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1.
Plast Reconstr Surg ; 145(3): 563e-573e, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097316

RESUMO

BACKGROUND: Many surgical techniques are used to treat symptomatic neuroma, but options are limited for digital neuromas because of a paucity of soft-tissue coverage and/or the absence of the terminal nerve end. The authors assessed factors that influence patient-reported outcomes after surgery for symptomatic digital neuroma. METHODS: The authors retrospectively identified 29 patients with 33 symptomatic digital neuromas that were treated surgically. Patients completed the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity and Pain Interference scales, a numeric rating scale for pain, and the PROMIS Depression scale at a median follow-up of 7.6 years postoperatively (range, 3.2 to 16.8 years). Surgical treatment for neuroma included excision with nerve repair/reconstruction (n =13; 39 percent), neuroma excision alone (n =10; 30 percent), and excision and implantation (n =10; 30 percent). Multivariable linear regression was performed to identify the factors that independently influenced patient-reported outcomes. RESULTS: The mean postoperative PROMIS Upper Extremity score was 45.2 ± 11.2, the mean Pain Interference score was 54.3 ± 10.7, and the mean numeric rating scale pain score was 3 (interquartile range, 1 to 5). Compared with other treatment techniques, neuroma excision with nerve repair/reconstruction was associated with lower numeric rating scale pain scores; lower Pain Interference scores, corresponding to less daily impact of pain; and higher Upper Extremity scores, reflecting better upper extremity function. Older age and higher Depression scores were associated with lower Upper Extremity scores and higher Pain Interference scores. Smoking was associated with higher Pain Interference and numeric rating scale pain scores. CONCLUSIONS: Neuroma excision followed by nerve repair/reconstruction resulted in better outcomes compared with neuroma excision alone with or without implantation. Patient age and psychosocial factors influenced patient-reported outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Depressão/diagnóstico , Neuroma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Dor/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias de Tecidos Moles/cirurgia , Adulto , Fatores Etários , Depressão/etiologia , Depressão/psicologia , Feminino , Dedos/inervação , Dedos/cirurgia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma/complicações , Neuroma/psicologia , Dor/diagnóstico , Dor/etiologia , Dor/psicologia , Medição da Dor , Medidas de Resultados Relatados pelo Paciente , Período Pós-Operatório , Escalas de Graduação Psiquiátrica , Estudos Retrospectivos , Neoplasias de Tecidos Moles/complicações , Neoplasias de Tecidos Moles/psicologia , Resultado do Tratamento
2.
Ann Neurol ; 87(3): 456-465, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31849107

RESUMO

OBJECTIVE: To describe morphological changes associated with degeneration and regeneration of large fibers in the skin using a model of chronic compression of the median nerve. METHODS: We studied cutaneous innervation in 30 patients with chronic compression of the median nerve at the wrist. Before surgery, we assessed the symptom severity and performed neurography, quantitative sensory testing, and analysis of nerve morphology and morphometry in skin biopsies from the third digit fingertip. Fifteen patients repeated all tests 12 months after the surgery. Thirty age- and sex-matched healthy subjects were included in the study. RESULTS: Clinical and neurophysiological basal assessment showed a moderate involvement of the median nerve. Quantitative sensory testing showed abnormal findings. The density of intraepidermal nerve fibers and intrapapillary myelinated endings was reduced. Myelinated fibers showed caliber reduction and nodal elongation. Meissner corpuscles had normal density but were located deeper in the dermis and their capsule appeared partially empty. During follow-up, patients exhibited a positive clinical and neurophysiological outcome. Quantitative sensory testing improved. Intraepidermal nerve fibers and intrapapillary myelinated endings remained unchanged, but the caliber of intrapapillary myelinated endings was increased. The neural component of the Meissner corpuscle filled the capsule of the mechanoreceptors that remained deeper in the dermis. The position of vasoactive intestinal peptide-immunoreactive fibers was more superficial compared to the basal assessment and controls. INTERPRETATION: We recognized and quantified the pathological changes associated with nerve degeneration and regeneration in skin and proposed new parameters that may increase the diagnostic yield of skin biopsy in clinical practice. Ann Neurol 2020;87:456-465.


Assuntos
Nervo Mediano/fisiopatologia , Bainha de Mielina/patologia , Degeneração Neural/patologia , Regeneração Nervosa/fisiologia , Pele/inervação , Estudos de Casos e Controles , Feminino , Dedos/inervação , Humanos , Masculino , Nervo Mediano/lesões , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Pele/patologia , Pele/fisiopatologia , Fatores de Tempo , Peptídeo Intestinal Vasoativo/imunologia
3.
J Hand Surg Asian Pac Vol ; 24(4): 477-482, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690192

RESUMO

Background: It may be difficult to diagnose a nerve injury on a finger or a hand under emergency settings. The goal of this study was to elaborate whether the clinical testing of two-point discrimination was a safe and reliable method in the diagnosis of acute finger nerve injuries. Methods: Through a retrospective assessment, patients' records were analyzed whether the result of the two-point discrimination test corresponded with the intraoperative findings of a damaged nerve. Patients with a prolonged or missing two-point discrimination, who had undergone surgery at our institution between the years 2008 and 2017, were included in the study. The control groups were identified in the same manner and as an additional group, patients with Dupuytren's contracture were included to serve as a healthy cohort regarding finger nerves. Results: A total of 249 patients with nerve lesion were enrolled in the study; apart from this, 25 patients with Dupuytren's contracture were included. The sensitivity of the two-point discrimination test was 99%, with a positive predictive value of 0.93 and with high inter-observer reliability. Conclusions: The two-point discrimination is a valid test to use in the routine examination of suspected nerve injuries on the hands and fingers; it is very reliable and safe for indicating surgical interventions.


Assuntos
Dedos/inervação , Imageamento Tridimensional , Traumatismos dos Nervos Periféricos/cirurgia , Adolescente , Feminino , Humanos , Osteotomia , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/etiologia , Radiografia , Reprodutibilidade dos Testes , Ulna/cirurgia , Fraturas da Ulna/complicações
4.
G Ital Nefrol ; 36(4)2019 Jul 24.
Artigo em Italiano | MEDLINE | ID: mdl-31373470

RESUMO

Arteriovenous access ischemic steal is a fairly uncommon complication associated with the creation of a vascular access for hemodialysis, which can sometimes cause potentially devastating complications, with permanent disability. Several old names for this syndrome have now been replaced by two new denominations: Hemodialysis Access-Induced Distal Ischemia (HAIDI) and Distal Hypoperfusion Ischemic Syndrome (DHIS). Clinically, we distinguish between the Peripheral Hypoperfusion Syndrome, which can cause gangrene of the fingers, and the Monomelic Syndrome, characterized by low incidence and by the presence of neurological dysfunctions. Risk factors include diabetes mellitus, atherosclerotic vascular disease, old age, female gender, tobacco use and hypertension. We report the case of a patient with HAIDI in order to increase awareness on this syndrome's early diagnosis and proper management. After describing the case, we also include a literature review.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Dedos/irrigação sanguínea , Dedos/inervação , Isquemia/etiologia , Mononeuropatias/etiologia , Diálise Renal/efeitos adversos , Dedos/patologia , Mãos/irrigação sanguínea , Humanos , Isquemia/cirurgia , Masculino , Pessoa de Meia-Idade , Necrose , Dor Processual/etiologia , Fatores de Risco , Síndrome , Terminologia como Assunto , Fatores de Tempo
5.
Einstein (Sao Paulo) ; 17(3): eAO4489, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31271607

RESUMO

OBJECTIVE: To analyze the anatomical variations of the innervation of the flexor digitorum superficialis muscle and to determine if the branch of the median nerve that supply this muscle is connected to the branches to the extensor carpi radialis brevis and the pronator teres muscles, without tension, and how close to the target-muscles the transfer can be performed. METHODS: Fifty limbs of 25 cadavers were dissected to collect data on the anatomical variations of the branches to the flexor digitorum superficialis muscle. RESULTS: This muscle received innervation from the median nerve in the 50 limbs. In 22 it received one branch, and in 28 more than one. The proximal branch was identified in 22 limbs, and in 12 limbs it shared branches with other muscles. The distal branch was present in all, and originated from the median nerve as an isolated branch, or a common trunk with the anterior interosseous nerve in 3 limbs, and from a common trunk with the flexor carpi radialis muscle and anterior interosseous nerve in another. It originated distally to the anterior interosseous nerve at 38, in 5 on the same level, and in 3 proximal to the anterior interosseous nerve. In four limbs, innervation came from the anterior interosseous nerve, as well as from the median nerve. Accessory branches of the median nerve for the distal portion of the flexor digitorum superficialis muscle were present in eight limbs. CONCLUSION: In 28 limbs with two or more branches, one of them could be connected to the branches to the extensor carpi radialis brevis and pronator teres muscles without tension, even during the pronation and supination movements of the forearm and flexion-extension of the elbow.


Assuntos
Denervação/métodos , Dedos/inervação , Antebraço/inervação , Nervo Mediano/anatomia & histologia , Músculo Esquelético/inervação , Punho/inervação , Adulto , Cadáver , Dissecação , Dedos/cirurgia , Humanos , Masculino , Nervo Mediano/cirurgia , Músculo Esquelético/cirurgia , Tendões
6.
PLoS One ; 14(6): e0217969, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31188859

RESUMO

Hand motor impairment is common after stroke but there are few comprehensive data on amount of hand movement. This study aimed to compare the amount of thumb and finger movement over an extended period of time in people with stroke and able-bodied people. Fifteen stroke subjects and 15 able-bodied control subjects participated. Stroke subjects had impaired hand function. Movement of the thumb and index finger was recorded using stretch sensors worn on the affected hand (stroke subjects) or the left or right hand (control subjects) for ∼4 hours during the day. A digit movement was defined as a monotonic increase or decrease in consecutive sensor values. Instantaneous digit position was expressed as a percentage of maximal digit flexion. Mixed linear models were used to compare the following outcomes between groups: (1) average amplitude of digit movement, (2) digit cadence and average digit velocity, (3) percentage of digit idle time and longest idle time. Amplitude of digit movement was not different between groups. Cadence at the thumb (between-group mean difference, 95% CI, p value: -0.6 movements/sec, -1.0 to -0.2 movements/sec, p = 0.003) and finger (-0.5 movements/sec, -0.7 to -0.3 movements/sec, p<0.001) was lower in stroke than control subjects. Digit velocity was not different between groups. Thumb idle time was not different between groups, but finger idle time was greater in stroke than control subjects (percentage of idle time: 6%, 1 to 11%, p = 0.02; longest idle time: 375 sec, 29 to 721 sec, p = 0.04). Rehabilitation after stroke should encourage the performance of functional tasks that involve movements at faster cadences, and encourage more frequent movement of the digits with shorter periods of inactivity.


Assuntos
Destreza Motora/fisiologia , Movimento/fisiologia , Amplitude de Movimento Articular , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos Transversais , Feminino , Dedos/inervação , Dedos/fisiologia , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Polegar/inervação , Polegar/fisiologia
7.
IEEE Trans Neural Syst Rehabil Eng ; 27(5): 887-894, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30990188

RESUMO

High-density surface electromyography (HD-EMG) provides detailed information about muscle activation. However, HD-EMG recordings can be interfered by motion artifacts and power line noise. In this paper, an interference detection and removal method with minimal distortion of the EMG was developed based on the independent component analysis (ICA). After the source separation, the independent components with power line noise were detected based on the spectra and were processed with notch filters. Components with motion artifacts were identified by analyzing the peak frequency of the spectrum, and motion artifacts were filtered with a high-pass filter and an amplitude thresholding method. The EMG signals were then reconstructed based on the processed source signals. The denoising performance was evaluated on both simulated and experimental EMG signals. The results showed that our method was significantly better than the digital filter method and the conventional ICA-based method where components with interferences were set to zero. Namely, our method showed a minimal distortion of the denoised EMG amplitude and frequency and a higher yield of decomposed motor units. Our interference detection and removal algorithm can be used as an effective preprocessing procedure and can benefit macro level EMG analysis and micro level motor unit analysis.


Assuntos
Eletromiografia/métodos , Eletromiografia/estatística & dados numéricos , Análise de Componente Principal , Adulto , Algoritmos , Artefatos , Feminino , Dedos/inervação , Dedos/fisiologia , Mãos/inervação , Mãos/fisiologia , Humanos , Masculino , Neurônios Motores/fisiologia , Fibras Musculares Esqueléticas/fisiologia , Músculo Esquelético/fisiologia , Processamento de Sinais Assistido por Computador , Razão Sinal-Ruído , Adulto Jovem
8.
IEEE Trans Neural Syst Rehabil Eng ; 27(7): 1467-1472, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31021800

RESUMO

Brain-machine interfaces (BMIs) translate brain signals into control signals for an external device, such as a computer cursor or robotic limb. These signals can be obtained either noninvasively or invasively. Invasive recordings, using electrocorticography (ECoG) or intracortical microelectrodes, provide higher bandwidth and more informative signals. Rehabilitative BMIs, which aim to drive plasticity in the brain to enhance recovery after brain injury, have almost exclusively used non-invasive recordings, such electroencephalography (EEG) or magnetoencephalography (MEG), which have limited bandwidth and information content. Invasive recordings provide more information and spatiotemporal resolution, but do incur risk, and thus are not usually investigated in people with stroke or traumatic brain injury (TBI). Here, in this paper, we describe a new BMI paradigm to investigate the use of higher frequency signals in brain-injured subjects without incurring significant risk. We recorded EEG in TBI subjects who required hemicraniectomies (removal of a part of the skull). EEG over the hemicraniectomy (hEEG) contained substantial information in the high gamma frequency range (65-115 Hz). Using this information, we decoded continuous finger flexion force with moderate to high accuracy (variance accounted for 0.06 to 0.52), which at best approaches that using epidural signals. These results indicate that people with hemicraniectomies can provide a useful resource for developing BMI therapies for the treatment of brain injury.


Assuntos
Lesões Encefálicas Traumáticas/cirurgia , Interfaces Cérebro-Computador , Craniectomia Descompressiva/métodos , Ritmo Gama , Adulto , Artefatos , Eletroencefalografia , Feminino , Dedos/inervação , Humanos , Magnetoencefalografia , Masculino , Contração Muscular , Desenho de Prótese , Desempenho Psicomotor
9.
Injury ; 50(4): 848-854, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30910242

RESUMO

BACKGROUND: Complex digital injuries involving soft-tissue loss and digital nerve defect continues to pose a reconstructive challenge. This study reports the repair of such neurocutaneous defect with the bipedicled nerve flap or the Littler flap and compares the results of the two techniques. METHODS: A retrospective study was conducted in 59 patients who had a neurocutaneous defect in the single digit treated with the bipedicled nerve flap or the Littler flap from Jul 2008 to May 2016. The patients were divided into two groups based on which flap was chosen. At the final follow-up, the two groups were compared for static two-point discrimination and Semmes-Weinstein monofilament scores on both flap and pulp, and pain, cold intolerance and patient satisfaction of the reconstructed digit. RESULTS: Significant differences were found in static two-point discrimination, pain, cold intolerance, and patient satisfaction (p < 0.05). In comparison with the bipedicled flap group, the Littler flap group presented better discriminatory sensation in the flap and pulp, but exhibited higher incidence of pain and cold intolerance in the reconstructed digit. In the donor digits, the bipedicled flap group achieved lower pain incidence. Finally, the bipedicled flap group attained a larger degree of satisfaction than the Littler flap group. CONCLUSIONS: When reconstructing a complex neurocutaneous defect in the digit, choosing the bipedicled nerve flap rather than the Littler flap attains lower incidence of pain and cold intolerance, and higher patient satisfaction. Our results suggest that repair of the transected digital nerves can reduce neuroma incidence.


Assuntos
Traumatismos dos Dedos/fisiopatologia , Dedos/inervação , Nervos Periféricos/cirurgia , Lesões dos Tecidos Moles/fisiopatologia , Retalhos Cirúrgicos , Adulto , Feminino , Traumatismos dos Dedos/cirurgia , Dedos/cirurgia , Seguimentos , Humanos , Masculino , Satisfação do Paciente/estatística & dados numéricos , Nervos Periféricos/fisiopatologia , Procedimentos Cirúrgicos Reconstrutivos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Resultado do Tratamento
10.
Ann Biomed Eng ; 47(6): 1357-1368, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30834478

RESUMO

Accurate prediction of motor output based on neural signals is critical in human-machine interactions. The objective was to evaluate the performance of predicting individual finger forces through an estimation of the descending neural drive to the spinal motoneuron pool. High-density surface electromyogram (EMG) signals of the extensor digitorum communis muscle were obtained, and were then decomposed into individual motor unit discharge events. The frequency of the composite discharge events at the population level was used to derive the descending neural drive, which was then used to predict the finger forces. The global EMG-based approach was used as a control condition. Compared with the EMG-based approach, the experimental results show that the neural-drive-based approach can better predict the individual finger forces with higher R2 values across different force levels and across different force trajectories (steady and varying forces). These findings indicate that the neural drive estimation based on motoneuron firing activities can be used as a reliable neural-machine interface signal involving individual fingers. However, real-time implementation of this approach is needed for future clinical translation.


Assuntos
Dedos/fisiologia , Modelos Neurológicos , Neurônios Motores/fisiologia , Adulto , Simulação por Computador , Eletromiografia , Feminino , Dedos/inervação , Humanos , Masculino , Adulto Jovem
11.
J Hand Surg Asian Pac Vol ; 24(1): 118-122, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30760136

RESUMO

A 25-year-old man sustained a right-sided brachial plexus injury from a high-velocity motocross accident. Physical examination and electromyography were consistent with a pan-brachial plexopathy with no evidence of axonal continuity. The patient underwent a spinal accessory to suprascapular nerve transfer and an intercostal to musculocutaneous nerve transfer with interpositional sural nerve grafts. He recovered MRC 4/5 elbow flexion and MRC 2/5 shoulder abduction and external rotation. Twenty-two months post-injury the patient displayed a flicker of flexion of his flexor pollicis longus and flexor digitorum profundus to his index finger - he went on to recover a functional pinch. Thirty-six months post-injury the patient displayed a flicker of contraction in brachioradialis with motor unit potentials on electromyography. This case demonstrates that some patients may have capacity for functional recovery after prolonged denervation and highlights the potential impact of anatomical anomalies in the assessment and treatment of peripheral nerve injuries.


Assuntos
Neuropatias do Plexo Braquial/cirurgia , Dedos/inervação , Transferência de Nervo , Recuperação de Função Fisiológica , Nervo Sural/transplante , Tendões/inervação , Adulto , Plexo Braquial/lesões , Plexo Braquial/cirurgia , Neuropatias do Plexo Braquial/etiologia , Eletromiografia , Humanos , Masculino , Veículos Off-Road
12.
PLoS One ; 14(2): e0212479, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30794630

RESUMO

Transcutaneous electrical nerve stimulation (TENS) allows the artificial excitation of nerve fibres by applying electric-current pulses through electrodes on the skin's surface. This work involves the development of a simulation environment that can be used for studying transcutaneous electrotactile stimulation and its dependence on electrode layout and excitation patterns. Using an eight-electrode array implementation, it is shown how nerves located at different depths and with different orientations respond to specific injected currents, allowing the replication of already reported experimental findings and the creation of new hypotheses about the tactile sensations associated with certain stimulation patterns. The simulation consists of a finite element model of a human finger used to calculate the distribution of the electric potential in the finger tissues neglecting capacitive effects, and a cable model to calculate the excitation/inhibition of action potentials in each nerve.


Assuntos
Modelos Neurológicos , Estimulação Elétrica Nervosa Transcutânea/métodos , Potenciais de Ação , Simulação por Computador , Eletrodos , Desenho de Equipamento , Dedos/inervação , Análise de Elementos Finitos , Humanos , Mecanorreceptores/fisiologia , Potenciais da Membrana , Fibras Nervosas/fisiologia , Pele/inervação , Estimulação Elétrica Nervosa Transcutânea/instrumentação , Estimulação Elétrica Nervosa Transcutânea/estatística & dados numéricos
13.
Biol Psychol ; 143: 103-112, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30771407

RESUMO

Recent research has indicated that the mismatch negativity (MMN) is elicited in response to a discernible small change of a somatosensory stimulus applied on the hand. However, the neural mechanism for detecting small change of somatosensory stimulus remains unknown. In the present study, we developed a novel pressure stimulation device using air jet applied on the index finger pad, and determined the just noticeable differences (JNDs) of pressure discrimination for each subject. Using the deviant-standard-reversed oddball paradigm, we analyzed the average dynamic changes in MMN amplitude and changes of evoked spectral power. We found a clear MMN component at the frontal and central regions at 100-300 msec after deviant stimulus presentation. Statistical tests showed that theta band activity played pivotal roles in the generation of the MMN elicited by a change in somatosensory pressure stimulation. Our results indicate that the somatosensory discriminatory process reflected on MMN is accompanied by phase-locked oscillation at the theta frequency.


Assuntos
Dedos/inervação , Limiar Sensorial/fisiologia , Ritmo Teta/fisiologia , Percepção do Tato/fisiologia , Adulto , Limiar Diferencial , Feminino , Humanos , Masculino , Adulto Jovem
14.
IEEE Trans Neural Syst Rehabil Eng ; 27(2): 129-138, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30629510

RESUMO

Event related potentials represent a noninvasive means for studying sensory and cognitive processes that occur in response to particular stimuli. Here, we report on a phase measure for estimating single trial interaction of late somatosensory potentials (LSPs) following a tribological well defined mechanical stimulation of the human fingertip. Stimuli are presented via a programmable Braille-display with actively switchable pins which was slid along the apex of the passive fingertip, i.e., the fingertip rested stationarily in a finger holding system with circular opening at the bottom. The event was the raising and the lowering of either one, three, or five lines of pins. Differences were identified by measures based on instantaneous phase synchronization to the stimuli across trials, in particular the wavelet phase synchronization stability (WPSS) measure for single trial sequences of LSPs. In particular, we show that the higher the friction the stronger and more localized the induced phase coherency is. We concluded that the WPSS analysis of single sequences of LSPs represents a reliable method which allows for the quantification of brain responses upon distinct tactile stimuli.


Assuntos
Potenciais Somatossensoriais Evocados/fisiologia , Fricção , Percepção do Tato/fisiologia , Adulto , Algoritmos , Eletroencefalografia , Feminino , Dedos/inervação , Dedos/fisiologia , Humanos , Masculino , Estimulação Física , Córtex Somatossensorial , Análise de Ondaletas , Adulto Jovem
15.
Microsurgery ; 39(5): 395-399, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30562848

RESUMO

BACKGROUND: In this study, we evaluated the clinical efficacy of a biodegradable nerve conduit constructed of polyglycolic acid (PGA) tube with external and internal collagen scaffolding for digital nerve repair. PATIENTS AND METHODS: A multi-center registry study was conducted in 11 locations between July 2013 and May 2016. Multiple mechanisms of injury included clean-cut (12 patients), crush (5 patients), and avulsion (3 patients) types of injuries. These patients underwent nerve repair with a biodegradable nerve conduit, with 9 patients having a primary repair and 11 patients having delayed repair. Average nerve gap was 16.7 mm (range: 1-50 mm). An average of 13 months follow-up (range: 12-15 months) was available including sensory assessments. RESULTS: Improved s2PD was found with less severe injury as in clean-cut (7.5 ± 1.5 mm), which was statistically significant in comparison to those in crush (9.8 ± 1.9 mm, P = .0384) and in avulsion (10.7 ± 4.7 mm, P = .0013) type injuries. A meaningful recovery (S3+ or S4) was observed in 90% of the 20 digital nerve repairs with a biodegradable nerve conduit of PGA with external and internal collagen scaffolding. Avulsion injuries had significantly lower levels of meaningful recovery (67%) in comparison to those of clean-cut (P = .0291) and crush (P = .0486) types of injury. No adverse effects were reported postoperatively. CONCLUSION: These results indicate that a biodegradable nerve conduit of PGA with external and internal collagen scaffolding is suitable for digital nerve repair of short nerve gaps with high levels of sensory recovery as measured by two-point discrimination.


Assuntos
Implantes Absorvíveis , Regeneração Nervosa/fisiologia , Traumatismos dos Nervos Periféricos/cirurgia , Ácido Poliglicólico/farmacologia , Sistema de Registros , Adulto , Fatores Etários , Idoso , Estudos de Coortes , Feminino , Traumatismos dos Dedos/cirurgia , Dedos/inervação , Dedos/cirurgia , Seguimentos , Força da Mão/fisiologia , Humanos , Escala de Gravidade do Ferimento , Japão , Masculino , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/diagnóstico , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Tecidos Suporte , Cicatrização/fisiologia , Adulto Jovem
16.
Orthop Clin North Am ; 50(1): 87-93, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30477709

RESUMO

In the field of upper extremity surgery there are myriad new and developing technologies. The purpose of this article is to highlight a few of the most compelling new technologies and review their background, indications for use, and most recently reported outcomes in clinical practice.


Assuntos
Artrite/cirurgia , Artroplastia/métodos , Articulações Carpometacarpais/cirurgia , Nervos Periféricos/transplante , Álcool de Polivinil , Procedimentos Cirúrgicos Reconstrutivos/métodos , Extremidade Superior/cirurgia , Aloenxertos , Articulações Carpometacarpais/inervação , Dedos/inervação , Dedos/cirurgia , Humanos , Próteses e Implantes , Desenho de Prótese , Extremidade Superior/inervação
17.
Clin Orthop Relat Res ; 477(1): 232-239, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30394951

RESUMO

BACKGROUND: Surgery has greatly benefited from various technologic advancements over the past decades. Surgery remains, however, mostly manual labor performed by well-trained surgeons. Little research has focused on improving osseous drilling techniques. The objective of this study was to compare the accuracy and precision of different orthopaedic drilling techniques involving the use of both index fingers. QUESTIONS/PURPOSES: (1) Does the shooting grip technique and aiming at the contralateral index finger improve accuracy and precision in drilling? (2) Is the effect of drilling technique on accuracy and precision affected by the experience level of the performer? METHODS: This study included 36 participants from two Dutch training hospitals who were subdivided into three groups (N = 12 per group) based on their surgical experience (that is, no experience, residents, and surgeons). The participants had no further experience with drilling outside the hospital nor were there other potential confounding variables that could influence the test outcomes. Participants were instructed to drill toward a target exit point on a synthetic bone model. There were four conditions: (1) clenched grip without aiming; (2) shooting grip without aiming; (3) clenched grip with aiming at the contralateral index finger; and (4) shooting grip aiming at the contralateral index finger. Participants were only used to a clenched grip without aiming in clinical practice. Each participant had to drill five times per technique per test, and the test was repeated after 4 weeks. Accuracy was defined as the systematic error of all measurements and was calculated as the mean of the five distances between the five exit points and the target exit point, whereas precision was defined as the random error of all measurements and calculated as the SD of those five distances. Accuracy and precision were analyzed using mixed-design analyses of variance. RESULTS: Accuracy was highest when using a clenched grip with aiming at the index finger (mean 4.0 mm, SD 1.1) compared with a clenched grip without aiming (mean 5.0 mm, SD 1.2, p = 0.004) and a shooting grip without aiming (mean 4.9 mm, SD 1.4, p = 0.015). The shooting grip with aiming at the index finger (mean 4.1 mm, SD 1.2) was also more accurate than a clenched grip without aiming (p = 0.006) and a shooting grip without aiming (p = 0.014). Shooting grip with aiming at the opposite index finger (median 2.0 mm, interquartile range [IQR] 1.2) showed the best precision and outperformed a clenched grip without aiming (median 2.9 mm, IQR 1.1, p = 0.016), but was not different than the shooting grip without aiming (median 2.2 mm, IQR 1.4) or the clenched grip with aiming (median 2.4 mm, IQR 1.3). The accuracy of surgeons (mean 4.1 mm, SD 1.1) was higher than the inexperienced group (mean 5.0 mm, SD 1.1, p = 0.012). The same applied for precision (median 2.2 mm, IQR 1.0 versus median 2.8 mm, IQR 1.4, p = 0.008). CONCLUSIONS: A shooting grip combined with aiming toward the index finger of the opposite hand had better accuracy and precision compared with a clenched grip alone. Based on this study, experience does matter, because the orthopaedic surgeons outperformed the less experienced participants. Based on our study, we advise surgeons to aim at the index finger of the opposite hand when possible and to align the ipsilateral index finger to the drill bit. LEVEL OF EVIDENCE: Level II, therapeutic study.


Assuntos
Competência Clínica , Dedos/inervação , Internato e Residência , Destreza Motora , Procedimentos Ortopédicos/métodos , Cirurgiões Ortopédicos , Educação de Pós-Graduação em Medicina , Força da Mão , Humanos , Países Baixos , Procedimentos Ortopédicos/educação , Cirurgiões Ortopédicos/educação , Análise e Desempenho de Tarefas
18.
Physiother Theory Pract ; 35(4): 348-354, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29482409

RESUMO

OBJECTIVES: To evaluate the reliability (intra and inter) of two-point discrimination (2PD) test in carpal tunnel syndrome (CTS) patients. PARTICIPANTS: Eighty-six adults with unilateral right hand CTS. METHODS: Two examiners performed measurements of 2PD sensation (using Dellon discriminator) on the first three fingers on both hands. The first examiner performed three series of measurements at 1-minute intervals. After 7 days, measurements were repeated by the same examiner (intra-rater). For inter-rater reliability, the examination (by second examiner) was also repeated after 7 days. RESULTS: For the first measurement, inter-rater reliability (ICC2,1) at the affected site ranged from 0.96 to 0.97; values at the non-affected site ranged from 0.79 to 0.89. Analysis of the averages of two measurements (ICC2,2) yielded values at the affected site of 0.98; values at the non-affected site ranged from 0.92 to 0.94. The average of two measurements reduces the smallest detectable difference (SDD) value < 1 mm in all cases. Intra-rater reliability was at least good for all tested fingers for the first measurement, but to record SDD < 1 mm it is necessary to use an average of the first two measurements. CONCLUSIONS: The execution of two repeated measurements provides adequate reliability in measurements of 2PD test in CTS patients. For clinical trials, we recommend using at least the average of two measurements of 2PD, which reduce SDD (below 1 mm). This may be particularly important in assessing the effectiveness of therapy.


Assuntos
Síndrome do Túnel Carpal/diagnóstico , Discriminação Psicológica , Dedos/inervação , Percepção do Tato , Tato , Adulto , Síndrome do Túnel Carpal/fisiopatologia , Síndrome do Túnel Carpal/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Limiar Sensorial
19.
J Hand Surg Am ; 44(2): 163.e1-163.e5, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29908928

RESUMO

Control of independent digital flexion and extension has remained an elusive goal in myoelectric prosthetics for upper extremity amputees. We first performed a cadaver study to determine the feasibility of transferring the interossei muscles for each digit to the dorsum of the hand without damaging the neurovascular pedicles. Once this capability was ensured, a clinical case was performed transferring the interossei of the middle and ring fingers to the dorsum of the hand where they could serve as a myoelectric signal for a partial hand amputee to allow individual digital control with a myoelectric prosthesis. Before surgery, it was impossible to detect an independent signal for each interossei; however, after the surgery, signals were reliably detected, which allowed these muscles to serve as myosites for finger flexion using a myoelectric prosthesis and move each digit independently. This concept of salvaging innervated and perfused muscles from an amputated part and transferring them into the more proximal and superficial portion of a salvaged limb has broad applications for improved myoelectric prosthetic control.


Assuntos
Membros Artificiais , Eletromiografia , Dedos/inervação , Músculo Esquelético/inervação , Músculo Esquelético/cirurgia , Adaptação Fisiológica , Adulto , Amputação Traumática/cirurgia , Amputados/reabilitação , Desenluvamentos Cutâneos/cirurgia , Traumatismos dos Dedos/cirurgia , Humanos , Masculino , Desenho de Prótese , Escala Visual Analógica
20.
J Mot Behav ; 51(4): 351-361, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30111261

RESUMO

When moving to grasp an object having adjacent obstacles that limit the space available for placing the fingers, the time for the reach/grasp is dependent on the distance of reaching and the space available for finger placement. Here we model the time taken in terms of these variables and develop mathematical models for the reach and grasp phases of the task and the location of obstacles. Data show that the movement to the target may be made under visual control and that, when the obstacles are close to the target object, a visually-controlled movement is made that is modeled by a modified form of Fitts' law. The time for the two components of the reach/grasp appear to be independent and linearly additive.


Assuntos
Força da Mão/fisiologia , Desempenho Psicomotor/fisiologia , Algoritmos , Fenômenos Biomecânicos , Feminino , Dedos/inervação , Dedos/fisiologia , Lateralidade Funcional/fisiologia , Humanos , Masculino , Modelos Neurológicos , Modelos Teóricos , Adulto Jovem
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