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Peripheral Nerve Examination
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Nikhil Agrawal, Chaitanya Mudgal
The most common causes of ulnar nerve palsy encountered by the hand surgeon are from trauma and from compression neuropathy. Understanding the anatomy of the ulnar nerve will guide your physical examination. Begin by observing and palpating the patient's extremity. Then move onto checking sensation and performing physical examination manoeuvres. Utilizing a thorough physical examination, the diagnosis can the distinguished from spinal cord pathology or mixed nerve injuries. In addition, the difference between and high and low ulnar nerve palsy can be elucidated.
Peripheral Nerve Examination in a Child
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
Remember that a peripheral nerve can be motor, sensory, or a mixed nerve, and presentation depends upon the composition of motor and sensory fibers. For example, the anterior interosseous nerve, which is a branch of the median nerve, and the posterior interosseous nerve (a branch of the radial nerve) are purely motor. Motor deficits produce certain characteristics, attitude, and deformity of the concerned limb, which can pinpoint the nerve involved and the site of the lesion. A wrist drop in the radial nerve (Figure 14.1), foot drop in the common peroneal nerve (Figure 14.2), claw hand in ulnar (Figure 14.3a) or combined ulnar median nerve lesions, pointing index, and Benediction hand of the median nerve (Figure 14.3b) fall under this category. The policeman tip hand deformity (Figure 14.4) is indicative of brachial plexus injury.
Diseases of the Peripheral Nerve and Mononeuropathies
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Diana Mnatsakanova, Charles K. Abrams
Nerve biopsy can be used as a diagnostic measure to further delineate the specific form of neuropathy. The biopsy site is chosen based on the following criteria:4Is affected by the neuropathy, based on clinical and electrophysiological evidence.Constant in its location and readily accessible.Pure sensory nerve: fewer postoperative complications compared with a pure motor or mixed nerve.A nerve that is long enough so that 6 cm of the same fascicle can be removed.Located away from a common site of compression.
Comparison of nerve conduction velocity distribution methods by cold exposure and ischemia
Published in International Journal of Neuroscience, 2021
Kamil Savaş, Hilmi Uysal, Nazmi Yaraş
An ideal CVD method should provide information about slow and fast fibers in a nerve bundle. Moreover, this method should have simple experimental protocols for clinical studies and be applicable to mixed nerve studies. As a result of our preliminary studies, some of the CVD estimation methods mentioned above can be used for mixed nerve studies. The CVD estimation methods mentioned above meet these criteria and would be applicable to mixed nerve studies. In the study, we assessed the accuracy and reliability of the Cummins [12], Barker [13] and Hirose [20] methods for their performance under different temperature and ischemic condition and discussed their clinical applicability. Temperature drop with cold exposure affects the fast conducting motor fibers earlier than the slower ones [22, 23]. Large myelinated fibers (> 6 µm in diameters) in a nerve bundle are relatively less vulnerable to ischemia than smaller myelinated fibers (< 6 µm) [24–26]. Testing these methods under such controlled experimental conditions can provide essential knowledge for use in clinical application since no CVD estimation method has yet been used in clinical studies.
Diffusion tensor tractography to visualize axonal outgrowth and regeneration in a 4-cm reverse autograft sciatic nerve rabbit injury model
Published in Neurological Research, 2019
Angel F. Farinas, Alonda C. Pollins, Michael Stephanides, Dillon O’Neill, Salam Al-Kassis, Isaac V. Manzanera Esteve, Juan M. Colazo, Patrick R. Keller, Timothy Rankin, Blair A. Wormer, Christodoulos Kaoutzanis, Richard D. Dortch, Wesley P. Thayer
Clinically, motor nerves will recover in a timelier fashion is important for two main reasons. Firstly, this has led to clinicians preferentially using motor nerve grafts during nerve autograft procedures. A study by Nichols et al. looked at how Lewis rats’ sensory vs. motor nerve grafts affected the regeneration of a cut mixed nerve system (both motor and sensory nerves). After 3 weeks, a mixed nerve defect had undergone substantial regeneration when paired with a motor nerve graft or a mixed nerve graft. In comparison, the sensory nerve graft was statistically less effective in regeneration, looking specifically at nerve fiber count, percent nerve, and nerve densities [25]. Secondly, being able to move your limbs without pain and sensory feedback can lead to re-injury and overall decreased functional outcomes, especially after a traumatic event in which muscular and other soft-tissue injuries may exist.
Sensory neurotization of muscle: past, present and future considerations
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Steven D. Kozusko, Alexander J. Kaminsky, Louisa C. Boyd, Petros Konofaos
Sönmez studied motor reinnervation of a denervated muscle by using a sensory nerve and found that some axonal regeneration occurred, muscle experienced only partial atrophy and some reinnervation was obtained on electrophysiologic studies [31]. In their study, they analyzed the effect of the lateral femoral cutaneous nerve (LFCN) on the gluteus maximus muscle in a rat model. Their histological analysis showed that axonal regenerations were present distal to the coaptation zones, indicating axons reached the gluteus maximus muscle through the LFCN. Scanning electron microscopic findings depicted only partial muscle atrophy, meaning that sensory reinnervation inhibited total atrophy. Li et al. [17,22] found that with sensory nerve protection, the ultrastructure and cross-sectional area of the target muscle, as well as areas postsynaptic to the motor endplate were preserved. In their rat model, they found that muscle fiber architecture was preserved with both sensory and mixed nerve neurotization. Superior results were demonstrated with mixed nerve neurotization than purely sensory. This study also showed that early innervation with sensory or a mixed nerve led to better functional recovery following native nerve reinnervation [22].