An early diagnosis of popliteal artery pseudoaneurysm-a sequela of popliteal artery trauma-is difficult owing to its late presentation following total knee arthroplasty. The incidence of a popliteal artery pseudoaneurysm with a hematoma presenting only a peripheral nerve injury after total knee arthroplasty is also uncommon in the absence of common diagnostic features such as a pulsatile swelling with an audible bruit on auscultation. In the present report, we describe popliteal artery pseudoaneurysm following total knee arthroplasty.
Aneurysm, False ; Arthroplasty ; Auscultation ; Early Diagnosis ; Hematoma ; Incidence ; Knee ; Peripheral Nerve Injuries ; Popliteal Artery

OBJECTIVE: To estimate the application of prognosis evaluation of ulnar nerve injury by 1H-magnetic resonance spectroscopy (1H-MRS). METHODS: The metabolites of first dorsal interossei (FDI) of two hands from 12 healthy volunteers and 1 volunteer with complete ulnar nerve injury were detected by 1H-MRS and the data were statistically analyzed. RESULTS: For the FDI of healthy adults, the female peaks area of extra-myocellular lipids (EMCL) was higher than the male (P < 0.05); There was no significant difference in Cho, Cr and intra-myocellular lipids (IMCL) between male and female (P > 0.05); There was no significant difference in all the peaks area between the left and right hand (P > 0.05). The EMCL peak of the injury side was higher than that of the healthy side, and the area of FDI was reduced in the volunteer with ulnar nerve injury. CONCLUSION Noninvasive and quantitative detection of 1H-MRS may be valuable for prognosis evaluation of peripheral nerve injury.
Adult ; Female ; Humans ; Male ; Peripheral Nerve Injuries/diagnosis* ; Prognosis ; Proton Magnetic Resonance Spectroscopy/methods* ; Sex Distribution ; Ulnar Nerve/metabolism*

Although the musculoskeletal injuries associated with break-dancing which is gaining more popularity among adolescent and young people has been reported, the report regarding a peripheral nerve injury associated with breakdance is scarce. We report a rare case of a young amateur break-dancer, 'b-boy' who suffered from a painful paresthesia in his left hand, later diagnosed as type III Guyon's canal syndrome. A 23-year-old, right handed college man presented with a tenderness over the left hypothenar eminence and painful paresthesia over the ring and little fingers of 3 months duration. He trained himself as an amateur 'b boy' break-dancer for the last 10 months. Conservative management under the diagnosis of wrist sprain before presentation did not improve his hand pain. An magnetic resonance imaging and electrodiagnostic study revealed that painful paresthesia was caused by type III Guyon's canal syndrome, and 4 weeks of corticosteroid treatment was given with resolution of pain and paresthesia.
Adolescent ; Athletic Injuries ; Diagnosis ; Fingers ; Hand ; Humans ; Magnetic Resonance Imaging ; Paresthesia ; Peripheral Nerve Injuries ; Sprains and Strains ; Ulnar Nerve ; Ulnar Nerve Compression Syndromes* ; Wrist ; Young Adult

OBJECTIVETo discuss the diagnosis and treatment of peripheral nerve injury in the earthquake.

METHODSFourteen patients with peripheral nerve injury injured in the earthquake were involved the retrospective study. All cases accepted the timely diagnosis and treatment including anastomosis and repair of the nerve and other conservative treatments. Then the therapeutic effects were observed.

RESULTSAll 14 patients got short-term follow-up and attained the improvement in their symptoms of nerve injury.

CONCLUSIONPeripheral nerve injury has a high incidence in the earthquake. Prevention is very important. The timely and effective treatment should be taken according to spot situations and traumatic conditions of casualties in earthquake.

China ; Earthquakes ; Female ; Follow-Up Studies ; Humans ; Male ; Peripheral Nerve Injuries ; Peripheral Nerves ; surgery ; Peripheral Nervous System Diseases ; diagnosis ; prevention & control ; surgery ; therapy ; Retrospective Studies

Neurological and vascular complications following hip arthroplasty are uncommon, and their impact ranges from transient and trivial to permanent and devastating. The proximity of neural and vascular structures makes any operation on the hip potentially hazardous. Direct or indirect injuries of these structures may occur during operative exposure and subsequent procedures. Thus, complete awareness of the anatomy of the pelvis and proximal femur is required. Peripheral nerve injuries can involve either distant sites or nerves in the immediate vicinity of the hip joint. Sciatic nerve injury is the most common nerve injury following total hip arthroplasty. Femoral nerve injury is much less common and is associated with an anterior approach. Its diagnosis is often delayed, but the prognosis is generally better than with sciatic nerve injury. The superior gluteal nerve is at risk during the direct lateral approach. Obturator nerve injury is the least common type of injury and has the least functional consequences. Vascular injuries are less common but more immediately life threatening. The mechanisms of vascular injury include occlusion associated with preexisting peripheral vascular disease and vascular injury during removal of cement during screw fixation of acetabular components, cages, or structural grafts. It is critical to avoid the anterior quadrants for acetabular screw fixation. All acetabular and femoral defects should be bone-grafted to avoid inadvertent cement migration. Following these guidelines, surgeons should be able to offer the most appropriate treatment and counseling to the patients.
Acetabulum ; Arthroplasty* ; Arthroplasty, Replacement, Hip ; Counseling ; Diagnosis ; Femoral Nerve ; Femur ; Hip Joint ; Hip* ; Humans ; Obturator Nerve ; Pelvis ; Peripheral Nerve Injuries ; Peripheral Vascular Diseases ; Prognosis ; Sciatic Nerve ; Transplants ; Vascular System Injuries

Degenerative and regnerative changes are occurred in the dorsal root ganglion (DRG) cells after the peripheral nerve injury. This experiment aimed to study the changes of neurotrophic factors and their receptors mRNA expressions in the regenerating sensory neurons after nerve crush injury. To study the regenration process of DRG neurons, the peripheral nerve was crushed rather than transection. mRNA expression was examined by in situ hybridization with oligonucleotide probes to nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin 3 (NT-3), nerve growth factor receptor (NGFR), trkA, trkB and trkC. The results are as following: 1. After the peripheral nerve crush injury, the number of NGF and BDNF mRNA containing neurons are increased for 5 weeks with peak at 1 day and 3 days, respectively. NGFR mRNA containing neurons are transiently decreased during several days after the lesion but return to normal within 1 week. 2. The number of trkA and trkB mRNA containing neurons are not altered by nerve crush. 3. NT-3 and trkC mRNA containing neurons are not observed in the control and lesioned DRG. This study provides the morphological evidences of neurotrophins and their receptors mRNAs changes in the DRG neurons in response to crush nerve injury.
Animals ; Brain-Derived Neurotrophic Factor ; Diagnosis-Related Groups ; Ganglia, Spinal* ; In Situ Hybridization ; Nerve Crush ; Nerve Growth Factor ; Nerve Growth Factors* ; Neurons ; Neurotrophin 3 ; Oligonucleotide Probes ; Peripheral Nerve Injuries* ; Peripheral Nerves* ; Rats* ; RNA, Messenger* ; Sensory Receptor Cells ; Spinal Nerve Roots*

PURPOSE: To determine the relationship between change in the expression of the p75 neurotrophin receptor (NTR) and transient receptor potential vanilloid 1 (TRPV1) after a spinal nerve injury with time. MATERIALS AND METHODS: The L5 and L6 spinal nerve of the rats were cut unilaterally. The spinal cord and dorsal root ganglion (DRG) were subjected to immunohistochemistry for p75 NTR and TRPV1. RESULTS: The immunoreaction (IR) for p75 NTR in the neuronal cytoplasm was persistently lower on the ipsilateral L5 and L6 DRG but higher in the satellite cells and fibers. The colocalization between p75 NTR and TRPV1 was increased temporarily in the L4 DRG in both sides. In the spinal cord, p75 NTR-IR decreased temporalily in the ipsilateral dorsal horn of the L4-L6 level and had recovered at 28 days after injury. CONCLUSION: These results show that a differential change in the expression of p75 NTR and TRPV1 is related to the different functional recovery of the sensory and motor system, and that increased colocalizations between p75 NTR and TRPV1 in a non-injured DRG might be related to the development of neuropathic pain after a peripheral nerve injury.
Animals ; Cytoplasm ; Diagnosis-Related Groups ; Ganglia, Spinal* ; Horns ; Immunohistochemistry ; Neuralgia ; Neurons ; Peripheral Nerve Injuries ; Rats* ; Receptor, Nerve Growth Factor* ; Spinal Cord* ; Spinal Nerve Roots* ; Spinal Nerves*

The use of artificial nerve conduit containing viable Schwann cells is one of the most promising strategies to repair the peripheral nerve injury. To fabricate an effective nerve conduit whose microstructure and internal environment are more favorable in the nerve regeneration than existing ones, a new three-dimensional Schwann cell culture technique using Matrigel(R) and dorsal root ganglion (DRG) was developed. Nerve conduit of three-dimensionally arranged Schwann cells was fabricated using direct seeding of freshly harvested DRG into a Matrigel(R) filled silicone tube (I.D. 1.98 mm, 14 mm length) and in vitro rafting culture for 2 weeks. The nerve regeneration efficacy of three-dimensionally cultured Schwann cell conduit (3D conduit group, n=6) was assessed using SD rat sciatic nerve defect of 10 mm, and compared with that of silicone conduit filled with Matrigel(R) and Schwann cells prepared from the conventional plain culture method (2D conduit group, n=6). After 12 weeks, sciatic function was evaluated with sciatic function index (SFI) and gait analysis, and histomorphology of nerve conduit and the innervated tissues of sciatic nerve were examined using image analyzer and electromicroscopic methods. The SFI and ankle stance angle (ASA) in the functional evaluation were -60.1+/-13.9, 37.9 degrees +/-5.4 degrees in 3D conduit group (n=5) and -87.0 +/-12.9, 32.2 degrees +/-4.8 degrees in 2D conduit group (n=4), respectively. And the myelinated axon was 44.91%+/-0.13% in 3D conduit group and 13.05%+/-1.95% in 2D conduit group to the sham group. In the TEM study, 3D conduit group showed more abundant myelinated nerve fibers with well organized and thickened extracellular collagen than 2D conduit group, and gastrocnemius muscle and biceps femoris tendon in 3D conduit group were less atrophied and showed decreased fibrosis with less fatty infiltration than 2D conduit group. In conclusion, new three-dimensional Schwann cell culture technique was established, and nerve conduit fabricated using this technique showed much improved nerve regeneration capacity than the silicone tube filled with Matrigel(R) and Schwann cells prepared from the conventional plain culture method.
Animals ; Ankle ; Axons ; Cell Culture Techniques ; Collagen ; Diagnosis-Related Groups ; Fibrosis ; Gait ; Ganglia, Spinal ; Muscle, Skeletal ; Myelin Sheath ; Nerve Fibers, Myelinated ; Nerve Regeneration ; Peripheral Nerve Injuries ; Peripheral Nerves* ; Rats ; Regeneration* ; Schwann Cells ; Sciatic Nerve ; Silicones ; Tendons

OBJECTIVE: To provide the evidences for the choice of normal reference value of nerve conduction velocity (NCV) in clinical forensic appraisal. METHODS: One hundred and fourteen cases with normal peripheral nerve and 155 cases with injured peripheral nerve were collected. The NCV of homonymous nerves in two limbs were detected. In the normal cases, the NCV of the left limbs were used as the normal reference values. The NCV of the right limbs were compared with that of left limbs, the commendatory normal reference values from Beijing Xiehe Hospital and Shanghai Huashan Hospital. In the injured cases, the results of NCV in injuried limbs were compared with the results of healthy limbs and the reference values from Beijing Xiehe Hospital and Shanghai Huashan Hospital. RESULTS: In the normal group, there was no statistical difference between the left and right limbs in NCV results of homonymous nerve (P > 0.05). The false positive rates (FPR) were 0, 11.4% and 5.2% for three choices normal reference respectively. The false negative rates (FNR) were 0, 9.7% and 12.3% for three choices normal reference in injuried group. Thee false negative cases were all slight nerve injury. CONCLUSION The reference value of self-control method could decrease the FPR of normal cases and FNR of injured cases. In clinical forensic appraisal of peripheral nerve, the nerve condition study results from healthy homonymous nerve should be regarded as the reference value at first, supplemented by reference values from clinical labs.
Adolescent ; Adult ; Electrodiagnosis/methods* ; Forearm ; Forensic Medicine ; Humans ; Median Nerve/physiology* ; Middle Aged ; Neural Conduction/physiology* ; Peripheral Nerve Injuries/diagnosis* ; Peripheral Nerves/physiology* ; Reference Values ; Ulnar Nerve/physiology* ; Young Adult

Thirty cases of peripheral nerve injury were selected and analysed by means of electromyographic studies at Severance Hospital, Yonsei University, from January 1972 to August 1972. 1. The sex ratio was 17:13 (male: female). The peak incidence occurred in the twenty to thirty year age group. Involved side: right side 18 cases: left side 12 cases. 2. Nerve involved: peroneal nerve (15 cases), tibial nerve (2 cases), median nerve (7 cases), ulnar nerve (4 cases) and radial nerve (2 case). 3. Mode of nerve injuries 1) Peroneal nerve: Nerve compression, variable (10 cases) Tibia & fibular fracture complication (4 cases) Stab wound, fibular neck region (1 case) 2) Tibial nerve: Injection neuritis, buttock (2 cases) 3) Median nerve: Cut glass laceration, wrist region (3 cases) Carpal tunnel syndrome (3 cases) Undetermined mode (1 case) 4) Ulnar nerve: Cut glass laceration, wrst region (2 cases) Forearm bones fracture complication (1 case) Supracondylar fracture (cubitus valgus) (1 case) 5) Radial nerve: Cut glass laceration, wrist region (1 case) Crushing injury, elbow region (1 case) 4. Among the 15 cases of peroneal nerve injury, there were 10 cases of partial denervation and 5 cases of complete denervation. 5. The mode of injury in 10 cases of partial denervation was nerve compression from the following causes: lithotomy posture during forceps delivery (1 case), external rotation of legs during recovery state after surgery (3 cases), abnormal posture during coma state after CO intoxication (2 cases), tight long leg cast (3 cases), and direct trauma while descending stairs (1 case). 6. In all 10 cases of partial denervation of the peroneal nerve, decreased motor nerve conduction velocities, diminished amplitude and prolonged latencies were observed. 7. In partial denervation of the peroneal nerve, the earliest that reinnervation was observed was within 3 weeks in 3 out of 10 cases. 8. Spontaneous fibrillation was observed 3weeks after injury in all cases except one in which it was observed only 7 days after peroneal nerve injury. 9, The earliest appearance of positive sharp waves among all peroneal nerve injuries was observed 2 weeks after injury. 10. The initial appearance of nascent potentials (polyphasic potentials) in peroneal nerve injuries was observed 3 weeks after injury (1 case), 5 weeks after injury (1 case), and 5 months after injury (1 case). They are all partial denervation cases due to nerve compression. 11. Ten cases of partial denervation of the peroneal nerve were treated with electrical stimulation and drop foot board with good recovery. Five cases of complete denervation of the peroneal nerve were treated with neurorrhaphy (1 case) and short leg bracing (4 cases). 12. The initial appearance, of polyphasic potentials was observed 5 months after injury in one case out of 3 cases of median nerve injury. 13. Three cases of median nerve injury were classified as carpal tunnel syndrome and occurred in women only. Observations included absence of sensory nerve action potentials below the lesion, delayed distal latency at wrist and normal motor nerve conduction velocity. They were treated by division of the deep transverse carpal ligament with good result. 14. The initial appearance of nascent potentials was observed 7 months after injury in one case among 3 cases of ulnar nerve injury. 15. In two cases each of radial and tibial nerve injury, no reinnervation pattern was observed until the six month follow-up study after injury. At that time no muscle contraction could be seen or palpated clinically. 16. We observed normal motor unit potentials in the muscles in the follow-up studies even though muscle contraction could not be seen or palpated clinically. 17. Electromyographic examination at selected intervals made accurate diagnosis and prognosis possible and aided in evaluating the course of nerve regeneration, which permictted the choice of appropriate treatment.
Action Potentials ; Braces ; Buttocks ; Carpal Tunnel Syndrome ; Coma ; Denervation ; Diagnosis ; Elbow ; Electric Stimulation ; Extremities ; Female ; Follow-Up Studies ; Foot ; Forearm ; Glass ; Humans ; Incidence ; Lacerations ; Leg ; Ligaments ; Median Nerve ; Muscle Contraction ; Muscles ; Neck ; Nerve Regeneration ; Neural Conduction ; Neuritis ; Peripheral Nerve Injuries ; Peripheral Nerves ; Peroneal Nerve ; Posture ; Prognosis ; Radial Nerve ; Sex Ratio ; Surgical Instruments ; Tibia ; Tibial Nerve ; Ulnar Nerve ; Wounds, Stab ; Wrist