Median and Ulnar Nerve Injuries: Prognosis and Predictors for Clinical Outcome

Jaquet, Jean-Bart; Shreuders, Tar; Kalmijn, Sandra; Ruys, A.C.J.; Coert, H.; Hovius, Steven E.R.

doi:10.1055/s-2006-949697

Cited by 7 publications

(10 citation statements)

References 308 publications

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“…This critical ‘age‐window’ for perfect sensory recovery presented by children corresponds well to what is known from other types of learning processes, for instance the ability for acquisition of a second language (Lundborg & Rosén 2001); (2) cognitive functions are important explanatory factors in adults for variations in recovery of tactile discrimination (Rosén et al. 1994, Jaquet 2004); (3) The peripheral repair technique in median nerve lesions has not been found to influence the functional outcome in a clinical randomized study at a 5‐year follow‐up (Lundborg et al. 2004).…”

Section: Functional Outcome After Nerve Repairsupporting

confidence: 54%

“…There are however at least three strong indications that central nervous factors associated with cortical re-modelling represent a major reason for the inferior functional outcome following nerve repair: (1) children up to the age of 10-12 years usually present excellent recovery of functional sensibility in contrast to adult patients. This critical 'age-window' for perfect sensory recovery presented by children corresponds well to what is known from other types of learning processes, for instance the ability for acquisition of a second language ; (2) cognitive functions are important explanatory factors in adults for variations in recovery of tactile discrimination (Rosén et al 1994, Jaquet 2004); (3) The peripheral repair technique in median nerve lesions has not been found to influence the functional outcome in a clinical randomized study at a 5-year follow-up . Silicone tubular repair, leaving a short distance between the nerve cuts, was compared with the outcome from routine microsurgical repair in a clinical randomized prospective study, comprising 30 patients with median or ulnar nerve injuries in the distal forearm.…”

Section: Functional Outcome After Nerve Repairmentioning

confidence: 54%

“…Five years following surgery, a mean functional symptom score of 19 (0 = no disability, 100 = max disability) on the Disability of the Arm, Shoulder and Hand (DASH) questionnaire has been reported (Jaquet 2004). In a recent Dutch study, 59% of patients with median or ulnar nerve repairs returned to work within 1 year with an average time off work of 31 weeks (Jaquet 2004). Substantial costs for the society are also generated in terms of sick leave.…”

Section: Functional Outcome After Nerve Repairmentioning

confidence: 99%

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Hand function after nerve repair

2007

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Treatment of injuries to major nerve trunks in the hand and upper extremity remains a major and challenging reconstructive problem. Such injuries may cause long-lasting disabilities in terms of lost fine sensory and motor functions. Nowadays there is no surgical repair technique that can ensure recovery of tactile discrimination in the hand of an adult patient following nerve repair while very young individuals usually regain a complete recovery of functional sensibility. Post-traumatic nerve regeneration is a complex biological process where the outcome depends on multiple biological and environmental factors such as survival of nerve cells, axonal regeneration rate, extent of axonal misdirection, type of injury, type of nerve, level of the lesion, age of the patient and compliance to training. A major problem is the cortical functional reorganization of hand representation which occurs as a result of axonal misdirection. Although protective sensibility usually occurs following nerve repair, tactile discriminative functions seldom recover--a direct result of cortical remapping. Sensory re-education programmes are routinely applied to facilitate understanding of the new sensory patterns provided by the hand. New trends in hand rehabilitation focus on modulation of central nervous processes rather than peripheral factors. Principles are being evolved to maintain the cortical hand representation by using the brain capacity for visuo-tactile and audio-tactile interaction for the initial phase following nerve injury and repair (phase 1). After the start of the re-innervation of the hand (phase 2), selective de-afferentation, such as cutaneous anaesthesia of the forearm of the injured hand, allows expansion of the nerve-injured cortical hand representation, thereby enhancing the effects of sensory relearning. Recent data support the view that training protocols specifically addressing the relearning process substantially increase the possibilities for improved functional outcome after nerve repair.

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Section: Functional Outcome After Nerve Repairsupporting

confidence: 54%

Section: Functional Outcome After Nerve Repairmentioning

confidence: 54%

Section: Functional Outcome After Nerve Repairmentioning

confidence: 99%

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Hand function after nerve repair

2007

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“…They mainly affect young adults and are very often followed by considerable disability [8]. In the United States in 2006, Jaquet and al. showed that approximately 2/3 of upper limb trauma concerned young adults and 65% of neurological lesions concerned individuals aged between 16 and 40 years in a study of traumatic injuries to the median and ulnar nerves for prognostic and predictive purposes [4]. A retrospective study in the United States in 2010 by lad and al.…”

Section: In the Worldmentioning

confidence: 99%

“…However, less diagnosed peripheral nerve injuries are very often associated with tendon, vascular and bone lesions, making them true emergencies, which may later lead to incomplete DOI: 10.51931/OAJCS.2021.01.000016 and random functional recovery [3]. For a very long time, rehabilitation methods were the only means of treatment without any real statistical improvement in prognosis until the introduction of microneuro-surgery in 1960 [4]. From these facts, several studies around the world show us the impact of traumatic neurological lesions on affected people.…”

Section: Introductionmentioning

confidence: 99%

Untitled

2020

OAJCS

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Traumatic neurological injuries of the upper limb are common conditions in traumatology and neurosurgery. The disabling nature of these injuries requires urgent diagnosis, medical-surgical therapy and adequate functional rehabilitation techniques, in order to ensure better recovery of function in the medium and long term. The aim our study was to determine the epidemiological and clinical aspects of traumatic neurological injuries of the upper limb and to describe their functional evolutions in rural areas. We conducted a descriptive cross-sectional study (over a period of 5 years and 8 months, from 1st January 2015 to 10th August 2020) at the Saint Jean of Malte Hospital of Njombe (SJMH). This preliminary study identified clinical data before and after treatment, from the medical records of patients and with the help of the Chanson and Michon classification modified by Amend we evaluated their evolution. Out of 468 upper limb traumas the prevalence of traumatic neurological injuries was 10.47%. The median age was 19 years with interquartile range of 38 years, the male sex was predominant with 39 males and 10 females. The ratio M/F was 3.9. The main etiological circumstances were; childbirth (36.74%) and road accidents (20.41%). Fractures were the most common associated injury with 51.02%. Lesions of the brachial plexus were the most common with 42.86%, followed by digital collateral nerves damage with 22.45%. Axonal injuries combining neurotmesis (34.69%) and axonotmesis (30.62%) were the most common type of traumatic neurological injury. The post-traumatic functional recovery reassessment time ranged from 2 weeks to 5 years. The clinical evolution of the sensitive and motor functions was good despite a therapy essentially based on rehabilitation techniques. In this context of limited technical facilities, prevention methods remain the best means of reducing the incidence of these neurological lesions.

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Ulnar Nerve Injuries (Sunderland Grade V): A Simplified Classification System and Treatment Algorithm

Ghoraba

Mahmoud

Elsergany³

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Background: This study introduced a novel technical approach to the ulnar nerve injuries. The ulnar nerve was divided into 4 distinct surgical zones, each mandating a unique management strategy. Methods: A prospective observational study was conducted to verify the hypothesized algorithm. The study included 110 patients diagnosed with ulnar nerve injury (Sunderland grade 5). We divided the patients into 4 groups depending on the site of injury. Each group of patients was managed in accordance with a particular strategy, exploiting nerve transfer techniques along with the updated knowledge of the internal topography of the ulnar nerve. The motor recovery of the small muscles of the hand was assessed after 2 years of follow-up, using the disabilities of the arm, shoulder, and hand score, and other parameters including key pinch strength, hand grip strength, and the motor power of the first dorsal interosseous muscle on the Medical Research Council scale. Results: The mean values of the disabilities of the arm, shoulder, and hand score, key pinch strength, and hand grip strength showed a statistically significant improvement across all patient groups (P < 0.05). Of those with zone (I) injury, postoperatively, 79.9% patients attained a first dorsal interosseous muscle power grade >3 on the Medical Research Council scale, while 93.9% of patients with zone (II) damage achieved the same result. Surprisingly, 84% of patients included in both zones (III) and (IV) also recovered to the same extent. Conclusions: This prospective observational study examined and successfully confirmed the validity of our proposed novel algorithm for the management of ulnar nerve injuries (Sunderland grade 5).

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Median and Ulnar Nerve Injuries: Prognosis and Predictors for Clinical Outcome

Cited by 7 publications

References 308 publications

Hand function after nerve repair

Hand function after nerve repair

Untitled

Ulnar Nerve Injuries (Sunderland Grade V): A Simplified Classification System and Treatment Algorithm

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