Evaluation and surgical management of peripheral nerve problems.

OBJECTIVE To illustrate how an understanding of the basic biological responses of peripheral nerves to injury is important in formulating a rational treatment plan. METHODS Peripheral nerve anatomy and physiology are described in a context that is relevant to understanding the different grades of peripheral nerve injury. Methods of evaluating and treating peripheral nerve injuries both medically and surgically are reviewed. Relevant scientific studies with potential clinical impact are also discussed. RESULTS The clinical symptoms, physical findings, and electrodiagnostic and imaging test results relevant to the diagnosis of peripheral nerve problems are reviewed. Conventional and new medical or surgical strategies in the management of peripheral nerve injuries and mass lesions are described. CONCLUSION The diagnosis and treatment of peripheral nerve injuries follow logically from an understanding of the biological responses of peripheral nerves after injury and during recovery.

[1]  Benson Ea.  Letter: Prevention of wound infection in acute appendicitis. , 1973 .

[2]  C. Bufalini,et al.  Posterior cervical electromyography in the diagnosis and prognosis of brachial plexus injuries. , 1969, Journal of Bone and Joint Surgery-british Volume.

[3]  Internal neurolysis in traumatic peripheral nerve lesions in continuity. , 1972, The Surgical clinics of North America.

[4]  J. Roberts,et al.  The effect of occlusive arterial diseases of the extremities on the blood supply of nerves; experimental and clinical studies on the role of the vasa nervorum. , 1948, American heart journal.

[5]  J. Nunley,et al.  Nerve transposition for the restoration of elbow flexion following brachial plexus avulsion injuries. , 1990, Journal of neurosurgery.

[6]  G. Nikkhah,et al.  Diagnosis of root avulsions in traumatic brachial plexus injuries: value of computerized tomography myelography and magnetic resonance imaging. , 1997, Journal of neurosurgery.

[7]  J. Tsuruda,et al.  Magnetic resonance neurography of peripheral nerve lesions in the lower extremity. , 1996, Neurosurgery.

[8]  R. Taylor,et al.  Brachial plexus root avulsion: role of myelography--review of diagnostic procedures. , 1975, The Journal of trauma.

[9]  M. Kofler,et al.  The role of motor evoked potentials during surgery for intramedullary spinal cord tumors. , 1997, Neurosurgery.

[10]  A. Gitter,et al.  Ulnar nerve entrapment at the elbow: correlation of magnetic resonance imaging, clinical, electrodiagnostic, and intraoperative findings. , 1996, Neurosurgery.

[11]  S SUNDERLAND,et al.  The intraneural topography of the radial, median and ulnar nerves. , 1945, Brain : a journal of neurology.

[12]  D. Grujičić,et al.  Reinnervation of avulsed brachial plexus using the spinal accessory nerve. , 1990, Surgical neurology.

[13]  D. Kline.  Civilian gunshot wounds to the brachial plexus. , 1989, Journal of neurosurgery.

[14]  Iyer Vg.  Understanding nerve conduction and electromyographic studies. , 1993 .

[15]  J. McGillicuddy.  Clinical decision making in brachial plexus injuries. , 1991, Neurosurgery clinics of North America.

[16]  J. S. Keene,et al.  Risk factors for restricted motion after anterior cruciate reconstruction. , 1994, Orthopedics.

[17]  R. Martini.  Expression and functional roles of neural cell surface molecules and extracellular matrix components during development and regeneration of peripheral nerves , 1994, Journal of neurocytology.

[18]  H. J. Seddon,et al.  THREE TYPES OF NERVE INJURY , 1943 .

[19]  Dolenc Vv.  Intercostal neurotization of the peripheral nerves in avulsion plexus injuries. , 1984 .

[20]  T. Carlstedt.  Spinal nerve root injuries in brachial plexus lesions: Basic science and clinical application of new surgical strategies. A review , 1995, Microsurgery.

[21]  V. Synek,et al.  Somatosensory evoked potentials in patients with supraclavicular brachial plexus injuries , 1982, Neurology.

[22]  F. M. Howard.  Electromyography and conduction studies in peripheral nerve injuries. , 1972, The Surgical clinics of North America.

[23]  N. Obuchowski,et al.  Association between peridural scar and recurrent radicular pain after lumbar discectomy: magnetic resonance evaluation. ADCON-L European Study Group. , 1996, Neurosurgery.

[24]  F. H. Lewey,et al.  Tensile strength of human nerves; an experimental physical and histologic study. , 1948, Archives of neurology and psychiatry.

[25]  E. Moberg,et al.  Objective methods for determining the functional value of sensibility in the hand. , 1958, The Journal of bone and joint surgery. British volume.

[26]  J. Tsuruda,et al.  Magnetic resonance imaging signal changes in denervated muscles after peripheral nerve injury. , 1994, Neurosurgery.

[27]  G. Brunelli,et al.  Invited review: Different conduits in peripheral nerve surgery , 1994 .

[28]  J. Silver,et al.  A carbohydrate polymer that effectively prevents epidural fibrosis at laminectomy sites in the rat , 1991, Experimental Neurology.

[29]  W. Henderson.  Clinical assessment of peripheral nerve injuries; Tinel's test. , 1948, Lancet.

[30]  H. B. Williams,et al.  THE NERVE GAP: SUTURE UNDER TENSION VS. GRAFT , 1975, Plastic and reconstructive surgery.

[31]  TM Brushart,et al.  Preferential reinnervation of motor nerves by regenerating motor axons , 1988, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[32]  G. Frykman,et al.  The quest for better recovery from peripheral nerve injury: current status of nerve regeneration research. , 1993, Journal of hand therapy : official journal of the American Society of Hand Therapists.

[33]  A. Dellon.  i) Clinical assessment of peripheral nerve injuries , 1993 .

[34]  J. Young,et al.  Nerve regeneration after immediate and delayed suture. , 1942, Journal of anatomy.

[35]  D. Kline,et al.  Surgery for lesions of the brachial plexus. , 1986, Archives of neurology.

[36]  H. Richter,et al.  Value of nerve action potentials in the surgical management of traumatic nerve lesions. , 1997, Neurosurgery.

[37]  D. Norman,et al.  Computerized tomography of peripheral nerve lesions. , 1983, Journal of neurosurgery.

[38]  A. Shetter,et al.  Comparative study of microepineurial anastomoses with the use of CO2 laser and suture techniques in rat sciatic nerves: Part 1. Surgical technique, nerve action potentials, and morphological studies. , 1985, Neurosurgery.

[39]  G Lundborg,et al.  Effects of stretching the tibial nerve of the rabbit. A preliminary study of the intraneural circulation and the barrier function of the perineurium. , 1973, The Journal of bone and joint surgery. British volume.

[40]  D. Kline.  Surgical repair of peripheral nerve injury , 1990, Muscle & nerve.

[41]  J R Griffiths,et al.  Application of magnetic resonance neurography in the evaluation of patients with peripheral nerve pathology. , 1996, Journal of neurosurgery.

[42]  T. Gordon,et al.  Long-term response to nerve injury. , 1997, Advances in neurology.

[43]  B. Shahani,et al.  The investigation of traumatic lesions of the brachial plexus by electromyography and short latency somatosensory potentials evoked by stimulation of multiple peripheral nerves. , 1983, Journal of neurology, neurosurgery, and psychiatry.

[44]  P. Richardson,et al.  Peripheral nerve injury , 1994, Current opinion in neurology.

[45]  S. Mackinnon,et al.  Enhancing nerve regeneration across a silicone tube conduit by using interposed short-segment nerve grafts. , 1997, Journal of neurosurgery.

[46]  Virginia M. Y. Lee,et al.  Myelin-Associated Glycoprotein Is a Myelin Signal that Modulates the Caliber of Myelinated Axons , 1998, The Journal of Neuroscience.

[47]  D. Kline,et al.  Neural sheath tumors of major nerves. , 1994, Journal of neurosurgery.

[48]  J. Buckwalter.  Activity vs. rest in the treatment of bone, soft tissue and joint injuries. , 1995, The Iowa Orthopaedic Journal.

[49]  S. Sunderland,et al.  STRESS-STRAIN PHENOMENA IN HUMAN PERIPHERAL NERVE TRUNKS , 1961 .

[50]  G. J. Romanes,et al.  Current Problems of Lower Vertebrate Phylogeny. , 1969 .

[51]  C. Gravel,et al.  Adenoviral gene transfer of ciliary neurotrophic factor and brain-derived neurotrophic factor leads to long-term survival of axotomized motor neurons , 1997, Nature Medicine.

[52]  Swei-Ming Lin,et al.  Intraoperative monitoring of motor function by magnetic motor evoked potentials. , 1995 .

[53]  S. Sunderland,et al.  The cross-sectional area of peripheral nerve trunks devoted to nerve fibers. , 1949, Brain : a journal of neurology.

[54]  H. Millesi.  Surgical management of brachial plexus injuries. , 1977, The Journal of hand surgery.

[55]  H. Millesi.  Reappraisal of nerve repair. , 1981, The Surgical clinics of North America.

[56]  M Swash,et al.  Longitudinal sliding of the median nerve during movements of the upper limb. , 1976, Journal of neurology, neurosurgery, and psychiatry.

[57]  J. Tsuruda,et al.  Magnetic resonance neurography of peripheral nerve degeneration and regeneration , 1997, The Lancet.

[58]  D. Kline,et al.  Selected recent advances in peripheral nerve injury research. , 1985, Surgical neurology.

[59]  F. Netter.  Atlas of Human Anatomy , 1967 .

[60]  W. O’Connor,et al.  Early results of continuous passive motion after rotator cuff repair: a prospective, randomized, blinded, controlled study. , 1996, American journal of orthopedics.

[61]  S. Hoppenfeld,et al.  Physical examination of the spine and extremities , 1976 .

[62]  J. Robertson,et al.  The reduction of postlaminectomy peridural fibrosis in rabbits by a carbohydrate polymer. , 1993, Journal of neurosurgery.

[63]  E E Almquist,et al.  Nerve repair by laser. , 1988, The Orthopedic clinics of North America.

[64]  E. F. Wilgis,et al.  The significance of longitudinal excursion in peripheral nerves. , 1986, Hand clinics.

[65]  G. Nikkhah,et al.  Surgical reconstruction of the musculocutaneous nerve in traumatic brachial plexus injuries , 1997 .

[66]  D. L. Mclellan.  LONGITUDINAL SLIDING OF MEDIAN NERVE DURING HAND MOVEMENTS: A CONTRIBUTORY FACTOR IN ENTRAPMENT NEUROPATHY ? , 1975, The Lancet.

[67]  M. Malessy,et al.  Evaluation of intercostal to musculocutaneous nerve transfer in reconstructive brachial plexus surgery. , 1998, Journal of neurosurgery.

[68]  J. Tsuruda,et al.  Magnetic resonance neurography , 1993, The Lancet.

[69]  R. Birch,et al.  Surgical Disorders of the Peripheral Nerves , 1998 .

[70]  R Goodkin,et al.  Carpal tunnel syndrome: correlation of magnetic resonance imaging, clinical, electrodiagnostic, and intraoperative findings. , 1995, Neurosurgery.

[71]  R. Gilliatt.  Physical injury to peripheral nerves. Physiologic and electrodiagnostic aspects. , 1981, Mayo Clinic proceedings.

[72]  D. Kline,et al.  Evaluation of nerve injuries by evoked potentials and electromyography. , 1969, Journal of neurosurgery.

[73]  W. Trojaborg.  Rate of recovery in motor and sensory fibres of the radial nerve: clinical and electrophysiological aspects1 , 1970, Journal of neurology, neurosurgery, and psychiatry.

[74]  Y. Gu,et al.  Phrenic nerve transfer for treatment of root avulsion of the brachial plexus. , 1990, Chinese medical journal.

[75]  S SUNDERLAND,et al.  A classification of peripheral nerve injuries producing loss of function. , 1951, Brain : a journal of neurology.

[76]  L. C. Russell,et al.  Reduction of extraneural scarring by ADCON-T/N after surgical intervention. , 1996, Neurosurgery.

[77]  A. Narakas.  Thoughts on neurotization or nerve transfers in irreparable nerve lesions. , 1984, Clinics in Plastic Surgery.

[78]  D. Kline,et al.  Operative management of selected brachial plexus lesions. , 1983, Journal of neurosurgery.

[79]  T. Carlstedt,et al.  Repair of ruptured spinal nerve roots in a brachial plexus lesion. Case report. , 1995, Journal of neurosurgery.

[80]  W. Mobley,et al.  Therapeutic potential of neurotrophic factors for neurological disorders , 1996, Annals of neurology.

[81]  M. Sundaram,et al.  Magnetic resonance imaging of soft tissue masses: an evaluation of fifty-three histologically proven tumors. , 1988, Magnetic resonance imaging.

[82]  R. Dykes,et al.  Electrophysiological recordings in peripheral nerve surgery: a review. , 1976, The Journal of hand surgery.

[83]  B. Tedeschi,et al.  Peripheral nerve regeneration. , 1991, Neurosurgery clinics of North America.

[84]  G. Peterson,et al.  Coaptation of the anterior rami of C-3 and C-4 to the upper trunk of the brachial plexus for cervical nerve root avulsion. , 1991, Journal of neurosurgery.

[85]  R. Cracco.  Evaluation of conduction in central motor pathways: techniques, pathophysiology, and clinical interpretation. , 1987, Neurosurgery.

[86]  T. Carlstedt,et al.  Return of function after spinal cord implantation of avulsed spinal nerve roots , 1995, The Lancet.

[87]  H. Göranson,et al.  Mr Imaging of Benign Peripheral Nerve Sheath Tumors , 1994, Acta radiologica.

[88]  G. Bourne,et al.  Perineural Epithelium: A New Concept of its Role in the Integrity of the Peripheral Nervous System , 1966, Science.

[89]  J. Tsuruda,et al.  Magnetic resonance neurography for cervical radiculopathy: a preliminary report. , 1996, Neurosurgery.

[90]  A. Narakas.  The use of fibrin glue in repair of peripheral nerves. , 1988, The Orthopedic clinics of North America.

[91]  M. Spinner,et al.  Management of Peripheral Nerve Problems , 1980 .

[92]  W. Friedman.  The electrophysiology of peripheral nerve injuries. , 1991, Neurosurgery clinics of North America.

[93]  L. Landmesser.  The development of specific motor pathways in the chick embryo , 1984, Trends in Neurosciences.