nerve repair can accelerate axon regeneration, which may improve the likelihood of recovery. However, widespread use of electrical stimulation may be limited by treatment protocols that increase operative time and complexity. This study evaluated whether a short-duration electrical stimulation protocol (10 minutes) was efficacious to enhance regeneration following nerve repair using rat models. METHODS Lewis and Thy1-green fluorescent protein rats were randomized to three groups: 0 minutes of electrical stimulation (no electrical stimulation; control), 10 minutes of electrical stimulation, and 60 minutes of electrical stimulation. All groups underwent tibial nerve transection and repair. In the intervention groups, electrical stimulation was delivered after nerve repair. Outcomes were assessed using immunohistochemistry, histology, and serial walking track analysis. RESULTS Two weeks after nerve repair, Thy1-green fluorescent protein rats demonstrated increased green fluorescent protein-positive axon outgrowth from the repair site with electrical stimulation compared to no electrical stimulation. Serial measurement of walking tracks after nerve repair revealed recovery was achieved more rapidly in both electrical stimulation groups as compared to no electrical stimulation. Histologic analysis of nerve distal to the repair at 8 weeks revealed robust axon regeneration in all groups. CONCLUSIONS As little as 10 minutes of intraoperative electrical stimulation therapy increased early axon regeneration and facilitated functional recovery following nerve transection with repair. Also, as early axon outgrowth increased following electrical stimulation with nerve repair, these findings suggest electrical stimulation facilitated recovery because of earlier axon growth across the suture-repaired site into the distal nerve to reach end-organ targets. CLINICAL RELEVANCE STATEMENT Brief (10-minute) electrical stimulation therapy can provide similar benefits to the 60-minute protocol in an acute sciatic nerve transection/repair rat model and merit further studies, as they represent a translational advantage.
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Affiliation(s)
- Joseph Roh
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Lauren Schellhardt
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Grace C. Keane
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Daniel A. Hunter
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Amy M. Moore
- Department of Plastic and Reconstructive Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Alison K. Snyder-Warwick
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Susan E. Mackinnon
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Matthew D. Wood
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO
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14
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Bittner GD, Bushman JS, Ghergherehchi CL, Roballo KCS, Shores JT, Smith TA. Typical and atypical properties of peripheral nerve allografts enable novel strategies to repair segmental-loss injuries. J Neuroinflammation 2022; 19:60. [PMID: 35227261 PMCID: PMC8886977 DOI: 10.1186/s12974-022-02395-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/19/2022] [Indexed: 12/20/2022] Open
Abstract
AbstractWe review data showing that peripheral nerve injuries (PNIs) that involve the loss of a nerve segment are the most common type of traumatic injury to nervous systems. Segmental-loss PNIs have a poor prognosis compared to other injuries, especially when one or more mixed motor/sensory nerves are involved and are typically the major source of disability associated with extremities that have sustained other injuries. Relatively little progress has been made, since the treatment of segmental loss PNIs with cable autografts that are currently the gold standard for repair has slow and incomplete (often non-existent) functional recovery. Viable peripheral nerve allografts (PNAs) to repair segmental-loss PNIs have not been experimentally or clinically useful due to their immunological rejection, Wallerian degeneration (WD) of anucleate donor graft and distal host axons, and slow regeneration of host axons, leading to delayed re-innervation and producing atrophy or degeneration of distal target tissues. However, two significant advances have recently been made using viable PNAs to repair segmental-loss PNIs: (1) hydrogel release of Treg cells that reduce the immunological response and (2) PEG-fusion of donor PNAs that reduce the immune response, reduce and/or suppress much WD, immediately restore axonal conduction across the donor graft and re-innervate many target tissues, and restore much voluntary behavioral functions within weeks, sometimes to levels approaching that of uninjured nerves. We review the rather sparse cellular/biochemical data for rejection of conventional PNAs and their acceptance following Treg hydrogel and PEG-fusion of PNAs, as well as cellular and systemic data for their acceptance and remarkable behavioral recovery in the absence of tissue matching or immune suppression. We also review typical and atypical characteristics of PNAs compared with other types of tissue or organ allografts, problems and potential solutions for PNA use and storage, clinical implications and commercial availability of PNAs, and future possibilities for PNAs to repair segmental-loss PNIs.
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15
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Simoncsics E, Konkolý Thege B, Stauder A. Pain acceptance and illness intrusiveness in low-back pain: A longitudinal study. Front Psychiatry 2022; 13:925251. [PMID: 36032245 PMCID: PMC9412953 DOI: 10.3389/fpsyt.2022.925251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In chronic pain syndromes, acceptance of pain may be a better approach than pain control. So far, little data have been available on how pain and its acceptance affect illness intrusiveness among patients with low-back pain (LBP). OBJECTIVE The present longitudinal study evaluates the impact of pain acceptance on illness intrusiveness in patients with LBP. METHODS Study participants were asked to complete the following questionnaires during their visit (T1) at one of four diverse rheumatologic outpatient clinics, and then 2-3 months later (T2) via phone or online: Chronic Pain Acceptance Questionnaire (CPAQ), Illness Intrusiveness Rating Scale (IIRS), Roland-Morris Disability Questionnaire (RMDQ), Patient Health Questionnaire Depression subscale (PHQ9), and socioeconomic data. RESULTS One hundred and twenty-seven individuals completed the questionnaires at baseline (31 having acute, 15 subacute and 81 chronic low back pain) and 97 at follow-up. Illness intrusiveness was negatively correlated with chronic pain acceptance both at T1 (r = -0.39) and T2 (r = -0.44). Illness intrusiveness scores have not changed significantly from T1 (M = 28.59 SD = 13.08) to T2 (M = 28.24, SD = 15.76). In a multiple regression model-including pain intensity, functional status, pain acceptance, depression severity, age, sex and educational level-the independent predictors of follow-up illness intrusiveness scores were lower pain acceptance and higher depression scores. CONCLUSIONS In our study, patients with acute, subacute and chronic low back pain reported similar levels of illness intrusiveness. In addition, illness intrusiveness scores have not changed significantly during the 2-month follow-up period and pain acceptance proved to be a significant independent predictor of illness intrusiveness among patients with chronic low-back pain.
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Affiliation(s)
- Eszter Simoncsics
- Doctoral School of Semmelweis University, Budapest, Hungary.,Mission Medical Center, Veresegyház, Hungary
| | - Barna Konkolý Thege
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Adrienne Stauder
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
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16
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Mattos E, Guedes A, Lessa PIF, Baptista AF. Influence of surface peripheral electrical stimulation on nerve regeneration after digital nerve neurorrhaphy: study protocol for a randomized clinical trial. F1000Res 2021; 10:219. [PMID: 34909180 PMCID: PMC8596177 DOI: 10.12688/f1000research.42120.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 11/28/2022] Open
Abstract
We will study the influence of low intensity and frequency surface peripheral electrical stimulation (PES) on nerve regeneration of digital nerve injuries of the hand after its surgical repair in humans. Participants will be patients with acute traumatic peripheral nerve injury referred to the Hand Surgery Service of the General Hospital of the State of Bahia, a reference service in the state. These patients will undergo surgery followed by PES in the immediate postoperative period. After hospital discharge, they will be followed up on an outpatient basis by researchers, who will remotely supervise a physiotherapy program. Our hypothesis is that PES will positively influence the recovery of sensory function in patients undergoing neurorrhaphy of digital nerves of the hand. ReBEC registration: U1111-1259-1998 (12/18/2020)
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Affiliation(s)
- Enilton Mattos
- Pos Graduate Program in Medicine and Human Health, Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil.,Professor Edgard Santos University Hospital Complex, Salvador, Bahia, Brazil
| | - Alex Guedes
- Professor Edgard Santos University Hospital Complex, Salvador, Bahia, Brazil.,Bahia Medical School, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Abrahão Fontes Baptista
- Pos Graduate Program in Medicine and Human Health, Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil.,Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, São Paulo, Brazil.,Laboratory of Medical Investigations 54 (LIM-54), São Paulo University, São Paulo, São Paulo, Brazil
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17
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Predictors of functional outcome after peripheral nerve injury and compression. J Hand Ther 2021; 34:369-375. [PMID: 32334939 DOI: 10.1016/j.jht.2020.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 03/04/2020] [Accepted: 03/16/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Retrospective cohort study. INTRODUCTION Upper-extremity peripheral nerve injuries can impact long-term pain, work performance, and disability, yet there are few studies evaluating treatment outcomes for a large sample of patients with varying peripheral nerve pathology. PURPOSE OF THE STUDY The purpose of this study was to identify outcomes of care and predictors of disability and health status in adults with peripheral nerve injuries. METHODS We explored medical records from 364 patients treated by a plastic surgeon over a three-year period. Descriptive and inferential statistics compared the Disabilities of the Arm, Shoulder, and Hand, Short-Form 8, and routine intake data between baseline and discharge, diagnosis, and intervention group. Multivariate linear regression models predicted disability, work disability, and physical and mental health at discharge. RESULTS We found significant improvements in disability, work disability, pain, depression, and stress. Health status changed minimally. Disability decreased most in patients who were working and who had symptoms fewer than six months. Outcomes were not statistically different between surgical and nonsurgical patients. Disability was the highest in patients with brachial plexus injuries. Multivariate models predicted 35 to 55% of the variance in the outcome measures. Factors that were highly predictive of functional outcomes included work status, household management, pain, depression, stress, and difficulty sleeping. CONCLUSIONS Patients with peripheral nerve injuries experience improved pain and disability whether treated surgically or nonsurgically. Maintaining engagement in meaningful home and work roles may improve outcomes. Helping patients manage pain remains important, along with combatting stress, depression, and sleep deprivation.
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18
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Saggaf M, Novak CB, Baltzer HL, Anastakis DJ. Ontario wait times for delayed surgical treatment of traumatic peripheral nerve injury. Can J Surg 2021; 64:E636-E643. [PMID: 34824152 PMCID: PMC8628844 DOI: 10.1503/cjs.011920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 02/07/2023] Open
Abstract
Background: To better understand the occurrence and operative treatment of peripheral nerve injury (PNI) and the potential need for additional resources, it is essential to define the frequency and distribution of peripheral nerve procedures being performed. The objective of this study was to evaluate Ontario’s wait times for delayed surgical treatment of traumatic PNI. Methods: We retrieved data on wait times for peripheral nerve surgery from the Ontario Ministry of Health and Long-Term Care Wait Time Information System. We reviewed the wait times for delayed surgical treatment of traumatic PNI among adult patients (age ≥ 18 yr) from April 2009 to March 2018. Data collected included total cases, mean and median wait times, and demographic characteristics. Results: Over the study period, 7313 delayed traumatic PNI operations were reported, with variability in the case volume distribution across Local Health Integration Networks (LHINs). The highest volume of procedures (2788) was performed in the Toronto Central LHIN, and the lowest volume (< 6) in the Waterloo Wellington and North Simcoe Muskoka LHINs. The population incidence of traumatic PNI requiring surgery was 5.1/10 000. The mean and median wait times from surgical decision to surgical repair were 45 and 27 days, respectively. Both the longest and shortest wait times occurred in LHINs with low case volumes. The provincial target wait time was met in 93% of cases, but women waited significantly longer than men (p < 0.001). Conclusion: The provincial distribution of traumatic PNI surgery was variable, and the highest volumes were in the LHINs with large populations. The provincial wait time strategy for traumatic PNI surgery is effective, but women waited longer than men. Precise reporting from all hospitals is necessary to accurately capture and understand the delivery of care after traumatic PNI.
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Affiliation(s)
- Moaath Saggaf
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Saggaf, Novak, Baltzer, Anastakis); the Hand Program, Toronto Western Hospital, University Health Network, Toronto, Ont. (Saggaf, Baltzer, Anastakis); the Institute of Medical Science, University of Toronto, Toronto, Ont. (Saggaf, Anastakis); the Division of Plastic and Reconstructive Surgery, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia (Saggaf); and the Krembil Research Institute, University Health Network, Toronto, Ont. (Anastakis)
| | - Christine B Novak
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Saggaf, Novak, Baltzer, Anastakis); the Hand Program, Toronto Western Hospital, University Health Network, Toronto, Ont. (Saggaf, Baltzer, Anastakis); the Institute of Medical Science, University of Toronto, Toronto, Ont. (Saggaf, Anastakis); the Division of Plastic and Reconstructive Surgery, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia (Saggaf); and the Krembil Research Institute, University Health Network, Toronto, Ont. (Anastakis)
| | - Heather L Baltzer
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Saggaf, Novak, Baltzer, Anastakis); the Hand Program, Toronto Western Hospital, University Health Network, Toronto, Ont. (Saggaf, Baltzer, Anastakis); the Institute of Medical Science, University of Toronto, Toronto, Ont. (Saggaf, Anastakis); the Division of Plastic and Reconstructive Surgery, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia (Saggaf); and the Krembil Research Institute, University Health Network, Toronto, Ont. (Anastakis)
| | - Dimitri J Anastakis
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Saggaf, Novak, Baltzer, Anastakis); the Hand Program, Toronto Western Hospital, University Health Network, Toronto, Ont. (Saggaf, Baltzer, Anastakis); the Institute of Medical Science, University of Toronto, Toronto, Ont. (Saggaf, Anastakis); the Division of Plastic and Reconstructive Surgery, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia (Saggaf); and the Krembil Research Institute, University Health Network, Toronto, Ont. (Anastakis)
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19
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Tactile stimulation programs in patients with hand dysesthesia after a peripheral nerve injury: A systematic review. J Hand Ther 2021; 34:3-17. [PMID: 32828612 DOI: 10.1016/j.jht.2020.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 03/20/2020] [Accepted: 05/02/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This is a systematic review performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. INTRODUCTION Diverse approaches based on tactile stimulation are used in hand rehabilitation settings to treat touch-evoked dysesthesias. However, there is a lack of literature synthesis on the description and the effectiveness of the various approaches based on tactile stimulation that can be used for treating hand dysesthesia after nerve injury. PURPOSE OF THE STUDY The purpose of the study was to summarize the current evidence on tactile stimulation programs for managing touch-evoked hand dysesthesia due to nerve injury. METHODS The search was carried out on Medline, Embase, CINAHL, and the Cochrane Library databases. The selected studies had to present patients with touch-evoked dysesthesia after nerve injury who were treated with tactile stimulation approaches to reduce pain. The methodological quality of the included studies was assessed using the methodological index for nonrandomized studies scale, as well as the risk of bias. RESULTS Eleven studies met the inclusion criteria. These studies present tactile stimulation interventions that are heterogeneous relative to the target populations and the intervention itself (desensitization versus somatosensory rehabilitation method). Painful symptoms appear to diminish in patients with touch-evoked hand dysesthesia, regardless of the tactile stimulation program used. However, the included studies present significant risks of bias that limit the confidence in these results. DISCUSSION The evidence does not unequivocally support the beneficial effects of tactile stimulation to treat touch-evoked hand dysesthesia. CONCLUSION Future studies with more rigorous methodological designs, such as randomized controlled trials, are required to verify the potential benefits of these approaches.
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20
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Shlomy I, Divald S, Tadmor K, Leichtmann-Bardoogo Y, Arami A, Maoz BM. Restoring Tactile Sensation Using a Triboelectric Nanogenerator. ACS NANO 2021; 15:11087-11098. [PMID: 34137606 PMCID: PMC8320237 DOI: 10.1021/acsnano.0c10141] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 06/08/2021] [Indexed: 05/28/2023]
Abstract
Loss of tactile sensation is a common occurrence in patients with traumatic peripheral nerve injury or soft tissue loss, but as yet, solutions for restoring such sensation are limited. Implanted neuro-prosthetics are a promising direction for tactile sensory restoration, but available technologies have substantial shortcomings, including complexity of use and of production and the need for an external power supply. In this work, we propose, fabricate, and demonstrate the use of a triboelectric nanogenerator (TENG) as a relatively simple, self-powered, biocompatible, sensitive, and flexible device for restoring tactile sensation. This integrated tactile TENG (TENG-IT) device is implanted under the skin and translates tactile pressure into electrical potential, which it relays via cuff electrodes to healthy sensory nerves, thereby stimulating them, to mimic tactile sensation. We show that the device elicits electrical activity in sensory neurons in vitro, and that the extent of this activity is dependent on the level of tactile pressure applied to the device. We subsequently demonstrate the TENG-IT in vivo, showing that it provides tactile sensation capabilities (as measured by a von Frey test) to rats in which sensation in the hindfoot was blocked through transection of the distal tibial nerve. These findings point to the substantial potential of self-powered TENG-based implanted devices as a means of restoring tactile sensation.
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Affiliation(s)
- Iftach Shlomy
- Department
of Biomedical Engineering, Tel Aviv University, Tel Aviv, 69978, Israel
| | - Shay Divald
- Department
of Biomedical Engineering, Tel Aviv University, Tel Aviv, 69978, Israel
| | - Keshet Tadmor
- Sagol
School of Neuroscience, Tel Aviv University, Tel Aviv, 69978, Israel
| | | | - Amir Arami
- Hand
Surgery Department, Microsurgery and Peripheral Nerve Surgery Unit, Sheba Medical Center, Tel Hashomer, 52621, Israel
- Sackler
School of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
| | - Ben M. Maoz
- Department
of Biomedical Engineering, Tel Aviv University, Tel Aviv, 69978, Israel
- Sagol
School of Neuroscience, Tel Aviv University, Tel Aviv, 69978, Israel
- The
Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, 69978, Israel
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21
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Cox CT, Suryavanshi JR, Osemwengie BO, Rosqvist S, Blue M, McKee D, MacKay BJ. Evaluation of postoperative outcomes in patients following multi-level surgical reconstructions with the use Avive ™ soft tissue membrane on nerve after traumatic injury of the upper extremity and lower extremity. SAGE Open Med 2021; 9:20503121211023356. [PMID: 34164128 PMCID: PMC8188973 DOI: 10.1177/20503121211023356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/19/2021] [Indexed: 11/17/2022] Open
Abstract
Background Treatment of patients with traumatic axonotmesis presents challenges. Processed human umbilical cord membrane has been recently developed with improved handling and resorption time compared to other amniotic membrane wraps, and may be beneficial in nerve reconstruction. This study evaluates postoperative outcomes after traumatic peripheral nerve injury after placement of commercially available processed human umbilical cord membrane. Methods We performed a prospective, single-center pilot study of patients undergoing multi-level surgical reconstruction for exposed, non-transected peripheral nerve. Functional outcomes including pain, range of motion, pinch and grip strength, and the QuickDASH and SF-36 patient-reported outcome measures were recorded, when possible, at the 1-week and 3, 6, and 9 months postop visit. One-tailed paired t-tests were performed to evaluate outcome improvement at final follow-up. Results Twenty patients had processed human umbilical cord membrane placement without surgical complications. Mean follow-up was 7.5 months (range: 3-10 months) and mean age was 39 years (range: 15-65). Twelve (67%) patients were male, and the majority of placement sites were in the upper extremity (85%). Mean preoperative visual analog scale pain score was significantly reduced at most recent follow-up, as were QuickDASH scores. All patients had improved functional outcomes at the 9-month follow-up, and SF-36 outcomes at 9 months showed improvement across all dimensions. Conclusion This study indicates that processed human umbilical cord membrane may be a useful adjunct in nerve surgery with noted improvements in postoperative function, pain, and patient-reported outcome measures. Future studies are needed to assess long-term outcomes after traumatic nerve injury treated with processed human umbilical cord membrane.
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Affiliation(s)
- Cameron T Cox
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Joash R Suryavanshi
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Bradley O Osemwengie
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Sterling Rosqvist
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Matthew Blue
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Desirae McKee
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,University Medical Center, Lubbock, TX, USA
| | - Brendan J MacKay
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,University Medical Center, Lubbock, TX, USA
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22
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Estrella EP, Castillo-Carandang NT, Cordero CP, Juban NR. Quality of life of patients with traumatic brachial plexus injuries. Injury 2021; 52:855-861. [PMID: 33461770 DOI: 10.1016/j.injury.2020.11.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Traumatic brachial plexus injuries are devastating injuries with lifelong disability and pain. The objective of this paper was to determine the functional disability of adult patients with traumatic brachial plexus injuries. PATIENTS AND METHODS A cross-sectional study was done to determine the functional disability of patients using the FIL-DASH (Filipino Disability of the Arm, Shoulder and Hand) and the BPI (Brief Pain Inventory) Severity Pain Score (Tagalog version) questionnaires to determine the functional disability and quality of life of patients with traumatic brachial plexus injuries. A regression analysis was done to determine the factors associated with the FIL-DASH score with the level of significance set at p < 0.05. RESULTS A total of 126 adult patients with traumatic brachial plexus injuries were evaluated with a mean age of 30.1(standard deviation [SD], 9.1; range, 17-69). There were 123 males and three females. The mean quality of life (FIL-DASH Score) of the 126 patients was 45.6 (95% CI: 42.5 - 48.7), (SD, 17.4), (range, 2.5 - 89.2), the mean BPI Severity Pain Score was 16.1 (95% CI: 14.6-17.8; SD, 8.9; range, 0-36) among 126 patients. On multivariate analysis using the hierarchical method of model building, higher range of elbow flexion, lower Brief Pain Inventory Severity Score, and longer months from injury were found to be associated with a better FIL-DASH score. CONCLUSION The study showed that elbow flexion recovery, pain and duration of the injury were significantly associated with the FIL-DASH scores.
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Affiliation(s)
- Emmanuel P Estrella
- ASTRO Study Group, Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines, Manila, Philippines; Department of Clinical Epidemiology, College of Medicine, University of the Philippines, Manila, Philippines; Microsurgery Unit, Division of Hand & Reconstructive Microsurgery, Department of Orthopedics, Philippine General Hospital, Manila, Philippines.
| | - Nina T Castillo-Carandang
- ASTRO Study Group, Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines, Manila, Philippines; Department of Clinical Epidemiology, College of Medicine, University of the Philippines, Manila, Philippines
| | - Cynthia P Cordero
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines, Manila, Philippines
| | - Noel R Juban
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines, Manila, Philippines
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23
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Yuan YS, Yu F, Zhang YJ, Niu SP, Xu HL, Kou YH. Changes in proteins related to early nerve repair in a rat model of sciatic nerve injury. Neural Regen Res 2021; 16:1622-1627. [PMID: 33433493 PMCID: PMC8323673 DOI: 10.4103/1673-5374.301025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Peripheral nerves have a limited capacity for self-repair and those that are severely damaged or have significant defects are challenging to repair. Investigating the pathophysiology of peripheral nerve repair is important for the clinical treatment of peripheral nerve repair and regeneration. In this study, rat models of right sciatic nerve injury were established by a clamping method. Protein chip assay was performed to quantify the levels of neurotrophic, inflammation-related, chemotaxis-related and cell generation-related factors in the sciatic nerve within 7 days after injury. The results revealed that the expression levels of neurotrophic factors (ciliary neurotrophic factor) and inflammation-related factors (intercellular cell adhesion molecule-1, interferon γ, interleukin-1α, interleukin-2, interleukin-4, interleukin-6, monocyte chemoattractant protein-1, prolactin R, receptor of advanced glycation end products and tumor necrosis factor-α), chemotaxis-related factors (cytokine-induced neutrophil chemoattractant-1, L-selectin and platelet-derived growth factor-AA) and cell generation-related factors (granulocyte-macrophage colony-stimulating factor) followed different trajectories. These findings will help clarify the pathophysiology of sciatic nerve injury repair and develop clinical treatments of peripheral nerve injury. This study was approved by the Ethics Committee of Peking University People’s Hospital of China (approval No. 2015-50) on December 9, 2015.
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Affiliation(s)
- Yu-Song Yuan
- Department of Trauma and Orthopedics, Peking University People's Hospital; Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, China
| | - Fei Yu
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing; National & Local Joint Engineering Research Center of Orthopedic Biomaterials, Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
| | - Ya-Jun Zhang
- National Center for Trauma Medicine, Beijing, China
| | - Su-Ping Niu
- Office of Academic Research, Peking University People's Hospital, Beijing, China
| | - Hai-Lin Xu
- Department of Trauma and Orthopedics; Diabetic Foot Treatment Center, Peking University People's Hospital, Beijing, China
| | - Yu-Hui Kou
- Department of Trauma and Orthopedics, Peking University People's Hospital; Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, China
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24
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Van der Gucht E, Dams L, Meeus M, Devoogdt N, Beintema A, Penen F, Hoelen W, De Vrieze T, De Groef A. Kinesiophobia contributes to pain-related disability in breast cancer survivors: a cross-sectional study. Support Care Cancer 2020; 28:4501-4508. [PMID: 31953624 DOI: 10.1007/s00520-020-05304-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Pain is one of the most prevalent problems reported by breast cancer survivors. As this long-lasting complication can result in disabilities on all different domains of functioning, we aimed to clarify the contribution of different factors (pain-related factors, psychosocial factors, and fatigue) to pain-related disability in female breast cancer survivors. METHODS Seventy women who had completed their primary breast cancer treatment were included in this cross-sectional study. The following outcome measures were evaluated as independent variables for their contribution to pain-related disability (measured by the Pain Disability Index, with a maximum score of 70): pain intensity, self-reported symptoms of central sensitization, fatigue, illness beliefs, pain catastrophizing, and kinesiophobia. At first, bi- and multivariable regression methods were conducted. Secondly, a stepwise regression analysis was performed to determine the explained variance of the PDI. RESULTS Mean score on the PDI was 16 at 4.5 years post-surgery. Multivariable regression analysis revealed higher levels of kinesiophobia as the main contributor to pain-related disability. Ultimately, stepwise regression showed that up to 40% of variance in pain-related disability could be explained by kinesiophobia, negative perceptions related to illness consequences, and pain catastrophizing. CONCLUSION This study shows that breast cancer survivors portray moderate self-reported pain-related disability. Kinesiophobia emerged as the main contributor to pain-related disability at this time point, which could shine a light on the improvement of treatment modalities for pain management in this population.
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Affiliation(s)
- Elien Van der Gucht
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, ON4 Herestraat 49 - box 1510, 3000, Leuven, Belgium.
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium.
| | - Lore Dams
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, ON4 Herestraat 49 - box 1510, 3000, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, ON4 Herestraat 49 - box 1510, 3000, Leuven, Belgium
- Department of Vascular Surgery and Department of Physical Medicine and Rehabilitation, Center for Lymphoedema, UZ Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Annemarie Beintema
- The Berekuyl Academy, Hierden, the Netherlands
- Cancer Care Center, Amsterdam, the Netherlands
| | - Frauke Penen
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, ON4 Herestraat 49 - box 1510, 3000, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
| | | | - Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, ON4 Herestraat 49 - box 1510, 3000, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
| | - An De Groef
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, ON4 Herestraat 49 - box 1510, 3000, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
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25
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Zuo KJ, Gordon T, Chan KM, Borschel GH. Electrical stimulation to enhance peripheral nerve regeneration: Update in molecular investigations and clinical translation. Exp Neurol 2020; 332:113397. [PMID: 32628968 DOI: 10.1016/j.expneurol.2020.113397] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/16/2020] [Accepted: 06/27/2020] [Indexed: 02/06/2023]
Abstract
Peripheral nerve injuries are common and frequently result in incomplete functional recovery even with optimal surgical treatment. Permanent motor and sensory deficits are associated with significant patient morbidity and socioeconomic burden. Despite substantial research efforts to enhance peripheral nerve regeneration, few effective and clinically feasible treatment options have been found. One promising strategy is the use of low frequency electrical stimulation delivered perioperatively to an injured nerve at the time of surgical repair. Possibly through its effect of increasing intraneuronal cyclic AMP, perioperative electrical stimulation accelerates axon outgrowth, remyelination of regenerating axons, and reinnervation of end organs, even with delayed surgical intervention. Building on decades of experimental evidence in animal models, several recent, prospective, randomized clinical trials have affirmed electrical stimulation as a clinically translatable technique to enhance functional recovery in patients with peripheral nerve injuries requiring surgical treatment. This paper provides an updated review of the cellular physiology of electrical stimulation and its effects on axon regeneration, Level I evidence from recent prospective randomized clinical trials of electrical stimulation, and ongoing and future directions of research into electrical stimulation as a clinically feasible adjunct to surgical intervention in the treatment of patients with peripheral nerve injuries.
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Affiliation(s)
- Kevin J Zuo
- Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto, ON, Canada; Neurosciences and Mental Health, SickKids Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Tessa Gordon
- Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto, ON, Canada; Neurosciences and Mental Health, SickKids Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - K Ming Chan
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB, Canada
| | - Gregory H Borschel
- Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto, ON, Canada; Neurosciences and Mental Health, SickKids Research Institute, Hospital for Sick Children, Toronto, ON, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
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26
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Malsagova AT, van Burink MV, Smits ES, Zöphel OT, Stassen CM, Botman JMJ, Rakhorst HA. Prospective assessment of function and cold-intolerance following revascularization for hypothenar hammer syndrome. J Plast Reconstr Aesthet Surg 2020; 73:2164-2170. [PMID: 32565138 DOI: 10.1016/j.bjps.2020.05.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/31/2020] [Accepted: 05/15/2020] [Indexed: 01/24/2023]
Abstract
Ulnar artery revascularization in hypothenar hammer syndrome has repeatedly been shown to reduce ischaemic symptoms, however with varying graft patency percentages. This study prospectively assesses the effect of revascularization surgery with a vein graft using validated questionnaires in seven patients. The Disabilities of the Arm, Shoulder and Hand (DASH) and the Cold Intolerance Symptom Severity (CISS) questionnaires have been used to compare the preoperative and postoperative functionality and cold intolerance. All patients showed improvement in either functionality, or cold intolerance, or both from disabled to nearly normalized levels and resumed their occupation at final follow-up (mean of 28 months). Strikingly this was also the case in a patient with graft stenosis. Patients with the highest preoperative questionnaire scores showed most postoperative improvement. In conclusion, revascularization surgery seems to improve the symptomatology irrespective of graft patency. Questionnaires can be a valuable contribution to quantify and to follow the symptomatology in hypothenar hammer syndrome.
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Affiliation(s)
- A T Malsagova
- Department of Plastic Surgery, Ziekenhuisgroep Twente in Almelo and Hengelo, Zilvermeeuw 1, 7609 PP Almelo, the Netherlands, Department of Plastic Surgery, Medisch Spectrum Twente, Koningsplein 1, 7512 Enschede, KZ, the Netherlands
| | - M V van Burink
- Department of Plastic Surgery, Ziekenhuisgroep Twente in Almelo and Hengelo, Zilvermeeuw 1, 7609 PP Almelo, the Netherlands, Department of Plastic Surgery, Medisch Spectrum Twente, Koningsplein 1, 7512 Enschede, KZ, the Netherlands.
| | - E S Smits
- Department of Plastic Surgery, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 Rotterdam, CE, the Netherlands
| | - O T Zöphel
- Department of Plastic Surgery, Ziekenhuisgroep Twente in Almelo and Hengelo, Zilvermeeuw 1, 7609 PP Almelo, the Netherlands, Department of Plastic Surgery, Medisch Spectrum Twente, Koningsplein 1, 7512 Enschede, KZ, the Netherlands
| | - C M Stassen
- Department of Radiology, Ziekenhuisgroep Twente in Almelo and Hengelo/Medisch Spectrum Twente, the Netherlands
| | - J M J Botman
- Department of General Surgery, Ziekenhuisgroep Twente Almelo and Hengelo, the Netherlands
| | - H A Rakhorst
- Department of Plastic Surgery, Ziekenhuisgroep Twente in Almelo and Hengelo, Zilvermeeuw 1, 7609 PP Almelo, the Netherlands, Department of Plastic Surgery, Medisch Spectrum Twente, Koningsplein 1, 7512 Enschede, KZ, the Netherlands
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27
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Pan D, Mackinnon SE, Wood MD. Advances in the repair of segmental nerve injuries and trends in reconstruction. Muscle Nerve 2020; 61:726-739. [PMID: 31883129 DOI: 10.1002/mus.26797] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 12/18/2022]
Abstract
Despite advances in surgery, the reconstruction of segmental nerve injuries continues to pose challenges. In this review, current neurobiology regarding regeneration across a nerve defect is discussed in detail. Recent findings include the complex roles of nonneuronal cells in nerve defect regeneration, such as the role of the innate immune system in angiogenesis and how Schwann cells migrate within the defect. Clinically, the repair of nerve defects is still best served by using nerve autografts with the exception of small, noncritical sensory nerve defects, which can be repaired using autograft alternatives, such as processed or acellular nerve allografts. Given current clinical limits for when alternatives can be used, advanced solutions to repair nerve defects demonstrated in animals are highlighted. These highlights include alternatives designed with novel topology and materials, delivery of drugs specifically known to accelerate axon growth, and greater attention to the role of the immune system.
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Affiliation(s)
- Deng Pan
- Division of Plastic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Susan E Mackinnon
- Division of Plastic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew D Wood
- Division of Plastic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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28
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Estrella EP, Orillaza NS, Castillo-Carandang NT, Cordero CP, Juban NR. The Validity, Reliability and Internal Consistency of the Cross-Cultural Adaptation of the FIL-DASH (Filipino Version of the Disability of the Arm, Shoulder and Hand) Questionnaire in Patients with Traumatic Brachial Plexus Injuries. J Hand Surg Asian Pac Vol 2019; 24:456-461. [PMID: 31690189 DOI: 10.1142/s2424835519500590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The objective of this paper was to determine the validity, reliability and internal consistency of the translated FILIPINO DASH (FIL-DASH) questionnaire in patients with traumatic brachial plexus injuries. Methods: Thirty-five adult patients with traumatic brachial plexus injury were enrolled in the validation stage. The same questionnaire was given to the patient between 7 to 14 days for the test-retest reliability. The validated Filipino version of the SF-36 was used as the gold standard to determine the construct validity of the translated DASH. We also compared the DASH score with the SF-36 total and subscale, validated Brief Pain Inventory Severity and Interference Scale and the Visual Acuity Scale (VAS) for Pain. Results: The internal consistency was adequate, with Cronbach's Alpha for the 30 items of 0.93 and an average inter-item covariance of 0.399. The test-retest reliability was 0.87 (p < 0.001). There was no significant difference in establising the validity of the translated DASH against SF-36 total and Subscale, validated Brief Pain Inventory Severity and Interference Scale and the Visual Analogue Scale (VAS). Conclusions: The translated DASH (FIL-DASH) questionnaire was internally consistent and showed no difference in testing for test-retest reliability and validity against functional outcome measures and pain scales validated for adult Filipinos.
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Affiliation(s)
- Emmanuel P Estrella
- ASTRO (Advanced Study and Research in Orthopedics) Study Group, Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines, Manila, Philippines.,Section of Hand & Reconstructive Microsurgery, Department of Orthopedics, Philippine General Hospital, Manila, Philippines
| | - Nathaniel S Orillaza
- ASTRO (Advanced Study and Research in Orthopedics) Study Group, Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines, Manila, Philippines.,Department of Clinical Epidemiology, College of Medicine, University of the Philippines, Manila, Philippines.,Section of Hand & Reconstructive Microsurgery, Department of Orthopedics, Philippine General Hospital, Manila, Philippines
| | - Nina T Castillo-Carandang
- ASTRO (Advanced Study and Research in Orthopedics) Study Group, Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines, Manila, Philippines.,Department of Clinical Epidemiology, College of Medicine, University of the Philippines, Manila, Philippines
| | - Cynthia P Cordero
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines, Manila, Philippines
| | - Noel R Juban
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines, Manila, Philippines
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Zuo KJ, Shafa G, Antonyshyn K, Chan K, Gordon T, Borschel GH. A single session of brief electrical stimulation enhances axon regeneration through nerve autografts. Exp Neurol 2019; 323:113074. [PMID: 31655047 DOI: 10.1016/j.expneurol.2019.113074] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/25/2019] [Accepted: 09/27/2019] [Indexed: 02/08/2023]
Abstract
Nerve graft reconstruction of gap defects may result in poor clinical outcomes, particularly with long regeneration distances. Electrical stimulation (ES) of nerves may improve outcomes in such patients. A single session of ES at 20 Hz for 1 h significantly enhances axon regeneration in animals and human subjects after nerve crush or nerve transection and repair. The objectives of this study were to evaluate if ES enhances axon regeneration through nerve grafts and if there is added benefit of a second, delayed session of ES (serial ES) on axon regeneration as compared to a single session only of ES. In female rats, a gap defect was created in the hindlimb common peroneal (CP) nerve and immediately reconstructed with a 10 mm nerve autograft (Experiment 1) or a 20 mm nerve autograft (Experiment 2). In Experiment 1, rats were randomized to 1 h of CP nerve ES or sham stimulation. In Experiment 2, rats were randomized to control (sham ES + sham ES), single ES (ES + sham ES), or serial ES (ES + ES), which consisted of an initial 1 h session of either ES or sham stimulation of the CP nerve, followed by a second 1 h session of ES or sham stimulation of the CP nerve 4 weeks later. In both experiments, after a 6 week period of nerve regeneration, CP neurons that had regenerated axons distal to the autograft were retrograde labelled for enumeration, and the CP nerve distal to the autograft was harvested for histomorphometry. In Experiment 1, rats that received CP nerve ES had statistically significantly more motor (p < .05) and sensory (p < .05) neurons that regenerated axons distal to the 10 mm nerve autograft, with more myelinated axons on histomorphometry (p < .001). Similarly, in Experiment 2, significantly more motor (p < .01) and sensory (p < .05) neurons regenerated axons distal to the 20 mm nerve autograft after a single session or two sessions of CP nerve ES. There was no significant difference in the number of regenerated motor or sensory neurons between rats with 20 mm CP nerve autografts receiving either one or two sessions of CP nerve ES (p > .05). In conclusion, a single session of ES enhances axon regeneration following nerve autografting with no added effect of a second, delayed session of ES. These findings support previous studies in animals and humans of the robust effect of a single session of ES in promoting nerve regeneration following injury and repair.
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Affiliation(s)
- Kevin J Zuo
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada; Neurosciences and Mental Health, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Golsa Shafa
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada; Neurosciences and Mental Health, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Kira Antonyshyn
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada; Neurosciences and Mental Health, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Katelyn Chan
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada; Neurosciences and Mental Health, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Tessa Gordon
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada; Neurosciences and Mental Health, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Gregory H Borschel
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada; Neurosciences and Mental Health, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
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30
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An update on the management of adult traumatic nerve injuries—replacing old paradigms: A review. J Trauma Acute Care Surg 2019; 86:299-306. [DOI: 10.1097/ta.0000000000002081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Jayakumar P, Overbeek CL, Lamb S, Williams M, Funes CJ, Gwilym S, Ring D, Vranceanu AM. What Factors Are Associated With Disability After Upper Extremity Injuries? A Systematic Review. Clin Orthop Relat Res 2018; 476:2190-2215. [PMID: 30188344 PMCID: PMC6259989 DOI: 10.1097/corr.0000000000000427] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/12/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Psychosocial factors are key determinants of health after upper extremity injuries. However, a systematic review is needed to understand which psychosocial factors are most consistently associated with disability and how the language, conceptualization, and types of measures used to assess disability impact these associations in upper extremity injuries. QUESTIONS/PURPOSES (1) What factors are most consistently associated with disability after upper extremity injuries in adults? (2) What are the trends in types of outcome measures and conceptualization of disability in patients' upper extremity injuries? METHODS We searched multiple electronic databases (PubMED, OVIDSP, PsycInfo, Google Scholar, ISI Web of Science) between January 1, 1996, and December 31, 2016, using terms related to the "upper extremity", "outcome measurement", and "impairment, psychological, social or symptomatic" variables. We included all studies involving adult patients with any musculoskeletal injury and excluded those that did not use patient-reported outcome measures. We identified and screened 9339 studies. Of these, we retained 41 studies that involved conditions ranging from fractures to soft tissue injuries in various regions of the arm. We conducted quality assessment using a 10-item validated checklist and a five-tier strength of evidence assessment. We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria and registered the review before performing our search (PROSPERO: CRD42017054048). None of the authors received any funding to perform this work. RESULTS Disability after upper extremity injury was most consistently associated with depression (21 cohorts), catastrophic thinking (13 cohorts), anxiety (11 cohorts), pain self-efficacy (eight cohorts), and pain interference (seven cohorts). Social and demographic factors were also associated with disability. Measures of impairment such as ROM and injury severity were least associated with disability. There has been a gradual increase in use of region or condition-specific patient-reported outcome measures and measures of psychological, social, and symptomatic factors over a period since the introduction of the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) around 2000. Approximately 17% of studies (n = 454 of 2628) had instances of unclear, conflicting, or inappropriate terminology and 11% of studies (n = 257 of 2628) involved misrepresentations of outcome measures related to disability. CONCLUSIONS Psychologic and social factors are most consistently associated with disability than factors related to impairment. Further research involving the assessment of depression, anxiety, and coping strategies in cohorts with specific injuries may support decision-making regarding the provision of emotional support and psychologic therapies during recovery. Using the WHO ICF framework to conceptualize disability is key in increasing strength of evidence and allowing accurate comparisons of research in this field. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Prakash Jayakumar
- P. Jayakumar, S. Lamb, S. Gwilym, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Medicine, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK C. L. Overbeek, Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands M. Williams, Department of Sport and Health Sciences, Oxford Brookes University, Oxford, UK C. Funes, Department of Psychiatry (Behavioral Medicine Service), Boston, MA, USA D. Ring, The University of Texas at Austin, Department of Surgery and Perioperative Care, Dell Medical School, Austin, TX, USA A.-M. Vranceanu, Massachusetts General Hospital and Harvard Medical School, Behavioral Medicine Program, Department of Psychiatry, Boston, MA, USA
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Ziemer KS, Korkmaz G. Using text to predict psychological and physical health: A comparison of human raters and computerized text analysis. COMPUTERS IN HUMAN BEHAVIOR 2017. [DOI: 10.1016/j.chb.2017.06.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Suzuki K, Tanaka H, Ebara M, Uto K, Matsuoka H, Nishimoto S, Okada K, Murase T, Yoshikawa H. Electrospun nanofiber sheets incorporating methylcobalamin promote nerve regeneration and functional recovery in a rat sciatic nerve crush injury model. Acta Biomater 2017; 53:250-259. [PMID: 28179161 DOI: 10.1016/j.actbio.2017.02.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/23/2017] [Accepted: 02/02/2017] [Indexed: 12/17/2022]
Abstract
Peripheral nerve injury is one of common traumas. Although injured peripheral nerves have the capacity to regenerate, axon regeneration proceeds slowly and functional outcomes are often poor. Pharmacological enhancement of regeneration can play an important role in increasing functional recovery. In this study, we developed a novel electrospun nanofiber sheet incorporating methylcobalamin (MeCbl), one of the active forms of vitamin B12 homologues, to deliver it enough locally to the peripheral nerve injury site. We evaluated whether local administration of MeCbl at the nerve injury site was effective in promoting nerve regeneration. Electrospun nanofiber sheets gradually released MeCbl for at least 8weeks when tested in vitro. There was no adverse effect of nanofiber sheets on function in vivo of the peripheral nervous system. Local implantation of nanofiber sheets incorporating MeCbl contributed to the recovery of the motor and sensory function, the recovery of nerve conduction velocity, and the promotion of myelination after sciatic nerve injury, without affecting plasma concentration of MeCbl. STATEMENT OF SIGNIFICANCE Methylcobalamin (MeCbl) is a vitamin B12 analog and we previously reported its effectiveness in axonal outgrowth of neurons and differentiation of Schwann cells both in vitro and in vivo. Here we estimated the effect of local administered MeCbl with an electrospun nanofiber sheet on peripheral nerve injury. Local administration of MeCbl promoted functional recovery in a rat sciatic nerve crush injury model. These sheets are useful for nerve injury in continuity differently from artificial nerve conduits, which are useful only for nerve defects. We believe that the findings of this study are relevant to the scope of your journal and will be of interest to its readership.
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Affiliation(s)
- Koji Suzuki
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Hiroyuki Tanaka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Mitsuhiro Ebara
- International Center for Materials Nanoarchitectonics (WPI-MANA), National Institute for Materials Science (NIMS), 1-1 Namiki, Tsukuba, Ibaraki 304-0044, Japan
| | - Koichiro Uto
- International Center for Materials Nanoarchitectonics (WPI-MANA), National Institute for Materials Science (NIMS), 1-1 Namiki, Tsukuba, Ibaraki 304-0044, Japan
| | - Hozo Matsuoka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Shunsuke Nishimoto
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Kiyoshi Okada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Medical Center for Translational and Clinical Research, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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Ziemer KS, Fuhrmann A, Hoffman MA. Effectiveness of a Positive Writing Intervention for Chronic Pain: A Randomized Trial. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/24708593.2017.1307893] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Kathryn Schaefer Ziemer
- The Department of Counseling, Special Education and Higher Education, University of Maryland, College Park, MD, USA
| | - Amy Fuhrmann
- The Department of Counseling, Special Education and Higher Education, University of Maryland, College Park, MD, USA
| | - Mary Ann Hoffman
- The Department of Counseling, Special Education and Higher Education, University of Maryland, College Park, MD, USA
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Stonner MM, Mackinnon SE, Kaskutas V. Predictors of Disability and Quality of Life With an Upper-Extremity Peripheral Nerve Disorder. Am J Occup Ther 2016; 71:7101190050p1-7101190050p8. [PMID: 28027047 DOI: 10.5014/ajot.2017.022988] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We sought to understand the wide range of problems that patients with upper-extremity peripheral nerve disorders experience and to identify predictors of disability and quality of life (QOL). METHOD Data from standardized assessments of disability and QOL, physical examination results, and intake surveys from 627 patients were analyzed using descriptive and inferential statistics. We compared results between groups and built multivariate models measuring disability, work disability, and physical and mental QOL. RESULTS The sample demonstrated substantial disability and even greater work disability, which both closely correlated with poorer QOL. Work status was integral in predicting disability. Common predictors across models included problems with sleep and intimate relationships, deficits in work and household performance, and higher pain. CONCLUSION To decrease disability and improve QOL, occupational therapy practitioners should help patients with upper-extremity peripheral nerve disorders identify strategies to maintain meaningful work and household roles, intimate relationships, and sleep, while continuing to address pain.
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Affiliation(s)
- Macyn Miller Stonner
- Macyn Miller Stonner is Occupational Therapy Clinical Doctoral Candidate, Washington University School of Medicine, St. Louis, MO
| | - S E Mackinnon
- S. E. Mackinnon, MD, is Shoenberg Professor and Chief of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO
| | - Vicki Kaskutas
- Vicki Kaskutas, OTD, OTR/L, FAOTA, is Associate Professor, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO;
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Rostami HR, Akbarfahimi M, Hassani Mehraban A, Akbarinia AR, Samani S. Occupation-based intervention versus rote exercise in modified constraint-induced movement therapy for patients with median and ulnar nerve injuries: a randomized controlled trial. Clin Rehabil 2016; 31:1087-1097. [DOI: 10.1177/0269215516672276] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To investigate effect of practice type during modified constraint-induced movement therapy on hand function in patients with chronic median and ulnar nerve injuries. Design: A prospective, single-blinded, randomized controlled clinical trial. Setting: Participants’ private home. Subjects: A convenience sample of 36 outpatient participants allocated randomly to three equal groups. Interventions: Intervention groups underwent 3-hour intensive training of affected hand each day, 3-day a week, 4-week in association with immobilisation of healthy hand: occupation-based group practiced meaningful occupations while rote exercise-based group performed rote exercises during constraint-induced movement therapy. Control group performed different activities with affected hand for 1.5-hour each day during 4-week without restriction of healthy hand. Main measures: A blinded assessor tested Canadian occupational performance measure, box and block, Static two-point discrimination, disabilities of arm, shoulder, hand questionnaire, and self-assessment manikin in a random order across sessions 3-time as baseline (pre-test), after 4-week intervention (post-test), and 1-month after intervention period (follow up). Results: Scores significantly changed in intervention groups compared to control. Despite significantly more improvement in occupation-based than rote exercise-based group in subjective measures at post-test and follow up (Canadian occupational performance measure: mean change 4.7 vs. 2.1 for performance, P< 0.001 and mean change 5.3 vs. 2.6 for satisfaction, P< 0.001), it was significant just at follow up for box and block and static two-point discrimination. Conclusions: Practice content of constraint-induced movement therapy is a critical part of its effectiveness on improving outcomes following peripheral nerve repair in favour of occupation-based intervention in present study.
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Affiliation(s)
- Hamid Reza Rostami
- Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
- Department of Occupational Therapy, School of Rehabilitation Sciences, Esfahan University of Medical Sciences, Esfahan, Iran
| | - Malahat Akbarfahimi
- Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Afsoon Hassani Mehraban
- Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Reza Akbarinia
- Department of Hand Microsurgery and Plastic Surgery, Laleh Hospital, Tehran, Iran
| | - Susan Samani
- Cognitive Research Centre, Shahid Beheshti University, Tehran, Iran
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Abstract
Traumatic nerve injuries can be devastating and life-changing events, leading to functional morbidity and psychological stress and social constraints. Even in the event of a successful surgical repair with recovered motor function, pain can result in continued disability and poor quality of life. Pain after nerve injury can also prevent recovery and return to preinjury life. It is difficult to predict which patients will develop persistent pain; once incurred, pain can be even challenging to manage. This review seeks to define the types of pain following peripheral nerve injuries, investigate the pathophysiology and causative factors, and evaluate potential treatment options.
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Affiliation(s)
- Gabrielle Davis
- Department of Surgery, Palo Alto VA, Suite 400, 770 Welch Road, Palo Alto, CA 94304, USA
| | - Catherine M Curtin
- Department of Surgery, Palo Alto VA, Suite 400, 770 Welch Road, Palo Alto, CA 94304, USA; Division of Plastic Surgery, Stanford University, Suite 400, 770 Welch Road, Palo Alto, CA 94304, USA.
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Wojtkiewicz DM, Saunders J, Domeshek L, Novak CB, Kaskutas V, Mackinnon SE. Social impact of peripheral nerve injuries. Hand (N Y) 2015; 10:161-7. [PMID: 26034424 PMCID: PMC4447662 DOI: 10.1007/s11552-014-9692-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Disorders involving the peripheral nervous system can have devastating impacts on patients' daily functions and routines. There is a lack of consideration of the impact of injury on social/emotional well-being and function. METHODS We performed a retrospective database and chart review of adult patients presenting between 2010 and 2012 with peripheral nerve compression, brachial plexus injury, thoracic outlet syndrome (TOS), or neuromas. At the initial assessment, patients completed a questionnaire used to obtain demographic and psychosocial variable data including the (1) average level of pain over the last month, (2) self-perceived depression, (3) how much pain impacts quality of life (QoL), (4) current level of stress, and (5) ability to cope with stress. Statistical analyses were used to assess the differences between the dependent variables and diagnostic and demographic groups. RESULTS This study included 490 patients (mean age 50 ± 15 years); the most common diagnosis was single nerve compression (n = 171). Impact on QoL was significantly greater in patients with TOS, cutaneous peroneal compressions, and neuroma versus single site nerve compressions. Average pain, impact on QoL, and stress at home were significantly higher in females versus males. Impact on QoL was correlated with average pain, depression, stress at home, and ability to cope with stress at home. CONCLUSIONS Our study demonstrates that patients with single site nerve compression neuropathies experience fewer negative psychosocial effects compared to patients with more proximal upper extremity peripheral nerve disorders and neuromas. The impact on QoL was strongly correlated with pain and depression, where patients with neuromas and painful peroneal nerve entrapments reported greater detriments to QoL.
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Affiliation(s)
- Danielle M. Wojtkiewicz
- />Department of Occupational Therapy, Washington University School of Medicine, St. Louis, MO USA
| | - James Saunders
- />Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Suite 1150, Northwest Tower, 660 South Euclid Avenue, Campus Box 8238, St. Louis, MO 63110 USA
| | - Leahthan Domeshek
- />Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Suite 1150, Northwest Tower, 660 South Euclid Avenue, Campus Box 8238, St. Louis, MO 63110 USA
| | - Christine B. Novak
- />Hand and Upper Extremity Program, Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON Canada
| | - Vicki Kaskutas
- />Department of Occupational Therapy, Washington University School of Medicine, St. Louis, MO USA
| | - Susan E. Mackinnon
- />Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Suite 1150, Northwest Tower, 660 South Euclid Avenue, Campus Box 8238, St. Louis, MO 63110 USA
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Mehta P, Claydon LS, Hendrick P, Cook C, Baxter DG. Pain and Physical Functioning in Neuropathic Pain: A Systematic Review of Psychometric Properties of Various Outcome Measures. Pain Pract 2015; 16:495-508. [DOI: 10.1111/papr.12293] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 11/14/2014] [Accepted: 01/09/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Poonam Mehta
- Centre for Physiotherapy Research; University of Otago; Dunedin New Zealand
| | - Leica S. Claydon
- Department of Allied Health and Medicine; Anglia Ruskin University; Chelmsford U.K
| | - Paul Hendrick
- Division of Physiotherapy Education; University of Nottingham; Nottingham U.K
| | - Chad Cook
- Division of Physical Therapy; Walsh University; North Canton Ohio U.S.A
| | - David G. Baxter
- Centre for Physiotherapy Research; University of Otago; Dunedin New Zealand
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Moore AM, Novak CB. Advances in nerve transfer surgery. J Hand Ther 2014; 27:96-104; quiz 105. [PMID: 24513183 DOI: 10.1016/j.jht.2013.12.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 12/15/2013] [Accepted: 12/15/2013] [Indexed: 02/09/2023]
Abstract
Peripheral nerve injuries are devastating injuries and can result in physical impairments, poor functional outcomes and high levels of disability. Advances in our understanding of peripheral nerve regeneration and nerve topography have lead to the development of nerve transfers to restore function. Over the past two decades, nerve transfers have been performed and modified. With the advancements in surgical management and recognition of importance of cortical plasticity, motor-reeducation and perioperative rehabilitation, nerve transfers are producing improved functional outcomes in patients with nerve injuries. This manuscript explores the recent literature as it relates to current nerve transfer techniques and advances in post-operative rehabilitation protocols, with a focus on indications, techniques and outcomes.
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Affiliation(s)
- Amy M Moore
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Christine B Novak
- Hand & Upper Extremity Program, Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto, ON, Canada.
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A scoping review of disabilities of the arm, shoulder, and hand scores for hand and wrist conditions. J Hand Surg Am 2014; 39:2472-80. [PMID: 25227601 DOI: 10.1016/j.jhsa.2014.07.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 07/28/2014] [Accepted: 07/29/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the variability of reported baseline Disabilities of the Arm, Shoulder, and Hand (DASH) scores for non-acute hand and wrist conditions. We hypothesized that DASH scores for evaluation of hand and wrist pathology would provide a map of scores that would correspond to severity. In addition to providing a catalog of DASH scores for various upper extremity pathologies, we hypothesized that this review would support the validity of the DASH instrument. METHODS A literature search was performed using 3 databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials) from the earliest available date through January 1, 2013. Search terms included "DASH" and "hand" and combinations of conditions found in the initial search. The search was restricted to studies with baseline DASH scores and DASH scores for isolated conditions, and written in the English language. RESULTS Our search identified 1,770 citations; 136 full-text articles were reviewed and 85 studies were included in the scoping review. This provided 100 DASH scores mapped for 24 different diagnoses. Most articles (67%) included chronic conditions for inflammatory or degenerative pathologies rather than posttraumatic disorders. Posttraumatic DASH score reporting ranged from 4 months to 11 years after injury, and final outcome scores varied among studies assessing the same pathology. The greatest variation and highest scores were for de Quervain tendinitis (range, 29-93) and scapholunate advance collapse (range, 17-89). These scores indicated higher disability in de Quervain tendinitis and wrist osteoarthritis compared with conditions such as thumb amputation and upper extremity replantation. CONCLUSIONS Substantial variation in the DASH scores and methodology was found and indicates a need for further study of the DASH to allow for standardized interpretation. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Health-related quality of life in 975 patients with complex regional pain syndrome type 1. Pain 2014; 155:629-634. [DOI: 10.1016/j.pain.2013.12.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/05/2013] [Accepted: 12/10/2013] [Indexed: 11/18/2022]
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Abstract
When possible, direct repair remains the current standard of care for the repair of peripheral nerve lacerations. In large nerve gaps, in which direct repair is not possible, grafting remains the most viable option. Nerve scaffolds include autologous conduits, artificial nonbioabsorbable conduits, and bioabsorbable conduits and are options for repair of digital nerve gaps that are <3 cm in length. Experimental studies suggest that the use of allografts may be an option for repairing larger sensory nerve gaps without associated donor-site morbidity.
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Affiliation(s)
- Justin W Griffin
- Department of Orthopaedic Surgery, University of Virginia Health System, 400 Ray C. Hunt Drive, Suite 330, P.O. Box 800159, Charlottesville, VA 22908-0159
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Dodakundi C, Doi K, Hattori Y, Sakamoto S, Fujihara Y, Takagi T, Fukuda M. Outcome of surgical reconstruction after traumatic total brachial plexus palsy. J Bone Joint Surg Am 2013; 95:1505-12. [PMID: 23965701 DOI: 10.2106/jbjs.k.01279] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Double free muscle transfer for the treatment of traumatic total brachial plexus injury provides useful prehensile function. We studied the outcome of this muscle transfer procedure, including the changes in disability and quality-of-life scores. METHODS Thirty-six patients with traumatic total brachial plexus injury who underwent double free muscle transfer for reconstruction from 2002 to 2008 and had a minimum follow-up of twenty-four months after the second free muscle transfer were studied. All were evaluated preoperatively and postoperatively with use of the Disabilities of the Arm, Shoulder and Hand (DASH) and Short Form-36 (SF-36) questionnaires. A separate questionnaire was used to determine job status, pain, use of the reconstructed hand, and satisfaction with the procedure. RESULTS The mean patient age was twenty-nine years (range, sixteen to forty-nine years), and the mean duration of follow-up was thirty-six months (range, twenty-four to seventy-nine months). The mean active range of motion was 23° (range, 0° to 80°) for shoulder flexion, 31° (range, 0° to 90°) for shoulder abduction, -18° (range, -80° to 40°) for shoulder external rotation, 62° (range, 0° to 130°) for the shoulder rotation arc, 119° (range, 90° to 150°) for elbow flexion, and -33° (range, -60° to -20°) for elbow extension. The power of elbow flexion was M4 in twenty-five patients and M3 in eleven. Twenty-three patients had triceps nerve reconstruction; extension was M0 in two of these patients, M1 in seven, M2 in ten, and M3 in four. Total active motion of the fingers was 46° (range, 0° to 98°), with a mean hook grip strength of 4 kg (range, 0 to 12 kg). Wilcoxon tests revealed significant improvements in the DASH score and the SF-36 physical functioning, role physical, and physical component summary scores. The majority of patients worked but had changed their type of work, used the reconstructed hand in activities of daily living that required both hands, and were satisfied with the procedure. CONCLUSIONS Double free muscle transfer yielded satisfactory function and allowed use of the reconstructed hand in activities that required both hands. The improvement in the DASH score was greater than that in the SF-36 score.
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Affiliation(s)
- Chaitanya Dodakundi
- Department of Orthopedics, Ogori Daiichi General Hospital, 862-3 Shimogo-Ogori, Yamaguchi 754-0002, Japan
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Abstract
Evaluation of outcomes after peripheral nerve surgeries include several assessment methods that reflect different aspects of recovery, including reinnervation, tactile gnosis, integrated sensory and motor function, pain and discomfort, and neurophysiologic and patient-reported outcomes. This review lists measurements addressing these aspects as well as the advantages and disadvantages of each tool. Because of complexities of neurophysiology, assessment remains a difficult process, which requires researchers to focus on measurements best relevant to specific conditions and research questions.
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Affiliation(s)
- Yirong Wang
- Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing
| | - Malay Sunitha
- Clinical Research Coordinator, Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System; Ann Arbor, MI
| | - Kevin C. Chung
- Professor of Surgery, Section of Plastic Surgery, Assistant Dean for Faculty Affairs, The University of Michigan Medical School
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Abstract
Laceration and irrecoverable stretch, crush, or avulsion of a major peripheral nerve in the upper extremity causes substantial impairment in an adult patient. Hand care professionals who treat these patients encounter a wide range of coping strategies leading to varied courses of recovery and strikingly different final outcomes. There is evidence that the cognitive, emotional, and behavioral aspects of recovery (not to mention the circumstantial aspects such as worker compensation and litigation) are as important as the physical aspects. Awareness of the factors that facilitate or hinder these aspects of recovery might improve the quality and effectiveness of our care.
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Affiliation(s)
- David Ring
- MGH Hand Service, Massachusetts General Hospital, Yawkey 2100, 55 Fruit Street, Boston, MA 02114, USA.
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Rosenbloom BN, Khan S, McCartney C, Katz J. Systematic review of persistent pain and psychological outcomes following traumatic musculoskeletal injury. J Pain Res 2013; 6:39-51. [PMID: 23357964 PMCID: PMC3555553 DOI: 10.2147/jpr.s38878] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Persistent pain and psychological distress are common after traumatic musculoskeletal injury (TMsI). Individuals sustaining a TMsI are often young, do not recover quickly, and place a large economic burden on society. Objectives The aim of this systematic review is to determine (1) the incidence of persistent pain following TMsI, (2) the characteristics of pain, characterized by injury severity and type, and (3) risk and protective factors associated with persistent pain following TMsI. Methods A systematic search of electronic databases (MEDLINE®, PubMed®, Embase, and PsycINFO®) was conducted for prospective, interventional, or noninterventional studies measuring the incidence of pain associated with TMsI. Results The search revealed 4388 studies. Eleven studies examined persistent pain and met inclusion criteria. Pain was assessed using a validated measure of pain intensity or pain presence in six studies. Persistent pain was reported by all studies at variable time points up to 84 months postinjury, with wide variation among studies in pain intensity (ie, from mild to very severe) and pain incidence at each time point. The incidence of pain decreased over time within each study. Two studies found significant relationships between injury severity and persistent pain. Frequently cited predictive factors for persistent pain included: symptoms of anxiety and depression, patient perception that the injury was attributable to external sources (ie, they were not at fault), cognitive avoidance of distressing thoughts, alcohol consumption prior to trauma, lower educational status, being injured at work, eligibility for compensation, pain at initial assessment, and older age. Conclusion and implications The evidence from the eleven studies included in this review indicates that persistent pain is prevalent up to 84 months following traumatic injury. Further research is needed to better evaluate persistent pain and other long-term posttraumatic outcomes.
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Dolan RT, Butler JS, Murphy SM, Hynes D, Cronin KJ. Health-related quality of life and functional outcomes following nerve transfers for traumatic upper brachial plexus injuries. J Hand Surg Eur Vol 2012; 37:642-51. [PMID: 22178751 DOI: 10.1177/1753193411432706] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report the patient-scored Health-Related Quality of Life (HRQoL) and functional outcomes of a cohort of 21 consecutive patients undergoing nerve transfer surgery for traumatic upper brachial plexus injuries. Outcomes were assessed using the British Medical Research Council power grading system, Short-Form 36, Disability of Arm, Shoulder and Hand questionnaire, and Pain Visual Analogue Scale (PVAS). The mean age of our cohort was 29.8 years (range 18-53 years), with a mean follow-up period of 42.9 months. At follow-up, elbow flexion ≥ M3 strength was achieved in 17/21 patients. Shoulder abduction ≥ M3 was achieved in 14/19 patients. External rotation ≥ M3 strength was achieved in 11/15 patients. Delayed surgical repair correlated negatively with HRQoL outcomes. Higher injury severity scores and smoking were associated with higher PVAS scores. These findings provide key prognostic information for patients and peripheral nerve surgeons embarking upon this intensive pathway to potential recovery.
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Affiliation(s)
- R T Dolan
- Department of Plastic & Reconstructive Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
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