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1.
Artigo em Russo | MEDLINE | ID: mdl-33306300

RESUMO

BACKGROUND: Complicated spinal cord injury occurs in 1-5 cases per 100.000. In children, cervical trauma makes up 72% of all spinal trauma. Spinal cord injury complicates vertebral trauma in 25-50% of cases that usually results severe disability. Rehabilitation of these patients is usually ineffective or results a little improvement. Restoration of even minimal movements is essential in these patients. There are reports devoted to surgical rehabilitation of important hand functions after cervical spinal cord injury. OBJECTIVE: To demonstrate the restoration of key hand functions in patients with CV-CVII complicated spinal cord injury using selective neurotization of the median nerve. MATERIAL AND METHODS: Three patients aged 17-19 years with complicated CV-CVII spinal cord injury and ASIA class A have been selected for surgery for 2 years. Mean period after rehabilitation was 11.3 months. Prior to surgery, all patients recovered flexion/extension in the elbow joints, forearm rotation, flexion and extension of hands. However, there were no active movements in distal phalanges of the fingers, and initial signs of flexor contracture were observed. RESULTS: Surgical strategy included selective neurotization of the median nerve with a motor branch of musculocutaneous nerve. In one case, we used additional neurotization of posterior interosseous nerve. Two patients recovered cylindrical grip up to M4 and pinch grip up to M3 within 15 months. In the third patient, postoperative data were not assessed due to short-term follow-up. CONCLUSION: Selective neurotization of anterior interosseous nerve may be considered as a stage or independent surgery for restoration of key hand functions. This approach improves the quality of life in patients with complicated spinal cord injury.


Assuntos
Transferência de Nervo , Traumatismos da Medula Espinal , Adolescente , Adulto , Criança , Humanos , Nervo Mediano , Movimento , Qualidade de Vida , Adulto Jovem
2.
Acta Ortop Mex ; 34(1): 31-37, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-33230997

RESUMO

INTRODUCTION: Currently there is no universally accepted standard of reference for the diagnosis of carpal tunnel syndrome so it is considered a «latent class¼ pathology, that is, it lacks any diagnostic tests that absolutely certain the presence of disease. METHODS: Prospective, observational and analytical study evaluating the three diagnostic methods used for carpal tunnel syndrome (clinical examination, ultrasound and electromyography). Normality values were set for each diagnostic method. RESULTS: 50 people (14 men and 36 women) were evaluated. The clinical examination showed a positive and significant correlation with the diameter of the affected median nerve (ecography) (R = 0.694, p = 0.032). The values of the under the curve area (UCA) for median nerve conduction speed (MNCS), cubital nerve conduction speed (CNCS), and distal latency (DL) by electromyography were 0.60, 0.519 and less than 0.50 respectively. This states that the diagnostic value of electromyography characteristics is bad. CONCLUSION: Our work establishes clinical examination as a good quality tool being the most sensitive method for diagnosing carpal tunnel syndrome. If there was a need for diagnostic confirmation, the ultrasound proved to be a highly satisfactory study generating less stress, pain and invasion to the patient, decreasing health expenditure and speeding up the process.


Assuntos
Síndrome do Túnel Carpal , Síndrome do Túnel Carpal/diagnóstico por imagem , Feminino , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Condução Nervosa , Estudos Prospectivos , Sensibilidade e Especificidade , Ultrassonografia
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2881-2884, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018608

RESUMO

Lack of sensory feedback is one of the main issues contributing to lack of control and embodiment for upper-limb prostheses. Noninvasive nerve stimulation may help amputees overcome such limitations by providing a degree of somatotopic feedback, however its neural correlates have been only partly characterized so far. While the effects of median nerve stimulation have been studied, little attention has been given to ulnar nerve and bipolar stimulation, which might provide a finer modulation of the somatotopic sensation. Here, monopolar and bipolar transcutaneous electrical nerve stimulation (TENS) is repeatedly applied to the ulnar and median nerves and elicited Somatosensory Evoked Potentials (SEPs) are characterized by means of electroencephalography (EEG). Clear P50, P150 and P270 SEPs were outlined, with significantly different amplitudes between configurations. In each case scalp topographies showed a strong contralateral activation in the early phase after the stimulus onset (40-100 ms), compatible with generators in the somatosensory cortex and in accordance to previous literature on actual tactile stimuli, which gives way to a frontal-central distribution at long latencies (130-190 ms). These findings, although needing further validation with a larger pool of subjects, show that bipolar TENS could have potential applications in improving prosthesis control with tactile feedback.


Assuntos
Potenciais Somatossensoriais Evocados , Córtex Somatossensorial , Estimulação Elétrica , Humanos , Nervo Mediano , Extremidade Superior
5.
Anticancer Res ; 40(11): 6563-6570, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33109598

RESUMO

BACKGROUND/AIM: In this study, we investigated the locations and surgical complications of schwannomas. PATIENTS AND METHODS: Data of 130 patients with schwannomas were retrospectively reviewed. Pre- and post-operative neurological symptoms, tumor locations, and nerves of origin (sensory, motor, or mixed) were reviewed. RESULTS: Before surgery, 69 patients had Tinel-like signs, 56 patients had pain, 32 patients had numbness, four patients had motor deficits. After surgery, 20 patients had developed a new neurological deficit; 11 patients had motor deficits, ten patients had sensory deficits, and one patient had both motor and sensory deficits. Most schwannomas occurred in mixed nerves, including the median nerve in 17 patients and tibial nerve in 13 patients. CONCLUSION: The most common site of schwannoma was the median nerve. Although the nerve of origin of the schwannoma could be identified in only 26.0% of cases, the data suggest that schwannomas occur in both sensory and motor nerves.


Assuntos
Nervo Mediano/cirurgia , Neurilemoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/cirurgia , Neoplasias Cutâneas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Nervo Mediano/fisiopatologia , Pessoa de Meia-Idade , Neurilemoma/complicações , Neurilemoma/tratamento farmacológico , Neurilemoma/fisiopatologia , Neoplasias do Sistema Nervoso Periférico/fisiopatologia , Período Pós-Operatório , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/fisiopatologia , Resultado do Tratamento , Adulto Jovem
6.
Sci Rep ; 10(1): 16697, 2020 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028841

RESUMO

We aimed to compare the electrophysiology and magnetic resonance neurography (MRN) results of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) subtypes and to explore the progression from atypical CIDP to typical CIDP. We collected the medical records of 45 CIDP patients to analyse the rate of progression from atypical CIDP to typical CIDP subtypes. The cerebrospinal fluid (CSF) protein (p = 0.024) and overall disability sum score (ODSS) (p = 0.000) differed among patients with typical CIDP, distal acquired demyelinating symmetric neuropathy (DADS) and Lewis-Sumner syndrome (LSS). The compound motor action potential (CMAP) of typical CIDP was lower than that of the other subtypes (p = 0.016, p = 0.022 and p = 0.012). The cross-sectional area (CSA) of nerve roots in typical CIDP was significantly thicker than that of nerve roots in DADS and LSS. There were fewer DADS and LSS patients who progressed to typical CIDP than those who progressed to pure motor and pure sensory CIDP (p = 0.000), and the progression from pure motor to typical CIDP required a significantly longer time than the progression from pure sensory to typical CIDP (p = 0.007). Typical CIDP was more severe than the other subtypes not only in terms of clinical and electrophysiology factors but also in terms of MRN factors.


Assuntos
Imagem por Ressonância Magnética/métodos , Nervo Mediano/fisiopatologia , Condução Nervosa/fisiologia , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/fisiopatologia , Adulto , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/diagnóstico por imagem , Raízes Nervosas Espinhais/fisiopatologia , Adulto Jovem
7.
Med Probl Perform Art ; 35(3): 138-144, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32870965

RESUMO

AIMS: Musicians spend numerous hours perfecting their skills and art, often leading to overuse injuries of the hand; of specific concern to musicians is carpal tunnel syndrome (CTS). This study evaluated the median nerve cross-sectional area and hand function of musicians and made comparisons to non-musicians. METHODS: Seventy-six participants took part in the study, 38 music students and professors in the musician group and 38 participants in the control group. Participants completed patient-reported questionnaires to assess the level of pain and hand function. Ultrasound images were collected at the carpal tunnel inlet and outlet. The median nerve cross-sectional area and the depth of the carpal tunnel were measured on ultrasound images using software imbedded in the ultrasound unit. RESULTS: Musicians showed higher levels of hand dysfunction and CTS symptoms than the non-musicians. The median nerve cross-sectional area was greater in musicians than in the non-musician group on both the right (mean difference 1.5 mm2, p=0.002) and left sides (mean difference 0.9 mm2, p=0.036). The depth of the carpal tunnel at the carpal tunnel inlet and outlet did not differ between the groups (p>0.05). CONCLUSION: The current research identified between-group differences in median nerve cross-sectional area and the level of hand dysfunction. Understanding the interaction between the anatomy of the wrist and wrist and hand dysfunction will benefit clinicians when evaluating and treating musicians.


Assuntos
Síndrome do Túnel Carpal , Nervo Mediano , Música , Síndrome do Túnel Carpal/etiologia , Humanos , Nervo Mediano/anatomia & histologia , Nervo Mediano/patologia , Ultrassonografia , Punho
8.
Zhongguo Gu Shang ; 33(8): 745-9, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32875766

RESUMO

OBJECTIVE: To explore the safety of classic Acupotomy in the treatment of carpal tunnel syndrome. METHODS: Twenty six adult specimens (15 males and 11 females), aged 60 to 95(82.54±6.94) years old, were selected from 10% formalin antiseptic fixation. There were 52 sides(two of them could not be tested). The study period was from November 2017 to May 2018. The specimens were collected from the body donation center of the school of basic medicine, Peking University. The operation of releasing the transverse carpal ligament on the human body specimen was simulated by the classic acupotomy, and the distance from the four points to the surrounding anatomical structure was measured to calculate the direct injury rate to the nerve and blood vessels, and the shortest distance between the acupotomy and the nerve and blood vessels was defined as ≥2 mm as safety. RESULTS: In the experimental operation, the direct injury rate of nerve and blood vessel was 14% and 12% respectively. There was significant difference in the rate of direct nerve injury between the four injection points (P<0.05). There was no significant difference in the rate of direct vascular injury between the four injection points (P>0.05). Among the four points, there was a statistically significant difference in the safety of nerves(P<0.05), and the safety of point 1 and point 3 of radial injection was higher than that of point 2 and point 4 of ulnar injection(P<0.05). There was significant difference in the safety of blood vessels between the four points(P<0.05), and the safety of radial point 1 was higher than that of ulnar point 2 and point 4 (P<0.05). CONCLUSION: The safety of the classic Acupotomy for carpal tunnel syndrome is related to the location of the needle entry point, and the safety of theradial proximal end of the needle is the highest.


Assuntos
Terapia por Acupuntura , Síndrome do Túnel Carpal , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Ligamentos Articulares , Masculino , Nervo Mediano/lesões , Pessoa de Meia-Idade , Agulhas , Articulação do Punho
9.
Sci Rep ; 10(1): 15895, 2020 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-32985579

RESUMO

Epilepsy is a network disease. The primary somatosensory cortex (S1) is usually considered to be intact, but could be subclinically disturbed based on abnormal functional connectivity in patients with temporal lobe epilepsy (TLE). We aimed to investigate if the S1 of TLE is abnormally modulated. Somatosensory evoked magnetic fields (SEFs) evoked by median nerve stimulation were recorded in each hemisphere of 15 TLE patients and 28 normal subjects. All responses were separately averaged in the awake state and light sleep using background magnetoencephalography. Latency and strength of the equivalent current dipole (ECD) was compared between the groups for the first (M1) and second peaks. Latencies showed no significant differences between the groups in either wakefulness or light sleep. ECD strengths were significantly lower in TLE patients than in controls only during wakefulness. The reduction of M1 ECD strength in the awake state is significantly correlated with duration of epilepsy. SEFs of TLE patients showed pure ECD strength reduction without latency delay. The phenomenon occurred exclusively during wakefulness, suggesting that a wakefulness-specific modulator of S1 is abnormal in TLE. Repetitive seizures may gradually insult the modulator of S1 distant from the epileptogenic network.


Assuntos
Epilepsia do Lobo Temporal/fisiopatologia , Potenciais Somatossensoriais Evocados/fisiologia , Córtex Somatossensorial/fisiopatologia , Vigília/fisiologia , Adulto , Estimulação Elétrica , Feminino , Humanos , Magnetoencefalografia , Masculino , Nervo Mediano/fisiopatologia , Adulto Jovem
10.
Sci Rep ; 10(1): 15607, 2020 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-32973181

RESUMO

There are conflicting hypotheses regarding the initial pathogenesis of carpal tunnel syndrome (CTS). One hypothesis characterizes it as inflammation of the median nerve caused by compression, while another hypothesis characterizes CTS as non-inflammatory fibrosis of the subsynovial connective tissue (SSCT). This study aimed to investigate the differences in the ultrasonography parameters before and after a steroid injection, which is effective for CTS, to elucidate the initial pathogenesis of CTS and the mechanisms of action of the injected steroid. Fourteen hands from 14 healthy participants and 24 hands from 24 participants with mild CTS were examined. Dynamic movement and morphology of the median nerve before and after steroid injection were measured. There was no significant difference in the normalized maximal distance of the median nerve, which reflects the degree of fibrosis in the SSCT indirectly, during finger and wrist movements before and after the injection among patients with CTS (p > 0.05). Among the parameters that indirectly reflects the degree of median nerve compression, such as normalized maximal change in the aspect ratio of the minimum-enclosing rectangle (MER), maximal change in the median nerve perimeter, and maximal value of the median nerve cross-sectional area (CSA), statistically significant differences were not observed between values of the normalized maximal change in the aspect ratio of the MER and maximal change in the median nerve perimeter, during finger and wrist movements recorded before and after the injection in patients with CTS (p > 0.05). However, multivariate logistic regression analysis revealed that the change in the normalized maximal value of the median nerve CSA, according to finger and wrist movement was correlated with the administration of the steroid injection (p < 0.05). In conclusion, compared to that noted before steroid injection, the median nerve CSA noted during finger and wrist movements changed significantly after injection in patients with mild CTS. Given the improvement in median nerve swelling after steroid injection, but no improvement in the movement of the median nerve during finger and wrist movements, median nerve swelling due to compression (rather than fibrosis of the SSCT may be the initial pathogenesis of early-stage (mild) CTS, and the fibrous changes around the median nerves (SSCT) may be indicative of secondary pathology after median nerve compression. Further studies are required to validate the findings of our study and confirm the pathogenesis of CTS.


Assuntos
Síndrome do Túnel Carpal/fisiopatologia , Nervo Mediano/fisiopatologia , Movimento , Esteroides/administração & dosagem , Punho/fisiopatologia , Idoso , Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/tratamento farmacológico , Estudos Transversais , Feminino , Humanos , Injeções , Masculino , Nervo Mediano/diagnóstico por imagem , Nervo Mediano/efeitos dos fármacos , Pessoa de Meia-Idade , Ultrassonografia , Punho/diagnóstico por imagem
11.
Pan Afr Med J ; 36: 173, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32952817

RESUMO

Carpal tunnel syndrome is a set of signs and symptoms caused by compression of the median nerve as it travels through the wrist at the carpal tunnel. The diagnosis is clinical and based on the presence of characteristic signs and symptoms. Proper nonsurgical treatment can stop the progression of this disorder and prevent the development of permanent disability. Surgical treatment may be indicated to patients with complications rated as moderate to severe. Although the surgery is relatively simple, basic antisepsis care before, during, and after the procedure, and guidance of patients for the management of wound hygiene upon discharge, make recovery more secure and prevent disabling sequelae. We report a case of a patient that had infection, edema, and temporary loss of flexibility of the fingers after a surgical procedure to release the median nerve.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Nervo Mediano/cirurgia , Complicações Pós-Operatórias/fisiopatologia , Adulto , Humanos , Masculino , Punho/cirurgia
12.
Int. j. morphol ; 38(4): 1096-1105, Aug. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1124901

RESUMO

Los músculos lumbricales (ML) de la mano humana son claves en la propiocepción de la flexoextensión de los dedos. La descripción de su inervación indica que el nervio mediano (NM) inerva los dos ML laterales (L1 y L2) y el nervio ulnar (NU) los ML mediales (L3 y L4). Diversos autores han reportado una gran variabilidad de esta inervación, tanto en los nervios que entregan ramos para estos músculos, como también en la distribución de sus ramos y la presencia de troncos comunes. Por otra parte, el número de ramos que recibe cada ML y los puntos motores (Pm) de los mismos ha sido escasamente reportado. El objetivo de este estudio fue determinar número, ubicación y Pm de los ramos destinados a los ML de la mano humana. Así mismo se estableció el patrón de inervación más frecuente. Para ello se utilizaron 24 manos formalizadas, pertenecientes al laboratorio de Anatomía, de la Universidad Andrés Bello, sede Viña del Mar, Chile. Se realizó una disección convencional por planos de profundidad. En todos los casos, el ramo del músculo L1 se originó del nervio digital palmar propio lateral del dedo índice, de la misma forma, en el 100 % el L2 fue inervado por un ramo del nervio digital palmar común del segundo espacio interóseo. En relación a los ML mediales en un 100 % ambos músculos fueron inervados por ramos del ramo profundo del NU (RPNM). En el caso del L3 en un 92 % se presentó un tronco común con el segundo músculo interóseo palmar, asimismo para L4 existió un tronco común con el tercer músculo interóseo palmar en un 79 %. En el 29 %, el L3 presentó una inervación dual. Considerando como referencia la línea biestiloidea, los Pm de los ramos del NM fue de 63,96 mm para L1; 67,91 mm para L2 y 68,69 mm para L3. Para los ramos provenientes del RPNU fue de 69,87 mm para L3 y 69, 21 mm para L4. Los resultados obtenidos aportan al conocimiento anatómico de la inervación de los músculos lumbricales y es de utilidad en procedimientos de neurocirugía que busquen la restauración de la funcionalidad de la mano.


The lumbrical muscles (LM) of the human hand are key in proprioception of flexion and finger extension. The description of its innervation indicates that the median nerve (MN) innervates the two lateral LMs (L1 and L2) and the ulnar nerve (UN) the medial LMs (L3 and L4). Various authors have reported a great variability of this innervation, both in which nerve delivers branches for these muscles, as well as in the distribution of their branches and the presence of common trunks. On the other hand, the number of branches that each LM receives and the motor points (Mp) of these have been scarcely reported. The aim of this study was to determine the number, location and Mp of the branches destined for the LM of the human hand. Likewise, the most frequent innervation pattern was established. For this, 24 formalized hands, belonging to the anatomy laboratory, of the Universidad Andrés Bello, Viña del Mar, Chile, were used. Conventional depth plane dissection was performed. In all cases, the branch of the L1 muscle originated from the palmar digital nerve proper to the index finger, in the same way, in 100 % the L2 was supplied with a branch of the common palmar digital nerve from the second interosseous space. In relation to the LM, in 100 % both muscles were innervated by branches of the deep branch of the UN (DBUN). In the case of L3, 92 % presented a common trunk with the second palmar interosseous muscle. Likewise, in 79 % of the cases, there was a common trunk between the L4 and the third palmar interosseous muscle. In 29 %, the L3 presented a dual innervation. The distance between of the Mp-BEstL was 63.96 mm for L1, 67.91 mm for L2 and 68.69 mm for L3. This distance was 69.87 mm for L3 and 69, 21 mm for L4. The results obtained contribute to the anatomical knowledge of the innervation of the lumbrical muscles and is useful in neurosurgery procedures that seek to restore the functionality of the hand.


Assuntos
Humanos , Adulto , Nervo Ulnar/anatomia & histologia , Músculo Esquelético/inervação , Mãos/inervação , Nervo Mediano/anatomia & histologia , Cadáver , Variação Anatômica
13.
Plast Reconstr Surg ; 146(3): 306e-313e, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32842108

RESUMO

BACKGROUND: Reverse end-to-side anterior interosseous nerve transfer has been reported to enhance treatment of severe, proximal ulnar neuropathy. The authors report on patients with severe neuropathy treated with ulnar nerve transposition and distal reverse end-to-side anterior interosseous nerve transfer. METHODS: Thirty patients with severe ulnar neuropathy at the elbow were reviewed. Clinical parameters included preoperative and postoperative Medical Research Council muscle strength, clawing, and degree of wasting. Electrodiagnostic data included compound motor action potential and sensory nerve action potential amplitudes. Summary statistics were used for demographic and clinical data. The t test and Wilcoxon signed rank test were used where appropriate. RESULTS: Average follow-up was 18.6 months. Preoperatively, 20 patients had Medical Research Council less than or equal to grade 1 in hand intrinsics, small finger sensory nerve action potentials were absent in all patients except for three, and average compound motor action potentials were severely reduced (absent in nearly 40 percent) confirming severity. All groups had a statistically significant increase in strength. More than three-quarters of patients noted partial or complete resolution of clawing and intrinsic muscle wasting. Seventy-three percent of patients regained Medical Research Council greater than or equal to grade 3 and 47 percent achieved Medical Research Council greater than or equal to grade 4. Mean time to observation of nascent units was 8.5 months, and 77 percent of patients demonstrated an augmentation of motor unit numbers with forearm pronation on needle electromyography CONCLUSION:: Proximal subcutaneous ulnar nerve transposition when combined with reverse end-to-side anterior interosseous nerve-to-ulnar nerve transfer demonstrates significant clinical and electrodiagnostic improvement of intrinsic muscle function. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Nervo Mediano/cirurgia , Transferência de Nervo/métodos , Nervo Ulnar/cirurgia , Neuropatias Ulnares/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença
14.
Muscle Nerve ; 62(5): 601-610, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32779757

RESUMO

Ultrasound has revealed cross-sectional nerve area (CSA) reduction in amyotrophic lateral sclerosis (ALS), but little is known about the sonographic nerve texture beyond CSA alterations. In a large cohort of 177 ALS patients and 57 control subjects, we investigated the covariance and disease-specific signature of several sonographic texture features of the median and ulnar nerves and their relationship to the patients' clinical characteristics. ALS patients showed atrophic nerves, a loss of the intranerve structures' echoic contrast, elevated coarseness, and a trend toward lower cluster shading compared with controls. A reduction in intranerve echoic contrast was related to longer disease duration and poorer functional status in ALS. Sonographic texture markers point toward a significant reorganization of the deep nerve microstructure in ALS. Future studies will be needed to further substantiate the markers' potential to assess peripheral nerve alterations in ALS.


Assuntos
Esclerose Amiotrófica Lateral/diagnóstico por imagem , Esclerose Amiotrófica Lateral/patologia , Nervo Mediano/patologia , Nervo Ulnar/patologia , Ultrassonografia , Idoso , Feminino , Antebraço/inervação , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Pessoa de Meia-Idade , Nervo Ulnar/diagnóstico por imagem , Senso de Humor e Humor como Assunto
15.
Arch Phys Med Rehabil ; 101(11): 1857-1864, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32682938

RESUMO

OBJECTIVES: To evaluate whether the therapeutic effect of ultrasound-guided injections with 10 mg or 40 mg triamcinolone acetonide (TA) was dose-dependent in patients with idiopathic mild to moderate carpal tunnel syndrome (CTS). DESIGN: Prospective, double-blind, randomized controlled study with 12 weeks of follow-up. SETTING: Rehabilitation outpatient clinic of a single medical center. PARTICIPANTS: Patients with CTS (N=56). INTERVENTION: Participants were randomly assigned to 2 treatment groups for injection: (A) 40 mg TA+2% lidocaine hydrochloride or (B) 10 mg TA+2% lidocaine hydrochloride. MAIN OUTCOME MEASURES: Participants were evaluated using visual analog scale (VAS) and Boston Carpal Tunnel Questionnaire (BCTQ, including Symptom Severity Scale [SSS] and Functional Status Scale [FSS]) at baseline and 6 and 12 weeks after injection). Nerve conduction studies, including parameters of distal motor latency, amplitude of compound motor action potential, amplitude of sensory nerve action potential and sensory nerve conduction velocity of median nerve, and the patient's subjective impression of improvement, were recorded before injection and 6 and 12 weeks after injection. RESULTS: No significant differences were observed in baseline demographic characteristics and clinical evaluations. The parameters in group A and B at baseline, 6 weeks, and 12 weeks were (1) SSS: 2.17±0.14, 1.19±0.04, and 1.34±0.09 and 1.87±0.11, 1.21±0.07, and 1.26±0.04; (2) FSS: 1.63±0.07, 1.27±0.06, and 1.33±0.08 and 1.50±0.10, 1.18±0.05, and 1.26±0.05; (3) VAS: 6.4±0.3, 2.2±0.3, and 3.0±0.1 and 6.7±0.3, 2.0±0.3, and 3.1±0.3, respectively, and significantly decreased after 6 and 12 weeks in both treatment groups (P<.05). All parameters of nerve conduction studies improved in both groups after 12 weeks (P<.05). VAS, BCTQ, and nerve conduction studies did not show significant intergroup differences after 6 and 12 weeks. CONCLUSION: In patients with idiopathic mild to moderate CTS, ultrasound-guided injection with 10 and 40 mg TA yield similar improvements in BCTQ, VAS, and nerve conduction studies at the 12-week follow-up.


Assuntos
Corticosteroides/administração & dosagem , Síndrome do Túnel Carpal/tratamento farmacológico , Lidocaína/administração & dosagem , Triancinolona Acetonida/administração & dosagem , Síndrome do Túnel Carpal/fisiopatologia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Injeções/métodos , Masculino , Nervo Mediano/efeitos dos fármacos , Pessoa de Meia-Idade , Condução Nervosa/efeitos dos fármacos , Estudos Prospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Ultrassonografia de Intervenção , Escala Visual Analógica
16.
Muscle Nerve ; 62(4): 522-527, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32644200

RESUMO

INTRODUCTION: The purpose of this study was to investigate in vivo median nerve longitudinal mobility in different segments of the carpal tunnel associated with active finger motion in carpal tunnel syndrome (CTS) patients in a comparison with healthy controls. METHODS: Eleven healthy volunteers and 11 CTS patients participated in this study. Dynamic ultrasound images captured location-dependent longitudinal median nerve mobility within the carpal tunnel during finger flexion at the metacarpophalangeal joints using a speckle cross-correlation algorithm. RESULTS: Median nerve longitudinal mobility in the carpal tunnel was significantly smaller in CTS patients (0.0037 ± 0.0011 mm/degree) compared with controls (0.0082 ± 0.0026 mm/degree) (P < .05), especially in the proximal (0.0064 vs 0.0132 mm/degree on average) and middle (0.0033 vs 0.0074 mm/degree on average) carpal tunnel sections. DISCUSSION: Median nerve mobility can potentially serve as a biomechanical marker when diagnosing CTS, or when assessing the effectiveness of surgical and conservative treatments.


Assuntos
Síndrome do Túnel Carpal/fisiopatologia , Nervo Mediano/fisiopatologia , Adulto , Idoso , Fenômenos Biomecânicos/fisiologia , Síndrome do Túnel Carpal/diagnóstico por imagem , Feminino , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Ultrassonografia
17.
J Hand Surg Asian Pac Vol ; 25(3): 307-314, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32723044

RESUMO

Background: The neural surgical options for reconstruction of elbow flexion in brachial plexus injuries depend on the availability of nerve donors. In upper-type avulsion injuries, the ulnar or median nerves, when intact, are reliable intra-plexal donor nerves for transfers to the biceps muscle. In complete avulsion injuries, donors are limited to extra-plexal sources, such as intercostal nerves (ICNs). Methods: We reviewed our results of ICN and partial distal nerve (ulnar or median) transfers for elbow flexion reconstruction in patients with brachial plexus avulsion injuries. The time taken for recovery of elbow flexion strength to M3 and the final motor outcome at 2 years were compared between both groups. Results: 38 patients were included in this study. 27 had ICN transfers to the musculocutaneous nerve (MCN), 8 had partial ulnar nerve transfers and 3 had partial median nerve transfers to the MCN's biceps motor branch. The mean time interval from injury to surgery was 3.6 months. Recovery of elbow flexion was observed earlier in the distal nerve transfer group (p < 0.05). Overall, success rates were higher in patients with distal nerve transfers (100%), compared to ICN transfers (63%) at 2 years (p = 0.018). Patients with distal nerve transfers achieved a higher final median strength of M4.0 [Interquartile range (IQR) 3.5-4.5], compared to M3.5 (IQR 2.0-4.0) in the ICN group (p = 0.031). In the subgroup of patients with upper-type brachial plexus injuries, there were no significant differences in motor outcomes between the ICN versus distal nerve transfers group. Conclusions: In our entire cohort, patients with distal nerve transfers had faster motor recovery and better elbow flexion power than patients with ICN transfers. In patients with partial brachial plexus injuries, outcomes of ICN transfers were not inferior to distal nerve transfers.


Assuntos
Plexo Braquial/cirurgia , Desenluvamentos Cutâneos/cirurgia , Articulação do Cotovelo/fisiologia , Transferência de Nervo , Amplitude de Movimento Articular/fisiologia , Adolescente , Adulto , Plexo Braquial/lesões , Estudos de Coortes , Feminino , Humanos , Nervos Intercostais/cirurgia , Masculino , Nervo Mediano/cirurgia , Pessoa de Meia-Idade , Nervo Musculocutâneo/cirurgia , Estudos Retrospectivos , Nervo Ulnar/cirurgia , Adulto Jovem
18.
J Hand Surg Asian Pac Vol ; 25(3): 373-377, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32723057

RESUMO

Management of malignant peripheral nerve sheath tumours (MPNSTs) is primarily surgical, involving surgical resection with wide margins, and frequently radiation therapy. When a MPNST involves a major peripheral nerve, wide resection leads to significant distal neurologic deficits. A patient who underwent resection of a MPNST involving the median nerve above the elbow is presented. Staged tendon and nerve transfers were performed to restore sensation to the thumb and index finger, thumb opposition and flexion, finger flexion and forearm pronation. These included: 1. radial sensory nerve branches to digital nerves of thumb and index finger, 2. ulnar nerve branch of flexor carpi ulnaris to pronator teres, 3. brachioradialis to flexor pollicis longus, 4. side-to-side transfer of flexor digitorum profundus tendon of index finger to middle, ring and little fingers, 5. extensor indicis proprius to abductor pollicis brevis. The rationale, approach, and favourable results of functional reconstruction in this patient are detailed.


Assuntos
Nervo Mediano/cirurgia , Transferência de Nervo , Neurofibrossarcoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/cirurgia , Transferência Tendinosa , Adulto , Humanos , Masculino , Nervo Radial/cirurgia , Nervo Ulnar/cirurgia
20.
J Neurosci ; 40(34): 6572-6583, 2020 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-32719161

RESUMO

Brain responses vary considerably from moment to moment, even to identical sensory stimuli. This has been attributed to changes in instantaneous neuronal states determining the system's excitability. Yet the spatiotemporal organization of these dynamics remains poorly understood. Here we test whether variability in stimulus-evoked activity can be interpreted within the framework of criticality, which postulates dynamics of neural systems to be tuned toward the phase transition between stability and instability as is reflected in scale-free fluctuations in spontaneous neural activity. Using a novel noninvasive approach in 33 male human participants, we tracked instantaneous cortical excitability by inferring the magnitude of excitatory postsynaptic currents from the N20 component of the somatosensory evoked potential. Fluctuations of cortical excitability demonstrated long-range temporal dependencies decaying according to a power law across trials, a hallmark of systems at critical states. As these dynamics covaried with changes in prestimulus oscillatory activity in the alpha band (8-13 Hz), we establish a mechanistic link between ongoing and evoked activity through cortical excitability and argue that the co-emergence of common temporal power laws may indeed originate from neural networks poised close to a critical state. In contrast, no signatures of criticality were found in subcortical or peripheral nerve activity. Thus, criticality may represent a parsimonious organizing principle of variability in stimulus-related brain processes on a cortical level, possibly reflecting a delicate equilibrium between robustness and flexibility of neural responses to external stimuli.SIGNIFICANCE STATEMENT Variability of neural responses in primary sensory areas is puzzling, as it is detrimental to the exact mapping between stimulus features and neural activity. However, such variability can be beneficial for information processing in neural networks if it is of a specific nature, namely, if dynamics are poised at a so-called critical state characterized by a scale-free spatiotemporal structure. Here, we demonstrate the existence of a link between signatures of criticality in ongoing and evoked activity through cortical excitability, which fills the long-standing gap between two major directions of research on neural variability: the impact of instantaneous brain states on stimulus processing on the one hand and the scale-free organization of spatiotemporal network dynamics of spontaneous activity on the other.


Assuntos
Ritmo alfa , Excitabilidade Cortical , Potenciais Somatossensoriais Evocados , Córtex Somatossensorial/fisiologia , Percepção do Tato/fisiologia , Adulto , Estimulação Elétrica , Humanos , Masculino , Nervo Mediano/fisiologia , Processamento de Sinais Assistido por Computador , Adulto Jovem
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