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1.
Medicine (Baltimore) ; 99(6): e18932, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028402

RESUMO

BACKGROUND: Spasticity is one of the manifestations of motor dysfunction in upper motor neuron syndrome, which is characterized by increased muscle tone. Spasticity seriously affects the motor function and activity of daily life of patients. Some studies have shown that extracorporeal shock wave therapy (ESWT) can relieve spasticity in recent years. However, the effectiveness and safety of ESWT on spasticity after motor neuron injury have not been confirmed. The purpose of this systematic review (SR) is to evaluate the effectiveness and safety of ESWT on spasticity after upper motor neuron injury. METHODS: We will search China National Knowledge Infrastructure (CNKI), the Chinese Science and Technology Periodical Database (VIP), Wan Fang Data, China Biology Medicine (CBM), PubMed, Embase, The Cochrane Library, and Web of Science systematically from their inception dates through October 2019 to obtain randomized controlled trials (RCTs) using ESWT to relieve spasticity in patients after upper motor neuron injury. The primary outcome will be the Modified Ashworth Scale (MAS). Secondary outcomes will include Composite Spasticity Scale (CSS), Spasm Frequency Scale, Modified Tardieu Scale (MTS), electrophysiological study (ratio of maximum H reflex to maximum M response, root mean square value, integrated electromyogram, co-contraction ratio, etc.), or other spasticity-related outcomes. In addition, adverse events will also be assessed as safety measurement. Study selection, data extraction, and quality assessment will be performed independently by 2 reviewers. Assessment of risk of bias and data synthesis will be performed using Review Manager software (RevMan, version 5.3.5) and R (version 3.6.1) software. RESULTS: We will synthesize current studies to evaluate the effectiveness and safety of ESWT on spasticity after upper motor neuron injury. CONCLUSION: Our study will provide evidence of ESWT on spasticity after upper motor neuron injury. ETHICS AND DISSEMINATION: The ethical approval is not required since SR is based on published studies. The results of this SR will be published in a peer-reviewed scientific journal according to the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) guidelines. PROSPERO REGISTRATION NUMBER: CRD42019131059.


Assuntos
Braço/inervação , Tratamento por Ondas de Choque Extracorpóreas , Espasticidade Muscular/terapia , Humanos , Projetos de Pesquisa
3.
Plast Reconstr Surg ; 144(6): 1037e-1043e, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31764652

RESUMO

BACKGROUND: Although the distal targets have been lost in proximal upper limb amputees, the neural signals for intuitive hand and arm function are still available and thus can be incorporated into more useful prosthetic function using targeted muscle reinnervation technique. In this article, the authors present their outcomes and range of indications in addition to experiences and pitfalls after 30 targeted muscle reinnervation cases at above-elbow and shoulder disarticulation level of amputation. METHODS: Thirty patients with above-elbow or shoulder disarticulation amputations were enrolled between 2012 and 2017. Indications for targeted muscle reinnervation surgery differed between improvement of prosthetic function (n = 19) and/or pain (n = 11). Functional outcome was evaluated with the Action Research Arm Test, the Southampton Hand Assessment Procedure, and the Clothespin-Relocation Test. Functional evaluation was performed at least at 6 months after final prosthetic fitting. RESULTS: All nerve transfers were successful and provided independent myoelectric signals. The 10 patients available for final functional evaluation showed Action Research Arm Test scores of 20.4 ± 1.9 and Southampton Hand Assessment Procedure scores of 40.5 ± 8.1. The Clothespin-Relocation Test showed a mean time of 34.3 ± 14.4 seconds. CONCLUSIONS: Targeted muscle reinnervation has improved prosthetic control and revolutionized neuroma treatment in upper limb amputees. Still, the rate of abandonment even after targeted muscle reinnervation surgery has been shown high, and several advances within the biotechnological interface will be needed to improve prosthetic function and acceptance in these patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Amputação Traumática/cirurgia , Amputação/métodos , Braço/inervação , Músculo Esquelético/inervação , Transferência de Nervo/métodos , Acidentes de Trânsito , Adolescente , Adulto , Amputação/reabilitação , Cotos de Amputação/inervação , Amputação Traumática/reabilitação , Braço/cirurgia , Humanos , Anormalidades Linfáticas/cirurgia , Masculino , Regeneração Nervosa/fisiologia , Transferência de Nervo/reabilitação , Resultado do Tratamento , Malformações Vasculares/cirurgia , Adulto Jovem
4.
Plast Reconstr Surg ; 144(6): 1044e-1050e, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31764654

RESUMO

BACKGROUND: Nerve transfers are planned based on the following parameters: location, number of branches, and axon count matching of the donor and recipient nerves. The authors have previously defined the former two in upper limb muscles. In the literature, axon counts are obtained from various sources, using different methods of histomorphometry. This study describes the axon counts of the same primary motor nerve branches from the authors' previous study using a uniform method of manual histomorphometry and completes the authors' blueprint of upper limb neuromuscular anatomy for reconstructive surgery. METHODS: The distal ends of the primary nerve branches of 23 upper limb muscles were harvested from 10 fresh frozen cadaveric upper limbs. Manual quantitative histomorphometry was performed by two independent investigators, and the average was reported. RESULTS: The primary nerve branches of the arm muscles had higher average axon counts (range, 882 to 1835) compared with those of the forearm muscles (range, 267 to 883). In the forearm, wrist flexor (range, 659 to 746) and extensor (range, 543 to 745) nerve branches had axons counts that were similar to those of potential donors (e.g., supinator, n = 602; pronator teres, n = 625; flexor digitorum superficialis, n = 883; and flexor digitorum profundus, n = 832). CONCLUSIONS: Apart from describing the axon counts of the upper limb, the authors have found that the forearm axon counts are very comparable. This insight, when combined with information on the location and number of primary nerve branches, will empower surgeons to tailor bespoke nerve transfers for every clinical situation.


Assuntos
Braço/inervação , Antebraço/inervação , Neurônios Motores/transplante , Músculo Esquelético/inervação , Transferência de Nervo/métodos , Adulto , Idoso , Axônios , Cadáver , Contagem de Células , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
5.
Elife ; 82019 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-31596230

RESUMO

Motor cortex (M1) has lateralized outputs, yet neurons can be active during movements of either arm. What is the nature and role of activity across the two hemispheres? We recorded muscles and neurons bilaterally while monkeys cycled with each arm. Most neurons were active during movement of either arm. Responses were strongly arm-dependent, raising two possibilities. First, population-level signals might differ depending on the arm used. Second, the same population-level signals might be present, but distributed differently across neurons. The data supported this second hypothesis. Muscle activity was accurately predicted by activity in either the ipsilateral or contralateral hemisphere. More generally, we failed to find signals unique to the contralateral hemisphere. Yet if signals are shared across hemispheres, how do they avoid impacting the wrong arm? We found that activity related to each arm occupies a distinct subspace, enabling muscle-activity decoders to naturally ignore signals related to the other arm.


Assuntos
Braço/inervação , Lateralidade Funcional , Córtex Motor/fisiologia , Neurônios Motores/fisiologia , Movimento , Animais , Macaca mulatta , Masculino
6.
BMJ Case Rep ; 12(8)2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31420428

RESUMO

Soft tissue sarcomas account for about 1% of malignant tumours. More than 50 subtypes of these tumours have been described with some being extremely rare, namely malignant peripheral nerve sheath tumours (MPNST). The authors present a case of a man aged 81 years with a medical history of an adenocarcinoma of the rectum, which was referred to our clinic due to a growing painless mass on the right arm. An MRI showed a well-delimited encapsulated mass involving the long head of the biceps muscle. Biopsy findings revealed a spindle cell tumour with cytonuclear pleomorphism. The patient underwent wide tumour excision and was successfully reconstructed with a latissimus dorsi functional muscle transfer. The presence of two pulmonary nodules on CT scan staging implied a lung biopsy that showed rectum primary tumour metastases. With these additional findings, the pathology department reassessed the case and reclassified the arm tumour as an MPNST, synchronous with pulmonary adenocarcinoma metastases of the rectum.


Assuntos
Adenocarcinoma/patologia , Neoplasias Pulmonares/patologia , Neoplasias Primárias Múltiplas/patologia , Neoplasias da Bainha Neural/patologia , Neoplasias Retais/patologia , Adenocarcinoma/secundário , Idoso de 80 Anos ou mais , Braço/inervação , Braço/patologia , Humanos , Neoplasias Pulmonares/secundário , Masculino
7.
Cornea ; 38(8): 1029-1032, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31246678

RESUMO

PURPOSE: We describe the first case of a novel surgical technique of mini-invasive corneal neurotization (MICORNE) using the lateral antebrachial cutaneous nerve as a graft nerve and the contralateral supraorbital nerve as a donor nerve in a herpetic patient with a neurotrophic keratopathy (NK). METHODS: A MICORNE procedure was performed in a 32-year-old man with a 5-year history of herpes simplex virus (HSV)-related NK in the right eye (RE). Visual acuity and corneal sensation were assessed over 9 months of follow-up. HSV-1 and HSV-2 genomes were screened preoperatively and postoperatively in the patient's tears using the quantitative polymerase chain reaction technique. A high does of the oral antiviral prophylaxis was prescribed during the follow-up. RESULTS: Preoperative best-corrected visual acuity was 20/200 in the RE. A Cochet-Bonnet esthesiometer revealed complete corneal anesthesia (<5 mm ie, >15.9 g/mm) in all quadrants in a scarred and neovascularized cornea. Twelve months after the procedure, the visual acuity of the RE was 20/80 and corneal sensitivity had increased to 40 mm, that is, 0.8 g/mm (superior quadrant), 35 mm, that is, 1 g/mm (inferior quadrant), 40 mm (temporal quadrant), 35 mm, that is, 1 g/mm (nasal quadrant), and 40 mm (centrally). We observed no clinical recurrence of herpes, and HSV was not detected in tears during the follow-up period. CONCLUSIONS: We report the first case of MICORNE, a novel surgical technique of corneal neurotization in a herpetic patient with NK. Despite the potential risk of viral recurrence, our patient showed dramatic improvement in corneal sensation and visual acuity.


Assuntos
Braço/inervação , Doenças da Córnea/cirurgia , Nervo Musculocutâneo/transplante , Transferência de Nervo/métodos , Doenças do Nervo Trigêmeo/cirurgia , Adulto , Antivirais/uso terapêutico , Autoenxertos , Doenças da Córnea/etiologia , Humanos , Hipestesia/etiologia , Hipestesia/cirurgia , Ceratite Herpética/complicações , Ceratite Herpética/tratamento farmacológico , Masculino , Órbita/inervação , Doenças do Nervo Trigêmeo/etiologia , Acuidade Visual/fisiologia
9.
Medicine (Baltimore) ; 98(13): e15017, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30921223

RESUMO

RATIONALE: Malignant peripheral nerve sheath tumor occurring in the context of neurofibromatosis type I (NF1) is relatively rare. Herein, we report a case of NF1 with malignant peripheral nerve sheath tumor in the upper arm. PATIENT CONCERNS: A 24-year-old man presented with a mass in the medial part of the left upper arm that had been present for more than 20 years. In the previous 1 year prior to admission, the mass had grown significantly. Physical examination showed cafe-au-lait spots of variable sizes throughout the body and multiple masses in the medial part of the left upper arm. Three months later after the resection of the masses, the patient was readmitted to our department due to tumor recurrence. Two months after the extended resection, in situ recurrence of the tumor was noted again. Four months after the operation and the administration of radiotherapy, a mass was found in the outside of the left upper arm. DIAGNOSIS: Immunohistochemical staining showed the masses were positivity for vimentin, CD34, and S100; the tumor cells were negative for PGP9.5, CD57, EMA, and SMA. The Ki-67 labeling index was approximately 40%. A diagnosis of malignant peripheral nerve sheath tumor was made. INTERVENTIONS: Surgical resection was performed for both the primary tumors and the 2 subsequent recurrence tumors. The patient underwent radiotherapy with 60 Gy in 30 fractions after the third operation. Four months after the administration of radiotherapy, the patient underwent tumorectomy of a mass in the outside of the left upper arm. OUTCOMES: During the 4-month follow-up after the fourth operation, the patient's condition was stable. LESSONS: Malignant peripheral nerve sheath tumor in NF1 is an exceedingly rare entity that poses a great diagnostic challenge. High-frequency ultrasound can support the diagnosis.


Assuntos
Neurofibromatose 1/patologia , Neoplasias do Sistema Nervoso Periférico/patologia , Braço/inervação , Braço/patologia , Humanos , Masculino , Adulto Jovem
10.
Surg Radiol Anat ; 41(4): 393-400, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30820647

RESUMO

PURPOSE: The brachialis (BM) is a complex muscle with a long-running controversy regarding its morphology and innervation. The primary objective of this study was to elucidate the detailed gross morphology of BM in an adult Sri Lankan population. METHOD: Cadaveric upper limbs (n = 240) were examined for the proximal and distal attachments, length, width, thickness of BM, and innervations by the musculocutaneous (MCN) and radial nerve (RN). RESULTS: In all cases, the BM consisted of two heads: superficial head (SHB) and deep head (DHB). Proximally SHB and DHB originated from the lateral, anterior, and medial aspects of the middle and distal thirds of the shaft of the humerus and inserted onto the coronoid process and the tuberosity of ulna, respectively, as two separate entities. Statistically significant (P < 0.05) gender differences were observed between the mean values (mm) of muscle length (male: 188.03 ± 10.54; female: 166.14 ± 7.97), width (male: 26.57 ± 4.80; female: 25.28 ± 4.67), thickness (male: 10.73 ± 1.74; female: 9.74 ± 1.28), and tendon length (male: 44.44 ± 7.73; female: 33.40 ± 5.09). In all cases, MCN innervated the BM, while the model site of piercing was in the middle third of the muscle. The incidence of RN contribution to BM was 83.33% and in the vast majority it pierced the inferior third of the BM. CONCLUSION: Present study provides a comprehensive anatomical overview of the BM. An in-depth knowledge of the anatomy of BM may aid in comprehending functional characteristics, enhance the accuracy of imaging modalities, and provide new insight to the current surgical approaches around the elbow joint which in turn will invariably minimize the potential complications encountered during clinical procedures.


Assuntos
Braço/anatomia & histologia , Músculo Esquelético/anatomia & histologia , Nervo Musculocutâneo/anatomia & histologia , Nervo Radial/anatomia & histologia , Idoso , Variação Anatômica , Braço/inervação , Cadáver , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/inervação , Fatores Sexuais , Sri Lanka
11.
BMJ Case Rep ; 12(3)2019 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-30846458

RESUMO

Neurolymphomatosis (NL) is the infiltration of lymphocytes into the peripheral nervous system in a haematological malignancy. We describe the imaging features of NL in a patient with relapsed Burkitt-like non-Hodgkin's lymphoma on positron emission tomography (PET) and ultrasound. Imaging features on ultrasound are infrequently described and provide useful information in helping to establish an imaging diagnosis of NL. Features of NL in our patient included intense linear fluorodeoxyglucose-18 (18FDG) uptake on PET along the affected median nerve. B-mode ultrasound demonstrated concentric tubular thickening and loss of fascicular architecture. Perineural and intraneural vascularity was present on colour Doppler ultrasound. It is important to be able to correlate ultrasound findings to features observed on 18FDG-PET as this aids in diagnosis and in guiding potential surgical biopsy.


Assuntos
Braço/inervação , Linfoma Difuso de Grandes Células B/patologia , Nervo Mediano/patologia , Neurolinfomatose/diagnóstico por imagem , Idoso , Braço/diagnóstico por imagem , Braço/patologia , Evolução Fatal , Feminino , Fluordesoxiglucose F18/administração & dosagem , Humanos , Linfoma não Hodgkin/patologia , Neurolinfomatose/patologia , Neurolinfomatose/radioterapia , Tomografia por Emissão de Pósitrons/métodos , Radioterapia/métodos , Ultrassonografia/métodos , Ultrassonografia Doppler Dupla/métodos
12.
J Neurophysiol ; 121(5): 1621-1632, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30785805

RESUMO

High-frequency electrical stimulation (HFS) of skin nociceptors triggers central sensitization (CS), manifested as increased pinprick sensitivity of the skin surrounding the site of HFS. Our aim was to assess the effect of CS on pinprick-evoked pupil dilation responses (PDRs) and pinprick-evoked brain potentials (PEPs). We hypothesized that the increase in the positive wave of PEPs following HFS would result from an enhanced pinprick-evoked phasic response of the locus coeruleus-noradrenergic system (LC-NS), indicated by enhanced PDRs. In 14 healthy volunteers, 64- and 96-mN pinprick stimuli were delivered to the left and right forearms, before and 20 minutes after HFS was applied to one of the two forearms. Both PEPs and pinprick-evoked PDRs were recorded. After HFS, pinprick stimuli were perceived as more intense at the HFS-treated arm compared with baseline and control site, and this increase was similar for both stimulation intensities. Importantly, the pinprick-evoked PDR was also increased, and the increase was stronger for 64- compared with 96-mN stimulation. This is in line with our previous results showing a stronger increase of the PEP positivity at 64 vs. 96-mN stimulation and suggests that the increase in PEP positivity observed in previous studies could relate, at least in part, to enhanced LC-NS activity. However, there was no increase of the PEP positivity in the present study, indicating that enhanced LC-NS activity is not the only determinant of the HFS-induced enhancement of PEPs. Altogether, our results indicate that PDRs are more sensitive for detecting CS than PEPs. NEW & NOTEWORTHY We provide the first demonstration in humans that activity-dependent central sensitization increases pinprick-evoked autonomic arousal measured by enhanced pupil dilation response.


Assuntos
Sensibilização do Sistema Nervoso Central , Pupila/fisiologia , Tato , Adulto , Braço/inervação , Braço/fisiologia , Potenciais Somatossensoriais Evocados , Feminino , Humanos , Locus Cerúleo/fisiologia , Masculino , Relaxamento Muscular , Nociceptores/fisiologia , Percepção do Tato
13.
Hum Mov Sci ; 64: 230-239, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30798047

RESUMO

In recent years, neuromodulation of the cervical spinal circuitry has become an area of interest for investigating rhythmogenesis of the human spinal cord and interaction between cervical and lumbosacral circuitries, given the involvement of rhythmic arm muscle activity in many locomotor tasks. We have previously shown that arm muscle vibrostimulation can elicit non-voluntary upper limb oscillations in unloading body conditions. Here we investigated the excitability of the cervical spinal circuitry by applying different peripheral and central stimuli in healthy humans. The rationale for applying combined stimuli is that the efficiency of only one stimulus is generally limited. We found that low-intensity electrical stimulation of the superficial arm median nerve can evoke rhythmic arm movements. Furthermore, the movements were enhanced by additional peripheral stimuli (e.g., arm muscle vibration, head turns or passive rhythmic leg movements). Finally, low-frequency transcranial magnetic stimulation of the motor cortex significantly facilitated rhythmogenesis. The findings are discussed in the general framework of a brain-spinal interface for developing adaptive central pattern generator-modulating therapies.


Assuntos
Braço/fisiologia , Córtex Motor/fisiologia , Movimento/fisiologia , Adulto , Idoso , Braço/inervação , Estimulação Elétrica , Eletromiografia , Feminino , Voluntários Saudáveis , Humanos , Masculino , Nervo Mediano/fisiologia , Pessoa de Meia-Idade , Medula Espinal/fisiologia , Estimulação Magnética Transcraniana , Vibração
14.
Neuroimage Clin ; 21: 101659, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30642759

RESUMO

PURPOSE: By applying diffusor tensor imaging (DTI) in patients with anterior interosseous nerve syndrome (AINS), this proof of principle study aims to quantify the extent of structural damage of a peripheral nerve at the anatomical level of individual fascicles. METHODS: In this institutional review board approved prospective study 13 patients with spontaneous AINS were examined at 3 Tesla including a transversal T2-weighted turbo-spin-echo and a spin-echo echo-planar-imaging pulse sequence of the upper arm level. Calculations of quantitative DTI parameters including fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) for median nerve lesion and non-lesion fascicles as well as ulnar and radial nerve were obtained. DTI values were compared to each other and to a previously published dataset of 58 healthy controls using one-way Analysis of Variance with Bonferroni correction and p-values <.05 were considered significant. Receiver operating characteristic (ROC) curves were performed to assess diagnostic accuracy. RESULTS: FA of median nerve lesion fascicles was decreased compared to median nerve non-lesion fascicles, ulnar nerve and radial nerve while MD, RD, and AD was increased (p < .001 for all parameters). Compared to median nerve values of healthy controls, lesion fascicles showed a significant decrease in FA while MD, RD, and AD was increased (p < .001 for all parameters). FA of median nerve non-lesion fascicles showed a weak significant decrease compared to healthy controls (p < .01) while there was no difference in MD, RD, and AD. ROC analyses revealed an excellent diagnostic accuracy of FA, MD and RD in the discrimination of median nerve lesion and non-lesion fascicles in AINS patients as well as in the discrimination of lesion fascicles and normative median nerve values of healthy controls. CONCLUSION: By applying this functional MR Neurography technique in patients with AINS, this proof of principle study demonstrates that diffusion tensor imaging is feasible to quantify structural nerve injury at the anatomical level of individual fascicles.


Assuntos
Anisotropia , Imagem de Tensor de Difusão , Nervo Mediano/fisiopatologia , Nervo Ulnar/fisiopatologia , Adulto , Idoso , Braço/inervação , Imagem de Difusão por Ressonância Magnética/métodos , Imagem de Tensor de Difusão/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Nervo Radial/fisiopatologia , Adulto Jovem
15.
Exp Brain Res ; 237(1): 223-236, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30377711

RESUMO

Reaching for an object is a basic motor skill that requires precise coordination between elbow, shoulder and trunk motion. The purpose of this research study was to examine age-related differences in compensatory arm-trunk coordination during trunk-assisted reaching. To engage the arm and trunk, an older and younger group of participants were asked to (1) maintain a fixed hand position while flexing forward at the trunk [stationary hand task (SHT)] and (2) reach to a within-arm's reach target while simultaneously flexing forward at the trunk [reaching hand task (RHT)] (Raptis et al. in J Neurophysiol 97:4069-4078, 2007; Sibindi et al. in J Vestib Res 23:237-247, 2013). Both tasks were completed with eyes closed. Participants completed the two tasks with their dominant and non-dominant arms, and at both a fast and a preferred speed. On average, young and older participants performed in a similar manner in the SHT, such that they maintained their hand position by compensating for trunk movement with modifications of the elbow and shoulder joints. In the RHT, young and older participants had similar endpoint accuracy. This similarity in performance between young and older participants in the SHT and RHT tasks was observed regardless of the arm used or movement speed. However, for both tasks, movements in older adults were significantly more variable compared to younger adults as shown by the larger variability in arm-trunk coordination performance (gain scores) in the SHT and higher movement time variability in the RHT. Thus, results imply that older adults maintain their ability to coordinate arm and trunk movements efficiently during reaching actions but are not as consistent as younger adults.


Assuntos
Envelhecimento/fisiologia , Braço/fisiologia , Movimento/fisiologia , Desempenho Psicomotor/fisiologia , Amplitude de Movimento Articular/fisiologia , Tronco/fisiologia , Adulto , Idoso , Análise de Variância , Braço/inervação , Feminino , Lateralidade Funcional , Humanos , Masculino , Tronco/inervação , Adulto Jovem
16.
J Neurosurg Anesthesiol ; 31(3): 291-298, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29787402

RESUMO

INTRODUCTION: Peripheral nerve injury is a potentially devastating complication after total shoulder arthroplasty (TSA) surgery. This pilot study aimed to assess the feasibility of using an automated somatosensory evoked potential (SSEP) device to provide a timely alert/intervention to minimize intraoperative nerve insults during TSA surgery. METHODS: A prospective, single-arm, observational study was conducted in a single university hospital. The attending anesthesiologist monitored the study participants using the EPAD automated SSEP device and an intervention was made if there was an alert during TSA surgery. The median, radial, and ulnar nerve SSEP on the operative arm, as well as the median nerve SSEP of the nonoperative arm were monitored for each patient. All patients were evaluated for postoperative neurological deficits 6 weeks postoperatively. RESULTS: In total, 21 patients were consented and were successfully monitored. In total, 4 (19%) patients developed intraoperative abnormal SSEP signal changes in the operative arm, in which 3 were reversible and 1 was irreversible till the end of surgery. Median and radial nerves were mostly involved (3/4 patients). The mean cumulative duration of nerve insult (abnormal SSEP) was 21.7±26.2 minutes. Univariate analysis did not identify predictor of intraoperative nerve insults. No patients demonstrated postoperative peripheral neuropathy at 6 weeks. CONCLUSIONS: A high incidence (19%) of intraoperative nerve insult was observed in this study demonstrating the feasibility of using an automated SSEP device to provide a timely alert and enable an intervention in order to minimize peripheral nerve injury during TSA. Further randomized studies are warranted.


Assuntos
Artroplastia do Ombro/métodos , Eletroencefalografia/instrumentação , Potenciais Somatossensoriais Evocados , Complicações Intraoperatórias/prevenção & controle , Monitorização Neurofisiológica Intraoperatória/instrumentação , Monitorização Neurofisiológica Intraoperatória/métodos , Traumatismos dos Nervos Periféricos/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Braço/inervação , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico , Masculino , Nervo Mediano/lesões , Nervo Mediano/fisiopatologia , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/diagnóstico , Projetos Piloto , Estudos Prospectivos , Nervo Radial/lesões , Nervo Radial/fisiopatologia , Nervo Ulnar/lesões , Nervo Ulnar/fisiopatologia
17.
Lymphat Res Biol ; 17(1): 78-86, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30358471

RESUMO

BACKGROUND: Multilayer bandaging used in complex decongestive therapy (CDT) may increase tissue pressure resulting in nerve entrapments. The aim of this study was to discover if median nerve damage is a consequence of CDT in patients with breast cancer-related lymphedema (BCRL). METHODS AND RESULTS: Eighty-two arms of 41 patients with BCRL were included. Mean age was 56.05 (8.16) years and all stages of lymphedema were equally included. Fifteen sessions of CDT was applied to all patients. The calculated volume of extremities, the quality of life (cancer adaptation of Ferrans-Powell), neuropathic pain (NP; Douleur Neuropathique 4), and disability (quick disabilities of arm, shoulder, and hand [Q-DASH]) tests were recorded before and after therapy. Skin and subcutaneous tissue thicknesses of volar and dorsal sides and median nerve cross-sectional area (CSA) at the level of carpal tunnel were measured using ultrasonography (US), before and after therapy. Carpal tunnel syndrome (CTS; 41.37%) and polyneuropathy (10.34%) were common findings confirmed by electromyography. Neuropathic pain profile was also found in 34.14% of patients. The arm volume of affected side, quality of life, and skin and subcutaneous tissue thicknesses were improved after therapy (p < 0.05). However, median nerve CSA, the NP, and Q-DASH scores were not changed after therapy. CONCLUSIONS: Although lymphedema is a painless condition, NP and CTS should not be ignored in patients with BCRL. US is an alternative, precise, and high technological method for evaluating treatment response. CDT is an effective and safe treatment according to volumetric calculations, US measurements of tissue thicknesses, and median nerve size.


Assuntos
Linfedema Relacionado a Câncer de Mama/terapia , Neoplasias da Mama/complicações , Carcinoma Ductal de Mama/complicações , Síndrome do Túnel Carpal/terapia , Bandagens Compressivas , Drenagem Linfática Manual/métodos , Neuralgia/prevenção & controle , Adulto , Idoso , Braço/diagnóstico por imagem , Braço/inervação , Braço/fisiopatologia , Braço/cirurgia , Linfedema Relacionado a Câncer de Mama/diagnóstico por imagem , Linfedema Relacionado a Câncer de Mama/etiologia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/radioterapia , Carcinoma Ductal de Mama/cirurgia , Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/etiologia , Eletromiografia , Exercício Físico , Feminino , Humanos , Nervo Mediano/diagnóstico por imagem , Nervo Mediano/fisiopatologia , Pessoa de Meia-Idade , Neuralgia/etiologia , Neuralgia/fisiopatologia , Estudos Prospectivos , Qualidade de Vida/psicologia , Higiene da Pele/métodos , Resultado do Tratamento , Ultrassonografia
18.
World Neurosurg ; 123: e488-e500, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30502477

RESUMO

OBJECTIVE: Epidemiology in upper extremity peripheral nerve injury (PNI) has not been comprehensively evaluated. The aim of this study was to calculate updated incidence of upper extremity PNIs in the United States and examine clinical trends and costs using a national database. METHODS: The National (Nationwide) Inpatient Sample was used to evaluate patients with upper extremity PNI (International Classification of Diseases, Ninth Revision, Clinical Modification 9534, 9550-9559) in 2001-2013. RESULTS: A weighted total of 170,579 patients experienced upper extremity PNI, representing a mean incidence of 43.8/1 million people annually. Mean (± SEM) age of patients was 38.1 ± 0.05 years, 74.3% of patients were male, and 49.0% were Caucasian. PNIs occurred to the ulnar (17.8%), radial (15.1%), digital (18.0%), median (13.0%), multiple (11.5%), and other (10.1%) nerves and brachial plexus (14.5%). The number of upper extremity PNIs decreased overall. Average care charge was $47,004 ± $185, with an average increase of $4623/year and compound annual growth rate of 9.59%. Although surgical nerve repair and home disposition were common with isolated PNIs, patients with brachial plexus PNIs did not have nerve surgery and were more likely to be discharged to skilled nursing facilities. Multivariate analysis showed that length of stay (ß = 0.677, P = 0.0001) and number of procedures (ß = 0.188, P = 0.0001) most affected total patient charges. CONCLUSIONS: These results suggest an overall decrease in number of PNIs, suggesting lower incidence or frequency of detection; however, the cost of care has increased. Despite advances in nerve repair techniques, nerve surgery rates have not increased, especially for brachial plexus injuries, which may be undertreated.


Assuntos
Braço/inervação , Procedimentos Neurocirúrgicos/economia , Traumatismos dos Nervos Periféricos/economia , Adulto , Custos e Análise de Custo , Honorários e Preços , Feminino , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Procedimentos Neurocirúrgicos/tendências , Traumatismos dos Nervos Periféricos/cirurgia , Resultado do Tratamento , Estados Unidos
19.
Musculoskelet Surg ; 103(2): 139-148, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29961233

RESUMO

PURPOSE: To describe and assess an overall surgical strategy addressing extensive proximal brachial plexus injuries (BPI). METHODS: Forty-five consecutive patients' charts with C5-C6-C7 and C5-C6-C7-C8 BPI were reviewed. Primary procedures were nerve transfers to restore elbow function and grafts to restore shoulder function when a cervical root was available; when nerve surgery was not possible or had failed, tendon transfers were conducted at the elbow while addressing shoulder function with glenohumeral arthrodesis or humeral osteotomy. Tendon transfers were used to restore finger extension. RESULTS: Forty-one patients underwent elbow flexion reanimation: thirty-eight had nerve transfers and eight received tendon transfers, including five cases secondary to nerve surgery failure; grade-3 strength or greater was reached in thirty-seven cases (90%). Twenty-nine patients had nerve transfers to restore elbow extension: twenty-five recovered grade-3 or grade-4 strength (86%). Forty-one patients underwent shoulder surgery: fourteen had nerve surgery and thirty-one received palliative procedures, including four cases secondary to nerve surgery failure; thirty patients recovered at least 60° of abduction and rotation (73%). Distal reconstruction was performed in thirty-seven patients, providing finger full extension in all cases but two (95%). CONCLUSIONS: A standardized strategy may be used in extensive proximal BPI, providing overall satisfactory outcomes.


Assuntos
Neuropatias do Plexo Braquial/cirurgia , Plexo Braquial/lesões , Úmero/cirurgia , Transferência de Nervo/métodos , Articulação do Ombro/cirurgia , Transferência Tendinosa/métodos , Adolescente , Adulto , Braço/inervação , Artrodese , Plexo Braquial/cirurgia , Cotovelo , Feminino , Dedos , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Movimento , Osteotomia , Recuperação de Função Fisiológica , Adulto Jovem
20.
Clin Anat ; 32(2): 183-195, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30113088

RESUMO

We aimed to establish the prevalence of the musculocutaneous nerve (MCN) variations and the probability of the variation being pure or mixed in the same plexus. We applied the principles of evidence-based anatomy to find, appraise, and synthesize data through a meta-analysis of anatomical studies. The variations were grouped based on the presence and location of the communicating branch with the median nerve and the origin of branches to anterior arm muscles. Forty-three cadaveric studies met the inclusion criteria, providing data from 4124 plexuses. The overall pooled prevalence of plexuses with MCN variations was 20%. Based on the classification applied in our study, the pooled prevalence of variations was 17% in region 1A, 20% in region 1B, 36% in region 2 and 49% in region 3. Importantly, 64.58% of variations in region 1A and 74.14% of variations in region 1B were mixed, that is, associated with a variation in another region. The odds of finding another variation in the presence of a variation in region 2 or 3 were equal 0.37 and 0.52, respectively, demonstrating a significantly lower probability of finding mixed variations involving these regions, when compared with region 1A. Variations of the MCN are most common in the part distal to the exit from within or beneath the coracobrachialis muscle. Proximal variations are more often associated with another variation located along the nerve. These findings can assist health care professionals in the treatment of brachial plexus lesions. Clin. Anat. 32:183-195, 2019. © 2018 Wiley Periodicals, Inc.


Assuntos
Braço/inervação , Músculo Esquelético/inervação , Nervo Musculocutâneo/anatomia & histologia , Cadáver , Feminino , Humanos , Masculino
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