Sonographic measurements of longitudinal median nerve sliding in patients following nerve repair

Abstract

Nerve sliding may be restricted following nerve repair. This could result in increased tension across the repair site and lead to poor functional recovery of the nerve. Ultrasound was used to examine longitudinal median nerve sliding in 10 patients who had previously undergone nerve repair surgery following complete division of the median nerve. The median longitudinal movement in the forearm in response to metacarpophalangeal (MCP) joint movements was 2.15 mm on the injured side, compared with 2.54 mm on the uninjured side, a difference that was significant. There was a significant reduction in nerve sliding following repair (median = 8%, range -8% to 54%; P = 0.02), which correlated with time from injury to surgery (rho = 0.87; P = 0.001). These results indicate that ultrasound can be used as an adjunct assessment tool to monitor both morphology and sliding of the nerve through the repair site. It may have future application in the investigation of patients with persisting functional impairment following primary nerve repair.

Antidromic vs orthodromic sensory median nerve conduction studies

“…To this date, this remains as the only electrophysiological evidence of normal and limited sliding of the nerves with joint movements, a condition that can certainly cause dysfunctions because of angulation, stretching or anchorage of the nerve caused by soft tissues or bones in the nerve’s vicinity (Wright et al, 2001, Wright et al, 2005). Recently nerve sliding has been assessed with a more appropriate tool for measuring aspects related to mechanical properties of the nerve sheaths, such as echography (Erel et al, 2010), which may open a new line of studies in search for evidence of dysfunction in syndromes presenting with pain and paresthesia, in which conventional EMG and nerve conduction studies are unable to demonstrate a lesion.…”

Double peak sensory nerve action potentials to single stimuli in nerve conduction studies

“…If sliding is prevented because of nerve compression or other circumstances, longitudinal and transverse sliding is reduced, and this could generate irritation of nerve fibers that could very well be the source of various symptoms . Unfortunately, there is no standardized method to measure the possible limitation of sliding produced by nerve entrapment or compression, although ultrasound may well bring important information in the near future . Valls‐Sole and Llanas devised a technique that allows for some indirect measurement of longitudinal nerve sliding in the upper limb.…”

“…44 Unfortunately, there is no standardized method to measure the possible limitation of sliding produced by nerve entrapment or compression, although ultrasound may well bring important information in the near future. [45][46][47] Valls-Sole and Llanas 5 devised a technique that allows for some indirect measurement of longitudinal nerve sliding in the upper limb. As discussed above, an electrical stimulus applied to the fourth finger should activate the median and ulnar nerves simultaneously.…”

Manualtherapie bei chronischem Spannungskopfschmerz

“…Die Verlagerung des N. medianus wurde an gesunden Probanden [9,10,12,13,14] mit und ohne protrahierter Schulterposition [11], bei Patienten mit Karpaltunnelsyndrom [12,13], nach Naht des Mittelhandnerven [14], mit unspezifischen Armschmerzen [15] und nach Schleudertrauma der HWS [16] mittels Ultraschallbildgebung untersucht.…”

“…Bei Patienten, bei denen wegen einer vollständigen Durchtrennung des N. medianus eine Nervennaht durchgeführt worden war [14], war die mediane Verlagerung des Mittelhandnervs am Unterarm mit 2,15 mm signifikant geringer als an der nichtoperierten Seite (mediane Verlagerung 2,54 mm).…”