An ultrasound-guided percutaneous nerve stimulation regimen based on finite element modeling for median nerve rupture

Abstract

Object: In order to promote the functional recovery of median nerve rupture patients, this paper proposes an ultrasound-guided percutaneous nerve stimulation regimen based on finite element modeling. Method: First, according to anatomy feature, a multi-layer human forearm model is constructed. What’s more, taking current density and activate function as optimization indicators, the percutaneous nerve stimulation regimen is designed with finite element modeling, including electrical needle angel, distance and position. Finally, to test the performance of designed regimen, a total of 22 patients with median nerve rupture participate in the clinical randomized controlled trial. And the clinical treatment effect is evaluated with BMRC, grip strength, functional score of median nerve and DASH scores. Results: The designed percutaneous nerve stimulation regimen is that, parallel to each other, electrical needles are located at both ends of the injury nerve with a distance of 3 cm. Besides, clinical trial results show that, after treatment the difference in sensory function was statistically significant. In terms of motor function, the BMRC of motor and grip strength are improved in both groups after treatment and there are significant differences between groups. Besides the grip strength improvement of experimental group is 4 times higher than that of control group. On global function, the DASH scores are reduced by 29% with experimental group but only 8% with control group; functional score of median nerve improved by 24% in the experimental group and by 22% in the control group, but the difference between groups is statistically significant after treatment. Conclusion: Clinical trial results demonstrate that the designed percutaneous nerve stimulation regimen can significantly improve the sensory, motor and global function of median nerve rupture, which is a potential clinical treatment regimen. Trial registration: ChiCTR, ChiCTR2000030790. Registered14 march 2020, http://www.chictr.org.cn/ChiCTR2000030790

A Systematic Review of Registered Clinical Trials for Peripheral Nerve Injuries

“…Despite advancements, surgical treatments are considered the primary method for treating nerve injuries. Techniques such as electrical stimulation therapy have been found to promote axon growth during nerve repair and hasten sensorimotor recovery 19,21,24,29,30,33–35,110–113 . A systematic review by Costello et al 114 further corroborates the potential of electrical stimulation as a beneficial nonsurgical intervention for PNIs, aligning with the diverse treatment methodologies emphasized in this review.…”

“…Electrical stimulation was a prominent method studied in 8 studies 19,21,24,29,30,33–35 . Of these, 6 are still in the active phase 21,24,29,33–35 and 2 have completed enrollment 19,30 . Mirror therapy was evaluated in 4 studies, 3 of which are completed and 1 is still actively recruiting 15,18,25,32 .…”

“…The reporting quality of the registered clinical trials included in this study varied across the selected studies. Eleven trials adhered to recommended reporting guidelines and provided detailed information on their data sharing, study design, interventions, outcome measures, and participant characteristics 14,22,29,31,36–39,42,45,92 . These trials provided description of their methodology, including randomization procedures and blinding protocols.…”

News in Brief

“…Local infection at the site of stimulator placement can lead to spread of infection to not only nearby structures, but also systemically. 29 For pacemakers and automated implantable cardioverter defibrillators, it is advised to consult a cardiologist for prior approval before placement of the peripheral nerve stimulator. 11 For severe psychological conditions, psychological screening is recommended before placement of the implant.…”

“…In an RCT of patients who had median nerve transection, ultrasound-guided electrical nerve stimulation was able to lead to vast improvement in patients' sensory and motor function. 29 Peripheral nerve injuries often result in limited functional recovery even after surgery, causing permanent motor and sensory deficits.…”