PURPOSE: The aim of this study was to evaluate the effect of modified end-to-side neurorrhaphy on functional recovery, by modulating the epineurial window and contact areas with a donor nerve, using a rat median nerve and finger flexors. MATERIALS AND METHODS: Four experimental groups (n=10) were used: a large epineurial window and a spiral circumferential contact with the donor nerve (Group A): a large epineurial window and half a contact with the donor nerve (Group B): a small epineurial window and half a contact with the donor nerve (Group C): and a nontransferred control (Group D). Grasping testing, muscle contractility testing, and a histological study were performed. RESULTS: Twenty weeks after surgery, the grasping strength, tetanic force and nerve fiber count were significantly higher in group A than group C. The modified end-to-side repair can enhance axonal sprouting from an intact nerve, and improve functional recovery. CONCLUSION: Either the epineurial window surface area or the contact configuration with the donor nerve is an important factor in an end-to-side coaptation model.
Animals ; Axons ; Fingers ; Hand Strength ; Humans ; Median Nerve ; Nerve Fibers ; Nerve Regeneration* ; Peripheral Nerve Injuries ; Rats* ; Tissue Donors

OBJECTIVE: To determine the incidence of peripheral neuropathy occurring in post-acute spinal cord injury patients. METHOD: We retrospectively reviewed the distribution of involved nerves in 94 spinal cord injury patients (men: 77, mean age: 45.2 years) who underwent electrodiagnostic studies at an early stage of rehabilitative therapy between March 1999 and June 2007 and looked for the existence of peripheral neuropathy according to the injured area (cervical/ thoracolumbar cord). RESULTS: The incidence of peripheral neuropathy observed on electrodiagnostic studies was 38.3% (36/94). Twenty-one (46.7%) of 45 patients with injured cervical cords exhibited peripheral neuropathy, and 15 (30.6%) of 49 thoracolumbar cord injury patients exhibited peripheral neuropathy; hence, tetraplegia had a higher incidence. The most commonly involved nerve was the peroneal nerve (24 cases), followed by the median nerve (9 cases) and the ulnar nerve (9 cases). CONCLUSION: The incidence of peripheral neuropathy observed in electrodiagnostic studies was high in spinal cord injury patients at the initiation of intensive rehabilitative therapy. The incidence of peripheral neuropathy in cervical cord injury patients was higher than that seen in thoracolumbar injury patients. Active education and training concerning appropriate bed positioning are necessary for spinal cord injury patients at an early stage after injury to prevent peripheral neuropathy.
Electrodiagnosis ; Humans ; Incidence ; Median Nerve ; Peripheral Nervous System Diseases ; Peroneal Nerve ; Quadriplegia ; Retrospective Studies ; Spinal Cord Injuries ; Ulnar Nerve

PURPOSE: We conduct a comprehensive review of demography, vector and cause of injury and results of zone 5 volar wrist lacerations. MATERIALS AND METHODS: From July 2001 and June 2010, a total of 170 patients with zone 5 wrist lacerations were reviewed retrospectively. Sex, age, vector and cause of injury, injured structures and results were investigated. The correlations between the wound length, vector, cause of injury and number of injured structures were analyzed statistically. RESULTS: The most common cause of injury is self-inflicted wrist injury followed by incidental accident, industrial accident, and the glass is the most common vector. Thirty six patients underwent primary repair only and 134 patients explored then underwent teno-neuro-arteriorraphy. Error rate between the preoperative and intraoperative evaluations was 30.6%, particularly greater than 50% in cases of flexor digitorum profundus and radial artery injuries. The most common injured structure was palmaris longus followed by flexor carpi radialis, flexor carpi ulnaris and median nerve. The cause and vector of injury did not correlate with the number of injured structures. Relationship between the mean length of wounds and the number of injured structures showed weak positive correlation. CONCLUSION: In zone 5 wrist lacerations, exploration should be performed if the laceration involved over dermis layer. In addition to the surgical treatment, psychological care of these injuries is necessary.
Accidents, Occupational ; Demography ; Dermis ; Glass ; Humans ; Lacerations ; Median Nerve ; Radial Artery ; Retrospective Studies ; Wrist ; Wrist Injuries

The central somatosensory conduction time(CCT) was measured by recording the cerebral and spinal evoked potentials following median nerve stimulation in 24 traumatic brain injury patients. The findings of evoked potential study correlated to the functional independence measure(FIM), mini mental status examination(MMSE) and Glasgow outcome scale(GOS). The CCT of head injured patients was prolonged compared to that of the controls. The CCT with stimulation of the affected side was significantly prolonged compared to that with non- affected side. Abnormal CCT was related to the poor functional status measured by FIM and GOS. There`s no significant difference between groups of absent evoked potential and prolonged CCT by FIM score. These results suggest that the CCT correlates with the functional status of head injured patients. Follow up studies are required to evaluate whether the CCT could be a valuable prognostic indicator or not.
Brain Injuries ; Evoked Potentials ; Glasgow Outcome Scale ; Head* ; Humans ; Median Nerve

Forearm fractures are common injuries in childhood. Median nerve entrapment is a rare complication of forearm fractures, but several cases have been reported in the literature. This case report discusses the diagnosis and management of median nerve entrapment in a 13-year-old male who presented acutely with a both-bone forearm fracture and numbness in the median nerve distribution. Following the delayed diagnosis, surgical exploration revealed complete nerve entrapment and a nerve graft was performed.
Adolescent ; Bony Callus ; Delayed Diagnosis ; Diagnosis ; Forearm Injuries ; Forearm ; Fractures, Bone ; Humans ; Hypesthesia ; Male ; Median Nerve ; Nerve Compression Syndromes ; Transplants

OBJECTIVE: To study injuries involving brachial plexus and its branches. METHODS: 66 cases collected from 2003 to 2005 in our department were analyzed statistically. RESULTS: 94% of injuries involved young adult males; 94% were blunt force injuries; 34% involved both nerve and bone mainly involving ulnar nerve and ulnar bone (50%); 40% of the injured nerves received electromyogram and 15 nerves were diagnosed with injuries clinically. CONCLUSION Forensic determination on severity of brachial plexus injuries mainly depends on movement recovery of limb. The best time for forensic appraisal is 20 d post operation+L (length of nerve severed distally)/R (growth rate)+90 d.
Adult ; Brachial Plexus/physiopathology* ; Brachial Plexus Neuropathies/physiopathology* ; Electromyography ; Female ; Forearm Injuries/physiopathology* ; Forensic Medicine ; Humans ; Male ; Median Nerve/injuries* ; Trauma Severity Indices ; Ulnar Nerve/injuries* ; Young Adult

Ninety two injuries of the main nerves in the upper extremity observed in 79 patients, were studied at the Department of the Orthopedic Surgery, 17th Army Hospital from May 1965 to Aug. 1968. The treatment given consisted of neurolysis in 15, neurorrhapy in 77(primary 43 and secondary 34) and tendon transplantation and transfer in 11 cases. The results for the median, ulnar and radial nerves after primary and secondary suture were analyzed with respect to the level of injury(high and lower). The results of the median nerve repair were more succesful than those of the ulnar nerve, In these two nerve injuries, the sensory recovery was better than the motor and secondary suture gave better results than primary suture. Thirteen cases failed to respond to primary or secondary nerve repair, among those tendon transfer or tendon transplantation was tried in eleven cases, from the latter approximately 25% of motor recovery could be seen.
Hospitals, Military ; Humans ; Median Nerve ; Orthopedics ; Peripheral Nerve Injuries ; Peripheral Nerves ; Radial Nerve ; Sutures ; Tendon Transfer ; Tendons ; Ulnar Nerve ; Upper Extremity

OBJECTIVE: Most spinal cord injured patients suffered form various autonomic dysfunction. The purpose of this study is evaluation of sympathetic skin response (SSR) and R-R interval variability (RRIV) as a method of autonomic function test in spinal cord injured patients. METHOD: Thirty-six spinal cord injured patients were enrolled in this study. SSR was recorded in the palm and sole by electrical stimulation of right median nerve and RRIV during rest, deep breathing and Valsalva maneuver for 1 minute. RESULTS: The higher level of spinal cord injury, the higher rate of the abnormal sympathetic skin response in the palm and sole and more reduced values of Valsalva ratio (p<0.05). The parameters of sympathetic skin response and R-R interval variability were not correlated with injury severity of spinal cord and their autonomic symptoms. CONCLUSION: Evaluation of SSR and RRIV could be helpful methods to evaluate autonomic function in the spinal cord injured patients.
Autonomic Nervous System ; Electric Stimulation ; Heart Rate* ; Heart* ; Humans ; Median Nerve ; Respiration ; Skin* ; Spinal Cord Injuries ; Spinal Cord* ; Valsalva Maneuver

Anatomically flexor pollicis longus is different from deep finger flexors. Flexor pollicis longus tendon is unique in that it may be advanced without disturbing its blood supply, since it has no vinculum. From January 1990 to December 1992, 17 cases of patients with laceration of the flexor pollicis longus tendon were treated at Kyungpook National University Hospital. The follow up period ranged from 3 to 36 months. The results were as follows; 1. agents causing the laceration were broken bottles in 10 cases(58.8%), knives in 3 cases(17.6%) and machinary like saw in 2 cases(11.8%). 2. Totally 17 cases, 9 cases of them were located at distal to metacarpophalageal joint. 3. As associated injuries, digital nerve injuries were 4 cases(23.5%) and the recurrent branch of median nerve injuries was 1 case. 4. The surgical treatment was direct suture with or without proximal lengthening in 13 cases(76%) as primary or secondary repair and distal advancement with or without proximal lengthening in 4 cases(24%) as secondary repair. 5. Distal to metacarpophalangeal joint, the surgical treatment was direct suture with or without proximal lengthening in 3 cases as primary or secondary repair and distal advancement with or without proximal lengthening in 4 cases as secondary repair. 6. The result by Urbaniak method was excellent in 8 cases(47.0%), good in 7 cases(41.2%) and fair in 2 cases(11.8%). 7. Based on the results in these patients, it was recommended that secondary treatment for lacerations distal to the metacarpophalangeal at the wrist, as needed is bettewr than free tendon graft.
Fingers ; Follow-Up Studies ; Gyeongsangbuk-do ; Humans ; Joints ; Lacerations ; Median Nerve ; Metacarpophalangeal Joint ; Methods ; Sutures ; Tendon Injuries ; Tendons ; Transplants ; Wrist

BACKGROUNDTo repair late median nerve injury, many methods have been used in the past years. The aim of this study was to review a thirteen-year experience in restoration of thumb opposition by transposing flexor pollicis brevis muscle.

METHODSFrom July 1992 to August 2005, 63 patients without thumb opposition because of late median never injury were treated by transposing the flexor pollicis brevis muscle. All the patients had received primary nerve repair after the jnjury. The interval between the injury and the second operation was (1.87 +/- 2.31) years (6 months to 4.2 years). The patients were followed up for 3 to 48 [months mean (22.93 +/- 2.31) months]. A functional evaluation system designed in 1992 were used to estimate the outcomes of the patients.

RESULTSAll the patients gained excellent functional results without complications and disabilities during follow-up.

CONCLUSIONSRestoration of thumb opposition by transposing flexsor pollicis brevis muscle has the following advantages: 1. Operative trauma is minimal; 2. It is not necessary to transpose other tendons; 3. Except for the thumb in opposition, movements of other fingers and the wrist are not restricted postoperatively.

Adolescent ; Adult ; Biomechanical Phenomena ; Female ; Forearm Injuries ; physiopathology ; surgery ; Humans ; Male ; Median Nerve ; injuries ; Middle Aged ; Muscle, Skeletal ; surgery ; Tendon Transfer ; Thumb ; physiopathology ; surgery ; Wrist Injuries ; physiopathology ; surgery