97 results on '"Digital nerve"'
Search Results
2. Evaluation of vapocoolant spray effect on pain reduction during digital nerve block: A randomized clinical trial
- Author
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Mehmet Akcimen, Fatih Selvi, and Cihan Bedel
- Subjects
Adult ,Male ,Visual analogue scale ,Administration, Topical ,Block (permutation group theory) ,Injections, Intramuscular ,law.invention ,Randomized controlled trial ,law ,Finger Injuries ,Injection site ,Local anesthetic infiltration ,Humans ,Pain Management ,Medicine ,Prospective Studies ,Anesthetics, Local ,Pain Measurement ,business.industry ,Nebulizers and Vaporizers ,Nerve Block ,General Medicine ,Pain reduction ,Cryotherapy ,Anesthesia ,Emergency Medicine ,Anxiety ,Female ,medicine.symptom ,Digital nerve ,business - Abstract
The digital nerve block is an effective method of anesthesia before minor surgical interventions on the fingers. However, patients may experience a lot of pain and anxiety during this procedure. The efficacy of topical vapocoolant spray during minor procedures has been demonstrated in previous studies. we aimed to evaluate the effectiveness of topical vapocoolant spray in reducing pain during digital nerve block.This prospective, randomized clinical study was conducted to evaluate the effectiveness of vapocoolant spray application in reducing pain during digital block. The patients were categorized into 2 groups as spray-treated and control group. A routine digital block process was applied to the control group. Spray application was performed in two groups of 50 each, in a manner of bilateral and unilateral to the finger. Demographic data of the patients, such as gender, age, dominant hand, injury patterns, injection site and injury sites, were recorded. After the application, the patients' visual analog scale (VAS) was evaluated.Of the participants, 100 were randomly assigned to the vapocoolant spray-treated group, and 50 were included in the control group. The VAS pain score during penetration in both spray groups was significantly lower than the control group (p0.001). Pain change during penetration was found to be significantly lower in the bilateral spray-treated group compared to the control group (p0.001). Pain change during infiltration was significantly lower in both spray groups compared to the control group (p0.001).Spray application prior to digital nerve blocking can be used to reduce needle penetration pain associated with this procedure and pain associated with local anesthetic infiltration.
- Published
- 2021
3. Comparison of nerve conduits and nerve graft in digital nerve regeneration: A systematic review and meta-analysis
- Author
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R. Mattiello, Bruna Leiria Meréje Leal, G.A. Magnus, J. Braga Silva, C.G. Wolff, and V. de Souza Stanham
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medicine.medical_specialty ,business.industry ,Regeneration (biology) ,Rehabilitation ,Nerve graft ,Prostheses and Implants ,Outcome assessment ,Placebo ,Neurosurgical Procedures ,Nerve Regeneration ,Surgery ,Peripheral ,Lesion ,Peripheral Nerve Injuries ,Meta-analysis ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Peripheral Nerves ,Digital nerve ,medicine.symptom ,business - Abstract
The goal of this systematic review and meta-analysis was to compare nerve conduits and nerve graft for peripheral nerve regeneration. This type of lesion frequently causes disability due to pain, paresthesia and motor deficit. On the PICO process, "P" corresponded to patients with peripheral digital nerve lesions of any age, gender or ethnicity, "I" to interventions with nerve conduits or nerve graft, "C" to the control group with no treatment, placebo or receiving other treatment, and "O" to outcome assessment of nerve regeneration. Initial search found in 3859 studies, including 2001 duplicates. The remaining 1858 studies were selected by title and/or abstract; 1798 articles were excluded, leaving 60 articles for full-text review. Thirty-nine of these 60 reports were excluded as not meeting our inclusion criteria, and 21 articles were ultimately included in the systematic review. For patients older than 40 years, there was a greater mean improvement on S2PD and M2PD tests with grafting, which seemed to be the better surgical technique, positively impacting prognosis. On the M2PD test, there was significantly greater improvement in 11-17.99 mm defects with grafting (P 0.001); this finding should guide surgical strategy in peripheral nerve regeneration, to ensure better outcomes.
- Published
- 2021
4. A Multicenter Matched Cohort Study of Processed Nerve Allograft and Conduit in Digital Nerve Reconstruction
- Author
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Bauback Safa, Brendan J. MacKay, Jozef Zoldos, Wesley P. Thayer, Dennis S. Kao, Gregory M. Buncke, Jason A. Nydick, Harry A. Hoyen, Fraser J. Leversedge, and Desirae M. McKee
- Subjects
medicine.medical_specialty ,Patient characteristics ,030230 surgery ,Repair method ,Neurosurgical Procedures ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Electrical conduit ,Matched cohort ,Peripheral Nerve Injuries ,medicine ,Humans ,Orthopedics and Sports Medicine ,Medical history ,Peripheral Nerves ,030222 orthopedics ,Nerve allograft ,business.industry ,Allografts ,Nerve Regeneration ,Surgery ,Mechanism of injury ,cardiovascular system ,Digital nerve ,business - Abstract
Purpose Biomaterials used to restore digital nerve continuity after injury associated with a defect may influence ultimate outcomes. An evaluation of matched cohorts undergoing digital nerve gap reconstruction was conducted to compare processed nerve allograft (PNA) and conduits. Based on scientific evidence and historical controls, we hypothesized that outcomes of PNA would be better than for conduit reconstruction. Methods We identified matched cohorts based on patient characteristics, medical history, mechanism of injury, and time to repair for digital nerve injuries with gaps up to 25 mm. Data were stratified into 2 gap length groups: short gaps of 14 mm or less and long gaps of 15 to 25 mm. Meaningful sensory recovery was defined as a Medical Research Council scale of S3 or greater. Comparisons of meaningful recovery were made by repair method between and across the gap length groups. Results Eight institutions contributed matched data sets for 110 subjects with 162 injuries. Outcomes data were available in 113 PNA and 49 conduit repairs. Meaningful recovery was reported in 61% of the conduit group, compared with 88% in the PNA group. In the group with a 14-mm or less gap, conduit and PNA outcomes were 67% and 92% meaningful recovery, respectively. In the 15- to 25-mm gap length group, conduit and PNA outcomes were 45% and 85% meaningful recovery, respectively. There were no reported adverse events in either treatment group. Conclusions Outcomes of digital nerve reconstruction in this study using PNA were consistent and significantly better than those of conduits across all groups. As gap lengths increased, the proportion of patients in the conduit group with meaningful recovery decreased. This study supports the use of PNA for nerve gap reconstruction in digital nerve reconstructions up to 25 mm. Type of study/level of evidence Therapeutic III.
- Published
- 2020
5. Epinephrine-Containing Digital Nerve Block: A Case of Digital Tip Necrosis Leading to Amputation in a Patient With No Known Vascular, Rheumatologic, or Smoking History
- Author
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Nancy J. Moontasri, David F. Ratliff, and Ian S. Hong
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medicine.medical_specialty ,Necrosis ,business.industry ,medicine.medical_treatment ,Ischemia ,Cryotherapy ,medicine.disease ,Smoking history ,Surgery ,Epinephrine ,Amputation ,Block (telecommunications) ,medicine ,Digital nerve ,medicine.symptom ,business ,medicine.drug - Abstract
The use of epinephrine-containing digital nerve blocks has been shown to be safe in recent literature, challenging the historical fear of complications arising from irreversible ischemia. We present a rare case of digital tip necrosis following the injection of lidocaine-containing epinephrine for the purpose of wart removal using cryotherapy, ultimately requiring amputation.
- Published
- 2021
6. Results of fracture-dislocation of interphalangeal treatment with volar buttressing hook plating techniques
- Author
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Ahmadreza Afshar, Ali Tabrizi, Milad Safari, and Hassan Taleb
- Subjects
medicine.medical_specialty ,Hook ,Visual analogue scale ,Fracture Fixation, Internal ,03 medical and health sciences ,Fixation (surgical) ,Grip strength ,0302 clinical medicine ,Finger Joint ,Finger Injuries ,medicine ,Humans ,Orthopedics and Sports Medicine ,Range of Motion, Articular ,030222 orthopedics ,Fracture Dislocation ,business.industry ,030229 sport sciences ,Surgery ,Treatment Outcome ,Hook plate ,Digital nerve ,Range of motion ,business ,Interphalangeal Joint ,Bone Plates - Abstract
Introduction Proximal interphalangeal joint (PIP) is one of the joints exposed to upper limb injury. The dorsal fracture-dislocations of the PIP is a common injury. Treatment of cases with small avulsed bone fragments is challenging. Stable fixation with rapid recovery is important in these patients. Hypothesis Volar buttress plating a new technique in treatment of the dorsal proximal interphalangeal joint fracture dislocations but the results of it is unknown. Methods In this case series, 21 patients with dorsal fracture-dislocations of the proximal interphalangeal were studied. We used a volar hook plate buttressing technique so that fixation was done by low-profile 2-mm stainless steel hook plate with a 1.5-mm screw. Range of motion movements, power and grip strength were measured after 3 months. At end of follow-up period, functional outcome was determined by the visual analogue scale, Quick Disabilities of the Arm, Shoulder, and Hand. Results After three-month follow-up a union of fractures occurred in all of the patients. There were no complications, such as infection, digital nerve injuries or flexor tendon rupture. The joints range of motion were stable and had no restrictions. Postoperative range of motion outcome in 19 (90.5%) patients was 85.7 ± 13.2 degree which was not significantly different from opposite side on other hand (p = 0.1). In two patients range of motion was 65.5 ± 5.4 degree and painful. Postoperative pain in 19 patients was 2.5 ± 0.8 so that there was no pain in 17(76.2%) patients, three (14.1%) patients had mild pain and two (9.5%) patients had moderate pain (5.4 ± 1.2). Two patients complained of plate irritation of especially at end of proximal intrphalangeal flexion. Conclusion Clinical application of hook plate buttressing technique induced stable fixation and rapid recovery. Because of maintaining articular congruity and restoring anatomically, this technique associated with good outcomes. Level of Evidence IV, Therapeutic study.
- Published
- 2020
7. Morton’s neuroma – Current concepts review
- Author
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Maneesh Bhatia and Lauren Thomson
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Forefoot ,Treatment options ,Physical examination ,Morton's neuroma ,Neuroma ,medicine.disease ,Surgery ,medicine ,Dorsal approach ,Orthopedics and Sports Medicine ,Surgical excision ,Digital nerve ,business ,Current Concept - Abstract
Morton's neuroma is a common pathology affecting the forefoot. It is not a true neuroma but is fibrosis of the nerve. This is caused secondary to pressure or repetitive irritation leading to thickness of the digital nerve, located in the third or second intermetatarsal space. The treatment options are: orthotics, steroid injections and surgical excision usually performed through dorsal approach. Careful clinical examination, patient selection, pre-operative counselling and surgical technique are the key to success in the management of this condition.
- Published
- 2020
8. Ultrasound-guided Therapeutic Injection and Cryoablation of the Medial Plantar Proper Digital Nerve (Joplin's Nerve): Sonographic Findings, Technique, and Clinical Outcomes
- Author
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Ronald S. Adler, Luis S. Beltran, William R. Walter, Julien Sanchez, and Christopher J. Burke
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medicine.medical_specialty ,medicine.medical_treatment ,Microtrauma ,Cryosurgery ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Medial plantar nerve ,medicine ,Performed Procedure ,Humans ,Radiology, Nuclear Medicine and imaging ,Ultrasonography, Interventional ,Retrospective Studies ,Ultrasonography ,business.industry ,Soft tissue ,Cryoablation ,medicine.disease ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Neuropathic pain ,Etiology ,Tibial Nerve ,Digital nerve ,business - Abstract
Rationale and Objectives The medial plantar proper digital nerve, also called Joplin's nerve, arises from the medial plantar nerve, courses along the medial hallux metatarsophalangeal joint, and can be a source of neuropathic pain due to various etiologies, following acute injury including bunion surgery and repetitive microtrauma. We describe our clinical experience with diagnostic ultrasound assessment of Joplin's neuropathy and technique for ultrasound-guided therapeutic intervention including both injection and cryoablation over a 6-year period. Materials and Methods Retrospective review of all diagnostic studies performed for Joplin's neuropathy and therapeutic Joplin's nerve ultrasound-guided injections and cryoablations between 2012 and 2018 was performed. Indications for therapeutic injection and cryoablation, were recorded. Studies were assessed for sonographic abnormalities related to the nerve and perineural soft tissues. Post-treatment outcomes including immediate pain scores, clinical follow-up, and periprocedural complications were documented. Results Twenty-four ultrasound-guided procedures were performed, including 15 perineural injections and nine cryoablations. With respect to sonographic abnormalities, nerve thickening (33%) and perineural hypoechoic scar tissue (27%) were the most common findings. The mean pain severity score prior to the therapeutic injection was 6.4/10 (range 4–10) and 0.25/10 (range 0–2) following the procedure; mean follow-up was 26.2 months (range 3–63 months). All of the cryoablation patients experienced sustained pain relief with a mean length follow-up of 3.75 months (range 0.2–10 months). Conclusion Therapeutic injection of Joplin's nerve is a safe and easily performed procedure under ultrasound guidance, with high rates of immediate symptom improvement. For those experiencing a relapse or recurrent symptoms, cryoablation offers an effective secondary potential treatment option.
- Published
- 2020
9. Collagen Nerve Conduits and Processed Nerve Allografts for the Reconstruction of Digital Nerve Gaps: A Single-Institution Case Series and Review of the Literature
- Author
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Nadia Rbia, Tiam M. Saffari, Alexander Y. Shin, Steven E.R. Hovius, Liselotte F. Bulstra, Dermatology, and Plastic and Reconstructive Surgery and Hand Surgery
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Type 1 collagen ,Nerve guidance conduit ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Peripheral Nerve Injuries ,medicine ,Animals ,Humans ,Peripheral Nerves ,Single institution ,Child ,Aged ,Retrospective Studies ,Graft rejection ,business.industry ,Perioperative ,Middle Aged ,Plastic Surgery Procedures ,Allografts ,Neuroma ,medicine.disease ,Surgery ,surgical procedures, operative ,030220 oncology & carcinogenesis ,Cattle ,Female ,Collagen ,Neurology (clinical) ,Outcome data ,Digital nerve ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
A single-institution case series is reported and a review of the literature on the outcomes of digital nerve gap reconstruction with the NeuraGen type 1 collagen nerve conduit (Integra Life Sciences, Plainsboro New Jersey, USA) and the Avance Nerve Graft (Axogen Inc., Alachua, Florida, USA) is presented.Thirty-seven patients were included with a minimal follow-up of 12 months. Primary outcome was postoperative sensory recovery measured by static 2-point discrimination test or the Semmes-Weinstein monofilament test. Secondary outcome measurements were perioperative or postoperative complications. Final outcome data were stratified to grade results as excellent, good, or poor.The mean nerve gap length was 14 ± 4.9 mm for the collagen conduits versus 18.4 ± 9.3 for nerve allografts. After 12 months, outcomes were graded as excellent sensory recovery in 48% of the collagen conduit repairs and 39% of the nerve allografts (P = 0.608), good in 26% of the conduits and 55% of the allografts (P = 0.074), and poor in 26% of the conduits versus 6% of the allografts (P = 0.091). One neuroma and 1 infection were reported. Graft rejection or extrusion was not observed.Nerve conduits and processed nerve allografts offer convenient off-the-shelf options for digital nerve gap repair. Both techniques offer effective means of reconstructing a digital nerve gap2.5 cm at a minimum of 12 months of follow-up. Future prospective randomized large sample size studies comparing nerve conduits with allografts are needed to perform subgroup analyses and to define their exact role in digital nerve injuries.
- Published
- 2019
10. A comparison of the bipedicled nerve flap with the Littler flap for reconstructing a neurocutaneous defect of digits
- Author
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Zhao Meng, Gang Zhao, Chao Chen, and Peifu Tang
- Subjects
Adult ,Male ,medicine.medical_specialty ,Soft Tissue Injuries ,Surgical Flaps ,Fingers ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,Finger Injuries ,medicine ,Humans ,Peripheral Nerves ,Digital nerves ,Retrospective Studies ,General Environmental Science ,030222 orthopedics ,business.industry ,Littler flap ,030208 emergency & critical care medicine ,Retrospective cohort study ,Recovery of Function ,Plastic Surgery Procedures ,Neuroma ,medicine.disease ,Numerical digit ,Surgery ,Lower incidence ,Treatment Outcome ,Patient Satisfaction ,General Earth and Planetary Sciences ,Female ,Digital nerve ,business ,Follow-Up Studies - Abstract
Complex digital injuries involving soft-tissue loss and digital nerve defect continues to pose a reconstructive challenge. This study reports the repair of such neurocutaneous defect with the bipedicled nerve flap or the Littler flap and compares the results of the two techniques.A retrospective study was conducted in 59 patients who had a neurocutaneous defect in the single digit treated with the bipedicled nerve flap or the Littler flap from Jul 2008 to May 2016. The patients were divided into two groups based on which flap was chosen. At the final follow-up, the two groups were compared for static two-point discrimination and Semmes-Weinstein monofilament scores on both flap and pulp, and pain, cold intolerance and patient satisfaction of the reconstructed digit.Significant differences were found in static two-point discrimination, pain, cold intolerance, and patient satisfaction (p 0.05). In comparison with the bipedicled flap group, the Littler flap group presented better discriminatory sensation in the flap and pulp, but exhibited higher incidence of pain and cold intolerance in the reconstructed digit. In the donor digits, the bipedicled flap group achieved lower pain incidence. Finally, the bipedicled flap group attained a larger degree of satisfaction than the Littler flap group.When reconstructing a complex neurocutaneous defect in the digit, choosing the bipedicled nerve flap rather than the Littler flap attains lower incidence of pain and cold intolerance, and higher patient satisfaction. Our results suggest that repair of the transected digital nerves can reduce neuroma incidence.
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- 2019
11. Emerging Technologies in Upper Extremity Surgery
- Author
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William J. Weller
- Subjects
030222 orthopedics ,medicine.medical_specialty ,Nerve allograft ,business.industry ,medicine.medical_treatment ,Nerve guidance conduit ,Upper extremity surgery ,030229 sport sciences ,Thumb ,Arthroplasty ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Medicine ,Polyvinyl alcohol hydrogel ,Orthopedics and Sports Medicine ,Implant ,Digital nerve ,business - Abstract
In the field of upper extremity surgery there are myriad new and developing technologies. The purpose of this article is to highlight a few of the most compelling new technologies and review their background, indications for use, and most recently reported outcomes in clinical practice.
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- 2019
12. Pedicled Osteo-Onchyocutaneous Island Flap for Finger Macrodactyly: A Review of Literature
- Author
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YE Win Kyi, Ruth En Si Tan, Sandeep J. Sebastin, and Alphonsus K.S. Chong
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Dorsum ,030222 orthopedics ,animal structures ,Macrodactyly ,integumentary system ,business.industry ,medicine.medical_treatment ,Epiphysiodesis ,Anatomy ,030230 surgery ,Middle finger ,Phalanx ,musculoskeletal system ,body regions ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Middle phalanx ,medicine ,Orthopedics and Sports Medicine ,Surgery ,Digital nerve ,business ,Reduction (orthopedic surgery) - Abstract
We present a case of middle finger macrodactyly reconstructed in a single stage using multiple techniques. We elevated a pedicled osteo-onychocutaneous island flap, excised the remnant distal phalanx with a segment of 1 digital nerve and skin over the dorsum of the middle phalanx, performed epiphysiodesis and reduction of the middle phalanx as well as soft-tissue debulking, and inset the flap over the dorsum of the middle phalanx. Follow-up at 12 months revealed a satisfactory aesthetic and functional outcome.
- Published
- 2022
13. Morton’s interdigital neuroma of the foot
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Marwan Shehab Eddine, Lorenzo Ponziani, Francesco Di Caprio, and Renato Meringolo
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Metatarsal ligament ,Metatarsalgia ,030222 orthopedics ,medicine.medical_specialty ,business.industry ,030229 sport sciences ,Tarsal tunnel syndrome ,medicine.disease ,Neuroma ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Orthopedics and Sports Medicine ,Presentation (obstetrics) ,Digital nerve ,business ,Interdigital neuroma ,Foot (unit) - Abstract
Morton's neuroma is one of the most common causes of metatarsalgia. Despite this, it remains little studied, as the diagnosis is clinical with no reliable instrumental diagnostics, and each study may deal with incorrect diagnosis or inappropriate treatment, which are difficult to verify. The present literature review crosses all key points, from diagnosis to surgical and nonoperative treatment, and recurrences. Nonoperative treatment is successful in a limited percentage of cases, but it can be adequate in those who want to delay or avoid surgery. Dorsal or plantar approaches were described for surgical treatment, both with strengths and weaknesses that will be scanned. Failures are related to wrong diagnosis, wrong interspace, failure to divide the transverse metatarsal ligament, too distal resection of common plantar digital nerve, an association of tarsal tunnel syndrome and incomplete removal. A deep knowledge of the causes and presentation of failures is needed to surgically face recurrences.
- Published
- 2018
14. Magnetic Resonance Imaging of the Digital Nerves of the Hand: Anatomy and Spectrum of Pathology
- Author
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Shivani Ahlawat, Laura M. Fayad, and Charles H. Mitchell
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Pathology ,medicine.medical_specialty ,Sensory system ,030218 nuclear medicine & medical imaging ,Fingers ,03 medical and health sciences ,0302 clinical medicine ,medicine ,High spatial resolution ,Humans ,Radiology, Nuclear Medicine and imaging ,Carpal tunnel ,Peripheral Nerves ,Digital nerves ,medicine.diagnostic_test ,business.industry ,Magnetic resonance neurography ,Peripheral Nervous System Diseases ,Magnetic resonance imaging ,Anatomy ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,Peripheral nerve injury ,Digital nerve ,business ,030217 neurology & neurosurgery - Abstract
Digital nerves are intrinsic to the sensory and motor function of the hand. These nerves represent the terminal ramifications of the ulnar, median, and radial nerves and are located distal to the carpal tunnel and Guyon canal. With magnetic resonance imaging, traumatic and nontraumatic abnormalities of the digital nerves can be shown with high contrast as well as high spatial resolution. Digital nerve abnormalities are most commonly posttraumatic in nature; however, infection, inflammatory, vascular malformations, and neoplasms can rarely occur. Magnetic resonance imaging is playing an increasing role in the assessment of peripheral nerve injury throughout the body, and in the hand, which can accurately identify the extent and character of digital nerve abnormalities before operative intervention.
- Published
- 2018
15. Ulnar-Sided Digital Nerve Tumor of the Thumb in the Professional Baseball Player Who Uses Grip-Adjusting Batting Equipment: A Report of 2 Cases
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Peter D. Asnis, Nicholas Coccoluto, Matthew I. Leibman, John M. Pinski, and Michael S. Guss
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musculoskeletal diseases ,030222 orthopedics ,medicine.medical_specialty ,business.industry ,Ulnar digital nerve ,030230 surgery ,Thumb ,Neuroma ,medicine.disease ,Symptomatic relief ,Nonsurgical treatment ,Surgery ,body regions ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Medicine ,Orthopedics and Sports Medicine ,Digital nerve ,business ,human activities - Abstract
Neuropathy of the ulnar digital nerve of the thumb is a relatively rare clinical entity. We report 2 cases of ulnar-sided digital nerve tumors of the thumb in 2 professional baseball players who routinely used grip-adjusting batting equipment. Symptomatic relief was achieved with nonsurgical treatment that allowed both players to continue playing during critical times during their season. We postulate that there may be an association with the grip-adjusting batting equipment and the development of digital neuropathy.
- Published
- 2021
16. Age does not affect the outcome after digital nerve repair in children – A retrospective long term follow up
- Author
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Illugi Birkisson, Derya Burcu Hazer Rosberg, Hans Eric Rosberg, and Lars B. Dahlin
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Male ,medicine.medical_specialty ,Time Factors ,Adolescent ,Long term follow up ,Affect (psychology) ,Neurosurgical Procedures ,Fingers ,03 medical and health sciences ,Grip strength ,0302 clinical medicine ,Peripheral Nerve Injuries ,Finger Injuries ,Dash ,Sensation ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Child ,Retrospective Studies ,030222 orthopedics ,business.industry ,Age Factors ,Follow up studies ,Infant ,Nerve injury ,humanities ,Treatment Outcome ,Child, Preschool ,Physical therapy ,Female ,Surgery ,Digital nerve ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Background Digital nerve injuries in children are not common, but they are considered to have an excellent prognosis, compared to adults, after nerve injury and repair. In studies including both children and adults age have been found to have an effect on outcome after nerve repair. Methods We investigated in a retrospective follow up study the long-time result after digital nerve injury and repair in children, 1–16 years of age (n = 38), and evaluate if age influences outcome. A group with young children, 1–10 years of age (n = 18), was compared with a group with older children, 11–16 years of age (n = 20). A clinical evaluation to evaluate sensation and grip strength was performed and questionnaires were used [Disability of the Arm, Shoulder and Hand (DASH), Cold Sensitivity Severity Scale (CISS), VAS-function and VAS-cosmetic] in median 40 months (range 12–131 months) after the injury and repair. Results All patient regained normal sensation. No correlations between age and monofilaments were found. Twenty children (52%) reported some problems with cold intolerance (i.e. CISS), but no other abnormal disability was found (i.e. DASH, VAS); again with no differences between the two groups. Conclusions Children have an excellent long-term recovery after a digital nerve repair and without any influence of age.
- Published
- 2017
17. Chronic Collateral Sesamoidean Desmopathy in Draft Horses: Magnetic Resonance Imaging and Histopathological Findings
- Author
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Ashraf M. Abu-Seida and Yahya M. Elemmawy
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medicine.medical_specialty ,040301 veterinary sciences ,Lameness, Animal ,Radiography ,0403 veterinary science ,Dystrophic calcification ,Forelimb ,medicine ,Animals ,Horses ,medicine.diagnostic_test ,Flexor tendon ,Equine ,business.industry ,Cartilaginous metaplasia ,0402 animal and dairy science ,Magnetic resonance imaging ,04 agricultural and veterinary sciences ,Anatomy ,medicine.disease ,Magnetic Resonance Imaging ,040201 dairy & animal science ,medicine.anatomical_structure ,Ligament ,Horse Diseases ,Histopathology ,Digital nerve ,business - Abstract
Desmopathy of the collateral sesamoidean ligament (CSL) is an unusual disorder in draft horses. This study records the magnetic resonance imaging (MRI) features of chronic CSL desmopathy in eight draft horses and confirms these features by histopathology. The recorded chronic CSL desmopathy has usually affected the forelimbs (100%) and commonly bilateral (62.5%). All horses showed positive proximal digital nerve block, positive front digital flexion test, and negative interphalangeal extension test. Radiography revealed no osseous abnormalities in all feet. MRI features of chronic CSL desmopathy included thickening of the ligament with increased moderate intensity in fast low-angle shot, T1 turbo spin echo, and proton density images in the affected part of the ligament. Chronic CSL desmopathy was concomitant with deep digital flexor tendon injury and distal sesamoidean impar desmitis. In most chronic cases of CSL desmopathy, heterogeneous signal intensities were seen with multiple foci of low signal intensities interlaced with increased moderate signal intensities of thickened CSL. Histopathology confirmed the MRI findings and revealed separated bundles and fascicles by septa of less organized and loose connective tissues containing fibroblasts and loose collagen fibers. Multifocal islands of cartilaginous metaplasia, mineralized areas, and dystrophic calcification were observed in the injured ligament. In conclusion, chronic CSL desmopathy may progress to cartilaginous metaplasia and dystrophic calcification. MRI is a beneficial diagnostic and prognostic tool for chronic CSL desmopathy, and histopathology is a gold standard to document the MRI findings associated with CSL dysmopathy in draft horses.
- Published
- 2021
18. Mechanical nociceptive thresholds of dorsal laminae in horses after local anaesthesia of the palmar digital nerves or dorsal branches of the digital nerve
- Author
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C.F.R. Paz, Geraldo Eleno Silveira Alves, Jéssica Fontana de Magalhães, Rafael Resende Faleiros, SdS Rocha Junior, Heloisa M. F. Mendes, and J.K. Belknap
- Subjects
Nociception ,Dorsum ,Hoof and Claw ,Heel ,040301 veterinary sciences ,Hoof ,Pain ,Stimulation ,0403 veterinary science ,03 medical and health sciences ,0302 clinical medicine ,Animals ,Medicine ,Horses ,Peripheral Nerves ,Anesthetics, Local ,Digital nerves ,Cross-Over Studies ,General Veterinary ,Foot ,business.industry ,04 agricultural and veterinary sciences ,Anatomy ,medicine.anatomical_structure ,Lameness ,Anesthesia ,Female ,Animal Science and Zoology ,Digital nerve ,business ,030217 neurology & neurosurgery ,Anesthesia, Local - Abstract
We examined the hypothesis that the palmar digital nerves (PDNs), but not the dorsal branches (DBs) of the digital nerves, innervate the sensitive dorsal laminae of the equine foot by evaluating the effects of perineural anaesthesia of the PDNs and DBs separately on pain sensation evoked via mechanical stimulation of the dorsal laminae and other regions of the equine foot. Six clinically normal mares were used in a crossover design. A portable dynamometer was used to evaluate mechanical nociceptive thresholds at different points on the dorsal laminae, bulbs of the heel, coronary band and sole before and after the horses underwent perineural injection of PDNs or DBs with a local anaesthetic solution (treated group) or an isotonic saline solution (control group). Cornified tissue was removed from the sole and the dorsal aspect of the hoof wall before evaluations of mechanical nociceptive thresholds. Anaesthetising PDNs distal to the DBs increased mechanical nociceptive thresholds compared to baseline values (P
- Published
- 2016
19. The Diagnosis and Treatment of Joplin's Neuroma
- Author
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A. Lee Dellon, Anup Patel, and Mark M. Melendez
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Adult ,Male ,medicine.medical_specialty ,Toe problem ,Adolescent ,Pain ,030218 nuclear medicine & medical imaging ,Neuroma ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Peripheral Nerve Injuries ,Peripheral Nervous System Neoplasms ,Medial plantar nerve ,medicine ,Humans ,Orthopedics and Sports Medicine ,Neurolysis ,Retrospective Studies ,business.industry ,Medical record ,Chronic pain ,Middle Aged ,medicine.disease ,Surgery ,030220 oncology & carcinogenesis ,Etiology ,Hallux ,Female ,Digital nerve ,business - Abstract
Joplin's neuroma is a rare perineurial fibrosis of the medial plantar digital proper nerve arising from various etiologies but most commonly after bunion surgery. Treatment for this painful great toe problem remains controversial. It is our purpose to describe our experience with this chronic pain problem, considering it to be a neuroma requiring resection. A retrospective medical record review of 8 patients with medial hallux pain related to the digital nerve was performed. Each patient had failed to respond to >6 months of nonoperative therapy. At surgery, the medial digital nerve to the hallux was identified distally, the neuroma was resected distally, and the proximal end of the nerve was implanted into the arch of the foot in 7 (87.5%) of the 8 patients. At a mean follow-up of 25 (range 13 to 43) months, 6 results (75%) were excellent, 1 (12.5%) was good, and 1 (12.5%) was fair. The 1 fair result was in the only patient in whom the distal end of the divided nerve was not implanted proximally, according to the patient's request. In conclusion, surgical resection of the medial plantar nerve to the hallux with implantation of the proximal end of the nerve into the arch of the foot, can be expected to result in good to excellent relief of pain in 80% of the patients.
- Published
- 2016
20. Safety of Epinephrine in Digital Nerve Blocks: A Literature Review
- Author
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Jonathan Ilicki
- Subjects
Epinephrine ,medicine.medical_treatment ,Cochrane Library ,law.invention ,Fingers ,Gangrene ,Necrosis ,Randomized controlled trial ,law ,Finger Injuries ,medicine ,Humans ,Vasoconstrictor Agents ,In patient ,Anesthetics, Local ,business.industry ,Nerve Block ,Toes ,medicine.disease ,Anesthesia ,Emergency Medicine ,Nerve block ,medicine.symptom ,Digital nerve ,business ,Vasoconstriction ,Anesthesia, Local ,medicine.drug - Abstract
Background Digital nerve blocks are commonly performed in emergency departments. Health care practitioners are often taught to avoid performing blocks with epinephrine due to a risk of digital necrosis. Objective To review the literature on the safety of epinephrine 1:100,000–200,000 (5–10 μg/mL) with local anesthetics in digital nerve blocks in healthy patients and in patients with risk for poor peripheral circulation. Methods PubMed, Web of Science, and the Cochrane Library were searched in June 2014 using the query “digital block AND epinephrine OR digital block AND adrenaline”. The searches were performed without any limits. Results Sixty-three articles were identified, and 39 of these were found to be relevant. These include nine reviews, 12 randomized control trials, and 18 other articles. Most studies excluded patients with risk for poor peripheral circulation. Two studies described using epinephrine on patients with vascular comorbidities. No study reported digital necrosis or gangrene attributable to epinephrine, either in healthy patients or in patients with risk for poor peripheral circulation. In total, at least 2797 digital nerve blocks with epinephrine have been performed without any complications. Conclusions Epinephrine 1:100,000–200,000 (5–10 μg/mL) is safe to use in digital nerve blocks in healthy patients. Physiological studies show epinephrine-induced vasoconstriction to be transient. There are no reported cases of epinephrine-induced harm to patients with risk for poor peripheral circulation despite a theoretical risk of harmful epinephrine-induced vasoconstriction. A lack of reported complications suggests that the risk of epinephrine-induced vasoconstriction to digits may be overstated.
- Published
- 2015
21. Résultats du traitement des fractures-luxation interphalangiennes avec plaque console palmaire munie de crochets
- Author
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Hassan Taleb, Ahmadreza Afshar, Ali Tabrizi, and Milad Safari
- Subjects
medicine.medical_specialty ,Mild pain ,business.industry ,Visual analogue scale ,Surgery ,Fixation (surgical) ,Grip strength ,Hook plate ,medicine ,Orthopedics and Sports Medicine ,Digital nerve ,Range of motion ,business ,Interphalangeal Joint - Abstract
Introduction Proximal interphalangeal joint (PIP) is one of the joints exposed to upper limb injury. The dorsal fracture-dislocations of the PIP is a common injury. Treatment of cases with small avulsed bone fragments is challenging. Stable fixation with rapid recovery is important in these patients. Hypothesis Volar buttress plating a new technique in treatment of the dorsal proximal interphalangeal joint fracture dislocations but the results of it is unknown. Methods In this case series, 21 patients with dorsal fracture-dislocations of the proximal interphalangeal were studied. We used a volar hook plate buttressing technique so that fixation was done by low-profile 2-mm stainless steel hook plate with a 1.5-mm screw. Range of motion movements, power and grip strength were measured after 3 months. At end of follow-up period, functional outcome was determined by the visual analogue scale, Quick Disabilities of the Arm, Shoulder, and Hand. Results After three-month follow-up a union of fractures occurred in all of the patients. There were no complications, such as infection, digital nerve injuries or flexor tendon rupture. The joints range of motion were stable and had no restrictions. Postoperative range of motion outcome in 19 (90.5 %) patients was 85.7 ± 13.2 degree which was not significantly different from opposite side on other hand (p = 0.1). In two patients range of motion was 65.5 ± 5.4 degree and painful. Postoperative pain in 19 patients was 2.5 ± 0.8 so that there was no pain in 17(76.2 %) patients, three (14.1 %) patients had mild pain and two (9.5 %) patients had moderate pain (5.4 ± 1.2). Two patients complained of plate irritation of especially at end of proximal interphalangeal flexion. Conclusion Clinical application of hook plate buttressing technique induced stable fixation and rapid recovery. Because of maintaining articular congruity and restoring anatomically, this technique associated with good outcomes. Level of evidence IV, Therapeutic study.
- Published
- 2020
22. Modified Heterodigital Neurovascular Island Flap for Sensory Reconstruction of Pulp or Volar Soft Tissue Defect of Digits
- Author
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Xiaoxi Yang, Chen Chao, Hui Wang, Bin Wang, Yongxin Huo, and Wei Wang
- Subjects
Soft Tissue Injuries ,Sensory system ,030230 surgery ,Thumb ,Surgical Flaps ,Fingers ,03 medical and health sciences ,0302 clinical medicine ,Finger Injuries ,medicine ,Humans ,Orthopedics and Sports Medicine ,030222 orthopedics ,business.industry ,Soft tissue ,Skin Transplantation ,Little finger ,Anatomy ,Plastic Surgery Procedures ,Neurovascular bundle ,Numerical digit ,body regions ,Treatment Outcome ,medicine.anatomical_structure ,Pulp (tooth) ,Surgery ,Digital nerve ,business - Abstract
Purpose We report the efficacy of a modified heterodigital neurovascular island flap innervated by the dorsal branch of the proper digital nerve and the proper digital nerve, for repairing either pulp or volar defects in the fingers. Method We repaired 14 digits of 14 patients who had a complex defect involving soft tissue and digital nerve in the pulp or volar surface of the digit using the modified heterodigital neurovascular island flap. Cases were divided into 2 groups: a pulp defect group including 5 thumbs and 1 little finger; and a volar defect group with a digital nerve defect, involving one thumb, 3 index and 3 middle fingers, and one ring finger. At the recipient site, nerve stumps of the PDNs in the pulp defect group were coapted with the proximal ends of the dorsal branch of the PDN and the proper digital nerve in the flap. The distal and proximal ends of the PDN in the flap were intercalated into the defect of the PDN in volar defect group, and the proximal end of dorsal branch of PDN in the flap was also coapted to the proximal end of the proper digital nerve of the recipient finger. At the donor site, the defect of the proper digital nerve was repaired with nerve graft harvested from the proximal portion of the dorsal branch of the same proper digital nerve, and a full-thickness skin graft covered the donor site. Results All flaps and the skin grafts of the donor site survived completely. At the final follow-up, 9 of 14 flaps had a static 2-point discrimination result below the normal threshold ( Conclusions The modified heterodigital neurovascular island flap is a useful and reliable treatment option for a digital pulp or volar defect, especially when the digital nerve defect requires repair. Type of study/level of evidence Therapeutic IV.
- Published
- 2020
23. Management of Complications of Dupuytren Contracture
- Author
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Kevin Cheung, Tamara D. Rozental, and Kempland C. Walley
- Subjects
medicine.medical_specialty ,Collagenase injection ,business.industry ,Dupuytren disease ,Dupuytren Contracture ,medicine.disease ,Needle fasciotomy ,Surgery ,Postoperative Complications ,Complex regional pain syndrome ,Hematoma ,medicine ,Humans ,Orthopedics and Sports Medicine ,Digital nerve ,Complication ,business - Abstract
This evidence-based article discusses the current management options of Dupuytren disease and strategies to avoid and manage any potential complications. Treatment options include fasciectomy, needle fasciotomy/aponeurotomy, and collagenase injection. Complications include digital nerve and artery injury, flexor tendon injury, skin fissures and wound healing complications, hematoma, infection, flare reaction/complex regional pain syndrome, and recurrence. Complication rates, prevention, and management differ with each treatment modality. A detailed understanding of each of these options allows hand surgeons to select the most appropriate treatment for each patient.
- Published
- 2015
24. Options for Digital Nerve Gap
- Author
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Anjan P. Kaushik and Warren C. Hammert
- Subjects
Adult ,medicine.medical_specialty ,Soft Tissue Injuries ,MEDLINE ,Wounds, Nonpenetrating ,Transplantation, Autologous ,Neurosurgical Procedures ,Finger injury ,Fingers ,Text mining ,Tissue scaffolds ,Peripheral Nerve Injuries ,Finger Injuries ,medicine ,Humans ,Transplantation, Homologous ,Orthopedics and Sports Medicine ,Tissue Scaffolds ,business.industry ,Plastic Surgery Procedures ,Bicycling ,Surgery ,Wounds nonpenetrating ,Transplantation ,Athletic Injuries ,Female ,Digital nerve ,business - Published
- 2015
25. Resistance of primary microsurgical repair of palmar digital nerves to finger mobilization: A cadaver study
- Author
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Valérie Matter-Parrat, Philippe Liverneaux, Santiago Salazar Botero, E. Pire, Sophie Honecker, A. Pereira, J.J. Hidalgo Diaz, Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, and Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)
- Subjects
Microsurgery ,medicine.medical_specialty ,medicine.medical_treatment ,030230 surgery ,Fingers ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Cadaver ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Complication rate ,Treatment Failure ,Range of Motion, Articular ,Digital nerves ,Ulnar Nerve ,Proper palmar digital nerves ,Rupture ,Mobilization ,business.industry ,Rehabilitation ,[PHYS.MECA]Physics [physics]/Mechanics [physics] ,Anatomy ,Plastic Surgery Procedures ,Surgery ,body regions ,030220 oncology & carcinogenesis ,Radial Nerve ,Digital nerve ,business ,Microsurgical repair - Abstract
The aim of this study was to assess the resistance of microsurgically repaired proper palmar digital nerves (PPDN) to mobilization. Thirty-nine PPDN from fresh forearms cadavers were transected and then sutured using 10/0 nylon. After skin closure, each finger was forcefully flexed and extended 10 times. Out of the 39 repaired nerves, two were elongated and four were ruptured; this amounts to a 15.38% complication rate. We recommend immobilization of nerve repairs, although this contradicts most recent studies.
- Published
- 2016
26. Sensory recovery after primary repair of palmar digital nerves using a Revolnerv® collagen conduit: A prospective series of 27 cases
- Author
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A. Arnaout, Christian Fontaine, and Christophe Chantelot
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Population ,Nerve guidance conduit ,Sensory system ,Neurosurgical Procedures ,Fingers ,Young Adult ,Electrical conduit ,Suture (anatomy) ,Peripheral Nerve Injuries ,Weber test ,medicine ,Humans ,Orthopedics and Sports Medicine ,Peripheral Nerves ,Prospective Studies ,education ,Aged ,Bioprosthesis ,education.field_of_study ,business.industry ,Suture Techniques ,Recovery of Function ,General Medicine ,Middle Aged ,Microsurgery ,Nerve Regeneration ,Surgery ,Touch ,Female ,Collagen ,Digital nerve ,business - Abstract
Despite advances in microsurgery, digital nerve repair remains a challenge due to the lack of reproducible procedures with satisfactory functional results. The aim of this study was to compare the sensory and functional results of direct microsurgical sutures protected by a Revolnerv(®) nerve regeneration conduit, with results of a series of direct sutures without a protective conduit in the literature. From November 2009 to April 2010, 35 patients were treated by direct epiperineural suture for digital nerve injury, protected by a Revolnerv(®) nerve regeneration conduit at the FESUM centre "SOS-mains Lesquin/CHRU de Lille". Sensory recovery was assessed by the static two-point discrimination Weber test (WS) and the Semmes-Weinstein (SW) test at postoperative months 1, 3, and 6. The final evaluation was performed after a minimum follow-up of 6 months. Statistical analysis of sensory results (WS and SW) was mainly performed with non-parametric tests (Wilcoxon, Mann and Whitney). P
- Published
- 2014
27. Use of Body-Mounted Inertial Sensors to Objectively Evaluate the Response to Perineural Analgesia of the Distal Limb and Intra-articular Analgesia of the Distal Interphalangeal Joint in Horses With Forelimb Lameness
- Author
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Christoph Lischer, Roberto J. Estrada, Wolfgang Staecker, Thorben Schulze, Pitiporn Leelamankong, and Porrakote K. Rungsri
- Subjects
musculoskeletal diseases ,Equine ,Local anesthetic ,medicine.drug_class ,business.industry ,Numerical digit ,Distal limb ,body regions ,Distal interphalangeal joint ,Intra articular ,Lameness ,Anesthesia ,medicine ,Forelimb lameness ,Digital nerve ,business - Abstract
Diagnostic analgesia of the distal interphalangeal (DIP) joint is theoretically helpful to localize the source of pain in the foot to the joint and/or navicular bursa. However, it has been suggested that potential diffusion of local anesthetic agent to nearby distal limb nerves may anesthetize other areas of the foot. The objective of this study was to compare the results of palmar digital (PD) and abaxial sesamoid (AS) nerve blocks to intra-articular anesthesia of the DIP joint in horses with distal forelimb lameness. Palmar digital nerve block (group 1) or PD and AS nerve blocks (group 2) were used to abolish digital pain in 22 horses. The following day lameness was again evaluated in all horses before and 2, 5, and 10 minutes after DIP joint anesthesia. All lameness evaluations were performed objectively with a body-mounted inertial sensor system (Lameness locator; Equinosis LLC, Columbia, MO). In group 1 horses, overall improvement in group lameness was the same after DIP joint block, but only six showed positive response after DIP joint analgesia, five after 2 minutes, and one after 5 minutes. In group 2 horses, overall improvement in lameness was less after DIP joint block, with seven showing a positive response after DIP joint analgesia, one after 2 minutes, four after 5 minutes, and two after 10 minutes. Intra-articular analgesia of the DIP joint and perineural analgesia of the digit result in overlapping but unequal areas of analgesia. In addition, a time-dependent response was observed after DIP joint block with full effect requiring 5–10 minutes.
- Published
- 2014
28. Anatomy of the direct small branches of the proper digital nerve of the fingers: A cadaveric study
- Author
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Soo Hyun Rhee, Young Ho Lee, Goo Hyun Baek, Jihyeung Kim, and Min Bom Kim
- Subjects
Male ,medicine.medical_specialty ,Proximal phalanx ,Fingers ,Cadaver ,Finger Joint ,Image Processing, Computer-Assisted ,medicine ,Humans ,Digital nerves ,Ulnar Nerve ,Aged ,business.industry ,Little finger ,Index finger ,Anatomy ,Median Nerve ,Surgery ,body regions ,medicine.anatomical_structure ,Middle phalanx ,Female ,Digital nerve ,business ,Cadaveric spasm - Abstract
Summary Background and aim The purpose of this study was to evaluate the anatomical constancy of the direct small branches of the proper digital nerve. Methods A total of 208 digital nerves of the index, long, ring, and little fingers from 13 cadavers were studied. For each digital nerve, the number of direct small branches was counted at the proximal and middle phalanx levels. In addition, the diameter of these branches was measured at the level of the branch bifurcation. We also measured the diameter of the proper digital nerve at the level of the distal interphalangeal (DIP) joint. Results The direct small branches of the proper digital nerve were anatomically constant among the index, long, and ring fingers. The average number of direct small branches was 2.7 at the proximal phalanx level and 2.3 at the middle phalanx level. At the level of the DIP joint, the average thickness of the proper digital nerve was 0.85 mm in the index finger, 0.84 mm in the long finger, 0.72 mm in the ring finger, and 0.49 mm in the little finger. Conclusion In this study, we verified the anatomical constancy of the direct small branches of the proper digital nerve. The size of these branches at the proximal phalanx level was similar to that of the corresponding proper digital nerve at the level of the DIP joint. Therefore, these nerve branches at the proximal phalanx could be applied to the creation of various sensate flaps for the reconstruction of the fingertip injuries.
- Published
- 2014
29. The Management of Digital Nerve Injuries
- Author
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David J. Slutsky
- Subjects
medicine.medical_specialty ,Autologous graft ,business.industry ,Host factors ,Neurosurgical Procedures ,Surgery ,Fingers ,surgical procedures, operative ,Peripheral Nerve Injuries ,Finger Injuries ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Peripheral Nerves ,Digital nerve ,business ,Epineurial repair ,Nerve repair ,Reference standards - Abstract
A tension-free coaptation is a key factor for the successful outcome of any nerve repair. A variety of host factors influence the outcome of digital nerve repair more than the type of repair per se. Although autologous graft remains the reference standard for reconstruction of any critical digital nerve defect, allografts and conduits have assumed an increasing role.
- Published
- 2014
30. Reconstruction of a neurocutaneous defect of the proximal phalanx with a heterodigital arterialised nerve pedicle flap
- Author
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Xu Zhang, Peifu Tang, and Chao Chen
- Subjects
Adult ,Male ,medicine.medical_specialty ,Soft Tissue Injuries ,Proximal phalanx ,Sensation ,Surgical Flaps ,Fingers ,Finger Injuries ,medicine ,Humans ,Peripheral Nerves ,Dorsal branch ,General Environmental Science ,Nerve grafting ,Pedicle flap ,business.industry ,Recovery of Function ,Little finger ,Anatomy ,Plastic Surgery Procedures ,Hand surgeons ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Patient Satisfaction ,Nerve Transfer ,General Earth and Planetary Sciences ,Female ,Digital nerve ,business - Abstract
Complex digital injuries involving soft-tissue loss and digital nerve defect pose a challenging problem for hand surgeons. The purpose of this study was to evaluate the efficacy of transferring the heterodigital arterialised nerve pedicle flap for reconstructing the digital neurocutaneous defects and to compare the results with those of transferring the cross-finger flap and secondary nerve grafting.From March 2008 to September 2011, the nerve pedicle flap was used in 12 patients who had a combination of soft-tissue and digital nerve defects. The injured fingers included four index, four long, three ring and one little finger. The mean size of the soft-tissue losses was 2.4×1.9 cm (range, 2.3×1.3 to 3.2×2.0 cm). The mean flap size was 2.6×2.1 cm (range, 2.5×1.5 to 3.4×2.2 cm). The length of the nerve defects ranged from 1.5 to 3.8 cm (mean, 2.8 cm). The nerve defect was reconstructed with transfer of the digital nerve dorsal branch. For comparison, we collected a series of 24 patients with similar defects treated with the cross-finger flap and secondary free nerve grafting.Significant differences were found between the two groups in static two-point discrimination (p.01) and pain (p=.03) in the reconstructed finger. In comparison, the study group presented better discriminatory sensation on the finger pulp and lower incidence of pain sensibility in the injured finger. There was no significant difference in cold intolerance and Semmes-Weinstein monofilament. In the study group, the total active motion of the donor fingers was similar to that of the opposite hands.The heterodigital arterialised nerve pedicle flap is useful and reliable for reconstructing the neurocutaneous defects in the proximal phalanx. Comparable sensory recovery and lower pain incidence can be achieved using our nerve pedicle flap instead of conventional nerve grafting.Therapeutic II.
- Published
- 2014
31. Bilateral Nonsynchronous Pacinian Corpuscle Neuroma
- Author
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Gustavo Muratore, Isidro Jiménez, A. Marcos-García, and J. Medina
- Subjects
Male ,Fingers ,Neuroma ,03 medical and health sciences ,0302 clinical medicine ,Dermis ,Peripheral Nervous System Neoplasms ,otorhinolaryngologic diseases ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Aged ,Left index finger ,Tenosynovitis ,business.industry ,Anatomy ,Right index finger ,medicine.disease ,030210 environmental & occupational health ,Nonsurgical treatment ,medicine.anatomical_structure ,Neuralgia ,030211 gastroenterology & hepatology ,Surgery ,Digital nerve ,business ,Pacinian Corpuscles ,Pacinian Corpuscle - Abstract
Pacinian corpuscles are rapidly adapting mechanoreceptors distributed in the dermis of the fingers and palm of the hand. A neuroma of the pacinian corpuscle is rare and extremely painful, with only a few cases reported in the literature. A 71-year-old man with pain and swelling on his left index finger, initially diagnosed as tenosynovitis resistant to nonsurgical treatment, was referred to our center. During surgery, a cluster of spherical, gray lesions close to the digital nerve was found and excised. The pathological diagnosis was neuroma of the pacinian corpuscles. Two years later, he reported the same clinical findings on his right index finger with no improvement after nonsurgical treatment. During surgery, the same lesions were found and also identified as pacinian corpuscle neuromas.
- Published
- 2018
32. Use of a bipedicled nerve flap taken from the dorsum of the digit for reconstruction of neurocutaneous defect in the adjacent finger
- Author
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Lihai Zhang, Peifu Tang, and Chao Chen
- Subjects
Adult ,Male ,Dorsum ,medicine.medical_specialty ,Soft Tissue Injuries ,Surgical Flaps ,Fingers ,Venous congestion ,Surveys and Questionnaires ,Finger Injuries ,Humans ,Medicine ,Retrospective Studies ,business.industry ,Nerve graft ,Soft tissue ,Venous drainage ,Recovery of Function ,Anatomy ,Middle Aged ,Plastic Surgery Procedures ,Functional recovery ,Numerical digit ,Surgery ,Treatment Outcome ,Female ,Digital nerve ,business - Abstract
Summary A digital nerve defect complicated by an associated soft-tissue loss poses a reconstructive challenge. This article reports reconstruction of a similar complex injury using a bipedicled nerve flap including a nerve graft from the dorsal branch of the digital nerve. From July 2008 to May 2010, a retrospective study was conducted with nine consecutive patients who had a combination of soft tissue and digital nerve defects. The injured fingers requiring reconstruction included three index, four middle and two ring fingers. The mean size of the soft-tissue losses was 2.8 × 2.1 cm. The flap is supplied by the digital artery and the venous drainage is by means of a dorsal vein. The mean flap size was 3.1 × 2.3 cm. The nerve gaps were bridged with the nerve graft attached with the flap. The average length of the nerve grafts was 3.0 cm. All flaps survived completely, and the defects were reconstructed successfully. Venous congestion was not observed in our series. At a mean follow-up period of 23 months, the average scores of static two-point discrimination (2PD) and Semmes–Weinstein monofilament on the finger pulp of the injured side were 7.5 mm and 3.93, respectively. The donor site morbidity was acceptable. According to the Michigan Hand Outcomes Questionnaire, four patients were strongly satisfied and five were satisfied with functional recovery of the injured finger. The bipedicled nerve flap is a safe and effective option for reconstruction of complex digital injury involving soft tissue and nerve defects. Our technique has been shown to provide sufficient sensory recovery. ClinicalTrials.gov ID: NCT01707654. Type of study/level of evidence: Therapeutic IV.
- Published
- 2013
33. Macrodactyly in the Setting of a Plexiform Schwannoma in Neurofibromatosis Type 2: Case Report
- Author
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Charlotte L. Bendon and Henk Giele
- Subjects
Male ,Neurofibroma, Plexiform ,Neurofibromatosis 2 ,Macrodactyly ,business.industry ,Limb Deformities, Congenital ,Anatomy ,medicine.disease ,Risk Assessment ,Plexiform Schwannoma ,Fingers ,Radiography ,Rare Diseases ,Treatment Outcome ,medicine ,Humans ,Radial Nerve ,Orthopedics and Sports Medicine ,Surgery ,Neurofibromatosis type 2 ,Digital nerve ,Child ,business - Abstract
Macrodactyly is a rare anomaly. Little is understood about the etiology and underlying mechanisms. To our knowledge, macrodactyly has not previously been associated with neurofibromatosis type 2. We present a case of macrodactyly of the small finger associated with a digital nerve plexiform schwannoma in a patient with neurofibromatosis type 2.
- Published
- 2013
34. Should I Use Lidocaine With Epinephrine in Digital Nerve Blocks?
- Author
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Julie L. Welch and Dylan D. Cooper
- Subjects
Lidocaine ,business.industry ,medicine.medical_treatment ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Epinephrine ,Text mining ,030220 oncology & carcinogenesis ,Anesthesia ,Emergency Medicine ,medicine ,Nerve block ,Vasoconstrictor Agents ,Digital nerve ,business ,medicine.drug - Published
- 2016
35. Penetration of the Digital Nerves by the Common Palmar Digital Arteries in Human Cadavers
- Author
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Ju-Young Lee, Wu-Chul Song, Yoo-Ri Kim, Jeong-Nam Kim, Ki-Seok Koh, and Hyungon Choi
- Subjects
Male ,Human cadaver ,business.industry ,Mean age ,Anatomy ,Hand ,Fingers ,body regions ,Cadaver ,Common Palmar Digital Artery ,Humans ,Medicine ,Female ,Orthopedics and Sports Medicine ,Surgery ,Digital nerves ,Digital nerve ,business ,Palm ,Proper palmar digital nerves ,Aged - Abstract
Purpose To investigate the incidence of digital nerve loop penetration by digital arteries (neural loops) in cadaver palms and to classify these neural loops according to their topography and morphology. Methods In total, 121 palms (from 57 right and 64 left hands) were dissected from 70 preserved cadavers (50 male and 20 female; mean age 66.1 y). Results Of the 121 palms, 98 had neural loops; 184 cases of neural loop were observed in total. The neural loops could be classified into 4 topographical types, according to their position relative to the digital arteries: ulnar (in which the ulnar proper palmar digital nerve of the finger is penetrated), radial (in which the radial proper palmar digital nerve of the finger is penetrated), common (in which the common palmar digital nerve of the finger is penetrated), and bridge (in which the neural loop is formed by connecting the ulnar and radial proper palmar digital nerves). The neural loops were also classified morphologically according to their size: form A (≥10 mm), form B (4.0–9.9 mm), and form C (≤3.9 mm). The mean lengths in these groups were 16.1, 7.2, and 3.0 mm, respectively, and the overall mean length of all neural loops was 10.8 mm. Conclusions It was confirmed that neural loops are a common occurrence in humans; hence, it is surprising that it is a little-known variation in the palm.
- Published
- 2010
36. A Retrospective Comparison of Collagen Nerve Conduits and Processed Nerve Allografts for the Reconstruction of Digital Nerve Gaps
- Author
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Mana Saffari, Nadia Rbia, Alexander Y. Shin, and Steven E.R. Hovius
- Subjects
business.industry ,Medicine ,Orthopedics and Sports Medicine ,Surgery ,Anatomy ,Digital nerve ,business - Published
- 2018
37. Treatment by collagen conduit of painful post-traumatic neuromas of the sensitive digital nerve: A retrospective study of 10 cases
- Author
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Philippe Bellemère, T. Loubersac, L. Thomsen, F. Chaise, Etienne Gaisne, and P. Poirier
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Sensation ,Severity of Illness Index ,Fingers ,Neuroma ,Primary outcome ,Peripheral Nervous System Neoplasms ,Severity of illness ,Humans ,Neoplasms, Post-Traumatic ,Medicine ,Orthopedics and Sports Medicine ,Pain Measurement ,Retrospective Studies ,Postoperative Care ,business.industry ,Amputation Stumps ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Discrimination testing ,Nerve Regeneration ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Upper limb ,Female ,Collagen ,Digital nerve ,business ,Follow-Up Studies - Abstract
Objectives The purpose of this retrospective study was to report the results of surgery in painful post-traumatic neuromas of the digital nerves treated by collagen conduits after excision of the neuromas, when two stumps were available. Methods We retrospectively reviewed all patients operated on for painful neuroma in our institution and having undergone repair with collagen conduits. Their files were retrieved by a coding file (CCAM version 10). Ten patients involving nine digital nerves and one common digital nerve were included. Primary outcome data points were static two-point discrimination, Semmes-Weinstein monofilament testing, Quick-Dash outcome survey scores, Cold Intolerance Symptom Severity (CISS) score and recurrence of pain at final follow-up. We set up a minimum follow-up period of 6 months after surgery. Results The patients’ average age was 30 years. The average follow-up duration was 11.8 months. Five patients had excellent or good results (50%) at static two-point discrimination testing. Semmes-Weinstein monofilament testing results were full, diminished light touch or diminished protective sensation in nine digits (80%). The average Quick-Dash survey score was 19.3. The average CISS score was 27.8. There was no recurrence of pain. Conclusions Our findings indicate that collagen conduit is an effective treatment for post-traumatic painful neuromas of digital nerves and common digital nerves.
- Published
- 2010
38. Influence de la perméabilité de l’artère digitale palmaire sur la récupération nerveuse dans les lésions des nerfs digitaux palmaires
- Author
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C. Vidal, M. Piquet, Julien Pauchot, P. Sarlieve, Laurent Obert, Yves Tropet, and C. Laveaux
- Subjects
medicine.medical_specialty ,business.industry ,General Medicine ,Surgery ,body regions ,Lesion ,Palmar digital artery ,medicine.anatomical_structure ,Weber test ,medicine ,Orthopedics and Sports Medicine ,Digital nerve ,Ultrasonography ,medicine.symptom ,business ,Artery ,Reinnervation - Abstract
Should the palmar digital artery be repaired in the pedicular section of the finger? This repair is discussed in the case of a unilateral pedicular lesion on a vascularised finger, and often neglected in current surgical practice. The problem is knowing the role of a permeable artery in sensory recovery and cold intolerance. The author presents a retrospective study on palmar digital nerve reinnervation after section with or without palmar digital artery section. Artery permeability was studied by doppler ultrasonography. Forty nerves in 35 patients were studied after at least 3 years had passed. Twenty-five nerves were associated with a permeable artery, 15 with a non permeable artery. The functional result was evaluated with the Weber test (S2PD) and by the presence or absence of cold intolerance. This work demonstrates the statistically significant role of the palmar digital artery in sensitive recovery quality and cold intolerance appearance. Its permeability ensures a better sensitive result with an 8.84 mm S2PD versus 13.47 mm with a non permeable artery. The benefit of the systematic repair of palmar digital artery is thus demonstrated for the first time. This repair is all the more justified if local conditions are unfavorable, in particular in contuse wounds with associated lesions (tendinous or bone).
- Published
- 2010
39. Synthetic Nerve Conduits for Digital Nerve Reconstruction
- Author
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Christine J. Cheng
- Subjects
Male ,medicine.medical_specialty ,Guided Tissue Regeneration ,business.industry ,Middle Aged ,Transplantation, Autologous ,Neurosurgical Procedures ,Surgery ,Fingers ,Lactones ,Peripheral Nerve Injuries ,Absorbable Implants ,Orthopedic surgery ,medicine ,Humans ,Orthopedics and Sports Medicine ,Collagen ,Peripheral Nerves ,Digital nerve ,business ,Caproates ,Polyglycolic Acid - Published
- 2009
40. Is Epinephrine Harmful When Used With Anesthetics for Digital Nerve Blocks?
- Author
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John C. Southall, Anna L. Waterbrook, and Carl A. Germann
- Subjects
medicine.medical_specialty ,Epinephrine ,Lidocaine ,business.industry ,MEDLINE ,Nerve Block ,Toes ,Surgery ,Fingers ,Infarction ,Anesthesia ,Finger Injuries ,Emergency Medicine ,Humans ,Vasoconstrictor Agents ,Medicine ,Anesthetics, Local ,Digital nerve ,business ,Anesthesia, Local ,medicine.drug - Published
- 2007
41. Ice reduces needle-stick pain associated with a digital nerve block of the hallux
- Author
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Karl B Landorf, Simon C. Hayward, and Anthony C. Redmond
- Subjects
medicine.medical_specialty ,Local anaesthetic ,business.industry ,medicine.medical_treatment ,Cryotherapy ,Numerical digit ,Visual analogue pain scale ,Surgery ,Minor surgery ,Anesthesia ,Injection site ,Medicine ,Orthopedics and Sports Medicine ,Podiatry ,Digital nerve ,business - Abstract
Background Digital nerve blocks are widely used prior to minor surgery to the digits but the injections are associated with some degree of unwanted pain and anxiety. Methods to reduce the pain associated with injection, such as cryotherapy, are therefore worthwhile. However, cryotherapy (e.g. ice) applied prior to digital injections has received little scientific evaluation. Objective This study aimed to assess whether there was any change in pain associated with an injection into the hallux, if the site of injection was first refrigerated using ice. Method Twenty participants each received two injections of lignocaine into the hallux (one each on the medial and lateral sides) as a standard digital nerve block. Prior to each injection, participants were randomized to receive either no-ice or a six-minute application of ice over the injection site. The primary outcomes were needle-stick pain and infiltration pain measured on a visual analogue pain scale. Results The application of ice significantly reduced needle-stick pain, with the median scores for the no-ice and ice injections being 57 and 16mm, respectively ( P P =0.204). Nevertheless, 16 out of 20 participants preferred ice prior to the injection. Only four indicated no preference and none indicated a preference for no-ice. Conclusion Icing the digit prior to injection is an effective and inexpensive method to reduce the discomfort of a local anaesthetic injection.
- Published
- 2006
42. Percutaneous trigger finger release: the ‘lift-cut’ technique
- Author
-
C.T.K. Khoo, R. Ragoowansi, and A. Acornley
- Subjects
Male ,medicine.medical_specialty ,Percutaneous ,Anti-Inflammatory Agents ,Trigger finger release ,Punctures ,Open release ,Triamcinolone ,Fingers ,Finger Joint ,medicine ,Trigger Digits ,Humans ,Stenosing tenosynovitis ,Child ,Glucocorticoids ,Flexor tendon ,business.industry ,Tenosynovitis ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Ambulatory Surgical Procedures ,Otorhinolaryngology ,Needles ,Female ,Trigger finger ,Digital nerve ,business - Abstract
One hundred and eighty patients with 240 trigger digits were treated by percutaneous release using a 'lift-cut' technique. All patients were reviewed at 3 months following release. Overall, 94% achieved an excellent or good result. Ten patients experienced recurrent symptoms and required a subsequent open release. There was no clinical evidence of digital nerve or flexor tendon injury. We recommend this technique as a safe and effective outpatient procedure.
- Published
- 2005
43. Application of Autogenous Venous Nerve Conduits for Digital Nerve Reconstruction
- Author
-
J Savundra and D Chiu
- Subjects
Electrical conduit ,business.industry ,Medicine ,Surgery ,Anatomy ,Digital nerve ,business - Published
- 2005
44. Painful foot neuromas after toe-to-thumb transfer
- Author
-
Ramon A. Dejesus, Christopher T. Maloney, and A. Lee Dellon
- Subjects
Adult ,Male ,musculoskeletal diseases ,medicine.medical_specialty ,Pain ,Thumb ,Resection ,Neuroma ,Peripheral Nervous System Neoplasms ,Peroneal nerves ,medicine ,Deformity ,Humans ,Orthopedic Procedures ,Orthopedics and Sports Medicine ,Muscle, Skeletal ,Peroneal Neuropathies ,Foot ,business.industry ,Nerve Block ,Plastic Surgery Procedures ,Toes ,medicine.disease ,Numerical digit ,Fasciotomy ,Surgery ,body regions ,medicine.anatomical_structure ,medicine.symptom ,Digital nerve ,business ,Foot (unit) - Abstract
Reconstruction of the thumb by transfer of a toe has evolved technically to the point that this complex procedure can result in a mobile, sensate, and aesthetically pleasing digit that contributes to an almost-normally functioning hand. Donor site deformity is well recognized, primarily as it relates to the appearance of the foot after transfer of the hallux to the thumb position and stiffness of the remaining portions of the big toe. The present report describes donor site disability related to painful neuromas of the superficial and deep peroneal nerves and the common plantar digital nerve to the first webspace. Salvage of the disabled donor foot is possible by applying techniques used to treat painful neuromas of the upper extremity, neuroma resection, and muscle implantation. The specific techniques used in treating this painful foot donor site after toe-to-thumb transfer are described.
- Published
- 2005
45. Closed partial rupture of a common digital nerve in the palm: A case report
- Author
-
Reuben A. Bueno, Matthew E. Cunningham, Andrew J. Weiland, and Hollis G. Potter
- Subjects
Adult ,Male ,medicine.medical_specialty ,Lifting ,Ischemia ,Wrist ,Wounds, Nonpenetrating ,Fingers ,Peripheral Nerve Injuries ,medicine ,Humans ,Orthopedics and Sports Medicine ,Peripheral Nerves ,Rupture ,business.industry ,medicine.disease ,Neurotomy ,Surgery ,Traumatic injury ,medicine.anatomical_structure ,Anesthesia ,Sensation Disorders ,Orthopedic surgery ,Crush injury ,Digital nerve ,business ,Palm - Abstract
Nerve injuries in the upper extremity after trauma are common. Typically nerve damage is the result of traction, crush injury, ischemic insult, or direct laceration of the peripheral nerve. Examination of the literature shows that nerve damage in closed traumatic injury is much less common than in open trauma, especially when this standard is applied to closed nerve injuries distal to the wrist. We report a case of closed partial neurotomy of a common digital nerve.
- Published
- 2005
46. Nerve conduction studies in hand surgery
- Author
-
David J. Slutsky
- Subjects
medicine.medical_specialty ,business.industry ,Hand surgery ,Radial tunnel syndrome ,medicine.disease ,Physical medicine and rehabilitation ,medicine.anatomical_structure ,Ulnar tunnel syndrome ,medicine ,Surgery ,Latency (engineering) ,Digital nerve ,Carpal tunnel syndrome ,business ,Nerve conduction ,Reinnervation - Abstract
The treatment of nerve disorders of the upper extremity has become a highly specialized area. There has been an evolution in the electrodiagnostic approach for evaluating patients with these disorders. Portable automated nerve conduction testing systems are becoming popular for limited nerve conduction testing in the office. Differential latency testing can aid in the diagnosis of dynamic nerve entrapment disorders such as radial tunnel syndrome. Comparative latency testing increases the test sensitivity in the diagnosis of carpal tunnel syndrome, cubital tunnel syndrome, and ulnar tunnel syndrome. Digital nerve conduction testing can detect isolated digital nerve lesions and can be used to monitor the adequacy of reinnervation after a nerve repair. Because of the inherent pitfalls of testing, it is not safe to rely on machine-generated reports. Hand surgeons who perform or supervise nerve conduction studies must be aware of the methodology and the limitations of the electrodiagnostic test.
- Published
- 2003
47. Symptomatic Neural Loop Causing Hemidigital Anesthesia: Case Report
- Author
-
Kurt J. Hofmann and David E. Ruchelsman
- Subjects
Male ,Neurologic Examination ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Middle Aged ,Microsurgery ,Median nerve ,Surgery ,Fingers ,Hypesthesia ,Anesthesia ,Orthopedic surgery ,medicine ,Humans ,Orthopedics and Sports Medicine ,Sensory symptoms ,Peripheral Nerves ,Differential diagnosis ,Digital nerve ,Cadaveric spasm ,business ,Neurolysis - Abstract
Digital neural loops were identified over a century ago and are common findings in cadaveric studies of palmar and digital anatomy. Symptomatic digital neural loops are rare. We report a case of hemidigital anesthesia resulting from a proper digital nerve neural loop penetrated by its common digital artery in the palm. After neurolysis of the median nerve and the common and proper digital nerves to the third webspace, we transected the common digital artery, transposed it out of the neural loop, and repaired it. The patient's sensory symptoms fully resolved over 6 weeks. The differential diagnosis, diagnostic workup, and surgical treatment are reviewed.
- Published
- 2012
48. Internal anatomy of the communicating branch between the ulnar and median nerves in the hand and its relevance to volar digital sensibility
- Author
-
Lucian Poliacu Prosé, J. Joris Hage, J. Peter W. Don Griot, J. Michiel Zuidam, and E.Oscar van Kooten
- Subjects
Adult ,Nervous system ,medicine.medical_specialty ,Fifth fingers ,Synaptic Transmission ,Hypesthesia ,Nerve Fibers ,Cadaver ,Small finger ,medicine ,Humans ,Orthopedics and Sports Medicine ,Ulnar nerve ,Ulnar Nerve ,business.industry ,Anatomy ,Hand ,Median nerve ,Ramus communicans ,Median Nerve ,Surgery ,body regions ,medicine.anatomical_structure ,Touch ,Digital nerve ,business - Abstract
We studied the microanatomy of the communicating branch between the ulnar and median nerves in 26 adult cadaver hands to explain diminished sensibility in the fourth and fifth fingers we had observed in 2 patients after complete transection of the median nerve. Two new variations of the communicating branch were observed. In the first variation the communicating branch originated proximally from the third common digital nerve to distally join the ring finger ulnar digital nerve and the small finger radial digital nerve. In the second variation the ramus communicans traversed perpendicularly between the third and fourth common digital nerves with a crossover of nerve fibers.
- Published
- 2002
49. Glomus tumour within digital nerve: A case report
- Author
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Sung-No Jung and Sang Wha Kim
- Subjects
Adult ,medicine.medical_specialty ,Risk Assessment ,Benign tumours ,Fingers ,Rare Diseases ,Peripheral Nervous System Neoplasms ,Humans ,Medicine ,Ultrasonography, Doppler, Color ,Histological examination ,business.industry ,Vascular disease ,Biopsy, Needle ,fungi ,Glomus Tumor ,Hand ,medicine.disease ,Immunohistochemistry ,Glomus tumor ,Surgery ,Treatment Outcome ,Glomus tumour ,Female ,Differential diagnosis ,Digital nerve ,business ,Follow-Up Studies ,Exploratory surgery - Abstract
Glomus tumour is a rare soft-tissue tumour developing in the hand. As it presents classic symptoms, it is most often diagnosed clinically. Preoperative radiological studies have been used to both determine exact location and size of the tumour as well as distinguish glomus tumour from other benign tumours of neural or non-neural origin. A 44-year-old woman presented with a painful, tender mass around the 4th web and tingling sensation on the fourth finger. Ultrasonography examination revealed a hypervascular mass on the ulnar side of the fourth proximal phalanx. We suspected a vascular tumour compressing the digital nerve and underwent exploratory surgery. Histological examination demonstrated the glomus tumour of the digital nerve. The patient's symptoms disappeared after surgery and there was no recurrence of the tumour at 3 years' follow-up. As glomus tumour can be successfully treated by excision, it is important to suspect the tumour and include it in differential diagnosis.
- Published
- 2011
50. Muscle-in-vein Nerve Guide for Secondary Reconstruction in Digital Nerve Lesions
- Author
-
M.S.S. Choi
- Subjects
medicine.anatomical_structure ,business.industry ,Magnetic resonance neurography ,medicine ,Anatomy ,Digital nerve ,Vein ,business ,Nerve guide - Published
- 2011
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