Factors predicting sensory and motor recovery after the repair of upper limb peripheral nerve injuries

OBJECTIVE: To investigate the factors associated with sensory and motor recovery after the repair of upper limb peripheral nerve injuries. DATA SOURCES: The online PubMed database was searched for English articles describing outcomes after the repair of median, ulnar, radial, and digital nerve injuries in humans with a publication date between 1 January 1990 and 16 February 2011. STUDY SELECTION: The following types of article were selected: (1) clinical trials describing the repair of median, ulnar, radial, and digital nerve injuries published in English; and (2) studies that reported sufficient patient information, including age, mechanism of injury, nerve injured, injury location, defect length, repair time, repair method, and repair materials. SPSS 13.0 software was used to perform univariate and multivariate logistic regression analyses and to investigate the patient and intervention factors associated with outcomes. MAIN OUTCOME MEASURES: Sensory function was assessed using the Mackinnon-Dellon scale and motor function was assessed using the manual muscle test. Satisfactory motor recovery was defined as grade M4 or M5, and satisfactory sensory recovery was defined as grade S3+ or S4. RESULTS: Seventy-one articles were included in this study. Univariate and multivariate logistic regression analyses showed that repair time, repair materials, and nerve injured were independent predictors of outcome after the repair of nerve injuries (P < 0.05), and that the nerve injured was the main factor affecting the rate of good to excellent recovery. CONCLUSION: Predictors of outcome after the repair of peripheral nerve injuries include age, gender, repair time, repair materials, nerve injured, defect length, and duration of follow-up.

[1]  Bo He,et al.  Safety and efficacy evaluation of a human acellular nerve graft as a digital nerve scaffold: a prospective, multicentre controlled clinical trial , 2015, Journal of tissue engineering and regenerative medicine.

[2]  John W Haycock,et al.  Next generation nerve guides: materials, fabrication, growth factors, and cell delivery. , 2012, Tissue engineering. Part B, Reviews.

[3]  W. Lineaweaver,et al.  Comparisons of outcomes from repair of median nerve and ulnar nerve defect with nerve graft and tubulization: a meta-analysis. , 2011, Journal of reconstructive microsurgery.

[4]  M. Mohseni,et al.  Primary and delayed repair and nerve grafting for treatment of cut median and ulnar nerves. , 2010, Pakistan journal of biological sciences : PJBS.

[5]  D. Chuang,et al.  Outcomes of Nerve Reconstruction for Radial Nerve Injuries Based on the Level of Injury in 244 Operative Cases , 2010, The Journal of hand surgery, European volume.

[6]  S. Hovius,et al.  Cognitive capacity: no association with recovery of sensibility by Semmes Weinstein test score after peripheral nerve injury of the forearm. , 2010, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[7]  I. Marcoccio,et al.  Muscle-in-vein nerve guide for secondary reconstruction in digital nerve lesions. , 2010, The Journal of hand surgery.

[8]  E. Nordh,et al.  Clinical evaluation of a resorbable wrap-around implant as an alternative to nerve repair: a prospective, assessor-blinded, randomised clinical study of sensory, motor and functional recovery after peripheral nerve repair. , 2009, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[9]  J. Murovic.  UPPER‐EXTREMITY PERIPHERAL NERVE INJURIES: A LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER LITERATURE REVIEW WITH COMPARISON OF THE OPERATIVE OUTCOMES OF 1837 LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER MEDIAN, RADIAL, AND ULNAR NERVE LESIONS , 2009, Neurosurgery.

[10]  F. Becchetti,et al.  Upper limb nerve injuries in developmental age , 2009, Microsurgery.

[11]  P. Papagelopoulos,et al.  Effect of sensory re-education after low median nerve complete transection and repair. , 2009, The Journal of hand surgery.

[12]  F. Siemers,et al.  Nerve Injuries of the Upper Extremity—Expected Outcome and Clinical Examination , 2009, Plastic surgical nursing : official journal of the American Society of Plastic and Reconstructive Surgical Nurses.

[13]  Hans-Günther Machens,et al.  The clinical use of artificial nerve conduits for digital nerve repair: a prospective cohort study and literature review. , 2009, Journal of reconstructive microsurgery.

[14]  Hao Jiang,et al.  Repair of electrically injured median nerve with the aid of somatosensory evoked potential , 2009, Microsurgery.

[15]  J. Terzis,et al.  Outcomes of Secondary Reconstruction of Ulnar Nerve Lesions: Our Experience , 2008, Plastic and reconstructive surgery.

[16]  Brandon D Bushnell,et al.  Early clinical experience with collagen nerve tubes in digital nerve repair. , 2008, The Journal of hand surgery.

[17]  H. Seçer,et al.  The clinical, electrophysiologic, and surgical characteristics of peripheral nerve injuries caused by gunshot wounds in adults: a 40-year experience. , 2008, Surgical neurology.

[18]  G. Baek,et al.  Sural nerve autografts for high radial nerve injury with nine centimeter or greater defects. , 2008, The Journal of hand surgery.

[19]  S. Shieh,et al.  Secondary nerve reconstruction using vein conduit grafts for neglected digital nerve injuries , 2008, Microsurgery.

[20]  A. Shiha,et al.  Early surgical exploration of radial nerve injury associated with fracture shaft humerus , 2008, Microsurgery.

[21]  H. Seçer,et al.  Surgical repair of ulnar nerve lesions caused by gunshot and shrapnel: results in 407 lesions. , 2007, Journal of neurosurgery.

[22]  D. Kuffler,et al.  A novel technique leading to complete sensory and motor recovery across a long peripheral nerve gap. , 2007, Puerto Rico health sciences journal.

[23]  M. Pieniążek,et al.  Regimen and results of physiotherapy in patients following surgical treatment of ulnar nerve injury. , 2007, Ortopedia, traumatologia, rehabilitacja.

[24]  M. Savic,et al.  Radial nerve repair using an autologous denatured muscle graft: comparison with outcomes of nerve graft repair , 2007, Acta Neurochirurgica.

[25]  M. Raschke,et al.  Long-term results after primary microsurgical repair of ulnar and median nerve injuries A comparison of common score systems , 2007, Clinical Neurology and Neurosurgery.

[26]  S. Shieh,et al.  Long-term functional results of primary reconstruction of severe forearm injuries. , 2007, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[27]  E. C. Sánchez,et al.  Hyperbaric oxygenation in peripheral nerve repair and regeneration , 2007, Neurological research.

[28]  A. Dellon,et al.  Reconstruction of the human median nerve in the forearm with the Neurotube™ , 2007, Microsurgery.

[29]  G. Gozzo,et al.  Microsurgical treatment of injury to peripheral nerves in upper and lower limbs: A critical review of the last 8 years , 2007, Microsurgery.

[30]  G. Pavlićević,et al.  Difference in Recovery Potential of Peripheral Nerves after Graft Repairs , 2006, Neurosurgery.

[31]  Tamara J Bond,et al.  Physical therapy following peripheral nerve surgeries. , 2006, Clinics in podiatric medicine and surgery.

[32]  S. Hovius,et al.  Median and Ulnar Nerve Injuries: A Meta-Analysis of Predictors of Motor and Sensory Recovery after Modern Microsurgical Nerve Repair , 2005, Plastic and reconstructive surgery.

[33]  Z. Roganović.  Missile-caused median nerve injuries: results of 81 repairs. , 2005, Surgical neurology.

[34]  G. Lundborg,et al.  Injury to the Human Median and Ulnar Nerves in the Forearm – Analysis of Costs for Treatment and Rehabilitation of 69 Patients in Southern Sweden , 2005, Journal of hand surgery.

[35]  Stefano Geuna,et al.  Nerve repair by means of tubulization: Literature review and personal clinical experience comparing biological and synthetic conduits for sensory nerve repair , 2005, Microsurgery.

[36]  REPAIR OF MEDIAN AND ULNAR NERVES , 2005 .

[37]  H. Stam,et al.  Long-term outcome of muscle strength in ulnar and median nerve injury: comparing manual muscle strength testing, grip and pinch strength dynamometers and a new intrinsic muscle strength dynamometer. , 2004, Journal of rehabilitation medicine.

[38]  Z. Roganović.  Missile-caused Ulnar Nerve Injuries: Outcomes of 128 Repairs , 2004, Neurosurgery.

[39]  S. Petković,et al.  Missile severances of the radial nerve. Results of 131 repairs , 2004, Acta Neurochirurgica.

[40]  Y. Izci,et al.  Surgical Outcomes of Ulnar Nerve Lesions in Children , 2004, Pediatric Neurosurgery.

[41]  B. Rosén,et al.  Tubular Repair of the Median or Ulnar Nerve in the Human Forearm: A 5-Year Follow-Up , 2004, Journal of hand surgery.

[42]  M. Merle,et al.  Surgical treatment of traumatic lesions of the axillary nerve. A retrospective study of 33 cases. , 2004, Acta orthopaedica Belgica.

[43]  S. Aktaş,et al.  Clinical evaluation of ulnar nerve repair at wrist level , 2004, Archives of Orthopaedic and Trauma Surgery.

[44]  T. Manabe,et al.  Vascularized nerve grafts for the treatment of large nerve gap after severe trauma to an upper extremity , 2004, Archives of Orthopaedic and Trauma Surgery.

[45]  Daniel H. Kim,et al.  Surgical outcomes of 654 ulnar nerve lesions. , 2003, Journal of neurosurgery.

[46]  M. Meek,et al.  Recovery of touch after median nerve lesion and subsequent repair , 2003, Microsurgery.

[47]  Guopeng Yu.  To improve the diagnosis and treatment of peripheral nerve injuries , 2003 .

[48]  T. Ogino,et al.  Digital nerve grafting using the terminal branch of posterior interosseous nerve: a report of three cases. , 2002, Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand.

[49]  K. An,et al.  Revascularization of nerve grafts: a qualitative and quantitative study of the soft-tissue bed contributions to blood flow in canine nerve grafts. , 2002, The Journal of hand surgery.

[50]  J. Passchier,et al.  Early Psychological Stress After Forearm Nerve Injuries: A Predictor for Long-Term Functional Outcome and Return to Productivity , 2002, Annals of plastic surgery.

[51]  R. Gore,et al.  The radial and posterior interosseous nerves. , 2002, The Journal of bone and joint surgery. British volume.

[52]  A. Baktır,et al.  Results of treatment of the extensive volar wrist lacerations: ‘the spaghetti wrist’ , 2002, European journal of emergency medicine : official journal of the European Society for Emergency Medicine.

[53]  M. Meek,et al.  Clinical Use of Nerve Conduits in Peripheral-Nerve Repair: Review of the Literature , 2002, Journal of reconstructive microsurgery.

[54]  H. Buncke,et al.  The Harvest and Clinical Application of the Superficial Peroneal Sensory Nerve for Grafting Motor and Sensory Nerve Defects , 2002, Plastic and reconstructive surgery.

[55]  V. Matejčík.  Surgical treatment of peripheral nerve injuries in upper extremities. , 2002, Acta chirurgiae plasticae.

[56]  D. Zierold,et al.  Machete injuries in Haiti. , 2001, Military medicine.

[57]  D. H. Kim,et al.  Surgical management and outcome in patients with radial nerve lesions. , 2001, Journal of neurosurgery.

[58]  G. Lundborg,et al.  The use of silicone tubing in the late repair of the median and ulnar nerves in the forearm. , 2001, Journal of hand surgery.

[59]  R. Birch,et al.  The radial and posterior interosseous nerves. Results fo 260 repairs. , 2001, The Journal of bone and joint surgery. British volume.

[60]  G. Lundborg,et al.  The Long Term Recovery Curve in Adults after Median or Ulnar Nerve Repair: A Reference Interval , 2001, Journal of hand surgery.

[61]  M. Merle,et al.  A Comparison Between Clinical Results and Electromyographic Analysis After Median or Ulnar Nerve Injuries in Children’s Wrists , 2001, Annals of plastic surgery.

[62]  S. Wolfe,et al.  Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature. , 2001, The Journal of hand surgery.

[63]  K A Segalman,et al.  Digital Neurorrhaphy after the Age of 60 Years , 2001, Journal of reconstructive microsurgery.

[64]  K. Ozer,et al.  Restoration of sensibility in irreparable ulnar and median nerve lesions with use of sensory nerve transfer: long-term follow-up of 20 cases. , 2001, The Journal of hand surgery.

[65]  R. Birch,et al.  The musculocutaneous nerve. , 2000, The Journal of bone and joint surgery. British volume.

[66]  R. Weber,et al.  A Randomized Prospective Study of Polyglycolic Acid Conduits for Digital Nerve Reconstruction in Humans , 2000, Plastic and reconstructive surgery.

[67]  G. Lundborg,et al.  Brain Plasticity and Hand Surgery: an Overview , 2000, Journal of hand surgery.

[68]  E. Vanderhooft.  Functional outcomes of nerve grafts for the upper and lower extremities. , 2000, Hand clinics.

[69]  G. Mora,et al.  Surgical management of neural injuries associated with elbow fractures in children. , 1999, Journal of pediatric orthopedics.

[70]  D. Hudson,et al.  Primary epineural repair of the ulnar nerve in children. , 1999, The Journal of hand surgery.

[71]  J. Taha,et al.  Results of suture of the radial, median, and ulnar nerves after missile injury below the axilla. , 1998, The Journal of trauma.

[72]  A. Minami,et al.  Functional results of low median and ulnar nerve repair with intraneural fascicular dissection and electrical fascicular orientation. , 1998, The Journal of hand surgery.

[73]  R. Brown,et al.  Inter-relationships between angiogenesis and nerve regeneration: a histochemical study. , 1997, British journal of plastic surgery.

[74]  D. Hudson,et al.  Primary epineural repair of the median nerve in children. , 1997, Journal of hand surgery.

[75]  B. Rosén,et al.  Tubular versus conventional repair of median and ulnar nerves in the human forearm: early results from a prospective, randomized, clinical study. , 1997, The Journal of hand surgery.

[76]  A. D. Nozdrachev,et al.  [Dynamics of the restoration of the function of the skin receptor apparatus after cryogenic damage to the sciatic nerve]. , 1997, Patologicheskaia fiziologiia i eksperimental'naia terapiia.

[77]  J. Nunley,et al.  Results of interfascicular nerve grafting for radial nerve lesions , 1996, Microsurgery.

[78]  H. Tadjalli,et al.  Digital Nerve Repair: Relationship Between Severity of Injury and Sensibility Recovery , 1995, Annals of plastic surgery.

[79]  D. Efstathopoulos,et al.  Clinical assessment of primary digital nerve repair. , 1995, Acta orthopaedica Scandinavica. Supplementum.

[80]  T. Trumble,et al.  A technique to quantitate motor recovery following nerve grafting. , 1995, The Journal of hand surgery.

[81]  J B Tang,et al.  Vein Conduits with Interposition of Nerve Tissue for Peripheral Nerve Defects , 1995, Journal of reconstructive microsurgery.

[82]  A. Navarro-Quilis,et al.  Contralateral median nerve autograft. , 1995, Acta orthopaedica Belgica.

[83]  J B Tang,et al.  Vein conduits for repair of nerves with a prolonged gap or in unfavorable conditions: An analysis of three failed cases , 1995, Microsurgery.

[84]  G. Lundborg,et al.  Tubular Repair of the Median Nerve in the Human Forearm , 1994, Journal of hand surgery.

[85]  M. Barinaga.  Neurotrophic factors enter the clinic. , 1994, Science.

[86]  Tetsuya Watanabe,et al.  Ultra-high dose methylcobalamin promotes nerve regeneration in experimental acrylamide neuropathy , 1994, Journal of the Neurological Sciences.

[87]  S. Mackinnon,et al.  Correlation of Two‐Point Discrimination and Hand Function Following Median Nerve Injury , 1993, Annals of plastic surgery.

[88]  J. Calder,et al.  Interpreting the Results of Unilateral Digital Nerve Repair , 1993, Journal of hand surgery.

[89]  M. Vastamäki,et al.  The Results of Secondary Microsurgical Repair of Radial Nerve in 33 Patients , 1993, Journal of hand surgery.

[90]  M. Vastamäki,et al.  The Results of Secondary Microsurgical Repair of Ulnar Nerve Injury , 1993, Journal of hand surgery.

[91]  W. Girsch,et al.  Peripheral nerve repair in the hand with and without motor sensory differentiation. , 1993, The Journal of hand surgery.

[92]  M. Vastamäki,et al.  An Analysis of the Results of Late Reconstruction of 132 Median Nerves , 1993, Journal of hand surgery.

[93]  R. W. Norris,et al.  Repair of mixed peripheral nerves using muscle autografts: a preliminary communication. , 1993, British journal of plastic surgery.

[94]  C. Barrios,et al.  Surgical management of nerve injuries of the upper extremity in children: a 15-year survey. , 1991, Journal of pediatric orthopedics.

[95]  R. Birch,et al.  Repair of median and ulnar nerves. Primary suture is best. , 1991, The Journal of bone and joint surgery. British volume.

[96]  Susan E. Mackinnon,et al.  Clinical Nerve Reconstruction with a Bioabsorbable Polyglycolic Acid Tube , 1990, Plastic and reconstructive surgery.

[97]  C. Barrios,et al.  Secondary repair of ulnar nerve injury. 44 cases followed for 2 years. , 1990, Acta orthopaedica Scandinavica.

[98]  J. Haase,et al.  Median and ulnar nerve transections treated with microsurgical interfascicular cable grafting with autogenous sural nerve. , 1980, Journal of neurosurgery.

[99]  A. Ward.  Nerves and Nerve Injuries , 1970, Neurology.