How electrodiagnosis predicts clinical outcome of focal peripheral nerve lesions

Robinson, Lawrence R.

doi:10.1002/mus.24709

Cited by 61 publications

(44 citation statements)

References 73 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…23 One should not delay any exploration of an injured nerve, if there is a strong indication for exploration, by waiting for an electrophysiological examination. Intra-operative nerve conduction and electrical stimulation of individual nerve branches or fascicles can be of great help in deciding how a nerve reconstruction of a nerve injury in continuity should be done since some intact fascicles can be spared if functional axons are located.…”

Section: Cellular Reactions After Nerve Injurymentioning

confidence: 99%

Nerve injuries of the upper extremity and hand

Dahlin

Wiberg

2017

EFORT Open Reviews

View full text Add to dashboard Cite

A nerve injury has a profound impact on the patient’s daily life due to the impaired sensory and motor function, impaired dexterity, sensitivity to cold as well as eventual pain problems.To perform an appropriate treatment of nerve injuries, a correct diagnosis must be made, where the injury is properly classified, leading to an optimal surgical approach and technique, where timing of surgery is also important for the outcome.Knowledge about the nerve regeneration process, where delicate processes occur in neurons, non-neuronal cells (i.e. Schwann cells) and other cells in the peripheral as well as the central nervous systems, is crucial for the treating surgeon.The surgical decision to perform nerve repair and/or reconstruction depends on the type of injury, the condition of the wound as well as the vascularity of the wound.To reconnect injured nerve ends, various techniques can be used, which include both epineurial and fascicular nerve repair, and if a nerve defect is caused by the injury, a nerve reconstruction procedure has to be performed, including bridging the defect using nerve-grafts or nerve transfer techniques.The patients must be evaluated properly and regularly after the surgical procedure and appropriate rehabilitation programmes are useful to improve the final outcome.Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160071. Originally published online at www.efortopenreviews.org

show abstract

Section: Cellular Reactions After Nerve Injurymentioning

confidence: 99%

Nerve injuries of the upper extremity and hand

Dahlin

Wiberg

2017

EFORT Open Reviews

View full text Add to dashboard Cite

show abstract

“…Thirteen of 16 articles demonstrated an additive predictive value of EDx. Prognostication of NBPP depends on extent, severity of the lesion, recruitment in muscles supplied by the damaged nerve, and the individual speed of recovery . EDx should provide this information accurately.…”

Section: Discussionmentioning

confidence: 99%

“…EDx can help to distinguish between these lesions. Comparing distal and proximal CMAP gives an estimation of the conduction block. In the case of axonal loss, there are timing limitations for using CMAP: using this measure too early or too late can overestimate the number of viable axons.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Early electrodiagnosis in the management of neonatal brachial plexus palsy: A systematic review

et al. 2019

View full text Add to dashboard Cite

Neonatal brachial plexus palsy (NBPP) is a prominent form of newborn morbidity with a potentially disabling persistence. Neurosurgical intervention is indicated in select NBPP patients. Early prognostic assessment would facilitate rational selection of those infants for surgery. We conducted a systematic literature review to determine the prognostic value of early electrodiagnosis (EDx) in NBPP. We included 16 observational studies with a total sample size of 747 children. Risk of bias and quality of evidence were rated. Wide variation was found in EDx techniques, outcome algorithms, and decisionmaking. Nevertheless, the most methodologically sound studies support the use of EDx, at standardized time-frames, as a key prognostic modality for complementing clinical judgment and neuroimaging. An accurate knowledge of the underlying anatomy of the nerve injury helps to counsel families and to guide reconstructive strategy. K E Y W O R D S brachial plexus neuropathy, electrodiagnosis, electrodiagnostic testing, neonatal brachial plexus palsy, prognosis 1 | INTRODUCTION Neonatal brachial plexus palsy (NBPP) is reported to occur in 0.1 to 8.10 per 1000 live births worldwide. 1-6 It is the result of a closed nerve stretch injury to the brachial plexus during the perinatal period. The most common lesions occur within the C5 and C6 spinal nerves (80% of patients), with a smaller group of patients having more extensive lesions, ranging from C5 to C7 and from C5 to T1 (panplexopathy). 7Prevention is difficult due to the unpredictability and multifactorial nature of the risk factors. As severity varies from neurapraxia, axonotmesis, and neurotmesis, to root avulsion, and the extent of injury varies between damage to one nerve or all roots, the impact of neonatal plexopathy ranges from temporary functional impairment to a lifelong total paralysis of one arm. 3,5,[8][9][10][11][12][13][14] Early management includes parental counseling; family support; handling information; splinting; and appropriate, early, and supervised rehabilitation. Neurosurgical intervention is usually undertaken between 3 and 12 months of age in children who have shown little or no significant improvement in the affected muscle groups. 2,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] It is generally agreed that early surgical nerve repair can greatly improve the functional outcome in select patients. 15,20,22,24,[31][32][33] Delay to time of surgery often results in progressive worsening of deformity in the shoulder joint as contractures progress quickly over time in a rapidly growing infant. 34 Surgery in the first months of life is therefore indicated for serious Abbreviations:

show abstract

“…It is fundamental to determine the amplitude of the CMAP in order to quantify the number of muscle fibers which are actually reinnervated (Robinson, ). In this study, the amplitude of CEE group was greater than that observed in the PEE group, possibly because a greater number of myelinated axons regenerated in the CEE group and consequently reinnervated a greater number of muscle fibers.…”

Section: Discussionmentioning

confidence: 99%

Convergent end‐to‐end neurorrhaphy: An alternative technique for dual innervation of the gastrocnemius muscle in rats

et al. 2019

View full text Add to dashboard Cite

Introduction: Muscle contraction generated by electrical impulses simultaneously originating from two different neural sources may be an interesting treatment alternative for long term facial palsy. An experimental model was designed to compare single and dual innervation of the gastrocnemius muscle (GM) in rats.Methods: Fifty adult Wistar rats underwent transection of their right peroneal nerve and were divided into five groups (n = 10): control (C), tibial nerve section (TS), tibial nerve primary end-toend neurorrhaphy (PEE), tibial nerve primary repair associated with end-to-side peroneal-to-tibial nerve transfer (PRES), and tibial nerve repair by convergent end-to-end (CEE) neurorrhaphy between the proximal stumps of the tibial and peroneal nerves to the distal stump of the tibial nerve. The outcomes were assessed 12 weeks after the experiment by walking track, electromyography, GM mass index, and histomorphometric analysis of the distal tibial nerve. Results:The functional recovery of the PRES (−33.77 ± 24.13) and CEE (−42.15 ± 31.14) groups was greater (P < 0.003) than the PEE group (−80.26 ± 17.20). The CEE group (18.35 ± 7.84) showed greater amplitude (P = 0.006) than the PEE group (8.2 ± 4.64). There was no difference in the muscle mass index among the reinnervation groups (P > 0.705). Histologic analysis revealed greater (P < 0.002) axonal density in the CEE group (126.70 ± 15.01) compared to PEE (99.70 ± 12.82) and PRES (92.00 ± 19.17) groups. Conclusions:The dual innervation techniques showed earlier and greater functional recovery of the GM than did the single innervation technique. The CEE group showed a 40% higher number of regenerated axons in the distal tibial nerve stump.

show abstract

How electrodiagnosis predicts clinical outcome of focal peripheral nerve lesions

Cited by 61 publications

References 73 publications

Nerve injuries of the upper extremity and hand

Nerve injuries of the upper extremity and hand

Early electrodiagnosis in the management of neonatal brachial plexus palsy: A systematic review

Convergent end‐to‐end neurorrhaphy: An alternative technique for dual innervation of the gastrocnemius muscle in rats

Contact Info

Product

Resources

About