796 results on '"Digital nerve"'
Search Results
52. One-stage human acellular nerve allograft reconstruction for digital nerve defects
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Xue-yuan Li, Hao-liang Hu, Jian-rong Fei, Xin Wang, Tian-bing Wang, Pei-xun Zhang, and Hong Chen
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nerve regeneration ,peripheral nerve ,allograft ,digital nerve ,nerve conduit ,nerve reconstruction ,nerve defect ,sensory nerve ,neural regeneration ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Human acellular nerve allografts have a wide range of donor origin and can effectively avoid nerve injury in the donor area. Very little is known about one-stage reconstruction of digital nerve defects. The present study observed the feasibility and effectiveness of human acellular nerve allograft in the reconstruction of < 5-cm digital nerve defects within 6 hours after injury. A total of 15 cases of nerve injury, combined with nerve defects in 18 digits from the Department of Emergency were enrolled in this study. After debridement, digital nerves were reconstructed using human acellular nerve allografts. The patients were followed up for 6-24 months after reconstruction. Mackinnon-Dellon static two-point discrimination results showed excellent and good rates of 89%. Semmes-Weinstein monofilament test demonstrated that light touch was normal, with an obvious improvement rate of 78%. These findings confirmed that human acellular nerve allograft for one-stage reconstruction of digital nerve defect after hand injury is feasible, which provides a novel trend for peripheral nerve reconstruction.
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- 2015
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53. Fibrin Glue Increases the Tensile Strength of Conduit-Assisted Primary Digital Nerve Repair.
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Childe, Jessica R., Regal, Steven, Schimoler, Patrick, Kharlamov, Alexander, Miller, Mark C., and Tang, Peter
- Abstract
Background: An ideal peripheral nerve repair construct does not currently exist. Our primary goal was to determine whether fibrin glue adds to the tensile strength of conduit-assisted primary digital nerve repairs. Our secondary goal was to evaluate the impact of varying suture number and location on the tensile strength. Methods: Ninety cadaveric digital nerves were harvested and divided equally into the following repair groups: A (4/4), B (2/2), C (0/2), D (0/1), and E (0/0) with the first number referring to the number of sutures at the coaptation and the second number referring to the number of sutures at each proximal and distal end of the nerve-conduit junction. When fibrin glue was added, the group was labeled prime. The nerve specimens were transected and then repaired with 8-0 nylon suture and conduit. The tensile strength of the repairs was tested, and maximum failure load was determined. The results were analyzed with a 2-way analysis of variance. The Tukey post hoc test compared repair groups if the 2-way analysis of variance showed significance. Results: Both suture group and glue presence significantly affected the maximum failure load. Increasing the number of sutures increased the maximum failure load, and the presence of fibrin glue also increased the failure load. Conclusions: Fibrin glue was found to increase the strength of conduit-assisted primary digital nerve repairs. Furthermore, the number of sutures correlated to the strength of the repair. Fibrin glue may be added to a conduit-assisted primary digital nerve repair to maintain strength and allow fewer sutures at the primary coaptation site. [ABSTRACT FROM AUTHOR]
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- 2018
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54. Microsurgical Procedures
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Seiler, John Gray, III, Mirilas, Petros, Skandalakis, Lee John, Skandalakis, John E., and Skandalakis, Panajiotis N.
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- 2009
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55. Tumors and Tumor-Like Lesions
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Bodner, Gerd, Peer, Siegfried, Baert, A. L., editor, Knauth, M., editor, Sartor, K., editor, Peer, Siegfried, editor, and Bodner, Gerd, editor
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- 2008
- Full Text
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56. Nerve Reconstruction by Means of Tubulization
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Lohmeyer, J. A., Mailänder, P., Eisenmann-Klein, Marita, editor, and Neuhann-Lorenz, Constance, editor
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- 2008
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57. Macrodactyly-Lipofibromatous Hamartoma of Nerves
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Duràn-Mckinster, Carola, Orozco-Covarrubias, Luz, Saez-De-Ocariz, Marimar, Ruiz-Maldonado, Ramòn, Ruggieri, Martino, editor, Pascual-Castroviejo, Ignacio, editor, and Di Rocco, Concezio, editor
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- 2008
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58. Long-term sensibility outcomes of secondary digital nerve reconstruction with sural nerve autografts: a retrospective study
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Tomasz Dębski, Bartłomiej Noszczyk, and Marcin Złotorowicz
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medicine.medical_specialty ,Temperature sensation ,Sports medicine ,Sural nerve ,030230 surgery ,Critical Care and Intensive Care Medicine ,Transplantation, Autologous ,Fingers ,03 medical and health sciences ,0302 clinical medicine ,Sural Nerve ,Finger Injuries ,Sensation ,medicine ,Humans ,Orthopedics and Sports Medicine ,Sensibility ,Autografts ,Retrospective Studies ,030222 orthopedics ,Proprioception ,business.industry ,Retrospective cohort study ,Surgery ,Emergency Medicine ,Digital nerve ,business - Abstract
Background Recovery of sensibility after digital nerve injury is crucial for restoring normal hand function. We evaluated long-term outcomes of digital nerve reconstruction with autografts. Methods This retrospective study included patients who underwent secondary reconstruction of digital nerves with nerve autografting. Recovery of sensibility was evaluated based on the following: patient self-assessment, two-point discrimination (2PD), and a total sensation score (sum of proprioception, temperature sensation, and sharp/dull discrimination). Mixed models regression was used to study predictors of sensibility outcomes. The predictors analyzed were age, sex, smoking status, number of fingers involved in a patient (as a measure of injury severity), time to reconstruction, and time to follow-up. Results In 61 patients, 174 digital nerves in 126 fingers were reconstructed after an average of 33.1 weeks from injury. The mean follow-up was 6.4 years from reconstruction. The mean graft length was 3.6 cm. Self-rated sensibility in the affected area was very good in 13% of patients, good in 33%, satisfactory in 40%, and poor in 24%. 2PD at 6 mm was present in 17% of patients, at 10 mm in 12%, and at 15 mm in 18% (mean 2PD was 10.8). Proprioception was preserved in 107 (85%) fingers, sensation of temperature was preserved in 99 (75%) of fingers, and sharp/dull discrimination in 88 (70%) fingers. Time from injury to reconstruction was the only significant predictor of the total sensation score. Conclusion Our data indicate that earlier reconstruction is associated with a favorable outcome.
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- 2021
59. Rare case of Intraneural Lipoma of Digital Nerve
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Yu-Jung Su and Laxminarayan Bhandari
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body regions ,stomatognathic diseases ,digital nerve ,Automotive Engineering ,otorhinolaryngologic diseases ,Case Report ,Lipoma ,hand - Abstract
Lipomas, although ubiquitous, are extremely uncommon in digital nerves. We present a 68-year-old male patient with right ring finger radial digital nerve intraneural lipoma. The tumor was enucleated preserving all the nerve fascicles. We present this case to highlight the rare occurrence of lipomas within a digital nerve.
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- 2022
60. Ronald Furlong 1909–2002
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Mostofi, Seyed Behrooz
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- 2005
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61. Ultrasound features of traumatic digital nerve injuries of the hand with surgical confirmation
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Yoshimi Endo, Duretti T. Fufa, Thiru Sivakumaran, Susan C. Lee, and Bin Lin
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030203 arthritis & rheumatology ,Long axis ,medicine.medical_specialty ,Short axis ,business.industry ,Ultrasound ,Nerve injury ,Neuroma ,medicine.disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Orthopedic surgery ,otorhinolaryngologic diseases ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Digital nerve ,medicine.symptom ,Digital nerves ,business - Abstract
Characterize the appearance of digital nerve injuries in different ultrasound planes and correlate the presence and size of neuromas with time from injury. Surgically confirmed nerve injuries were retrospectively evaluated. Appearances of the nerve injury in the available imaging planes were reviewed by two readers. Associations between presence and size of neuroma with time from injury were analyzed. Injuries of 29 digital nerves (3 incomplete lacerations, 17 complete lacerations, 6 with 7 stump neuromas, 3 neuromas-in-continuity) noted on ultrasound were surgically confirmed. Among the 20 lacerations, long-axis images were obtained in 15, of which 10 depicted the injury and 4 did not. Among the 10 depicting the injury in long axis, 2 showed a discrete gap, and 7 showed the nerve obscured by laceration tissue without a gap. In short axis, the nerve injury was visible in all 20, and nerve laceration was seen as a discrete gap in 2, and obscuration by laceration tissue in 14. Neuromas were hypoechoic and well-defined. There was a positive association between time and presence of neuroma (OR = 1.3, p = 0.002). Correlations between time and cross-sectional area (rs = 0.45) and volume (rs = 0.57) of neuromas were moderately positive. Ultrasound long axis may be less useful, and those short axis may be more reliable for assessing digital nerve injuries than previously reported. Neuromas are hypoechoic and well-defined, and their size can vary based on time from injury.
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- 2021
62. Tumors and Tumor-Like Lesions
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Peer, S., Bodner, G., Baert, A. L., editor, Sartor, K., editor, Peer, Siegfried, editor, and Bodner, Gerd, editor
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- 2003
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63. Replantation
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Matsuda, Masao, Tamai, Susumu, editor, Usui, Masamichi, editor, and Yoshizu, Takae, editor
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- 2003
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64. Nerve Injury in the Hand
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Hirasawa, Yasusuke and Hirasawa, Yasusuke, editor
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- 2002
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65. Dupuytren’s Contracture
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McCusker, Barney, Wichmann, Matthias, editor, Borgstrom, David C., editor, Caron, Nadine R., editor, and Maddern, Guy, editor
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- 2011
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66. A Multicenter Matched Cohort Study of Processed Nerve Allograft and Conduit in Digital Nerve Reconstruction
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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
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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.
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- 2020
67. 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
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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.
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- 2021
68. Anatomy of the Carpal Tunnel
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Yugueros, P., Berger, R. A., Luchetti, Riccardo, editor, and Amadio, Peter, editor
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- 2007
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69. The effect of digital sensory loss on hand dexterity
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Olli Leppänen, Jarkko Jokihaara, and Patrick Luukinen
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030222 orthopedics ,medicine.medical_specialty ,Hand Strength ,business.industry ,medicine.medical_treatment ,Sensation ,Sensory loss ,030230 surgery ,Thumb ,Middle finger ,Hand ,Fingers ,body regions ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Physical medicine and rehabilitation ,Nerve block ,Humans ,Medicine ,Surgery ,Digital nerve ,business - Abstract
The purpose of this study is to determine how loss of sensation affect hand dexterity. In this study, digital nerve block anaesthesia was performed in different stages of timing for thumb, index and middle fingers of 12 volunteers. The Moberg pick-up test was conducted in the assessment of hand dexterity. Grip and pinch forces were also measured. Loss of thumb sensation had the greatest effect on dexterity, increasing average timing by at least 10.5 seconds (range 3.4 to 32.4). Loss of sensation to the index and middle fingers has a lesser impact, but decreased hand grip and chuck pinch forces (grip –25% or –33%, chuck pinch –31% or –32% depending on the timing of injections). We concluded that loss of thumb sensation has the greatest impact on hand dexterity. Index and middle finger sensory loss had less of an impact on hand dexterity but decreased grip and chuck pinch forces. Level of evidence: IV
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- 2020
70. Complex Irreducible Dorsal Dislocation of Thumb Interphalangeal Joint: Controversies and Consensus in Management
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Leon Alexander
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Adult ,Male ,musculoskeletal diseases ,Dorsum ,medicine.medical_specialty ,Joint Dislocations ,Palmar Plate ,030230 surgery ,Thumb ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Finger Joint ,medicine ,Humans ,medicine.bone ,Joint dislocation ,Volar plate ,030222 orthopedics ,Flexor pollicis longus tendon ,business.industry ,General Medicine ,medicine.disease ,medicine.anatomical_structure ,Sesamoid bone ,Digital nerve ,business ,Interphalangeal Joint ,Algorithms ,Bone Wires - Abstract
Dislocations of thumb interphalangeal (IP) joint are rare injuries due to inherent stability of the joint. This report presents a case of complex irreducible dorsal IP joint dislocation of thumb due to interposition of four structures – volar plate, sesamoid bone, flexor pollicis longus tendon and digital nerve which is perhaps the only case reported so far in literature where more than three structures have been implicated for this joint irreducibility. The author presents a comparative review of similar case reports previously reported in literature listing the controversies in management and forming a broad consensus in the management of these difficult injuries. Finally, an algorithm for the management of these injures has been proposed in this article which maybe helpful for other operators in tackling these injuries so as to deliver predictable treatment outcomes.
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- 2020
71. Results of fracture-dislocation of interphalangeal treatment with volar buttressing hook plating techniques
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Ahmadreza Afshar, Ali Tabrizi, Milad Safari, and Hassan Taleb
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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.
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- 2020
72. Morton’s neuroma – Current concepts review
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Maneesh Bhatia and Lauren Thomson
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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
73. Ultrasound-guided Therapeutic Injection and Cryoablation of the Medial Plantar Proper Digital Nerve (Joplin's Nerve): Sonographic Findings, Technique, and Clinical Outcomes
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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.
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- 2020
74. The assessment of ice pack effect in pain reduction during digital nerve block: A randomized clinical study
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Mehran Sotoodehnia, Amir Nejati, Pooya Payandemehr, and Fatemeh Rasooli
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Emergency department ,lcsh:RC86-88.9 ,Institutional review board ,digital nerve block ,Clinical trial ,Pain reduction ,Block (telecommunications) ,Physical therapy ,Numeric Rating Scale ,Medicine ,Ice pack ,Original Article ,pain ,Digital nerve ,business ,ice packing - Abstract
OBJECTIVES: Digital nerve block is a painful procedure. Several methods have been proposed to decrease the injection pain. Applying an ice pack is a pertinent choice due to its effectiveness on pain reduction, convenience, and low costs. In this study, the degree of injection pain reduction was assessed after applying an ice pack to the site of anesthetic injection. METHODS: One hundred participants with traumatic finger injury were assessed. Digital nerve block was performed in fifty patients in the intervention group after 6 min of ice application. In the control group, this procedure was done without ice. The primary outcome was the difference between the needle stick and infiltration pain scores with and without ice pack. The secondary outcome the patient satisfaction score. The protocol of this study was approved by the Institutional Review Board, and it is registered in the Iranian Registry of Clinical Trials. RESULTS: The pain score was assessed using a Numeric Rating Scale. Both the needle skin and infiltration pain scores were statistically significantly lower in the intervention group (P < 0.001). The mean and median needle stick pain scores were 1.5 and 1.0 in the intervention group and 6.8 and 7.0 in the control group, respectively. Moreover, the mean and median infiltration pain scores were 2.7 and 2.0 in the intervention group and 8.5 and 9.0 in the control group, respectively. Patient satisfaction score was significantly higher in the intervention group. CONCLUSIONS: Ice pack is inexpensive, readily available, and is easy to apply. We recommend this method to reduce the injection pain before digital nerve block in the emergency department.
- Published
- 2020
75. First dorsal metacarpal artery flap with dorsal digital nerve with or without dorsal branch of the proper digital nerve produces comparable short-term sensory outcomes
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Nicola Maffulli, Wei Xu, Shi-Ming Feng, Jia-Ju Zhao, and Filippo Migliorini
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Adult ,Male ,Dorsum ,medicine.medical_specialty ,Soft Tissue Injuries ,Dorsal digital nerve ,Sensory system ,Diseases of the musculoskeletal system ,Thumb ,Surgical Flaps ,Young Adult ,First dorsal metacarpal artery ,Finger Injuries ,Sensation ,medicine ,Humans ,Orthopedics and Sports Medicine ,Retrospective Studies ,Orthopedic surgery ,business.industry ,First dorsal metacarpal artery flap ,Dorsal branches of the proper digital nerve ,Anatomy ,Index finger ,Middle Aged ,Plastic Surgery Procedures ,Treatment Outcome ,medicine.anatomical_structure ,RC925-935 ,Female ,Surgery ,Digital nerve ,business ,RD701-811 ,Research Article - Abstract
Background The first dorsal metacarpal artery flap, including dorsal digital nerves with or without dorsal branches of the proper digital nerves, can be used to reconstruct thumb pulp defects with good results. However, it is still unclear whether there are differences in the sensory outcomes between preserving or not preserving the dorsal branches of the proper digital nerves. Methods This retrospective cohort study included 137 thumb pulp defect patients who underwent first dorsal metacarpal artery flap reconstruction procedure from October 2015 to June 2019. Patients were divided into two groups according to whether the dorsal branches of the proper digital nerves were preserved. In the non-preservation group (n = 80), the dorsal digital nerves were included in the flap for sensory reconstruction. In the preservation group (n = 57), the dorsal digital nerves and the dorsal branches of the proper digital nerves of the index finger were included in the flap. The stump of the proper digital nerves in the defect was coaptated to the donor nerves of the flap using the end-to-end fashion. At the last follow-up, static two-point discrimination, Semmes–Weinstein monofilament scores, pain, cold intolerance of the reconstructed finger, and patient satisfaction in both groups were compared. Results All patients were followed up for at least 17 months. No significant differences were found regarding pain of thumb pulp, static two-point discrimination, Semmes–Weinstein monofilament score, cold intolerance in the injured finger, and patient satisfaction. The non-preservation group presented slightly shorter operative times (p Conclusion There are no differences at 2 years in postoperative clinical outcomes when dorsal digital nerves are used to reconstruct flap sensation regardless of preservation of the dorsal branches of the proper digital nerves in the first dorsal metacarpal artery flap. Level of evidence: Level III, retrospective comparative study.
- Published
- 2021
76. Comparison of Threshold and Tolerance Nociceptive Withdrawal Reflexes in Horses
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Claudia Spadavecchia, Massimo Leandri, Selina Mühlemann, and Åse I Risberg
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medicine.medical_specialty ,electromyography ,nociceptive withdrawal reflex ,Veterinary medicine ,Deltoid curve ,Withdrawal reflex ,Stimulation ,Electromyography ,Audiology ,Article ,SF600-1100 ,Medicine ,nociception ,Latency (engineering) ,horse ,equine ,tolerance ,630 Agriculture ,General Veterinary ,medicine.diagnostic_test ,business.industry ,Nociception ,QL1-991 ,Reflex ,Animal Science and Zoology ,Digital nerve ,business ,Zoology - Abstract
Simple Summary Nociception is the physiological basis of the complex experience of pain. An established model for its quantification in equine studies is based on the nociceptive withdrawal reflex evoked by electrical stimulation of a sensory nerve. The reflex is recorded via electromyography and it is common to determine the threshold at which a nociceptive-specific reflex activity can be observed. In the present study, the classical methodology was expanded for a deeper understanding of the physiology of nociceptive reflexes in horses. First, for each individual horse, a threshold was determined as the minimal stimulation intensity able to evoke a nociceptive withdrawal reflex. Second, the stimulation intensity was stepwise increased up to tolerance, which was defined as the stimulus that is able to elicit the maximal tolerable behavioral reaction. The characteristics of the reflex activity on the electromyographic records were compared for threshold and tolerance stimulation intensities. At tolerance, the reflex became faster and wider than at threshold, indicating that either a spinal summation mechanism or the recruitment of faster sensory fibers occurs in response to high-intensity noxious stimuli. A novel endpoint (i.e., tolerance) can now be considered when applying the nociceptive withdrawal reflex model in equine studies. Abstract The nociceptive withdrawal reflex (NWR) is used to investigate nociception in horses. The NWR threshold is a classical model endpoint. The aims of this study were to determine NWR tolerance and to compare threshold and tolerance reflexes in horses. In 12 horses, the NWR was evoked through electrical stimulation of the digital nerve and recorded via electromyography from the deltoid. Behavioral reactions were scored from 0 to 5 (tolerance). First, the individual NWR threshold was defined, then stimulation intensity was increased to tolerance. The median NWR threshold was 7.0 mA, whereas NWR tolerance was 10.7 mA. Upon visual inspection of the records, two main reflex components R1 (median latency 44 ms) and R2 (median latency 81 ms) were identified at threshold. Increasing stimulation intensity to tolerance led to a significant increase in the amplitude and duration of R1 and R2, whereas their latency decreased. At tolerance, a single burst of early, high-amplitude reflex activity, with a median latency of 39 ms, was detected in 15 out of 23 stimulations (65%). The results of this study suggest that (1) it is feasible to determine NWR tolerance in horses and (2) high-intensity stimuli initiate ultrafast bursts of reflex activity, which is well known in practice and has now been quantified using the NWR model.
- Published
- 2021
77. Apitherapy in Orthopaedic Diseases
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Feraboli, Franco, Mizrahi, Avshalom, editor, and Lensky, Yaacov, editor
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- 1997
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78. Carpal Tunnel
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Skandalakis, John E., Skandalakis, Panajiotis N., Skandalakis, Lee John, Skandalakis, John E., Skandalakis, Panajiotis N., and Skandalakis, Lee John
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- 1995
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79. The Complications and Unsatisfactory Results of Treatment for Dupuytren’s Disease
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Hueston, J. T., Berger, Alfred, editor, Delbrück, Axel, editor, Brenner, Peter, editor, and Hinzmann, Rolf, editor
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- 1994
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80. Fasciotomy and the Open Palm Technique
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Burge, P., Berger, Alfred, editor, Delbrück, Axel, editor, Brenner, Peter, editor, and Hinzmann, Rolf, editor
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- 1994
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81. Application of Topical Lidocaine for Pain Relief in the Setting of Targeted Therapy-Induced Onycholysis: A Case Report
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Hannah Bromberg, Diane Portman, David S. Craig, and Young Doo Chang
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medicine.medical_specialty ,Lidocaine ,business.industry ,medicine.medical_treatment ,Pain relief ,Onycholysis ,Pain ,General Medicine ,Nail plate ,medicine.disease ,Dermatology ,Targeted therapy ,Topical lidocaine ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Nail (anatomy) ,Humans ,Medicine ,Digital nerve ,business ,General Nursing ,medicine.drug - Abstract
Selective pan fibroblast growth factor receptor (FGFR) inhibitors have been linked to severe onycholysis, the uncomfortable separation of the nail plate from the nail bed. Recommendations to assist with FGFR inhibitor onycholysis vary based on the severity. We hypothesized that the application of topical lidocaine to mimic a digital nerve block would be beneficial in addition to traditional supportive care interventions and subsequently report its immediate and continued efficacy for targeted therapy-induced onycholysis.
- Published
- 2022
82. A cadaveric study of the distribution pattern of the cutaneous sensory fibres of the distal palm of the hand.
- Author
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Filfilan, R., Kinsella, A., Yong, L., and Davidson, D. M.
- Abstract
We investigated the cutaneous innervation of the distal palm, an area frequently dissected by the hand surgeon. Ten (five paired) fresh-frozen cadaveric hands were dissected under 3.0× loupe magnification. Volar branches were found on both sides in the majority of digits. They originated alongside, or at the proximal margin of, the A1 pulley in 84% of digits. The mean distance from the palmar digital crease to the origin of volar branches was 21 mm. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
83. A Multicenter, Prospective, Randomized, Pilot Study of Outcomes for Digital Nerve Repair in the Hand Using Hollow Conduit Compared With Processed Allograft Nerve.
- Author
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Means Jr, Kenneth R., Rinker, Brian D., Higgins, James P., Payne Jr, S. Houston, Merrell, Gregory A., and Wilgis, E. F. Shaw
- Abstract
Background: Current repair options for peripheral nerve injuries where tension-free gap closure is not possible include allograft, processed nerve allograft, and hollow tube conduit. Here we report on the outcomes from a multicenter prospective, randomized, patient- and evaluator-blinded, pilot study comparing processed nerve allograft and hollow conduit for digital nerve reconstructions in the hand. Methods: Across 4 centers, consented participants meeting inclusion criteria while not meeting exclusion criteria were randomized intraoperatively to either processed nerve allograft or hollow conduit. Standard sensory and safety assessments were conducted at baseline, 1, 3, 6, 9, and 12 months after reconstruction. The primary outcome was static 2-point discrimination (s2PD) testing. Participants and assessors were blinded to treatment. The contralateral digit served as the control. Results: We randomized 23 participants with 31 digital nerve injuries. Sixteen participants with 20 repairs had at least 6 months of follow-up while 12-month follow-up was available for 15 repairs. There were no significant differences in participant and baseline characteristics between treatment groups. The predominant nerve injury was laceration/sharp transection. The mean ± SD length of the nerve gap prior to repair was 12 ± 4 mm (5-20 mm) for both groups. The average s2PD for processed allograft was 5 ± 1 mm (n = 6) compared with 8 ± 5 mm (n = 9) for hollow conduits. The average moving 2PD for processed allograft was 5 ± 1 mm compared with 7 ± 5 mm for hollow conduits. All injuries randomized to processed nerve allograft returned some degree of s2PD as compared with 75% of the repairs in the conduit group. Two hollow conduits and one allograft were lost due to infection during the study. Conclusions: In this pilot study, patients whose digital nerve reconstructions were performed with processed nerve allografts had significantly improved and more consistent functional sensory outcomes compared with hollow conduits. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
84. The Diagnosis and Treatment of Joplin's Neuroma.
- Author
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Melendez, Mark M., Patel, Anup, and Dellon, A. Lee
- 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. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
85. Translating morphology from bench side to bed side via neurophysiology: 8-minute protocol for peripheral neuropathy research
- Author
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Monza, L, Fumagalli, G, Chiorazzi, A, Alberti, P, Monza, Laura, Fumagalli, Giulia, Chiorazzi, Alessia, Alberti, Paola, Monza, L, Fumagalli, G, Chiorazzi, A, Alberti, P, Monza, Laura, Fumagalli, Giulia, Chiorazzi, Alessia, and Alberti, Paola
- Abstract
Background: Peripheral neuropathy treatment is not always satisfactory. To fill this gap, inferences from bench side are warranted, where morphological and pathogenetic determinations can be performed. Nerve conduction studies (NCS) are ideal to translate results from preclinical to clinical setting. New methods: We propose a comprehensive 8-minute protocol for sensory-motor neurophysiological assessment, similar to routine clinical practice: sensory proximal and distal caudal nerves, motor caudal nerve, and sensory digital nerve recordings were used and tested in 2 different experimental settings. In Experiment 1 we compared control (CTRL) animals to a severe sensory-motor polyneuropathy (animals treated with vincristine [VCR]), and in Experiment 2 CTRL animals were compared to a mild sensory polyneuropathy (animals treated with oxaliplatin [OHP]). NCS were performed after 1-month of chemotherapy and matched with confirmatory neuropathological analyses. Results: VCR treated animals showed, at NCS, a relevant sensory-motor polyneuropathy ensued at the end of treatment; whereas, OHP animals showed a mild distal sensory neuropathy. These patterns were confirmed by neuropathological analysis. Comparison with existing methods: In literature, the majority of proposed neurophysiological protocols relies mainly on a single nerve testing, rather than a combination of them, and only a few studies tested both caudal and sciatic nerve branches, nevertheless not aiming at fully reproduce clinical protocols (e.g., seeking for length-dependency); to provide evidence of appropriateness of our protocol we applied a gold standard: neuropathology. Conclusion: The simple and rapid protocol here presented can be suggested as a good translation outcome measure in preclinical setting.
- Published
- 2021
86. A cadaveric assessment of percutaneous trigger finger release with 15° stab knife: its effectiveness and complications
- Author
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Majid Asadian, Seyed Houssein Saeed Banadaky, Rabeah Sarram, and Abbas Abdoli
- Subjects
Adult ,Male ,Success rate ,medicine.medical_specialty ,Percutaneous ,genetic structures ,Trigger finger release ,Diseases of the musculoskeletal system ,Fingers ,Tendons ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Trigger fingers ,Cadaver ,Finger Injuries ,A1 pulley ,medicine ,Humans ,Orthopedics and Sports Medicine ,Aged ,Orthopedic surgery ,030203 arthritis & rheumatology ,15° stab knife ,030222 orthopedics ,business.industry ,Middle Aged ,Surgical Instruments ,eye diseases ,Stab ,Surgery ,body regions ,Treatment Outcome ,Trigger Finger Disorder ,RC925-935 ,Female ,Percutaneous release ,sense organs ,Digital nerve ,business ,Cadaveric spasm ,RD701-811 ,Research Article - Abstract
Abstract Percutaneous release of the A1 pulley has been introduced as a therapeutic approach for trigger fingers and is suggested as an effective and safe alternative, where conservative treatments fail. The aim of the current study was to determine if percutaneous release with a 15° stab knife can effectively result in acceptable efficacy and lower complication rate. Methods In the present study, the percutaneous release of the A1 pulley was evaluated by percutaneous release using a 15° stab knife in 20 fresh-frozen cadaver hands (10 cadavers). One hundred fingers were finally included in the present study. The success rate of A1 pulley release as well as the complications of this method including digital vascular injury, A2 pulley injury, and superficial flexor tendon injury was evaluated, and finally, the data were analyzed by the SPSS software. Results The results showed a success rate of 75% for A1 pulley release in four fingers, followed by eleven fingers (90%) and eighty-five fingers (100%). Therefore, the A1 pulley was found to be completely released in eighty-five fingers (100%). Overall, the mean of A1 pulley release for these fingers was determined as 97.9%, indicating that percutaneous trigger finger release can be an effective technique using a 15° stab knife. Furthermore, our findings revealed no significant difference in the amount of A1 pulley release in each of the fingers in the right and left hands. Additionally, 17 fingers developed superficial scrape in flexor tendons, while 83 fingers showed no flexor tendons injuries and no other injuries (i.e., vascular, digital nerve, and A2 pulley injuries). Conclusions Percutaneous release of the A1 pulley using a 15° stab knife was contributed to acceptable efficacy and a relatively good safety in the cadaveric model.
- Published
- 2021
87. Effect on analgesia duration and pain intensity of adding dexamethasone to lidocaine in digital nerve block in patients with finger trauma
- Author
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Mohamadreza Rafiei, Mohamad Afsahi, Behroz Kheradmand, Mehrshad Namazi, and Ebrahi Hazrati
- Subjects
Lidocaine ,business.industry ,medicine.medical_treatment ,Rehabilitation ,Block (permutation group theory) ,Nerve Block ,Dexamethasone ,Intensity (physics) ,Anesthesia ,medicine ,Humans ,Orthopedics and Sports Medicine ,Surgery ,In patient ,Local anesthesia ,Digital nerve ,Analgesia ,Anesthetics, Local ,business ,Saline ,medicine.drug ,Pain Measurement - Abstract
Digital nerve block is one of the multimodal analgesia methods used in finger trauma cases. According to some studies, dexamethasone needs further investigation before being used routinely. We therefore investigated dexamethasone's effect on the parameters of digital nerve block. In this double-blind clinical study, 60 patients were allocated to two groups: lidocaine alone and lidocaine + dexamethasone. Groups were compared for pain intensity, analgesia duration and demographic characteristics. Patients in the intervention group received 3 cc 2% lidocaine + 1 cc (equivalent to 4 mg) dexamethasone and patients in the control group received 3 cc lidocaine 2% + 1 cc normal saline. The two groups were comparable for age and gender. In the lidocaine + dexamethasone group, postoperative pain severity was significantly lower and the pain-free period was longer (P 0.05). Dexamethasone as an adjuvant in digital nerve block after trauma reduced the severity of postoperative pain and increased the pain-free period.
- Published
- 2021
88. Interdigital Nerve Entrapment
- Author
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Turner, Oscar A., Taslitz, Norman, Ward, Steven, Turner, Oscar A., Taslitz, Norman, and Ward, Steven
- Published
- 1990
- Full Text
- View/download PDF
89. Median Nerve
- Author
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Turner, Oscar A., Taslitz, Norman, Ward, Steven, Turner, Oscar A., Taslitz, Norman, and Ward, Steven
- Published
- 1990
- Full Text
- View/download PDF
90. Digital Nerve Entrapment
- Author
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Turner, Oscar A., Taslitz, Norman, Ward, Steven, Turner, Oscar A., Taslitz, Norman, and Ward, Steven
- Published
- 1990
- Full Text
- View/download PDF
91. A Hybrid Soft Robotic Surgical Gripper System for Delicate Nerve Manipulation in Digital Nerve Repair Surgery
- Author
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Jin Huat Low, Jasmin Shimin Lee, Jin Guo, Yoke-Rung Wong, Raye Chen Hua Yeow, and Xinquan Liang
- Subjects
0209 industrial biotechnology ,medicine.medical_specialty ,Pneumatic actuator ,Computer science ,Forceps ,Soft robotics ,02 engineering and technology ,Computer Science Applications ,Surgery ,020901 industrial engineering & automation ,Control and Systems Engineering ,Grippers ,Cadaver ,Control system ,medicine ,Electrical and Electronic Engineering ,Digital nerve ,Actuator - Abstract
In digital nerve repair surgery, handling the digital nerves using traditional forceps requires surgeons to be extremely cautious in order to minimize unintended iatrogenic nerve trauma. These injuries are mainly caused by excessively forceful manipulation with metallic rigid forceps. Soft pneumatic actuators have been increasingly adopted to broaden the biomedical applications of conventional rigid structures due to their inherent excellent compliance and compressibility. Existing soft grippers, however, face barriers to their use in digital nerve repair, due to their large prototype size or limited gripping force. In this paper, a new two-arm hybrid soft surgical gripper system is proposed to reduce the risk of excessive stress to nerves and facilitate surgeons’ delicate nerve manipulation in digital nerve repair surgery. It consists of two hybrid soft surgical grippers, two stiffness-tunable positioning arms, and a pedal-based control system. The inflated soft pneumatic gripping actuator is capable of providing compliant gripping and soft interaction with nerve tissues. This can prevent sudden overgripping force stimulation. The ability to position two surgical grippers is provided by two stiffness-tunable arms combining six pneumatic locking actuators. The inflation of the soft pneumatic actuator is investigated using a theoretical model and finite element analysis. Cadaver experiments, rodent experiments, and histopathological studies are conducted to validate that the proposed surgical gripper system is capable of completing required digital nerve manipulations in digital nerve repair surgery and exhibits very low disruption to nerve tissues.
- Published
- 2019
92. Use of a vascularized dorsal sensory branch of an ulnar nerve flap for repairing a proper digital nerve with coverage of a volar soft tissue defect: Report of two cases
- Author
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Yuichi Hirase, Satoshi Usami, Kohei Inami, and Sanshiro Kawahara
- Subjects
Adult ,Male ,medicine.medical_specialty ,Soft Tissue Injuries ,Sensory system ,030230 surgery ,Surgical Flaps ,Fifth metacarpal bone ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Finger Injuries ,medicine ,Humans ,medicine.bone ,Ulnar nerve ,Ulnar Nerve ,business.industry ,Soft tissue ,Little finger ,Index finger ,Plastic Surgery Procedures ,Surgery ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Digital nerve ,business - Abstract
To repair a short nerve gap, autograft, allograft, autogenous, or synthetic conduits are selected, but a vascularized nerve autograft is preferred to obtain a reliable postoperative outcome in the case of an unfavorable wound bed. The purpose of this report is to describe and evaluate two cases of repair of a proper digital nerve and volar soft tissue defect with a vascularized dorsal sensory branch of an ulnar nerve flap. The cases of two men, 40 and 20 years old, who suffered index finger defects due to crush lacerations that required a flap and a nerve graft, are presented. A 4.0 cm × 2.0 cm and a 3.2 cm × 1.6 cm flap, which were nourished by the perforators from the ulnar proper digital artery of the little finger, were elevated from the ulnar side of fifth metacarpal bone head and transferred for coverage of the soft tissue defect. A 4.6-cm and a 3.0-cm vascularized nerve graft was interposed in the nerve gap. The patients' postoperative courses were uneventful, and both patients had no complaints related to the donor site. Static and moving two-point discrimination were 8 and 6 mm, respectively, at 6 months after surgery in the first case and 5 and 3 mm, respectively, at 9 months after surgery in the second case. This flap, which could be elevated in the same operative field with a nerve having similar diameter to that of the proper digital nerve, was useful for repair of a finger volar tissue defect.
- Published
- 2019
93. 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
94. Distal Digital Nerve Repair Using Nerve Allograft With a Dermal Substitute: A Case Report
- Author
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Cameron Cox, Desirae M. McKee, and Bradley O. Osemwengie
- Subjects
medicine.medical_specialty ,Nerve allograft ,business.industry ,Nerve graft ,Soft tissue ,Case Report ,Skin Transplantation ,Plastic Surgery Procedures ,Allografts ,Surgical Flaps ,Numerical digit ,Surgery ,Peripheral Nerve Injuries ,Normal sensation ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Full thickness ,Digital nerve ,Nerve repair ,business - Abstract
Background: Distal digital nerve repairs can present unique challenges for hand surgeons due to their sensitive location and ongoing difficulty obtaining soft tissue coverage in this region. Although autografts and nerve conduits have been shown to be of benefit with nerve gaps, they can have morbidities associated with their use. Nerve allografts have become a viable option over the past decade as their use has increased and data are now showing similar outcomes, particularly in short gap segments. Flaps and skin grafts are traditional coverage options for full thickness wounds but can pose challenges with multiple digit involvement, depth of wound, and critical structures exposed. Methods: We present a case where nerve allograft was used for distal digital nerve repair. Due to the distal nature of the nerve repair in the index digit distal to the trifurcation, the distal end of the nerve graft was connected to multiple small nerve ends. Dermal substitute was placed to achieve distal coverage of the affected digits. Results: At 6-month follow-up, the patient demonstrated improved strength, normal sensation, and full return of digital function. Conclusion: Nerve allograft can be used in combination with dermal skin substitute to achieve normal sensation and return of digital function following distal digital nerve injuries.
- Published
- 2019
95. Sensory Outcomes in Digital Nerve Repair Techniques: An Updated Meta-analysis and Systematic Review
- Author
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Asif M. Ilyas and Zachary J Herman
- Subjects
030222 orthopedics ,medicine.medical_specialty ,business.industry ,Sensory system ,030230 surgery ,Surgery ,03 medical and health sciences ,surgical procedures, operative ,0302 clinical medicine ,Meta-analysis ,Direct repair ,Inclusion and exclusion criteria ,medicine ,Digital nerve injury ,Orthopedics and Sports Medicine ,Digital nerve ,Digital nerves ,Complication ,business - Abstract
Background: Injuries to digital nerves are common with trauma to the hand, often requiring surgery. Surgical management of these injuries can be performed using several techniques: direct repair (neurorrhaphy), autograft, allograft, and conduit repair. In light of increasing the availability and use of various digital nerve repair techniques, a new systematic review and meta-analysis was undertaken to comparatively review the available evidence to determine any differences in outcomes to better guide treatment in cases with digital nerve gaps. Methods: Current literature on sensory outcomes of various digital nerve repair techniques was reviewed using static 2-point discrimination (S2PD), moving 2-point discrimination (M2PD), Semmes-Weinstein monofilament testing (SWMF), and complication rates as outcomes of interest. After inclusion and exclusion criteria were applied, 15 articles were reviewed and 625 nerve repairs were analyzed. Results: The average gap length for allograft repair, autograft repair, and conduit repair was 15.4, 24.7, and 13.4 mm, respectively. For S2PD outcomes, autograft repair was statistically superior to all other forms of repair. Allograft trended higher than neurorrhaphy and conduit repair, but results were not statistically significant. For SWMF outcomes, autograft repair was statistically superior to conduit repair and neurorrhaphy; it was statistically comparable with allograft repair. Allograft performed statistically superior to conduit repair relative to M2PD. Conclusions: Based on the current updated meta-analysis using newer data and techniques, we found that all available techniques have reasonable outcomes. Yet when managing a digital nerve injury with a gap, thereby excluding direct neurorrhaphy, both autograft and allograft performed comparably and were superior to conduit repair.
- Published
- 2019
96. 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.
- Published
- 2019
97. Treatment of a patient suffering from posttraumatic painful neuromas formed at the bilateral digital nerves of the left middle finger using two neurovascular island flaps
- Author
-
Shunki Iemura, Masao Akagi, Ryosuke Kakinoki, Kazuhiko Hashimoto, Kazuhiro Ohtani, Fumihisa Nakamura, and Hiroki Tanaka
- Subjects
medicine.medical_specialty ,Neurovascular island flap ,Painful neuromas ,medicine.medical_treatment ,Finger pain ,lcsh:Surgery ,Island Flaps ,030230 surgery ,Digit tip amputation ,03 medical and health sciences ,0302 clinical medicine ,medicine ,otorhinolaryngologic diseases ,Digital nerves ,Referred pain ,business.industry ,Case Reports and Short Communication ,Left middle finger ,lcsh:RD1-811 ,Neurovascular bundle ,Surgery ,body regions ,Amputation ,030220 oncology & carcinogenesis ,Scar tissue ,sense organs ,Digital nerve ,business - Abstract
Hand surgeons often encounter painful posttraumatic neuromas in daily practice and the treatment of these neuromas is still challenging for them, because of the tendency of recurrence.1,2 The patient injured his left middle finger and was treated by amputation in a previous hospital. After this operation, the patient started to feel pain at the fingertip and complained of severe electric radiating pain when the radial and ulnar ends of the finger were touched. We treated painful neuromas formed on both palmar digital nerve stumps using a reverse pedicle island flap containing subcutaneous nerves, which were connected to the nerve stumps after removal of the neuromas of the finger. This maneuver relieved the finger pain completely.Removal of finger digital nerve neuromas, connecting the nerve stumps to the subcutaneous nerves included in a skin island flap and, covering the neurorrhaphy sites with the flap may have reduced the chance of the recurrence of neuromas and resulted in restoration of considerable function of the hand. Keywords: Digit tip amputation, Painful neuromas, Neurovascular island flap, Scar tissue
- Published
- 2019
98. 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.
- Published
- 2019
99. Reverse vascular pedicle digital island flap with preservation of the dorsal branch of the digital nerve
- Author
-
Kazunobu Hashikawa, Takeo Osaki, Hiroto Terashi, and Tadashi Nomura
- Subjects
Reverse vascular pedicle digital island flap ,Vascular pedicle ,business.industry ,dorsal branch of the digital nerve ,Fingertip amputation ,fingertip amputation ,Treatment options ,Case Report ,Anatomy ,fingertip reconstruction ,eye diseases ,body regions ,Middle phalanx ,Automotive Engineering ,Medicine ,Digital nerve ,business ,Dorsal branch - Abstract
A reverse vascular pedicle digital island flap is a useful treatment option for reconstruction in fingertip amputation. We describe a surgical procedure to preserve the dorsal branch of the digital nerve in the middle phalanx during elevation of this flap with favourable outcomes.
- Published
- 2019
100. Pedicled Osteo-Onchyocutaneous Island Flap for Finger Macrodactyly: A Review of Literature
- Author
-
YE Win Kyi, Ruth En Si Tan, Sandeep J. Sebastin, and Alphonsus K.S. Chong
- Subjects
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
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