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O’Driscoll J, Minarro JC, Sanchez-Sotelo J. Paralysis of the trapezius muscle: evaluation and surgical management. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:329-340. [PMID: 39157246 PMCID: PMC11329012 DOI: 10.1016/j.xrrt.2024.03.014] [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] [Indexed: 08/20/2024]
Abstract
Background Paralysis of the trapezius muscle most commonly results from iatrogenic injury to the spinal accessory nerve. Methods The clinical presentation and physical examination findings of trapezius palsy have been well characterized, but unfortunately the diagnosis of this condition is oftentimes missed or delayed, sometimes leading to unnecessary surgery on the rotator cuff or tendon of the long head of the biceps. Results The diagnosis can be confirmed using electromyography with nerve conduction studies. Although nonoperative treatment may help some patients with temporary neurapraxia of the spinal accessory nerve, nerve repair with or without nerve grafting should be performed soon for patients suspected of a nerve transection. Nerve transfers can be considered within the first year after the injury when nerve repair and grafting cannot be completed. For chronic trapezius palsy, transfer of the levator scapulae and rhomboids has been refined and represents a very successful surgical procedure. Rarely, scapulothoracic arthrodesis is considered for individuals with failed tendon transfers or multiple nerve involvement. Conclusion Trapezius palsy is oftentimes missed. An accurate diagnosis allows consideration of various treatment modalities that have been reported to provide good outcomes for properly selected patients.
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Affiliation(s)
- Jesse O’Driscoll
- Biomechanics Research Laboratory, Mayo Clinic Rochester, Rochester, MN, USA
| | - José Carlos Minarro
- Orthopaedics and Traumatology Department, University Hospital Reina Sofía, Córdoba, Spain
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2
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Gonzales J, Adilbay D, de Souza Franca PD, Artschwager R, Chow CY, Viray T, Johnson DS, Jiang Y, Patel SG, Ganly I, Schroeder CI, Lewis JS, King GF, Reiner T, Pillarsetty N. Na V1.7 targeted fluorescence imaging agents for nerve identification during intraoperative procedures. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.06.588368. [PMID: 38617358 PMCID: PMC11014580 DOI: 10.1101/2024.04.06.588368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Surgeries and trauma result in traumatic and iatrogenic nerve damage that can result in a debilitating condition that approximately affects 189 million individuals worldwide. The risk of nerve injury during oncologic surgery is increased due to tumors displacing normal nerve location, blood turbidity, and past surgical procedures, which complicate even an experienced surgeon's ability to precisely locate vital nerves. Unfortunately, there is a glaring absence of contrast agents to assist surgeons in safeguarding vital nerves. To address this unmet clinical need, we leveraged the abundant expression of the voltage-gated sodium channel 1.7 (NaV1.7) as an intraoperative marker to access peripheral nerves in vivo, and visualized nerves for surgical guidance using a fluorescently-tagged version of a potent NaV1.7-targeted peptide, Tsp1a, derived from a Peruvian tarantula. We characterized the expression of NaV1.7 in sensory and motor peripheral nerves across mouse, primate, and human specimens and demonstrated universal expression. We synthesized and characterized a total of 10 fluorescently labeled Tsp1a-peptide conjugates to delineate nerves. We tested the ability of these peptide-conjugates to specifically accumulate in mouse nerves with a high signal-to-noise ratio in vivo. Using the best-performing candidate, Tsp1a-IR800, we performed thyroidectomies in non-human primates and demonstrated successful demarcation of the recurrent laryngeal and vagus nerves, which are commonly subjected to irreversible damage. The ability of Tsp1a to enhance nerve contrast during surgery provides opportunities to minimize nerve damage and revolutionize standards of care across various surgical specialties.
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Affiliation(s)
- Junior Gonzales
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA
| | - Dauren Adilbay
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA
| | - Paula Demetrio de Souza Franca
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA
- Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo, SP, Brazil
| | - Raik Artschwager
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA
| | - Chun Yuen Chow
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland 4072, Australia
- Australian Research Council Centre of Excellence for Innovations in Peptide and Protein Research, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - Tara Viray
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA
| | - Delissa S. Johnson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA
| | - Yan Jiang
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - Snehal G. Patel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA
- Department of Otorhinolaryngology, Weill Cornell Medical College, 1300 York Avenue, New York, New York, 10065, USA
| | - Ian Ganly
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA
- Department of Otorhinolaryngology, Weill Cornell Medical College, 1300 York Avenue, New York, New York, 10065, USA
| | - Christina I. Schroeder
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - Jason S. Lewis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA
- Department of Pharmacology, Weill-Cornell Medical College, New York, New York, 10065, USA
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA
- Department of Radiology, Weill Cornell Medical College, 1300 York Avenue, New York, New York, 10065, USA
| | - Glenn F. King
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland 4072, Australia
- Australian Research Council Centre of Excellence for Innovations in Peptide and Protein Research, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - Thomas Reiner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA
- Department of Pharmacology, Weill-Cornell Medical College, New York, New York, 10065, USA
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA
- Department of Radiology, Weill Cornell Medical College, 1300 York Avenue, New York, New York, 10065, USA
| | - Nagavarakishore Pillarsetty
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York, 10065, USA
- Department of Pharmacology, Weill-Cornell Medical College, New York, New York, 10065, USA
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, USA
- Department of Radiology, Weill Cornell Medical College, 1300 York Avenue, New York, New York, 10065, USA
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3
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Chalk C, Zaloum A. Femoral and obturator neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:183-194. [PMID: 38697739 DOI: 10.1016/b978-0-323-90108-6.00007-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
The femoral and obturator nerves both arise from the L2, L3, and L4 spinal nerve roots and descend into the pelvis before emerging in the lower limbs. The femoral nerve's primary function is knee extension and hip flexion, along with some sensory innervation to the leg. The obturator nerve's primary function is thigh adduction and sensory innervation to a small area of the medial thigh. Each may be injured by a variety of potential causes, many of them iatrogenic. Here, we review the anatomy of the femoral and obturator nerves and the clinical features and potential etiologies of femoral and obturator neuropathies. Their necessary investigations, including electrodiagnostic studies and imaging, their prognosis, and potential treatments, are discussed in this chapter.
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Affiliation(s)
- Colin Chalk
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Austin Zaloum
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.
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4
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Scarpelli EM, Park CH, Jeng CL. Regional anesthesia and anticoagulation: a narrative review of current considerations. Int Anesthesiol Clin 2024; 62:1-9. [PMID: 38063032 DOI: 10.1097/aia.0000000000000420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Enrico M Scarpelli
- Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Hospital, New York, New York
| | - Chang H Park
- Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Hospital, New York, New York
| | - Christina L Jeng
- Department of Anesthesiology, Perioperative and Pain Medicine; Orthopaedics; and Medical Education, Mount Sinai Hospital, New York, New York
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5
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Throckmorton GA, Thayer W, Duco Jansen E, Mahadevan-Jansen A. Infrared neural stimulation markedly enhances nerve functionality assessment during nerve monitoring. Sci Rep 2023; 13:4362. [PMID: 36928795 PMCID: PMC10020565 DOI: 10.1038/s41598-023-31384-3] [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: 09/11/2022] [Accepted: 03/10/2023] [Indexed: 03/18/2023] Open
Abstract
In surgical procedures where the risk of accidental nerve damage is prevalent, surgeons commonly use electrical stimulation (ES) during intraoperative nerve monitoring (IONM) to assess a nerve's functional integrity. ES, however, is subject to off-target stimulation and stimulation artifacts disguising the true functionality of the specific target and complicating interpretation. Lacking a stimulation artifact and having a higher degree of spatial specificity, infrared neural stimulation (INS) has the potential to improve upon clinical ES for IONM. Here, we present a direct comparison between clinical ES and INS for IONM performance in an in vivo rat model. The sensitivity of INS surpasses that of ES in detecting partial forms of damage while maintaining a comparable specificity and sensitivity to more complete forms. Without loss in performance, INS is readily compatible with existing clinical nerve monitoring systems. These findings underscore the clinical potential of INS to improve IONM and surgical outcomes.
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Affiliation(s)
- Graham A Throckmorton
- Department of Biomedical Engineering, Vanderbilt University, 5824 Stevenson Center, Station B, Box 351631, Nashville, TN, 37235-1631, USA
- Vanderbilt Biophotonics Center, 410 24th Ave. South, Nashville, TN, 37232, USA
| | - Wesley Thayer
- Department of Plastic Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA
| | - E Duco Jansen
- Department of Biomedical Engineering, Vanderbilt University, 5824 Stevenson Center, Station B, Box 351631, Nashville, TN, 37235-1631, USA
- Vanderbilt Biophotonics Center, 410 24th Ave. South, Nashville, TN, 37232, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, 1161 21St Avenue, Nashville, TN, 37232-2380, USA
| | - Anita Mahadevan-Jansen
- Department of Biomedical Engineering, Vanderbilt University, 5824 Stevenson Center, Station B, Box 351631, Nashville, TN, 37235-1631, USA.
- Vanderbilt Biophotonics Center, 410 24th Ave. South, Nashville, TN, 37232, USA.
- Department of Neurological Surgery, Vanderbilt University Medical Center, 1161 21St Avenue, Nashville, TN, 37232-2380, USA.
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA.
- Department of Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA.
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Brenna CTA, Khan S, Katznelson R, Brull R. The role of hyperbaric oxygen therapy in the management of perioperative peripheral nerve injury: a scoping review of the literature. Reg Anesth Pain Med 2022:rapm-2022-104113. [PMID: 36418044 DOI: 10.1136/rapm-2022-104113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022]
Abstract
Background/importancePeripheral nerve injury is an uncommon but potentially catastrophic complication of anesthesia and surgery, for which there are limited effective treatment options. Hyperbaric oxygen therapy is a unique medical intervention which improves tissue oxygen delivery and reduces ischemia via exposure to oxygen at supra-atmospheric partial pressures. While the application of hyperbaric oxygen therapy has been evidenced for other medical conditions involving relative tissue ischemia, its role in the management of peripheral nerve injury remains unclear.ObjectiveThis scoping review seeks to characterize rehabilitative outcomes when hyperbaric oxygen therapy is applied as an adjunct therapy in the treatment of perioperative peripheral nerve injury.Evidence reviewThe review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines for scoping reviews, using a systematic screening and extraction process. The search included articles published from database inception until June 11, 2022, which reported clinical outcomes (in both human and non-human models) of peripheral nerve injury treated with hyperbaric oxygen therapy.FindingsA total of 51 studies were included in the narrative synthesis. These consisted of animal (40) and human studies (11) treating peripheral nerve injury due to various physiological insults. Hyperbaric oxygen therapy protocols were highly heterogenous and applied at both early and late intervals relative to the time of peripheral nerve injury. Overall, hyperbaric oxygen therapy was reported as beneficial in 88% (45/51) of included studies (82% of human studies and 90% of animal studies), improving nerve regeneration and/or time to recovery with no reported major adverse events.ConclusionsExisting data suggest that hyperbaric oxygen therapy is a promising intervention in the management of perioperative peripheral nerve injury, in which tissue ischemia is the most common underlying mechanism of injury, neurological deficits are severe, and treatment options are sparse. This positive signal should be further investigated in prospective randomized clinical trials.
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7
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DXM-TransFuse U-net: Dual cross-modal transformer fusion U-net for automated nerve identification. Comput Med Imaging Graph 2022; 99:102090. [PMID: 35709628 DOI: 10.1016/j.compmedimag.2022.102090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 04/13/2022] [Accepted: 06/03/2022] [Indexed: 11/23/2022]
Abstract
Accurate nerve identification is critical during surgical procedures to prevent damage to nerve tissues. Nerve injury can cause long-term adverse effects for patients, as well as financial overburden. Birefringence imaging is a noninvasive technique derived from polarized images that have successfully identified nerves that can assist during intraoperative surgery. Furthermore, birefringence images can be processed under 20 ms with a GPGPU implementation, making it a viable image modality option for real-time processing. In this study, we first comprehensively investigate the usage of birefringence images combined with deep learning, which can automatically detect nerves with gains upwards of 14% over its color image-based (RGB) counterparts on the F2 score. Additionally, we develop a deep learning network framework using the U-Net architecture with a Transformer based fusion module at the bottleneck that leverages both birefringence and RGB modalities. The dual-modality framework achieves 76.12 on the F2 score, a gain of 19.6 % over single-modality networks using only RGB images. By leveraging and extracting the feature maps of each modality independently and using each modality's information for cross-modal interactions, we aim to provide a solution that would further increase the effectiveness of imaging systems for enabling noninvasive intraoperative nerve identification.
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8
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Wiman K, Hulkkonen S, Miettunen J, Auvinen J, Karppinen J, Ryhänen J. Total, gender- and age-specific incidence rates of upper extremity nerve injuries in Finland. J Hand Surg Eur Vol 2022; 47:639-643. [PMID: 35172640 DOI: 10.1177/17531934221079230] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to describe the epidemiology of nerve injuries of the upper extremity in the whole population of Finland (1998-2016). Data based on diagnosis codes were obtained from the Care Register for Health Care, including cases of median, radial, ulnar, musculocutaneous, axillary and digital nerves. Age- and gender-specific incidence rates, both crude and standardized (for the European normal population in 2011), were calculated. Our study included 13,440 patients with upper extremity nerve injury. The mean standardized annual incidence rate of any upper extremity nerve injury was 18.18 among men and 8.15 among women per 100,000 person-years over the study period. The incidence peaked among men at working age. Nerve injuries occurred most commonly in the fingers and thumb, with 5532 cases and mean standardized incidence rates per 100,000 person-years of 7.84 among men and 2.95 among women. The annual incidence did not change significantly over the study period.Level of evidence: III.
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Affiliation(s)
- Kirsi Wiman
- Department of Surgery, Lapland Central Hospital, Rovaniemi, Finland.,Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sina Hulkkonen
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juha Auvinen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Finnish Institute of Occupational Health, Oulu, Finland
| | - Jorma Ryhänen
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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9
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Polat M, Ayaz N. An overlooked nerve in neuropathies associated with intragluteal injections: the posterior femoral cutaneous nerve. Postgrad Med 2021; 134:1-6. [PMID: 34802377 DOI: 10.1080/00325481.2021.2008727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the frequency of posterior femoral cutaneous nerve (PFCN) lesions in patients referred to the electrophysiology laboratory with an initial diagnosis of sciatic nerve lesion following injection, and to create awareness that PFCN lesions can occur following intramuscular injections administered to the gluteal region. METHODS Fifty-seven patients who were referred to the electrophysiology laboratory because of injection neuropathy were identified from the hospital records. In addition to the routine electrophysiological examination, PFCN sensory conduction study was performed according to the technique of Dumitru and Nelson. The scores of the Hospital Anxiety and Depression Scale (HADS) and the Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale were recorded for all participants. RESULTS Of the 21 participants who agreed to participate in the study, 2 patients were diagnosed with PFCN lesions, one of them had isolated complete PFCN lesion, and another had it accompanied by sciatic nerve lesion. Patients with PFCN lesions had a lower body mass index and a higher HADS score than patients with sciatic nerve lesions (p = 0.01, p = 0.04, respectively). CONCLUSIONS As correct diagnosis is the priority starting point for successful treatment, clinicians should plan examinations taking into consideration the fact that PFCN lesions can occur following gluteal region injection.
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Affiliation(s)
- Musa Polat
- Medicine Faculty, Department of Physical Medicine and Rehabilitation, Nigde Omer Halisdemir University, Nigde, Turkey.,Medicine Faculty, Department of Physical Medicine and Rehabilitation, Cumhuriyet University, Sivas, Turkey
| | - Nusret Ayaz
- Department of Forensic Medicine, Nigde Training and Research Hospital, Nigde, Turkey
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10
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Duarte JM, Rolón JI, Bertotti AB. Frequency of Type-1 Berrettini's Connection in a Neurophysiology Laboratory. J Neurosci Rural Pract 2021; 12:652-655. [PMID: 34737498 PMCID: PMC8559070 DOI: 10.1055/s-0041-1734005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective
This study aims to estimate the frequency of Berrettini's ulnar-median nerves communication in a neurophysiology laboratory.
Materials and Methods
A total of 358 hands belonging to patients, both sexes, median age of 58 years, was studied. Antidromic sensory nerve conduction studies of the ulnar nerves, registered in digits III and IV were performed in search of the ulnar-median communication. A Berrettini's percentage was calculated in each communication: [(amplitude SAP digit III/amplitude SAP digit IV) × 100].
Results
Ulnar-median nerves communication (Berrettini's branch) was found in 37 hands (10.95%), with a female gender predominance. Bilaterality percentage was low (1.78%). Most communications encountered had a Berretini's percentage between 11 and 50%. Some of them exceeded 100%.
Conclusions
Electromyographers should routinely search for this nerve communication, especially in those patients undergoing carpal tunnel syndrome or Dupuytren's contracture surgeries.
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Affiliation(s)
- Juan M Duarte
- Clinical Neurophysiology Unit-Hospital Alemán, Buenos Aires, República Argentina
| | - Juan I Rolón
- Clinical Neurophysiology Unit-Hospital Alemán, Buenos Aires, República Argentina
| | - Alicia B Bertotti
- Clinical Neurophysiology Unit-Hospital Alemán, Buenos Aires, República Argentina
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11
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Hara T, Tatebe M, Kurahashi T, Hirata H. Iatrogenic peripheral nerve injuries - Common causes and treatment: A retrospective single-center cohort study. J Orthop Sci 2021; 26:1119-1123. [PMID: 33115634 DOI: 10.1016/j.jos.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Iatrogenic nerve injuries can result from surgical damage. Thus, physicians should be aware of the risk factors and procedures that need to be followed in such patients. The purpose of this study was to examine data pertaining to patients with known iatrogenic nerve injuries and to elucidate the detailed causes of these injuries, the affected nerves, and the type of surgical procedures for treatment. METHODS This retrospective study included 232 consecutive patients who underwent surgical treatment for peripheral nerve palsy or nerve injury between 2006 and 2017 at our hospital. Among the 232 patients investigated, we identified 51 cases with iatrogenic nerve injuries (23 women and 28 men; mean age, 51.3 years). Among the 51 patients, 45 were referred from other hospitals, and the remaining were from our hospital. Data were summarized using descriptive statistics. RESULTS Direct surgical damage occurred in 94% (48/51) of patients with iatrogenic nerve injuries. Such injuries mostly developed after surgery for bone fractures (33%), resection of soft tissue tumors (22%), and carpal tunnel release procedures (20%). The nerves most commonly affected in such procedures are the radial nerve (26%), median nerve (24%), and ulnar nerve (17%). The median interval of referral to our hospital after nerve injury was 5.1 months. The median interval of surgery to correct the injury was 7 months. Surgeries to correct iatrogenic nerve injuries performed at our hospital included neurolysis (55%), nerve grafts (29%), direct suture procedures (10%), and tendon transfers (6%). CONCLUSIONS We believe that wide dissemination of the results obtained in this study will reduce the incidence of iatrogenic peripheral nerve injuries and increase the speed of referrals to specialized centers.
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Affiliation(s)
- Tatsuya Hara
- Department of Orthopaedic Surgery, Anjo Kosei Hospital, Japan.
| | - Masahiro Tatebe
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Japan
| | | | - Hitoshi Hirata
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Japan
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12
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Abstract
Nerves may be inadvertently injured during trauma surgery due to distorted anatomy, traction applied to a limb, soft tissue retraction, by power tools, instrumentation and from compartment syndrome. Elective orthopaedic surgery has additional risks of joint dislocation for arthroplasty surgery, limb lengthening, thermal injury from cement and direct injury from peripheral nerve blocks.The true incidence is unknown, and many cases are diagnosed as neurapraxia with the expectation of a full and timely recovery without the need for intervention. The incorrect assignation of a neurapraxia diagnosis may delay treatment for a higher grade of injury and in addition fails to recognize that a diagnosis of neurapraxia should be made with caution and a commitment to regular clinical review. Untreated, a neurapraxia can deteriorate and result in axonopathy. The failure to promptly diagnose such a nerve injury and instigate treatment may result in further deterioration and expose the clinician to medicolegal challenge.The focus of this review is to raise awareness of iatrogenic peripheral nerve injuries in orthopaedic limb surgery, the importance of regular clinical examination, the role of investigations, timing and nature of interventions and also to provide a guide to when onward referral to a specialist peripheral nerve injury unit is recommended. Cite this article: EFORT Open Rev 2021;6:607-617. DOI: 10.1302/2058-5241.6.200123.
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Affiliation(s)
- Timothy Bage
- The Peripheral Nerve Injury Service, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Dominic M Power
- The Peripheral Nerve Injury Service, Queen Elizabeth Hospital Birmingham, Birmingham, UK
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13
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Orenga Orenga JV, Parra Escorihuela S, Barreda Altaba I, Estarelles Marco MJ, Ghinea AD, Leal Galicia DE, López García R. Iatrogenic lesions of the peripheral nervous system in orthopaedic surgery and traumatology procedures. ACTA ACUST UNITED AC 2021. [PMID: 34112446 DOI: 10.1016/j.recote.2021.04.007] [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: 11/25/2022]
Abstract
OBJECTIVE To describe iatrogenic lesions of the peripheral nervous system and their relationship with different orthopaedic and traumatological procedures, through their assessment by means of electromyographic study. MATERIAL AND METHODS Retrospective descriptive study of the electromyographies performed in the clinical neurophysiology service of the Hospital General Universitari de Castelló between July 2015 and March 2019, recovering those in which the aetiology was diagnosed as iatrogenic in relation to surgical procedures and analysing those that were initiated after orthopaedic and traumatological procedures. RESULTS Of the total number of electromyographies reviewed, 1.37% corresponded to iatrogenic surgical lesions and 55.1% of these were secondary to orthopaedic surgery and traumatology procedures, the incidence in relation to the procedures performed was 0.65%. The most frequent locations related to injuries were the lumbar spine, hip and hand/wrist. Injuries due to postural causes not directly related to the surgical field are noteworthy. CONCLUSION Iatrogenic injuries to the peripheral nervous system after orthopaedic surgery and traumatology procedures are infrequent, but given their mechanism of injury and the high severity of most of them, it would be advisable to implement corrective mechanisms to reduce their incidence. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- J V Orenga Orenga
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, Spain.
| | - S Parra Escorihuela
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, Spain
| | - I Barreda Altaba
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, Spain
| | - M J Estarelles Marco
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, Spain
| | - A D Ghinea
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, Spain
| | - D E Leal Galicia
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, Spain
| | - R López García
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, Spain
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Fleisch MC, Bader W, Balzer K, Bennefeld L, Boeing C, Bremerich D, Gass P, Geissbuehler V, Koch MC, Nothacker MJ, Pietzner K, Renner SP, Römer T, Roth S, Schütz F, Schulte-Mattler W, Sehouli J, Lippach K, Tamussino K, Teichmann A, Tempfer C, Thill M, Tinneberg HR, Zarras K. The Prevention of Positioning Injuries During Gynecologic Surgery. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/077, October 2020). Geburtshilfe Frauenheilkd 2021; 81:447-468. [PMID: 33867563 DOI: 10.1055/a-1378-4209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 10/21/2022] Open
Abstract
Purpose Positioning injuries are relatively common, forensically highly relevant complications of gynecologic surgery. The aim of this official AWMF S2k-guideline is to provide statements and recommendations on how to prevent positioning injuries using the currently available literature. The literature was evaluated by an interdisciplinary group of experts from professional medical societies. The consensus on recommendations and statements was achieved in a structured consensus process. Method The current guideline is based on the expired S1-guideline, which was updated by a systematic search of the literature and a review of relevant publications issued between February 2014 and March 2019. Statements were compiled and voted on by a panel of experts. Recommendations The guideline provides general and specific recommendations on the prevention, diagnosis and treatment of positioning injuries.
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Affiliation(s)
- Markus C Fleisch
- Landesfrauenklinik, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - Werner Bader
- Zentrum für Frauenheilkunde, Klinikum Bielefeld Mitte, Bielefeld, Germany
| | - Kai Balzer
- Klinik für Gefäßchirurgie, GFO Kliniken, Bonn, Germany
| | - Luisa Bennefeld
- Landesfrauenklinik, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - Carsten Boeing
- Klinik für Gynäkologie und Geburtshilfe, AMEOS Klinikum St. Clemens Oberhausen, Oberhausen, Germany
| | | | | | | | - Martin C Koch
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Monika J Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement, Universität Marburg, Marburg, Germany
| | - Klaus Pietzner
- Charité Frauenklinik, Universitätsmedizin Berlin, Berlin, Germany
| | | | - Thomas Römer
- Frauenklinik, Evangelisches Krankenhaus Weyertal, Köln, Germany
| | - Stephan Roth
- Klinik für Urologie, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
| | | | - Jalid Sehouli
- Charité Frauenklinik, Universitätsmedizin Berlin, Berlin, Germany
| | - Kristina Lippach
- Pflegewissenschaften und Praxisentwicklung, LMU München, München, Germany
| | - Karl Tamussino
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Graz, Graz, Austria
| | - Alexander Teichmann
- Sichuan Center for Gynaecology and Breast Surgery, Dept. of Perinatal Medicine, Medical University of Southwest China, Luzhou (Sichuan), China
| | - Clemens Tempfer
- Klinik für Frauenheilkunde und Geburtshilfe, Marienhospital Herne, Universitätsklinikum Bochum, Bochum/Herne, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | | | - Konstantinos Zarras
- Abteilung für Allgemein-, Viszeral- und Minimalinvasive Chirurgie des VVKD Marienhospitals Düsseldorf, Düsseldorf, Germany
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15
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Orenga Orenga JV, Parra Escorihuela S, Barreda Altaba I, Estarelles Marco MJ, Ghinea AD, Leal Galicia DE, López García R. Iatrogenic lesions of the peripheral nervous system in orthopaedic surgery and traumatology procedures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [PMID: 33714695 DOI: 10.1016/j.recot.2020.11.002] [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: 11/15/2022] Open
Abstract
OBJECTIVE To describe iatrogenic lesions of the peripheral nervous system and their relationship with different orthopaedic and traumatological procedures, through their assessment by means of electromyographic study. MATERIAL AND METHODS Retrospective descriptive study of the electromyographies performed in the clinical neurophysiology service of the Hospital General Universitari de Castelló between July 2015 and March 2019, recovering those in which the aetiology was diagnosed as iatrogenic in relation to surgical procedures and analysing those that were initiated after orthopaedic and traumatological procedures. RESULTS Of the total number of electromyographies reviewed, 1.37% corresponded to iatrogenic surgical lesions and 55.1% of these were secondary to orthopaedic surgery and traumatology procedures, the incidence in relation to the procedures performed was 0.65%. The most frequent locations related to injuries were the lumbar spine, hip and hand/wrist. Injuries due to postural causes not directly related to the surgical field are noteworthy. CONCLUSION Iatrogenic injuries to the peripheral nervous system after orthopaedic surgery and traumatology procedures are infrequent, but given their mechanism of injury and the high severity of most of them, it would be advisable to implement corrective mechanisms to reduce their incidence. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- J V Orenga Orenga
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, España.
| | - S Parra Escorihuela
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, España
| | - I Barreda Altaba
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, España
| | - M J Estarelles Marco
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, España
| | - A D Ghinea
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, España
| | - D E Leal Galicia
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, España
| | - R López García
- Servicio de Neurofisiología Clínica, Hospital General Universitari de Castelló, Castelló, España
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16
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Gonzales J, Pirovano G, Chow CY, de Souza Franca PD, Carter LM, Klint JK, Guru N, Lewis JS, King GF, Reiner T. Fluorescence labeling of a Na V1.7-targeted peptide for near-infrared nerve visualization. EJNMMI Res 2020; 10:49. [PMID: 32409881 PMCID: PMC7225226 DOI: 10.1186/s13550-020-00630-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/08/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Accidental peripheral nerve injury during surgical intervention results in a broad spectrum of potentially debilitating side effects. Tissue distortion and poor visibility can significantly increase the risk of nerve injury with long-lasting consequences for the patient. We developed and characterized Hs1a-FL, a fluorescent near-infrared molecule for nerve visualization in the operating theater with the aim of helping physicians to visualize nerves during surgery. Hs1a was derived from the venom of the Chinese bird spider, Haplopelma schmidti, and conjugated to Cy7.5 dye. Hs1a-FL was injected intravenously in mice, and harvested nerves were imaged microscopically and with epifluorescence. RESULTS Hs1a-FL showed specific and stable binding to the sodium channel NaV1.7, present on the surface of human and mouse nerves. Hs1a-FL allowed epifluorescence visualization of sciatic mouse nerves with favorable nerve-to-muscle contrast. CONCLUSIONS Fluorescent NaV1.7-targeted tracers have the potential to be adopted clinically for the intraoperative visualization of peripheral nerves during surgery, providing guidance for the surgeon and potentially improving the standard of care.
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Affiliation(s)
- Junior Gonzales
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Giacomo Pirovano
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Chun Yuen Chow
- Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland, 4072, Australia
| | | | - Lukas M Carter
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Julie K Klint
- Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland, 4072, Australia
- Current address: H. Lundbeck A/S, Ottiliavej 9, 2500, Valby, Denmark
| | - Navjot Guru
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Jason S Lewis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Radiology, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
- Department of Pharmacology, Weill-Cornell Medical College, New York, NY, 10065, USA
| | - Glenn F King
- Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Queensland, 4072, Australia
| | - Thomas Reiner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
- Center for Molecular Imaging and Nanotechnology (CMINT), Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
- Department of Radiology, Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA.
- Chemical Biology Program, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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17
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Heinen C, Dömer P, Schmidt T, Kewitz B, Janssen-Bienhold U, Kretschmer T. Fascicular Ratio Pilot Study: High-Resolution Neurosonography-A Possible Tool for Quantitative Assessment of Traumatic Peripheral Nerve Lesions Before and After Nerve Surgery. Neurosurgery 2020; 85:415-422. [PMID: 30107513 DOI: 10.1093/neuros/nyy355] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 07/11/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Clinical and electrophysiological assessments prevail in evaluation of traumatic nerve lesions and their regeneration following nerve surgery in humans. Recently, high-resolution neurosonography (HRNS) and magnetic resonance neurography have gained significant importance in peripheral nerve imaging. The use of the grey-scale-based "fascicular ratio" (FR) was established using both modalities allowing for quantitative assessment. OBJECTIVE To find out whether FR using HRNS can assess nerve trauma and structural reorganization in correlation to postoperative clinical development. METHODS Retrospectively, 16 patients with operated traumatic peripheral nerve lesions were included. The control group consisted of 6 healthy volunteers. All imaging was performed with a 15 to 6 MHz ultrasound probe (SonoSite X-Porte; Fujifilm, Tokyo, Japan). FR was calculated using Fiji () on 8-bit-images ("MaxEntropy" using "Auto-Threshold" plug-in). RESULTS Thirteen of 16 patients required autologous nerve grafting and 3 of 16 extra-intraneural neurolysis. There was no statistical difference between the FR of nonaffected patients' nerve portion with 43.48% and controls with FR 48.12%. The neuromatous nerve portion in grafted patients differed significantly with 85.05%. Postoperatively, FR values returned to normal with a mean of 39.33%. In the neurolyzed patients, FR in the affected portion was 78.54%. After neurolysis, FR returned to healthy values (50.79%). Ten of 16 patients showed clinical reinnervation. CONCLUSION To our best knowledge, this is the first description of FR using HRNS for quantitative assessment of nerve damage and postoperative structural reorganization. Our results show a significant difference in healthy vs lesioned nerves and a change in recovering nerve portions towards a more "physiological" ratio. Further evaluation in larger patient groups is required.
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Affiliation(s)
- Christian Heinen
- Department of Neurosurgery, Evangelisches Krankenhaus, Campus Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany
| | - Patrick Dömer
- Department of Neurosciences, Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany.,Research Center Neurosensory Science, Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany
| | - Thomas Schmidt
- Department of Neurosurgery, Evangelisches Krankenhaus, Campus Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany
| | - Bettina Kewitz
- Department of Neurosciences, Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany
| | - Ulrike Janssen-Bienhold
- Department of Neurosciences, Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany.,Research Center Neurosensory Science, Carl-von-Ossietzky University Oldenburg, Oldenburg, Germany
| | - Thomas Kretschmer
- Department of Neurosurgery, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
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18
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Use of fluoroscopic-guided transsacral block for the treatment of iatrogenic post-injection sciatic neuropathy: Report of three cases. Turk J Phys Med Rehabil 2020; 65:406-410. [PMID: 31893279 DOI: 10.5606/tftrd.2019.3077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 08/31/2018] [Indexed: 11/21/2022] Open
Abstract
Post-injection sciatic neuropathy (PISN) from an inadvertent intramuscular injection in the gluteal region is a type of iatrogenic sciatic nerve injury. Patients with neuropathic pain following PISN frequently experience disability leading to restrictions in daily activities and pain, which may be resistant to conventional treatments and physiotherapy in some cases. To date, minimal invasive procedures for neuropathic pain have been performed with various medications at the site of lesion. Herein, we report three adult male cases with PISN-associated neu- ropathic pain who were resistant to conservative management and were treated with fluoroscopy-guided transsacral block.
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19
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Xu H, Chen J, Feng Z, Fu K, Qiao Y, Zhang Z, Wang W, Wang Y, Zhang J, Perdanasari AT, Hanasono MM, Levin LS, Yang X, Hao Y, Li Y, Wo Y, Zhang Y. Shortwave infrared fluorescence in vivo imaging of nerves for minimizing the risk of intraoperative nerve injury. NANOSCALE 2019; 11:19736-19741. [PMID: 31626258 DOI: 10.1039/c9nr06066a] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Here, we present a novel nerve specific imaging agent for preventing intraoperative nerve injuries based on SWIR QD-based in vivo imaging, which not only provides real-time and long-time SWIR images to intraoperatively identify nerves but can also markedly minimize the risk of iatrogenic nerve injuries during surgeries.
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Affiliation(s)
- Heng Xu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Jun Chen
- Department of Orthopedic Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China.
| | - Zhujun Feng
- Department of Anatomy and Physiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kan Fu
- Silicon Products Group, Applied Materials Inc., Sunnyvale, CA, USA
| | - Yusen Qiao
- P. Roy and Diana T. Vagelos Laboratories, Department of Chemistry, University of Pennsylvania, Philadelphia, PA, USA
| | - Zheng Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Wenjin Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yueming Wang
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jian Zhang
- Department of Orthopedic Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China.
| | | | - Matthew M Hanasono
- Department of Plastic Surgery, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L Scott Levin
- Division of Plastic Surgery, Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Xing Yang
- Department of orthopedics, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215500, Jiangsu, China.
| | - Yuefeng Hao
- Department of orthopedics, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215500, Jiangsu, China.
| | - Yunxia Li
- Department of Orthopedic Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China.
| | - Yan Wo
- Department of Anatomy and Physiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. and National Engineering Research Center for Nanotechnology, Shanghai, China
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20
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Gonzales J, Demetrio de Souza Franca P, Jiang Y, Pirovano G, Kossatz S, Guru N, Yarilin D, Agwa AJ, Schroeder CI, Patel SG, Ganly I, King GF, Reiner T. Fluorescence Imaging of Peripheral Nerves by a Na v1.7-Targeted Inhibitor Cystine Knot Peptide. Bioconjug Chem 2019; 30:2879-2888. [PMID: 31647222 DOI: 10.1021/acs.bioconjchem.9b00612] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Twenty million Americans suffer from peripheral nerve injury caused by trauma and medical disorders, resulting in a broad spectrum of potentially debilitating side effects. In one out of four cases, patients identify surgery as the root cause of their nerve injury. Particularly during tumor resections or after traumatic injuries, tissue distortion and poor visibility can challenge a surgeon's ability to precisely locate and preserve peripheral nerves. Intuitively, surgical outcomes would improve tremendously if nerves could be highlighted using an exogeneous contrast agent. In clinical practice, however, the current standard of care-visual examination and palpation-remains unchanged. To address this unmet clinical need, we explored the expression of voltage-gated sodium channel Nav1.7 as an intraoperative marker for the peripheral nervous system. We show that expression of Nav1.7 is high in peripheral nerves harvested from both human and mouse tissue. We further show that modification of a Nav1.7-selective peptide, Hsp1a, can serve as a targeted vector for delivering a fluorescent sensor to the peripheral nervous system. Ex vivo, we observe a high signal-to-noise ratio for fluorescently labeled Hsp1a in both histologically prepared and fresh tissue. Using a surgical fluorescent microscope, we show in a simulated clinical scenario that the identification of mouse sciatic nerves is possible, suggesting that fluorescently labeled Hsp1a tracers could be used to discriminate nerves from their surrounding tissues in a routine clinical setting.
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Affiliation(s)
| | | | - Yan Jiang
- Institute for Molecular Bioscience , The University of Queensland , St Lucia , Queensland 4072 , Australia
| | | | | | | | | | - Akello J Agwa
- Institute for Molecular Bioscience , The University of Queensland , St Lucia , Queensland 4072 , Australia
| | - Christina I Schroeder
- Institute for Molecular Bioscience , The University of Queensland , St Lucia , Queensland 4072 , Australia
| | | | | | - Glenn F King
- Institute for Molecular Bioscience , The University of Queensland , St Lucia , Queensland 4072 , Australia
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21
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Abstract
Iatrogenic peripheral nerve injuries from orthopaedic surgery can occur via many scenarios, including direct injury to the nerve during surgery, indirect injury via retraction or compartment syndrome, and injury from nonsurgical treatments such as injections and splinting. Successful management of iatrogenic nerve injuries requires an accurate diagnosis and timely, appropriate treatment. All orthopaedic surgeons must understand the preclinical study of nerve injury and the evaluation and treatment options for iatrogenic nerve injuries. Although a sharply transected nerve can be repaired immediately in the operating room under direct visualization, many injuries are not appreciated until the postoperative period. Advances in diagnostic studies and nerve repair techniques, nerve grafting, and nerve transfers have improved our ability to identify and treat such injuries.
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22
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Guedes-Corrêa JF, Pereira MRDC, Torrão-Junior FJL, Martins JV, Barbosa DAN. A Neglected Cause of Iatrogenic Brachial Plexus Injuries in Psychiatric Patients. Neurosurgery 2019; 82:307-311. [PMID: 28521032 DOI: 10.1093/neuros/nyx162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 03/10/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Psychiatric patients are often kept immobilized during hospitalization to avoid self-inflicted injuries and danger to third parties. Inadequate positioning can lead to brachial plexus injuries (BPI). OBJECTIVE To present a series of 5 psychiatric patients with BPI after being left sedated and restrained for prolonged periods of time during hospitalization. METHODS We retrospectively reviewed the charts of 5 psychiatric patients with iatrogenic BPI referred by other institutions to our service. The restraint technique adopted by those institutions consisted of a high-thoracic restraint. All patients underwent complete clinical and neurological examination at our center. Information concerning patient demographics, BPI characteristics, treatment choice, and ultimate outcome was recorded. RESULTS Three patients were male. The age of our patients ranged from 25 to 61 years old (mean: 41.2; median: 43). Three patients had a diagnosis of bipolar disorder while 2 had schizophrenia. Duration of immobilization ranged from 5 to 168 h (mean: 77.8; median: 72). Four patients presented with a unilateral right-sided lesion. Time to presentation ranged from 1 to 9 mo (mean: 4.2; median: 4). All patients also had intense pain and axillary lesions. Four patients received conservative treatment with partial or full functional recovery and complete pain resolution. The remaining patients underwent surgical repair and experienced good functional outcome. CONCLUSION Psychiatric patients who need to be sedated and immobilized must be monitored closely, as BPI can occur from high-thoracic restraints. When such an injury occurs, the patient must be referred to a center specialized in peripheral nerve surgery and rehabilitation.
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Affiliation(s)
- José Fernando Guedes-Corrêa
- Division of Neurosurgery. Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.,Deolindo Couto Neurology Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maristella Reis da Costa Pereira
- Division of Neurosurgery. Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - José Vicente Martins
- Deolindo Couto Neurology Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daniel Alves Neiva Barbosa
- Division of Neurosurgery. Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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23
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Das P, Santos S, Park GK, Hoseok I, Choi HS. Real-Time Fluorescence Imaging in Thoracic Surgery. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:205-220. [PMID: 31403028 PMCID: PMC6687041 DOI: 10.5090/kjtcs.2019.52.4.205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 12/24/2018] [Accepted: 12/24/2018] [Indexed: 12/12/2022]
Abstract
Near-infrared (NIR) fluorescence imaging provides a safe and cost-efficient method for immediate data acquisition and visualization of tissues, with technical advantages including minimal autofluorescence, reduced photon absorption, and low scattering in tissue. In this review, we introduce recent advances in NIR fluorescence imaging systems for thoracic surgery that improve the identification of vital tissues and facilitate the resection of tumorous tissues. When coupled with appropriate NIR fluorophores, NIR fluorescence imaging may transform current intraoperative thoracic surgery methods by enhancing the precision of surgical procedures and augmenting postoperative outcomes through improvements in diagnostic accuracy and reductions in the remission rate.
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Affiliation(s)
- Priyanka Das
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sheena Santos
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - G Kate Park
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - I Hoseok
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hak Soo Choi
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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24
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Paskal AM, Paskal W, Pietruski P, Wlodarski PK. Polyethylene Glycol: The Future of Posttraumatic Nerve Repair? Systemic Review. Int J Mol Sci 2019; 20:E1478. [PMID: 30909624 PMCID: PMC6471459 DOI: 10.3390/ijms20061478] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 12/13/2022] Open
Abstract
Peripheral nerve injury is a common posttraumatic complication. The precise surgical repair of nerve lesion does not always guarantee satisfactory motor and sensory function recovery. Therefore, enhancement of the regeneration process is a subject of many research strategies. It is believed that polyethylene glycol (PEG) mediates axolemmal fusion, thus enabling the direct restoration of axon continuity. It also inhibits Wallerian degeneration and recovers nerve conduction. This systemic review, performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, describes and summarizes published studies on PEG treatment efficiency in various nerve injury types and repair techniques. Sixteen original experimental studies in animal models and one in humans were analyzed. PEG treatment superiority was reported in almost all experiments (based on favorable electrophysiological, histological, or behavioral results). To date, only one study attempted to transfer the procedure into the clinical phase. However, some technical aspects, e.g., the maximal delay between trauma and successful treatment, await determination. PEG therapy is a promising prospect that may improve the surgical treatment of peripheral nerve injuries in the clinical practice.
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Affiliation(s)
- Adriana M Paskal
- Laboratory of Centre for Preclinical Research, Department of Research Methodology, Medical University of Warsaw, Banacha 1B, 02-091 Warsaw, Poland.
| | - Wiktor Paskal
- Laboratory of Centre for Preclinical Research, Department of Research Methodology, Medical University of Warsaw, Banacha 1B, 02-091 Warsaw, Poland.
| | - Piotr Pietruski
- Timeless Plastic Surgery Clinic, gen. Romana Abrahama 18/322, 03-982 Warsaw, Poland.
| | - Pawel K Wlodarski
- Laboratory of Centre for Preclinical Research, Department of Research Methodology, Medical University of Warsaw, Banacha 1B, 02-091 Warsaw, Poland.
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25
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Mehta CR, Constantinidis A, Farhat M, Suthersan M, Graham E, Kanawati A. The distance of the femoral neurovascular bundle from the hip joint: an intraoperative guide to reduce iatrogenic injury. J Orthop Surg Res 2018; 13:135. [PMID: 29866137 PMCID: PMC5987397 DOI: 10.1186/s13018-018-0847-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/28/2018] [Indexed: 11/24/2022] Open
Abstract
Background Iatrogenic injury to the femoral neurovascular bundle is not uncommon during primary and revision total hip replacement (THR) and can result in permanent weakness, pain and poor function. Prevention of injury to these structures relies on a sound knowledge of their relationships to the hip joint. Methods We studied 115 consecutive hip magnetic resonance imaging (MRI) results in order to identify objective relationships between these structures and the hip joint that can be used intraoperatively. Results We determined that the shortest mean distances of the femoral nerve, artery and vein from the hip joint are 23.62 (standard deviation, SD = 5.44), 19.62 (SD = 4.17) and 17.47 (SD = 4.41) mm, respectively. The femoral nerve was lateral to the hip joint in 30 (55.5%) left- and 37 (60.7%) right-sided hip joints. The femoral artery was located medial to the hip joint in 28 (51.9%) left- and 34 (55.7%) right-sided hips. The femoral vein was medial to the hip joint in 52 (96.3%) left- and 58 (95.1%) right-sided hips. Conclusion We have identified objective relationships between the hip joint and femoral neurovascular bundle that can be used with ease intraoperatively during THR. Our data show that patients with a low body weight and the elderly may be at a higher risk of iatrogenic injury due to increased proximity of the neurovascular structures to the hip. Application of this knowledge may serve to reduce the risk of iatrogenic injury to these structures and thereby improve patient satisfaction and outcomes.
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Affiliation(s)
- Cyrus R Mehta
- Westmead Hospital, corner of Hawkesbury and Darcy Roads, Westmead, Sydney, New South Wales, 2145, Australia.
| | - Alex Constantinidis
- Westmead Hospital, corner of Hawkesbury and Darcy Roads, Westmead, Sydney, New South Wales, 2145, Australia
| | - Moussa Farhat
- Westmead Hospital, corner of Hawkesbury and Darcy Roads, Westmead, Sydney, New South Wales, 2145, Australia
| | - Mayuran Suthersan
- Westmead Hospital, corner of Hawkesbury and Darcy Roads, Westmead, Sydney, New South Wales, 2145, Australia
| | - Edward Graham
- Westmead Hospital, corner of Hawkesbury and Darcy Roads, Westmead, Sydney, New South Wales, 2145, Australia
| | - Andrew Kanawati
- Westmead Hospital, corner of Hawkesbury and Darcy Roads, Westmead, Sydney, New South Wales, 2145, Australia
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Cha J, Broch A, Mudge S, Kim K, Namgoong JM, Oh E, Kim P. Real-time, label-free, intraoperative visualization of peripheral nerves and micro-vasculatures using multimodal optical imaging techniques. BIOMEDICAL OPTICS EXPRESS 2018; 9. [PMID: 29541506 PMCID: PMC5846516 DOI: 10.1364/boe.9.001097] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Accurate, real-time identification and display of critical anatomic structures, such as the nerve and vasculature structures, are critical for reducing complications and improving surgical outcomes. Human vision is frequently limited in clearly distinguishing and contrasting these structures. We present a novel imaging system, which enables noninvasive visualization of critical anatomic structures during surgical dissection. Peripheral nerves are visualized by a snapshot polarimetry that calculates the anisotropic optical properties. Vascular structures, both venous and arterial, are identified and monitored in real-time using a near-infrared laser-speckle-contrast imaging. We evaluate the system by performing in vivo animal studies with qualitative comparison by contrast-agent-aided fluorescence imaging.
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Affiliation(s)
- Jaepyeong Cha
- Sheikh Zyaed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
- These authors contributed equally to this work
| | - Aline Broch
- Sheikh Zyaed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
- These authors contributed equally to this work
| | - Scott Mudge
- Sheikh Zyaed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Kihoon Kim
- Sheikh Zyaed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
- Department of Surgery, Inje University Haeundae Paik Hospital, 875 Haeun-daero, Haeundae-gu, Busan 612-896, South Korea
| | - Jung-Man Namgoong
- Sheikh Zyaed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
- Department of Surgery, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, South Korea
| | - Eugene Oh
- Sheikh Zyaed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
- Department of Biomedical Engineering, The Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21218, USA
| | - Peter Kim
- Sheikh Zyaed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
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Reichert P, Królikowska A, Witkowski J, Szuba Ł, Czamara A. Surgical Management of Distal Biceps Tendon Anatomical Reinsertion Complications: Iatrogenic Posterior Interosseous Nerve Palsy. Med Sci Monit 2018; 24:782-790. [PMID: 29411738 PMCID: PMC5812427 DOI: 10.12659/msm.907260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Although iatrogenic posterior interosseous nerve (PIN) palsy is an uncommon complication of ruptured distal biceps brachii tendon surgical anatomical reinsertion, it is the most severe complication leading to functional limitation. The present study investigated possible types of PIN palsy as a postoperative complication of anatomical distal biceps tendon reinsertion, and aimed to clinically assess patients at 2 years after its surgical treatment. Material/Methods The studied sample comprised 7 male patients diagnosed with an iatrogenic PIN palsies after anatomical reinsertion of the distal biceps tendon, who were referred to the reference center for management of a peripheral nervous system injury. The nerve injury was intraoperatively evaluated. The clinical assessment used the Medical Research Council (MRC) System for motor recovery, and the Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) was performed before the surgical treatment of the PIN injuries and at 2 years postoperatively. In all studied cases, electromyography was performed preoperatively and postoperatively. Results The comparison of the preoperative (x=1.43±0.53) and postoperative (x=4.71±0.49) results of the motor recovery of the PIN demonstrated a statistically significant improvement (p<0.001). Moreover, the results of functional assessments with the use of the Quick DASH questionnaire significantly improved (p<0.001) postoperatively (x=6.14±6.86) compared to the preoperative evaluations (x=54.29±12.05). Conclusions The PIN palsies as complications of the surgical anatomical reinsertion of ruptured distal biceps brachii resulted from mechanical nerve compression or direct intraoperative damage. The 2-year outcomes justified the clinical use of surgical management for iatrogenic PIN palsy.
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Affiliation(s)
- Paweł Reichert
- Division of Sports Medicine, Departament of Physiotherapy, Wrocław Medical University, Wrocław, Poland
| | | | - Jarosław Witkowski
- Division of Sports Medicine, Department of Physiotherapy, Wrocław Medical University, Wrocław, Poland
| | - Łukasz Szuba
- Department of Physiotherapy, The College of Physiotherapy in Wrocław, Wrocław, Poland
| | - Andrzej Czamara
- Departament of Physiotherapy, The College of Physiotherapy in Wrocław, Wrocław, Poland
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Lolis AM, Falsone S, Beric A. Common peripheral nerve injuries in sport: diagnosis and management. HANDBOOK OF CLINICAL NEUROLOGY 2018; 158:401-419. [PMID: 30482369 DOI: 10.1016/b978-0-444-63954-7.00038-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Peripheral nerve injuries are unusual in sport but impact an athlete's safe return to play. Nerve injuries result from either acute trauma (most commonly in contact/collision sports) or from repetitive microtrauma and overuse. Diagnosis of overuse nerve injuries includes nerve localization and surrounding soft-tissue anatomy, and must account for possible causes of repetitive microtrauma, including biomechanics, equipment, training schedule, and recovery. Prognosis is related to the type of nerve injury. Management should not simply be rest and gradual return to sport but should address biomechanical and training predispositions to injury. Understanding the type of injury and the tissues involved will guide appropriate rehabilitation decisions. Recognizing acute care considerations and implementing appropriate strategies can help minimize secondary trauma to an area following acute injury.
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Affiliation(s)
- Athena M Lolis
- Division of Clinical Neurophysiology, Department of Neurology, NYU School of Medicine, New York, NY, United States
| | - Susan Falsone
- Department of Athletic Training, A.T. Still University, Mesa, AZ, United States
| | - Aleksandar Beric
- Division of Clinical Neurophysiology, Department of Neurology, NYU School of Medicine, New York, NY, United States.
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29
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Dengler NF, Antoniadis G, Grolik B, Wirtz CR, König R, Pedro MT. Mechanisms, Treatment, and Patient Outcome of Iatrogenic Injury to the Brachial Plexus-A Retrospective Single-Center Study. World Neurosurg 2017; 107:868-876. [PMID: 28847555 DOI: 10.1016/j.wneu.2017.08.119] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/16/2017] [Accepted: 08/17/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Injury to the brachial plexus is a devastating condition, with severe impairment of upper extremity function resulting in distinct disability. There are no systematic reports on epidemiology, causative mechanisms, treatment strategies. or outcomes of iatrogenic brachial plexus injury (iBPI). METHODS We screened all cases of iatrogenic nerve injuries recorded between 2007 and 2017 at a single specialized institution. Mechanism of iBPI, type of previous causative intervention, location and type of the lesion as well as the type of revision surgery and functional patient outcome were analyzed. RESULTS We identified 14 cases of iBPI, which all presented with significant impairment of upper extremity motor function (at least 1 muscle Medical Research Council grade 0). Neuropathic pain was present in most patients (11/14). Orthopedic shoulder procedures such as rotator cuff fixation, arthroplasty, and repositioning of a clavicle fracture accounted for iBPI in 7 of 14 patients. Other reasons for iBPI were resection or biopsy of a peripheral nerve sheath tumor in 3 patients or lymph node situated at the cervicomediastinal area in 2 patients. Mechanisms also included transaxillary rib resection in one and sternotomy in another patient. The treatment of iBPI was conducted according to each individual's needs and included neurolysis in 4, nerve grafting in 9, and nerve transfers in 1 patient. We found improved symptoms after treatment in most patients (11/14). CONCLUSIONS Most common causes for iBPI were shoulder surgery and resection or biopsy of peripheral nerve sheath tumor and lymph nodes. Early referral to specialized peripheral nerve centers may help to improve functional patient outcome.
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Affiliation(s)
| | - Gregor Antoniadis
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Brigitta Grolik
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Christian Rainer Wirtz
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Ralph König
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Maria Teresa Pedro
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Günzburg, Germany
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30
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The Transition of Acute Postoperative Pain to Chronic Pain: An Integrative Overview of Research on Mechanisms. THE JOURNAL OF PAIN 2017; 18:359.e1-359.e38. [DOI: 10.1016/j.jpain.2016.11.004] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 10/15/2016] [Accepted: 11/16/2016] [Indexed: 01/01/2023]
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31
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Boyer RB, Kelm ND, Riley DC, Sexton KW, Pollins AC, Shack RB, Dortch RD, Nanney LB, Does MD, Thayer WP. 4.7-T diffusion tensor imaging of acute traumatic peripheral nerve injury. Neurosurg Focus 2016; 39:E9. [PMID: 26323827 DOI: 10.3171/2015.6.focus1590] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Diagnosis and management of peripheral nerve injury is complicated by the inability to assess microstructural features of injured nerve fibers via clinical examination and electrophysiology. Diffusion tensor imaging (DTI) has been shown to accurately detect nerve injury and regeneration in crush models of peripheral nerve injury, but no prior studies have been conducted on nerve transection, a surgical emergency that can lead to permanent weakness or paralysis. Acute sciatic nerve injuries were performed microsurgically to produce multiple grades of nerve transection in rats that were harvested 1 hour after surgery. High-resolution diffusion tensor images from ex vivo sciatic nerves were obtained using diffusion-weighted spin-echo acquisitions at 4.7 T. Fractional anisotropy was significantly reduced at the injury sites of transected rats compared with sham rats. Additionally, minor eigenvalues and radial diffusivity were profoundly elevated at all injury sites and were negatively correlated to the degree of injury. Diffusion tensor tractography showed discontinuities at all injury sites and significantly reduced continuous tract counts. These findings demonstrate that high-resolution DTI is a promising tool for acute diagnosis and grading of traumatic peripheral nerve injuries.
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Affiliation(s)
- Richard B Boyer
- Departments of 1 Biomedical Engineering and.,Plastic Surgery, Vanderbilt University Medical Center
| | - Nathaniel D Kelm
- Departments of 1 Biomedical Engineering and.,Vanderbilt University Institute of Imaging Science, Nashville, Tennessee; and
| | | | - Kevin W Sexton
- Plastic Surgery, Vanderbilt University Medical Center;,Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - R Bruce Shack
- Plastic Surgery, Vanderbilt University Medical Center
| | - Richard D Dortch
- Departments of 1 Biomedical Engineering and.,Vanderbilt University Institute of Imaging Science, Nashville, Tennessee; and
| | | | - Mark D Does
- Departments of 1 Biomedical Engineering and.,Vanderbilt University Institute of Imaging Science, Nashville, Tennessee; and
| | - Wesley P Thayer
- Departments of 1 Biomedical Engineering and.,Plastic Surgery, Vanderbilt University Medical Center
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32
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Löscher WN, Wanschitz J, Iglseder S, Vass A, Grinzinger S, Pöschl P, Grisold W, Ninkovic M, Antoniadis G, Pedro M, König R, Quasthoff S, Oder W, Finsterer J. Iatrogenic lesions of peripheral nerves. Acta Neurol Scand 2015; 132:291-303. [PMID: 25882317 DOI: 10.1111/ane.12407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2015] [Indexed: 11/28/2022]
Abstract
Iatrogenic nerve lesions (INLs) are an integral part of peripheral neurology and require dedicated neurologists to manage them. INLs of peripheral nerves are most frequently caused by surgery, immobilization, injections, radiation, or drugs. Early recognition and diagnosis is important not to delay appropriate therapeutic measures and to improve the outcome. Treatment can be causative or symptomatic, conservative, or surgical. Rehabilitative measures play a key role in the conservative treatment, but the point at which an INL requires surgical intervention should not be missed or delayed. This is why INLs require close multiprofessional monitoring and continuous re-evaluation of the therapeutic effect. With increasing number of surgical interventions and increasing number of drugs applied, it is quite likely that the prevalence of INLs will further increase. To provide an optimal management, more studies about the frequency of the various INLs and studies evaluating therapies need to be conducted. Management of INLs can be particularly improved if those confronted with INLs get state-of-the-art education and advanced training about INLs. Management and outcome of INLs can be further improved if the multiprofessional interplay is optimized and adapted to the needs of the patient, the healthcare system, and those responsible for sustaining medical infrastructure.
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Affiliation(s)
- W. N. Löscher
- Department of Neurology; Medical University Innsbruck; Innsbruck Austria
| | - J. Wanschitz
- Department of Neurology; Medical University Innsbruck; Innsbruck Austria
| | - S. Iglseder
- Department of Neurology; Barmherzige Brüder Linz; Linz Austria
| | - A. Vass
- Private Practice; Vienna Austria
| | - S. Grinzinger
- Department of Neurology; Paracelsus Private Medical University; Salzburg Austria
| | - P. Pöschl
- Barmherzige Brüder Regensburg; Regensburg Germany
| | - W. Grisold
- Department of Neurology; Kaiser-Franz-Josef Spital; Vienna Austria
| | - M. Ninkovic
- Department of Physical Medicine and Rehabilitation; Medical University Innsbruck; Innsbruck Austria
| | - G. Antoniadis
- Neurosurgical Clinic; University of Ulm and Province Hospital; Günzburg Germany
| | - M.T. Pedro
- Neurosurgical Clinic; University of Ulm and Province Hospital; Günzburg Germany
| | - R. König
- Neurosurgical Clinic; University of Ulm and Province Hospital; Günzburg Germany
| | - S. Quasthoff
- Department of Neurology; Graz Medical University; Graz Austria
| | - W. Oder
- AUVA Rehabilitation Center Wien Meidling; Vienna Austria
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33
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Fleisch MC, Bremerich D, Schulte-Mattler W, Tannen A, Teichmann AT, Bader W, Balzer K, Renner SP, Römer T, Roth S, Schütz F, Thill M, Tinneberg H, Zarras K. The Prevention of Positioning Injuries during Gynecologic Operations. Guideline of DGGG (S1-Level, AWMF Registry No. 015/077, February 2015). Geburtshilfe Frauenheilkd 2015; 75:792-807. [PMID: 26365999 PMCID: PMC4554497 DOI: 10.1055/s-0035-1557776] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Purpose: Official guideline published and coordinated by the German Society of Gynecology and Obstetrics (DGGG). Positioning injuries after lengthy gynecological procedures are rare, but the associated complications can be potentially serious for patients. Moreover, such injuries often lead to claims of malpractice and negligence requiring detailed medical investigation. To date, there are no binding evidence-based recommendations for the prevention of such injuries. Methods: This S1-guideline is the work of an interdisciplinary group of experts from a range of different professions who were commissioned by DGGG to carry out a systematic literature search of positioning injuries. Members of the participating scientific societies develop a consensus in an informal procedure. Afterwards the directorate of the scientific society approves the consensus. The recommendations cover.
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Affiliation(s)
| | - D. Bremerich
- Klinik für Anästhesiologie, Agaplesion Markus Krankenhaus Frankfurt am Main, Frankfurt am Main
| | - W. Schulte-Mattler
- Klinik und Poliklinik für Neurologie Universitätsklinikum Regensburg, Regensburg
| | - A. Tannen
- Institut für Gesundheits- und Pflegewissenschaften, Charité Universitätsmedizin Berlin, Berlin
| | | | - W. Bader
- Zentrum für Frauenheilkunde, Klinikum Bielefeld Mitte, Bielefeld
| | - K. Balzer
- Gefäß- und Endovaskulärchirurgie, GFO Kliniken Bonn, Betriebsstätte St. Marien, Bonn
| | - S. P. Renner
- Universitätsklinikum Erlangen-Nürnberg, Frauenklinik, Erlangen
| | - T. Römer
- Klinik für Gynäkologie und Geburtshilfe, Evangelisches Krankenhaus, Cologne
| | - S. Roth
- Urologische Klinik, Helios Klinikum Wuppertal, Wuppertal
| | - F. Schütz
- Allgemeine Frauenheilkunde und Geburtshilfe, Universitätsklinikum Heidelberg, Heidelberg
| | - M. Thill
- Klinik für Gynäkologie, Agaplesion Markus Krankenhaus, Frankfurt am Main
| | - H. Tinneberg
- Zentrum für Frauenheilkunde und Geburtshilfe, Universitätsklinium Gießen, Gießen
| | - K. Zarras
- Abteilung für Allgemein-, Viszeral- und Minimalinvasive Chirurgie, Marienhospital Düsseldorf, Düsseldorf
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34
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Cotero VE, Kimm SY, Siclovan TM, Zhang R, Kim EM, Matsumoto K, Gondo T, Scardino PT, Yazdanfar S, Laudone VP, Tan Hehir CA. Improved Intraoperative Visualization of Nerves through a Myelin-Binding Fluorophore and Dual-Mode Laparoscopic Imaging. PLoS One 2015; 10:e0130276. [PMID: 26076448 PMCID: PMC4468247 DOI: 10.1371/journal.pone.0130276] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 05/19/2015] [Indexed: 11/18/2022] Open
Abstract
The ability to visualize and spare nerves during surgery is critical for avoiding chronic morbidity, pain, and loss of function. Visualization of such critical anatomic structures is even more challenging during minimal access procedures because the small incisions limit visibility. In this study, we focus on improving imaging of nerves through the use of a new small molecule fluorophore, GE3126, used in conjunction with our dual-mode (color and fluorescence) laparoscopic imaging instrument. GE3126 has higher aqueous solubility, improved pharmacokinetics, and reduced non-specific adipose tissue fluorescence compared to previous myelin-binding fluorophores. Dosing and kinetics were initially optimized in mice. A non-clinical modified Irwin study in rats, performed to assess the potential of GE3126 to induce nervous system injuries, showed the absence of major adverse reactions. Real-time intraoperative imaging was performed in a porcine model. Compared to white light imaging, nerve visibility was enhanced under fluorescence guidance, especially for small diameter nerves obscured by fascia, blood vessels, or adipose tissue. In the porcine model, nerve visualization was observed rapidly, within 5 to 10 minutes post-intravenous injection and the nerve fluorescence signal was maintained for up to 80 minutes. The use of GE3126, coupled with practical implementation of an imaging instrument may be an important step forward in preventing nerve damage in the operating room.
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Affiliation(s)
- Victoria E. Cotero
- Diagnostics, Imaging and Biomedical Technologies, GE Global Research, Niskayuna, New York, United States of America
| | - Simon Y. Kimm
- Urology Service, Department of Surgery, Memorial Sloan—Kettering Cancer Center, New York, New York, United States of America
| | - Tiberiu M. Siclovan
- Diagnostics, Imaging and Biomedical Technologies, GE Global Research, Niskayuna, New York, United States of America
| | - Rong Zhang
- Diagnostics, Imaging and Biomedical Technologies, GE Global Research, Niskayuna, New York, United States of America
| | - Evgenia M. Kim
- Diagnostics, Imaging and Biomedical Technologies, GE Global Research, Niskayuna, New York, United States of America
| | - Kazuhiro Matsumoto
- Urology Service, Department of Surgery, Memorial Sloan—Kettering Cancer Center, New York, New York, United States of America
| | - Tatsuo Gondo
- Urology Service, Department of Surgery, Memorial Sloan—Kettering Cancer Center, New York, New York, United States of America
| | - Peter T. Scardino
- Urology Service, Department of Surgery, Memorial Sloan—Kettering Cancer Center, New York, New York, United States of America
| | - Siavash Yazdanfar
- Diagnostics, Imaging and Biomedical Technologies, GE Global Research, Niskayuna, New York, United States of America
| | - Vincent P. Laudone
- Urology Service, Department of Surgery, Memorial Sloan—Kettering Cancer Center, New York, New York, United States of America
| | - Cristina A. Tan Hehir
- Diagnostics, Imaging and Biomedical Technologies, GE Global Research, Niskayuna, New York, United States of America
- * E-mail:
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35
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Cesmebasi A, Spinner RJ. An anatomic-based approach to the iatrogenic spinal accessory nerve injury in the posterior cervical triangle: How to avoid and treat it. Clin Anat 2015; 28:761-6. [DOI: 10.1002/ca.22555] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 04/11/2015] [Accepted: 04/11/2015] [Indexed: 01/23/2023]
Affiliation(s)
- Alper Cesmebasi
- Department of Neurologic Surgery; Mayo Clinic; Rochester Minnesota
- Department of Anatomical Sciences; St George's University; West Indies Grenada
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36
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Colsa Gutiérrez P, Viadero Cervera R, Morales-García D, Ingelmo Setién A. Intraoperative peripheral nerve injury in colorectal surgery. An update. Cir Esp 2015; 94:125-36. [PMID: 26008880 DOI: 10.1016/j.ciresp.2015.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 02/04/2015] [Accepted: 03/08/2015] [Indexed: 12/15/2022]
Abstract
Intraoperative peripheral nerve injury during colorectal surgery procedures is a potentially serious complication that is often underestimated. The Trendelenburg position, use of inappropriately padded armboards and excessive shoulder abduction may encourage the development of brachial plexopathy during laparoscopic procedures. In open colorectal surgery, nerve injuries are less common. It usually involves the femoral plexus associated with lithotomy position and self-retaining retractor systems. Although in most cases the recovery is mostly complete, treatment consists of physical therapy to prevent muscular atrophy, protection of hypoesthesic skin areas and analgesics for neuropathic pain. The aim of the present study is to review the incidence, prevention and management of intraoperative peripheral nerve injury.
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Affiliation(s)
- Pablo Colsa Gutiérrez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Sierrallana , Torrelavega, Cantabria, España.
| | | | - Dieter Morales-García
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - Alfredo Ingelmo Setién
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Sierrallana , Torrelavega, Cantabria, España
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Antoniadis G, Kretschmer T, Pedro MT, König RW, Heinen CPG, Richter HP. Iatrogenic nerve injuries: prevalence, diagnosis and treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 111:273-9. [PMID: 24791754 DOI: 10.3238/arztebl.2014.0273] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 02/11/2014] [Accepted: 02/11/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Iatrogenic nerve injuries can result from direct surgical trauma, mechanical stress on a nerve due to faulty positioning during anesthesia, the injection of neurotoxic substances into a nerve, and other mechanisms. Treating physicians should know the risk factors and the procedure to be followed when an iatrogenic nerve injury arises. METHOD This review is based on pertinent articles retrieved by a selective search in PubMed and on the authors' own data from the years 1990-2012. RESULTS In large-scale studies, 25% of sciatic nerve lesions that required treatment were iatrogenic, as were 60% of femoral nerve lesions and 94% of accessory nerve lesions. Osteosyntheses, osteotomies, arthrodeses, lymph node biopsies in the posterior triangle of the neck, carpal tunnel operations, and procedures on the wrist and knee were common settings for iatrogenic nerve injury. 340 patients underwent surgery for iatrogenic nerve injuries over a 23-year period in the District Hospital of Günzburg (Neurosurgical Department of the University of Ulm). In a study published by the authors in 2001, 17.4% of the traumatic nerve lesions treated were iatrogenic. 94% of iatrogenic nerve injuries occurred during surgical procedures. CONCLUSION A thorough knowledge of the anatomy of the vulnerable nerves and of variants in their course can lessen the risk of iatrogenic nerve injury. When such injuries arise, early diagnosis and planning of further management are the main determinants of outcome. If adequate nerve regeneration does not occur, surgical revision should optimally be performed 3 to 4 months after the injury, and 6 months afterward at the latest. On the other hand, if postoperative high resolution ultrasound reveals either complete transection of the nerve or a neuroma in continuity, surgery should be performed without any further delay. If the surgeon becomes aware of a nerve transection during the initial procedure, then either immediate end-to-end suturing or early secondary management after three weeks is indicated.
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Affiliation(s)
- Gregor Antoniadis
- District Hospital of Günzburg (Neurosurgical Department of the University of Ulm), Department of Neurosurgery of the University of Oldenburg/Protestant Hospital of Oldenburg, Ulm
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The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine. Reg Anesth Pain Med 2015; 40:401-30. [DOI: 10.1097/aap.0000000000000286] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Elhassan B. Pectoralis major transfer for the management of scapula winging secondary to serratus anterior injury or paralysis. J Hand Surg Am 2014; 39:353-61. [PMID: 24480693 DOI: 10.1016/j.jhsa.2013.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/11/2013] [Indexed: 02/02/2023]
Abstract
Pectoralis major transfer (partial or complete) is the most common transfer to the scapula for winging as a result of serratus anterior paralysis or injury. The most commonly described technique is to transfer the pectoralis major prolonged with tendon allograft or autograft to the scapula. We present a technique that entails direct transfer of the sternal head of the pectoralis major with its bony insertion to the lower scapula.
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Affiliation(s)
- Bassem Elhassan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
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Gologan RE, Walter V, Röhl H. [Peripheral nerve lesions of the lower leg due to tibiofibular ganglion]. DER NERVENARZT 2014; 85:749-52. [PMID: 24441848 DOI: 10.1007/s00115-013-3966-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cystic formations around the knee are a common object of orthopedic treatment. When associated with neurological or vascular deficits further diagnostic imaging is required. This case study demonstrates the appearance of an intramuscular ganglion causing drop foot, arising from the tibio-fibular joint.
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Affiliation(s)
- R E Gologan
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland,
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Hendrix P, Griessenauer CJ, Foreman P, Loukas M, Fisher WS, Rizk E, Shoja MM, Tubbs RS. Arterial supply of the lower cranial nerves: A comprehensive review. Clin Anat 2013; 27:108-17. [DOI: 10.1002/ca.22318] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 08/08/2013] [Accepted: 08/11/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Philipp Hendrix
- Division of Neurosurgery; Department of Surgery; University of Alabama at Birmingham; Birmingham Alabama
| | - Christoph J. Griessenauer
- Division of Neurosurgery; Department of Surgery; University of Alabama at Birmingham; Birmingham Alabama
| | - Paul Foreman
- Division of Neurosurgery; Department of Surgery; University of Alabama at Birmingham; Birmingham Alabama
| | - Marios Loukas
- Department of Anatomical Sciences; St. George's University; Grenada
| | - Winfield S. Fisher
- Division of Neurosurgery; Department of Surgery; University of Alabama at Birmingham; Birmingham Alabama
| | - Elias Rizk
- Pediatric Neurosurgery; Children's Hospital; Birmingham Alabama
| | | | - R. Shane Tubbs
- Department of Anatomical Sciences; St. George's University; Grenada
- Pediatric Neurosurgery; Children's Hospital; Birmingham Alabama
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Bouyer-Ferullo S. Preventing perioperative peripheral nerve injuries. AORN J 2013; 97:110-124.e9. [PMID: 23265653 DOI: 10.1016/j.aorn.2012.10.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 01/16/2012] [Accepted: 10/23/2012] [Indexed: 10/27/2022]
Abstract
Peripheral nerve injuries are largely preventable injuries that can result from incorrect patient positioning during surgery. Patients who are diabetic, are extremely thin or obese, use tobacco, or undergo surgery lasting more than four hours are at increased risk for developing these injuries. When peripheral nerve injuries occur, patients may experience numbness, burning, or tingling and may have difficulty getting out of bed, walking, gripping objects, or raising their arms. These symptoms can interrupt activities of daily living and impede recovery. Signs and symptoms of peripheral nerve injury may appear within 24 to 48 hours of surgery or may take as long as a week to appear. Careful attention to body alignment and proper padding of bony prominences when positioning patients for surgery is necessary to prevent peripheral nerve injury. The use of a preoperative assessment tool to identify at-risk patients, collaboration between physical therapy and OR staff members regarding patient positioning, and neurophysiological monitoring can help prevent peripheral nerve injuries.
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Cotero VE, Siclovan T, Zhang R, Carter RL, Bajaj A, LaPlante NE, Kim E, Gray D, Staudinger VP, Yazdanfar S, Tan Hehir CA. Intraoperative fluorescence imaging of peripheral and central nerves through a myelin-selective contrast agent. Mol Imaging Biol 2013; 14:708-17. [PMID: 22488576 PMCID: PMC3492698 DOI: 10.1007/s11307-012-0555-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Purpose Patients suffer from complications as a result of unintentional nerve damage during surgery. We focus on improving intraoperative visualization of nerves through the use of a targeted fluorophore and optical imaging instrumentation. Procedure A myelin-targeting fluorophore, GE3111, was synthesized, characterized for its optical and myelin-binding properties using purified myelin basic protein, and evaluated in mice. Additionally, a compact instrument was adapted to visualize nerves. Results GE3111 was synthesized using a versatile methodology. Its optical properties were sensitive to the local environment both in vitro and in vivo. Following intravenous injection, central and peripheral nerves were visualized, with the kinetics of nerve uptake modifiable depending on the formulation. Fluorescence polarization showed specific and strong binding to purified myelin basic protein. Nerves were visualized in vivo using a dedicated compact imaging device requiring less than 2.5 mW/cm2 of illumination at 405 nm. Conclusions Fluorescence imaging of nerves through myelin showed a potential for use in image-guided surgery. Intraoperative nerve imaging is an example where contrast agent and instrument development come together as a result of clinical need. Electronic supplementary material The online version of this article (doi:10.1007/s11307-012-0555-1) contains supplementary material, which is available to authorized users.
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Bajaj A, LaPlante NE, Cotero VE, Fish KM, Bjerke RM, Siclovan T, Tan Hehir CA. Identification of the protein target of myelin-binding ligands by immunohistochemistry and biochemical analyses. J Histochem Cytochem 2012; 61:19-30. [PMID: 23092790 DOI: 10.1369/0022155412467353] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The ability to visualize myelin is important in the diagnosis of demyelinating disorders and the detection of myelin-containing nerves during surgery. The development of myelin-selective imaging agents requires that a defined target for these agents be identified and that a robust assay against the target be developed to allow for assessment of structure-activity relationships. We describe an immunohistochemical analysis and a fluorescence polarization binding assay using purified myelin basic protein (MBP) that provides quantitative evidence that MBP is the molecular binding partner of previously described myelin-selective fluorescent dyes such as BMB, GE3082, and GE3111.
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Affiliation(s)
- Anshika Bajaj
- GE Global Research, One Research Circle, Niskayuna, NY, USA
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Murphy RKJ, Ray WZ, Mackinnon SE. Repair of a median nerve transection injury using multiple nerve transfers, with long-term functional recovery. J Neurosurg 2012; 117:886-9. [PMID: 22978538 DOI: 10.3171/2012.8.jns111356] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Complete loss of median nerve motor function is a rare but devastating injury. Loss of median motor hand function and upper-extremity pronation can significantly impact a patient's ability to perform many activities of daily living independently. The authors report the long-term follow-up in a case of median nerve motor fiber transection that occurred during an arthroscopic elbow procedure, which was then treated with multiple nerve transfers. Motor reconstruction used the nerves to the supinator and extensor carpi radialis brevis to transfer to the anterior interosseous nerve and pronator. Sensory sensation was restored using the lateral antebrachial cutaneous (LABC) nerve to transfer to a portion of the sensory component of the median nerve, and a second cable of LABC nerve as a direct median nerve sensory graft. The patient ultimately recovered near normal motor function of the median nerve, but had persistent pain symptoms 4 years postinjury.
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Affiliation(s)
- Rory K J Murphy
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Abstract
Scapular winging is a rare disorder often caused by neuromuscular imbalance in the scapulothoracic stabilizer muscles. Lesions of the long thoracic nerve and spinal accessory nerves are the most common cause. Numerous underlying etiologies have been described. Patients report diffuse neck, shoulder girdle, and upper back pain, which may be debilitating, associated with abduction and overhead activities. Accurate diagnosis and detection depend on appreciation of the scapulothoracic anatomy and a comprehensive physical examination. Although most cases resolve nonsurgically, surgical treatment of scapular winging has been met with success.
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Iatrogenic femoral nerve injury: a systematic review. Surg Radiol Anat 2011; 33:649-58. [DOI: 10.1007/s00276-011-0791-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 02/02/2011] [Indexed: 11/24/2022]
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Affiliation(s)
- John Zhang
- Department of Anatomy & Structural Biology, Otago School of Medical Sciences, University of Otago, Dunedin, New Zealand
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