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Couch B, Hayward D, Baum G, Sakthiyendran NA, Harder J, Hernandez EJ, MacKay B. A systematic review of steroid use in peripheral nerve pathologies and treatment. Front Neurol 2024; 15:1434429. [PMID: 39286807 PMCID: PMC11402678 DOI: 10.3389/fneur.2024.1434429] [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] [Received: 05/20/2024] [Accepted: 08/21/2024] [Indexed: 09/19/2024] Open
Abstract
Background The use of corticosteroids has become a part of the standard of care in various pathologies but their use in peripheral nerve injury treatment is limited. Given corticosteroids' anti-inflammatory properties and their regulatory role in neuronal protein production and myelination, corticosteroids could serve as an adjunct therapy for peripheral nerve injuries. This review aims to systematically investigate the current use of corticosteroid treatment in peripheral nerve pathologies. Methods The systematic search was performed on PubMed, MEDLINE, EMBASE, Scopus, Cochrane, and Web of Science using keywords such as "corticosteroid treatment," "peripheral nerve damage," "peripheral neuropathy," and "complications." The PRISMA guidelines were used to conduct the systematic review and all articles were reviewed by the corresponding author. After the initial search, individual study titles and abstracts were further screened and categorized using an inclusion and exclusion criteria followed by a final full-text review. Results Out of the total 27,922 identified records, 203 studies were included based on the selection criteria. These studies focused on the use and efficacy of steroids across a spectrum of compression and non-compression peripheral neuropathies such as cubital tunnel syndrome and chronic inflammatory demyelinating polyradiculoneuropathy. Various studies noted the promising role of steroids in offering pain relief, nerve block, and nerve regeneration effects. Additionally, safety considerations and potential complications regarding steroid use in peripheral nerve injuries were analyzed. Conclusion While there is currently limited clinical utilization of corticosteroids in peripheral nerve pathologies, the anti-inflammatory and regenerative effects that steroids provide may be a beneficial tool in managing various peripheral neuropathies and their associated pain. Additional clinical trials and investigation into the mechanism of action could improve the reputation of steroid use as peripheral nerve injury treatment.
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Affiliation(s)
- Brandon Couch
- Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Dan Hayward
- Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Gracie Baum
- Department of Orthopaedic Hand Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | | | - Justin Harder
- Department of Orthopaedic Hand Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Evan J Hernandez
- Department of Orthopaedic Hand Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Brendan MacKay
- Department of Orthopaedic Hand Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, United States
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Bertelli JA, Rosa ICN, Ghizoni MF. Retrograde peripheral nerve regeneration from sensory to motor pathways in rats: a new experimental concept in nerve repair. Neurol Res 2024; 46:125-131. [PMID: 37729085 DOI: 10.1080/01616412.2023.2258039] [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: 02/06/2023] [Accepted: 09/03/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND The polarity of nerve grafts does not interfere with axon growth. Our goal was to investigate whether axons can regenerate in a retrograde fashion within sensory pathways and then extend into motor pathways, leading to muscle reinnervation. METHODS Fifty-four rats were randomized into four groups. In Group 1, the ulnar nerve was connected end-to-end to the superficial radial nerve after neurectomy of the radial nerve in the axilla. In Group 2, the ulnar nerve was connected end-to-end to the radial nerve distal to the humerus; the radial nerve then was divided in the axilla. In Group 3, the radial nerve was divided in the axilla, but no nerve reconstruction was performed. In Group 4, the radial nerve was crushed in the axilla. Over 6 months, we behaviorally assessed the recovery of toe spread in the right operated-upon forepaw by lifting the rat by its tail and lowering it onto a flat surface. Six months after surgery, rats underwent reoperation, nerve transfers were tested electrophysiologically, and the posterior interosseous nerve (PIN) was removed for histological evaluation. RESULTS Rats in the crush group recovered toe spread between 5 and 8 days after surgery. Rats with nerve transfers demonstrated electrophysiological and histological findings of nerve regeneration but no behavioral recovery. CONCLUSIONS Ulnar nerve axons regrew into the superficial radial nerve and then into the PIN to reinnervate the extensor digitorum communis. We were unable to demonstrate behavioral recovery because rats cannot readapt to cross-nerve transfer.
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Affiliation(s)
- Jayme A Bertelli
- Department of Surgery in lieu of Department of Surgical Techniques, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Isadora Carvalho Nunes Rosa
- Center of Biological and Health Sciences, University of the South of Santa Catarina (UNISUL), Tubarão, Santa Catarina, Brazil
| | - Marcos F Ghizoni
- Department of Neurosurgery, Center of Biological and Health Sciences, University of the South of Santa Catarina (UNISUL), Tubarão, Santa Catarina, Brazil
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Lauer H, Prahm C, Thiel JT, Kolbenschlag J, Daigeler A, Hercher D, Heinzel JC. The Grasping Test Revisited: A Systematic Review of Functional Recovery in Rat Models of Median Nerve Injury. Biomedicines 2022; 10:biomedicines10081878. [PMID: 36009423 PMCID: PMC9405835 DOI: 10.3390/biomedicines10081878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022] Open
Abstract
The rat median nerve model is a well-established and frequently used model for peripheral nerve injury and repair. The grasping test is the gold-standard to evaluate functional recovery in this model. However, no comprehensive review exists to summarize the course of functional recovery in regard to the lesion type. According to PRISMA-guidelines, research was performed, including the databases PubMed and Web of Science. Groups were: (1) crush injury, (2) transection with end-to-end or with (3) end-to-side coaptation and (4) isogenic or acellular allogenic grafting. Total and respective number, as well as rat strain, type of nerve defect, length of isogenic or acellular allogenic allografts, time at first signs of motor recovery (FSR) and maximal recovery grasping strength (MRGS), were evaluated. In total, 47 articles met the inclusion criteria. Group I showed earliest signs of motor recovery. Slow recovery was observable in group III and in graft length above 25 mm. Isografts recovered faster compared to other grafts. The onset and course of recovery is heavily dependent from the type of nerve injury. The grasping test should be used complementary in addition to other volitional and non-volitional tests. Repetitive examinations should be planned carefully to optimize assessment of valid and reliable data.
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Affiliation(s)
- Henrik Lauer
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (H.L.); (C.P.); (J.T.T.); (J.K.); (A.D.)
| | - Cosima Prahm
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (H.L.); (C.P.); (J.T.T.); (J.K.); (A.D.)
| | - Johannes Tobias Thiel
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (H.L.); (C.P.); (J.T.T.); (J.K.); (A.D.)
| | - Jonas Kolbenschlag
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (H.L.); (C.P.); (J.T.T.); (J.K.); (A.D.)
| | - Adrien Daigeler
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (H.L.); (C.P.); (J.T.T.); (J.K.); (A.D.)
| | - David Hercher
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Donaueschingenstraße 13, 1200 Vienna, Austria;
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Johannes C. Heinzel
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (H.L.); (C.P.); (J.T.T.); (J.K.); (A.D.)
- Correspondence:
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Ronchi G, Morano M, Fregnan F, Pugliese P, Crosio A, Tos P, Geuna S, Haastert-Talini K, Gambarotta G. The Median Nerve Injury Model in Pre-clinical Research - A Critical Review on Benefits and Limitations. Front Cell Neurosci 2019; 13:288. [PMID: 31316355 PMCID: PMC6609919 DOI: 10.3389/fncel.2019.00288] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 06/13/2019] [Indexed: 12/21/2022] Open
Abstract
The successful introduction of innovative treatment strategies into clinical practise strongly depends on the availability of effective experimental models and their reliable pre-clinical assessment. Considering pre-clinical research for peripheral nerve repair and reconstruction, the far most used nerve regeneration model in the last decades is the sciatic nerve injury and repair model. More recently, the use of the median nerve injury and repair model has gained increasing attention due to some significant advantages it provides compared to sciatic nerve injury. Outstanding advantages are the availability of reliable behavioural tests for assessing posttraumatic voluntary motor recovery and a much lower impact on the animal wellbeing. In this article, the potential application of the median nerve injury and repair model in pre-clinical research is reviewed. In addition, we provide a synthetic overview of a variety of methods that can be applied in this model for nerve regeneration assessment. This article is aimed at helping researchers in adequately adopting this in vivo model for pre-clinical evaluation of peripheral nerve reconstruction as well as for interpreting the results in a translational perspective.
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Affiliation(s)
- Giulia Ronchi
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi Foundation (NICO), University of Turin, Turin, Italy
| | - Michela Morano
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi Foundation (NICO), University of Turin, Turin, Italy
| | - Federica Fregnan
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi Foundation (NICO), University of Turin, Turin, Italy
| | - Pierfrancesco Pugliese
- Dipartimento di Chirurgia Generale e Specialistica, Azienda Ospedaliera Universitaria, Ancona, Italy
| | - Alessandro Crosio
- UO Microchirurgia e Chirurgia della Mano, Ospedale Gaetano Pini, Milan, Italy
| | - Pierluigi Tos
- UO Microchirurgia e Chirurgia della Mano, Ospedale Gaetano Pini, Milan, Italy
| | - Stefano Geuna
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi Foundation (NICO), University of Turin, Turin, Italy
| | - Kirsten Haastert-Talini
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Hanover, Germany.,Center for Systems Neuroscience (ZSN) Hannover, Hanover, Germany
| | - Giovanna Gambarotta
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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Muratori L, Fregnan F, Ronchi G, Haastert-Talini K, Metzen J, Bertolo R, Porpiglia F, Geuna S. New basic insights on the potential of a chitosan-based medical device for improving functional recovery after radical prostatectomy. BJU Int 2019; 124:1063-1076. [PMID: 31134718 DOI: 10.1111/bju.14834] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate: (i) the neuro-regenerative potential of chitosan membrane (CS-Me) on acutely axotomised autonomic neurones in vitro; (ii) to exclude the possibility that a pro-regenerative biomaterial could interfere with the proliferation activity of prostate cancer cell lines; (iii) to provide an in vivo proof of the biocompatibility and regeneration promoting effect of CS-Me in a standardised rat model of peripheral nerve injury and repair; (iv) finally, to evaluate the tissue reaction induced by the degrading material; as previous studies have shown promising effects of CS-Me for protection of the neurovascular bundles for potency recovery in patients that undergo nerve-sparing radical prostatectomy (RP). MATERIALS AND METHODS Addressing aim (i), the neuro-regenerative potential, organotypic cultures derived from primary sympathetic ganglia were cultured on CS-Me over 3 days and neurite extension and axonal sprouting were evaluated. Addressing aim (ii), effects of CS on cancer cells, different human prostate cancer cell lines (PC3, DU-145, LN-Cap) were seeded on CS-coated plates or cultured in the presence of CS-Me dissolution products. Addressing aims (iii) and (iv), functional recovery of peripheral nerve fibres and tissue reaction with the biomaterial, CS-Me and CS nerve guides were used to repair a median nerve injury in the rat. Functional recovery was evaluated during the post-recovery time by the behavioural grasping test. RESULTS CS-Me significantly stimulated axon elongation from autonomic ganglia in comparison to control conditions in organotypic three-dimensional cultures. CS coating, as well as the dissolution products of CS-Me, led to a significantly lower proliferation rate of prostate cancer cell lines in vitro. Tissue reaction towards CS-Me and standard CS nerve guides was similar in the rat median nerve model, as was the outcome of nerve fibre regeneration and functional recovery. CONCLUSION The results of this study provide the first experimental evidence in support of the clinical safety of CS-Me and of their postulated effectiveness for improving functional recovery after RP. The presented results are coherent in demonstrating that acutely axotomised autonomic neurones show increased neurite outgrowth on CS-Me substrate, whilst the same substrate reduces prostate cancer cell line proliferation in vitro. Furthermore, CS-Me do not demonstrate any disadvantage for peripheral nerve repair in a standard animal model.
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Affiliation(s)
- Luisa Muratori
- Department of Clinical and Biological Sciences, Cavalieri Ottolenghi Neuroscience Institute, University of Turin, Orbassano, Italy
| | - Federica Fregnan
- Department of Clinical and Biological Sciences, Cavalieri Ottolenghi Neuroscience Institute, University of Turin, Orbassano, Italy
| | - Giulia Ronchi
- Department of Clinical and Biological Sciences, Cavalieri Ottolenghi Neuroscience Institute, University of Turin, Orbassano, Italy
| | - Kirsten Haastert-Talini
- Hannover Medical School, Institute of Neuroanatomy and Cell Biology, Center for Systems Neuroscience (ZSN), Hannover, Germany
| | - Jennifer Metzen
- Hannover Medical School, Institute of Neuroanatomy and Cell Biology, Hannover, Germany
| | - Riccardo Bertolo
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy.,Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Stefano Geuna
- Department of Clinical and Biological Sciences, Cavalieri Ottolenghi Neuroscience Institute, University of Turin, Orbassano, Italy
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Effects of nandrolone decanoate on time to consolidation of bone defects resulting from osteotomy for tibial tuberosity advancement. Vet Comp Orthop Traumatol 2017; 30:351-356. [PMID: 28763519 DOI: 10.3415/vcot-16-09-0130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 06/12/2017] [Indexed: 11/17/2022]
Abstract
STUDY DESIGN Experimental study. OBJECTIVE The aim of this study was to evaluate the effect of nandrolone decanoate (ND) on the time taken for bone consolidation in dogs undergoing tibial tuberosity advancement surgery (TTA). MATERIALS AND METHODS Seventeen dogs that underwent TTA surgery were randomly divided into two groups: group C (TTA; 9 stifles), and group TTA+ND (TTA and systemic administration of ND; 8 stifles). Three observers (two radiologists and an orthopaedic surgeon), assessed bone consolidation by visual inspection of serial radiographs at intervals of 21 days following surgery. RESULTS There were no differences in median weight and age between groups, nor between the medians of the variables right and left stifle. Only weight and age values were normally distributed. The other variables, right and left stifle and time to consolidation, showed non-normal distribution. Meniscal injury was present in all animals in group C and all animals in group TTA+ND. There was a significant difference between time to consolidation in groups C and TTA+ND (p <0.05). One animal in the group TTA+ND showed increased libido. Kappa agreement among observers on radiographs was 0.87. CONCLUSION Administration of ND reduces time to bone consolidation in dogs undergoing TTA.
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Meyers EC, Granja R, Solorzano BR, Romero-Ortega M, Kilgard MP, Rennaker RL, Hays S. Median and ulnar nerve injuries reduce volitional forelimb strength in rats. Muscle Nerve 2017; 56:1149-1154. [PMID: 28120500 DOI: 10.1002/mus.25590] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 01/13/2017] [Accepted: 01/16/2017] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Peripheral nerve injuries (PNI) are among the leading causes of physical disability in the United States. The majority of injuries occur in the upper extremities, and functional recovery is often limited. Robust animal models are critical first steps for developing effective therapies to restore function after PNI. METHODS We developed an automated behavioral assay that provides quantitative measurements of volitional forelimb strength in rats. Multiple forelimb PNI models involving the median and ulnar nerves were used to assess forelimb function for up to 13 weeks postinjury. RESULTS Despite multiple weeks of task-oriented training following injury, rats exhibit significant reductions in multiple quantitative parameters of forelimb function, including maximal pull force and speed of force generation. DISCUSSION This study demonstrates that the isometric pull task is an effective method of evaluating forelimb function following PNI and may aid in development of therapeutic interventions to restore function. Muscle Nerve 56: 1149-1154, 2017.
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Affiliation(s)
- Eric C Meyers
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, Texas, 75080-3021, USA.,The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Richardson, Texas, USA
| | - Rafael Granja
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, Texas, 75080-3021, USA.,The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Richardson, Texas, USA
| | - Bleyda R Solorzano
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, Texas, 75080-3021, USA
| | - Mario Romero-Ortega
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, Texas, 75080-3021, USA.,The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Richardson, Texas, USA
| | - Michael P Kilgard
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, Texas, 75080-3021, USA.,The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, Texas, USA
| | - Robert L Rennaker
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, Texas, 75080-3021, USA.,The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Richardson, Texas, USA.,The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, Texas, USA
| | - Seth Hays
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, Texas, 75080-3021, USA.,The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Richardson, Texas, USA
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Bertelli JA, Ghizoni MF. Nerve and Free Gracilis Muscle Transfers for Thumb and Finger Extension Reconstruction in Long-standing Tetraplegia. J Hand Surg Am 2016; 41:e411-e416. [PMID: 27593485 DOI: 10.1016/j.jhsa.2016.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 05/09/2016] [Accepted: 08/01/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE With spinal cord injuries, muscles below the level of the lesion remain innervated despite the absence of volitional control. This persistent innervation protects against denervation atrophy and may allow for nerve transfers to treat long-standing lesions within the spinal cord. We tested the hypothesis that in chronic spinal cord lesions, muscles remained viable for reinnervation. METHODS To test this hypothesis, we operated on 7 patients with tetraplegia to reconstruct thumb and finger extension after a mean interval of 5 years since injury. During surgery, if electrical stimulation of the posterior interosseous nerve (PIN) produced muscle contraction, the nerve to the supinator (NS) was transferred to the PIN. If no contractions were demonstrated, the muscles of the extensor compartment of the forearm were replaced via a free gracilis transfer with innervation supplied by the NS. RESULTS After an average of 26 months, M3 recovery of thumb and finger extension was observed in the 3 upper limbs from the 2 youngest patients who underwent a nerve transfer. None of the free gracilis-treated patients achieved scores above M2. CONCLUSIONS In our youngest patients aged 27 and 34 years, who were operated on 6 years after spinal cord injury, transfer of the NS to the PIN partially restored hand span. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Jayme Augusto Bertelli
- Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul), Tubarão, Santa Catarina, Brazil; Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina, Brazil.
| | - Marcos Flávio Ghizoni
- Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul), Tubarão, Santa Catarina, Brazil
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Bertelli JA, Ghizoni MF. Nerve transfers for elbow and finger extension reconstruction in midcervical spinal cord injuries. J Neurosurg 2015; 122:121-7. [PMID: 25343189 DOI: 10.3171/2014.8.jns14277] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECT The objective of this study was to report the results of elbow, thumb, and finger extension reconstruction via nerve transfer in midcervical spinal cord injuries. METHODS Thirteen upper limbs from 7 patients with tetraplegia, with an average age of 26 years, were operated on an average of 7 months after a spinal cord injury. The posterior division of the axillary nerve was used to reinnervate the triceps long and upper medial head motor branches in 9 upper limbs. Both the posterior division and the branch to the middle deltoid were used in 2 upper limbs, and the anterior division of the axillary nerve in the final 2 limbs. For thumb and finger extension reconstruction, the nerve to the supinator was transferred to the posterior interosseous nerve. RESULTS In 22 of the 27 recipient nerves, a peripheral type of palsy with muscle denervation was identified. At an average of 19 months follow-up, elbow strength scored M4 in 11 upper limbs and M3 in 2, according to the British Medical Research Council scale. Thumb extension scored M4 in 8 upper limbs and scored M3 in 4. Finger extension scored M4 in 12 hands. No donor-site deficits were reported or observed. CONCLUSIONS Nerve transfers are effective at restoring elbow, thumb, and finger extension in patients with a midcervical spinal cord injury, which occurs in the majority of patients with a peripheral type of palsy with muscle denervation in their upper limbs. Efforts should be made to perform operations in these patients within 12 months of injury.
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Affiliation(s)
- Jayme Augusto Bertelli
- Department of Neurosurgery, University of the South of Santa Catarina (UNISUL), Tubarão, Brazil
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10
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Bertelli JA, Ghizoni MF. Nerve transfer from triceps medial head and anconeus to deltoid for axillary nerve palsy. J Hand Surg Am 2014; 39:940-7. [PMID: 24582845 DOI: 10.1016/j.jhsa.2014.01.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 01/01/2014] [Accepted: 01/03/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To report our results with reconstruction of the axillary nerve by transferring the branch to the triceps lower medial head and anconeus to the anterior division of the axillary nerve. METHODS This study included 9 patients with isolated injury of the axillary nerve. Their average age ± SD was 35 ± 9 years, and the mean interval ± SD between injury and surgery was 6.6 ± 2.6 months. Through a posterior arm approach, the radial nerve branch to the lower triceps medial head and anconeus was transferred to the anterior division of the axillary nerve. We observed patients for a mean of 34 ± 7 months. At final evaluation, we measured range of shoulder motion, shoulder abduction and elbow extension strength, and abduction endurance. Patients were assessed via the deltoid extension lag test and abduction-in-internal-rotation test. RESULTS All patients recovered deltoid function and maintained full active elbow extension. Seven of 9 patients recovered from lagging abduction in internal rotation. Abduction strength improved from approximately 40% that of the normal side at 90° of abduction preoperatively to 60% of normal strength postoperatively. There was improved endurance in abduction from approximately 25% to 65% that of the normal side, which was sufficient to eliminate all reports of shoulder pain or fatigability. CONCLUSIONS Transfer of the radial nerve branch for the lower triceps medial head and anconeus to the anterior division of the axillary nerve proved to be an effective method of deltoid reinnervation. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Jayme Augusto Bertelli
- Center of Biological and Health Sciences, Department of Neurosurgery, University of South of Santa Catarina (Unisul), Tubarão, Santa Catarina, Brazil; Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina, Brazil.
| | - Marcos Flávio Ghizoni
- Center of Biological and Health Sciences, Department of Neurosurgery, University of South of Santa Catarina (Unisul), Tubarão, Santa Catarina, Brazil; Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina, Brazil
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11
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Isaacs J, Feher J, Shall M, Vota S, Fox MA, Mallu S, Razavi A, Friebe I, Shah S, Spita N. Effects of nandrolone on recovery after neurotization of chronically denervated muscle in a rat model. J Neurosurg 2013; 119:914-23. [PMID: 23829817 DOI: 10.3171/2013.5.jns121837] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Suboptimal recovery following repair of major peripheral nerves has been partially attributed to denervation atrophy. Administration of anabolic steroids in conjunction with neurotization may improve functional recovery of chronically denervated muscle. The purpose of this study was to evaluate the effect of the administration of nandrolone on muscle recovery following prolonged denervation in a rat model. METHODS Eight groups of female Sprague-Dawley rats (15 rats per group, 120 in all) were divided into 3- or 6-month denervated hind limb and sham surgery groups and, then, nandrolone treatment groups and sham treatment groups. Evaluation of treatment effects included nerve conduction, force of contraction, comparative morphology, histology (of muscle fibers), protein electrophoresis (for muscle fiber grouping), and immunohistochemical evaluation. RESULTS Although a positive trend was noted, neither reinnervated nor normal muscle showed a statistically significant increase in peak muscle force following nandrolone treatment. Indirect measures, including muscle mass (weight and diameter), muscle cell size, muscle fiber type, and satellite cell counts, all failed to support significant anabolic effect. CONCLUSIONS There does not seem to be a functional benefit from nandrolone treatment following reinnervation of either mild or moderately atrophic muscle (related to prolonged denervation) in a rodent model.
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Affiliation(s)
- Jonathan Isaacs
- Division of Hand Surgery, Department of Orthopaedic Surgery, and
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Single-stage surgery combining nerve and tendon transfers for bilateral upper limb reconstruction in a tetraplegic patient: case report. J Hand Surg Am 2013; 38:1366-9. [PMID: 23751324 DOI: 10.1016/j.jhsa.2013.03.056] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 03/27/2013] [Accepted: 03/27/2013] [Indexed: 02/02/2023]
Abstract
A 39-year-old tetraplegic patient had paralysis of elbow, thumb, and finger extension and thumb and finger flexion. We transferred axillary nerve branches to the triceps long and upper medial head motor branches, supinator motor branches to the posterior interosseous nerve, and brachioradialis tendon to the flexor pollicis longus and flexor superficialis of the index finger. Surgery was performed bilaterally 18 months after spinal cord injury. At 12 months after surgery, we performed bilateral distal radioulnar arthrodesis percutaneously. By 22 months postoperatively, we observed triceps strength scoring M3 bilaterally and full metacarpophalangeal joint extension scoring M4 bilaterally. The thumb span was 53 and 66 mm from the proximal index phalanx on the right and left sides, respectively. Pinch strength measured 1.5 kg on the left side and 2.0 kg on the right. Before surgery, the patient was incapable of grasping; after surgery, a useful grasp had been restored bilaterally.
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