ABSTRACT
Median and ulnar nerve interconnections commonly occur in the brachial plexus, forearm, and hand. Each is classified based on location, fiber type (sensory fibers, motor fibers, or both), and directionality (ie, carrying fibers from median to ulnar or vice versa). There are 4 main interconnections found in the forearm and hand: Martin-Gruber and Marinacci anastomoses in the forearm and Riche-Cannieu and Berrettini anastomoses in the hand. The presence of an interconnection may skew electrodiagnostic findings, possibly resulting in misdiagnosis and iatrogenic injury. Clinicians should perform nerve studies of both nerves at proximal and distal stimulation sites to rule out interconnections and guide treatment. This review details anatomy, electrodiagnostic findings, and clinical approach.
Subject(s)
Median Nerve/abnormalities , Nervous System Malformations/classification , Nervous System Malformations/diagnosis , Neural Conduction , Ulnar Nerve/abnormalities , Electrodiagnosis , Forearm/innervation , Hand/innervation , Humans , Muscle, Skeletal/innervationABSTRACT
The purpose of this study was to compare venous blood flow velocity of intermittent pneumatic compression to electrical stimulation of the foot. A prospective randomized controlled study of 40 healthy volunteers was conducted. Subjects were seated for 4 hours during which they received electrical stimulation of the sole of the foot or intermittent pneumatic compression of the foot... Short-term electrical foot stimulation is at least as effective as foot intermittent pneumatic compression in increasing popliteal and femoral blood flow velocity. [corrected] Popliteal and femoral venous blood flow velocities were measured via Doppler ultrasonography. Blood flow velocity in the nonstimulated or noncompressed lower extremity served as a simultaneous control. For both the femoral and popliteal veins, the electrical foot stimulation group exhibited a greater increase in blood flow velocity than the intermittent pneumatic compression group. Electrical foot stimulation was noninferior relative to standard intermittent pneumatic compression. Specifically, this result of a greater increase in blood flow velocity is achieved at time = 120 minutes for the femoral vein (t = 2.70; p = .005) and time = 120 (t = 2.75; p = .004) and 240 (t = 2.27; p = .014) minutes for the popliteal vein. Short-term electrical foot stimulation is at least as effective as knee-high intermittent pneumatic compression in increasing popliteal and femoral blood flow velocity. Electrical foot stimulation has the potential to be an effective method of deep venous thrombosis prophylaxis.
Subject(s)
Electric Stimulation Therapy , Femoral Vein/physiopathology , Foot/innervation , Intermittent Pneumatic Compression Devices , Obesity/physiopathology , Popliteal Vein/physiopathology , Venous Thrombosis/prevention & control , Aged , Aged, 80 and over , Blood Flow Velocity , Electric Stimulation Therapy/adverse effects , Female , Femoral Vein/diagnostic imaging , Humans , Intermittent Pneumatic Compression Devices/adverse effects , Laser-Doppler Flowmetry , Male , Middle Aged , Patient Satisfaction , Popliteal Vein/diagnostic imaging , Prospective Studies , Regional Blood Flow , Surveys and Questionnaires , Time Factors , Treatment Outcome , Ultrasonography, Doppler , Venous Thrombosis/physiopathologyABSTRACT
BACKGROUND: Venous stasis caused by immobility is an important risk factor for deep vein thrombosis following surgery and lower limb trauma, in bed-ridden medical patients, and in high-risk long distance air travelers. A safe and convenient method for reducing venous stasis would be useful in patients while in hospital and after discharge during their rehabilitation. SUBJECTS AND METHODS: 49 healthy subjects aged 51-76 were seated for 4 hours during which they received mild electrical stimulation of the calf, or sole of the foot (plantar muscles). Popliteal and femoral venous blood flow velocities were measured via doppler ultrasound. The non-stimulated lower extremity served as the simultaneous control. Subjects completed a questionnaire regarding their acceptance and tolerance of the electrical stimulation. RESULTS: There was a significant increase in venous femoral and popliteal blood flow for both calf (p < 0.035, p < 0.003), and plantar muscles (p < 0.0001, p < 0.009) on the stimulated side compared to the unstimulated side. The magnitude of the effect was similar for calf and plantar muscle stimulation. Subjects did not find the experience uncomfortable, and would use an electrical stimulator if told by their physician that they were at risk for developing blood clots. CONCLUSIONS: Mild electrical stimulation of the feet, as well as the calf, is a safe effective and convenient method for counteracting venous stasis and therefore has the potential to reduce the risk of deep vein thrombosis and pulmonary embolism for subjects who are immobilized.