The biomechanical responses to tension in a peripheral nerve

Bora, F. William; Richardson, Stephen K.; Black, Jonathan

doi:10.1016/s0363-5023(80)80037-2

Cited by 59 publications

(27 citation statements)

References 2 publications

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“…Stretch Ͼ6 -10%, however, nearly always increases strain. Strain Ͼ30 g has been reported consistently to cause nerve dysfunction by disruption of axonal transmission, reduction of intraneural blood flow, and anatomic damage (Kendall et al, 1979;Bora et al, 1980;Ogata and Naito, 1986;Flores et al, 2000). In our fresh cadaver model, we found that abduction of the hip to 30°and 45°would generate sufficient strain on the obturator nerve to cause its dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…Peripheral nerves are elastic (Rempel et al, 1999). Most unscarred nerves can withstand stretch of 6 -10% of their lengths between points of fixation without increasing strain on their intra-and perineural tissues or sustaining structural or function damage (Bora et al, 1980;Kwan et al, 1992;Wall et al, 1992;Tanoue et al, 1996). Stretch Ͼ6 -10%, however, nearly always increases strain.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, we did not determine if strain of these nerves was associated with their dysfunction. Nerve strain Ͼ30 g, however, is known to cause blood flow reduction and produce dysfunction in a variety of peripheral nerves (Kendall et al, 1979;Bora et al, 1980;Ogata and Naito, 1986;Flores et al, 2000). Second, the duration of elevated nerve strain required to cause prolonged nerve dysfunction is not known.…”

Section: Discussionmentioning

confidence: 99%

“…Second, the duration of elevated nerve strain required to cause prolonged nerve dysfunction is not known. In anatomic models, structural damage to the intra-and perineural tissues with strain Ͼ30 g is immediate (Kendall et al, 1979;Bora et al, 1980;Ogata and Naito, 1986;Kwan et al, 1992;Wall et al, 1992;Tanoue et al, 1996;Flores et al, 2000). This finding, however, may not apply to human nerves in vivo.…”

Section: Discussionmentioning

confidence: 99%

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Effect of lithotomy positions on strain of the obturator and lateral femoral cutaneous nerves

Litwiller¹,

Wells²,

Halliwill³

et al. 2003

Clinical Anatomy

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The purpose of this study was to determine if various lithotomy positions increase strain on the obturator and lateral femoral cutaneous nerves in fresh adult cadavers. A static load cell was used to record strain changes of the obturator and lateral femoral cutaneous nerves in the pelvis and anterior thigh when the lower limbs were placed in three sets of positions of varying hip abduction and flexion. The means of the strain measurements, which were measured in grams in all positioning angles were compared to the baseline 0 degrees measurements. Analysis of variance was calculated for the differences. Flexion of the hip did not increase strain on either nerve. Abduction to 30 degrees or 45 degrees increased strain by more than 30 g on the obturator nerve (P < 0.05) but not the lateral femoral cutaneous nerve. The addition of 45 degrees or more of flexion to abduction negated the strain increase on the obturator nerves seen with abduction alone. Nerve strain >30 g has been associated consistently with nerve dysfunction, disrupting axonal transmission, and causing structural neural damage. Our findings suggest that concomitant hip flexion should be used when placing anesthetized patients in a lithotomy position that includes abduction of the lower limbs to >30 degrees to decrease the risk for perioperative neuropathy of the obturator nerve.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effect of lithotomy positions on strain of the obturator and lateral femoral cutaneous nerves

Litwiller¹,

Wells²,

Halliwill³

et al. 2003

Clinical Anatomy

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“…55 The most compelling evidence for a role of tension in nerve regeneration may be found in animal and human models of limb lengthening, where nerves tolerate substantial deformations during the lengthening process. 34,[56][57][58][59][60][61][62][63][64][65] Therefore, the more appropriate debate should be on defining an appropriate threshold beyond which tension is detrimental. Our device design is motivated by the hypothesis that maintaining physiological strain during the lengthening process will accelerate nerve regeneration.…”

Section: A Role For Tension In Nerve Repairmentioning

confidence: 99%

A Novel Internal Fixator Device for Peripheral Nerve Regeneration

Chuang

Wilson

Love

et al. 2013

Tissue Engineering Part C: Methods

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Recovery from peripheral nerve damage, especially for a transected nerve, is rarely complete, resulting in impaired motor function, sensory loss, and chronic pain with inappropriate autonomic responses that seriously impair quality of life. In consequence, strategies for enhancing peripheral nerve repair are of high clinical importance. Tension is a key determinant of neuronal growth and function. In vitro and in vivo experiments have shown that moderate levels of imposed tension (strain) can encourage axonal outgrowth; however, few strategies of peripheral nerve repair emphasize the mechanical environment of the injured nerve. Toward the development of more effective nerve regeneration strategies, we demonstrate the design, fabrication, and implementation of a novel, modular nerve-lengthening device, which allows the imposition of moderate tensile loads in parallel with existing scaffold-based tissue engineering strategies for nerve repair. This concept would enable nerve regeneration in two superposed regimes of nerve extension-traditional extension through axonal outgrowth into a scaffold and extension in intact regions of the proximal nerve, such as that occurring during growth or limb-lengthening. Self-sizing silicone nerve cuffs were fabricated to grip nerve stumps without slippage, and nerves were deformed by actuating a telescoping internal fixator. Poly(lactic co-glycolic) acid (PLGA) constructs mounted on the telescoping rods were apposed to the nerve stumps to guide axonal outgrowth. Neuronal cells were exposed to PLGA using direct contact and extract methods, and they exhibited no signs of cytotoxic effects in terms of cell morphology and viability. We confirmed the feasibility of implanting and actuating our device within a sciatic nerve gap and observed axonal outgrowth following device implantation. The successful fabrication and implementation of our device provides a novel method for examining mechanical influences on nerve regeneration.

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Mechanical Properties of the Human Tibial and Peroneal Nerves Following Stretch With Histological Correlations

Kerns

Piponov

Helder

et al. 2019

The Anatomical Record

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Despite the extensive literature regarding peripheral nerve stretch injuries, there are few studies that compare the nerve histology with the mechanical properties in humans. There is clinical evidence suggesting that the peroneal nerve is at greater risk for injury compared to the tibial nerve following total hip arthroplasty and hip trauma. We examined the two nerves from fresh human cadavers with or without controlled stretch. The mechanical properties, stiffness, and strain were compared with light microscopic preparations in longitudinal sections stained by the trichrome method for collagen and showing the effects of structural deformation. The tibial nerve had an average failure load 1.7× that for the peroneal nerve (P = 0.0001). Although the corresponding average stiffness showed a trend toward being larger (4.39 vs. 3.81 N/mm), the difference was not significant (P = 0.126). Histologically, the perineurium along with the underlying nerve fascicle was undulated in the control specimens and straightened out in the stretched specimens. Peroneal nerves went on to failure at lower loads and exhibited a wavy pattern on pathologic slides after failure, which shows that peroneal nerves fail mechanically before they can unfold. The tibial nerve has a biomechanical and histological advantage compared to the peroneal nerve during tensile testing, which could be the reason why it is less commonly damaged. We conclude that the perineurium is especially protective against deformation changes in human nerves relative to the respective nerve size and number of fascicles.

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The biomechanical responses to tension in a peripheral nerve

Cited by 59 publications

References 2 publications

Effect of lithotomy positions on strain of the obturator and lateral femoral cutaneous nerves

Effect of lithotomy positions on strain of the obturator and lateral femoral cutaneous nerves

A Novel Internal Fixator Device for Peripheral Nerve Regeneration

Mechanical Properties of the Human Tibial and Peroneal Nerves Following Stretch With Histological Correlations

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