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Luca Padua - One of the best experts on this subject based on the ideXlab platform.
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Ultrasound is a useful tool to evaluate nerve involvement in children with supracondylar humerus fractures.
Muscle & nerve, 2017Co-Authors: Marina A Bellavia, Chiara Cambise, Daniele Coraci, Giulio Maccauro, Antonio Valassina, Luca PaduaAbstract:Supracondylar humerus fracture (SHF) is a common childhood injury and represents approximately 60% of all\ud elbow fractures in children. Nerve injures associated with this fracture are well-known, and may be a direct\ud consequence of the trauma itself or iatrogenic. Neurophysiological study is the gold standard to assess\ud peripheral nerve injuries but it is invasive and may be difficult to perform in children. Furthermore,\ud neurophysiology can best provide useful information 2-4 weeks post-injury, it does not show nerve anatomy,\ud and is not able to distinguish between axonotmesis and Neurotmesis. Nerve ultrasound (US) represents an\ud extension of clinical examination8 and can provide morphologic information. US is being used with increasing\ud frequency to visualize nerves and their surroundings in traumatic nerve lesion, because it helps localize and\ud define the peripheral nerve injury. In particular US can distinguish axonotmesis and neuroapraxia (in which there\ud is nerve continuity) from Neurotmesis (in which nerve continuity is absent) to provide information useful for\ud surgery, and it can also facilitate post-operative management
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Fibular nerve Neurotmesis after knee dislocation: Ultrasonographic findings.
Muscle & nerve, 2016Co-Authors: Daniele Coraci, Andrea Faiola, Ilaria Paolasso, Valter Santilli, Luca PaduaAbstract:N/
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Fibular nerve Neurotmesis secondary to knee trauma: a diagnosis requiring nerve ultrasound.
Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology, 2013Co-Authors: Maria Laura Ester Bianchi, Daniele Coraci, G. Granata, Luca PaduaAbstract:Peripheral nerve trauma may be the result of contusion, laceration, mechanical damage by bone fragments, stretching and traction, or iatrogenic causes. In closed trauma, it is often challenging to detect the site, mechanism, and severity of nerve damage (Padua et al., 2012).\ud \ud Ultrasound (US) is a relatively new, but useful tool in the diagnosis of peripheral nerve disease, complementing the electrodiagnostic (EDx) evaluation (Beekman and Visser, 2003). One of its most important contributions is the ability to differentiate axonotmesis from Neurotmesis soon after acute injury, providing detailed information useful for surgery (Padua et al., 2012)
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149. Clinical, neurophysiological and ultrasound assessment in post-surgical follow up of nerve injuries: A case report
Clinical Neurophysiology, 2013Co-Authors: A. Gagliardo, Daniele Coraci, Marcello Romano, E.m. Fernandez Marquez, H. Tsukamoto, P. De Franco, Luca PaduaAbstract:A 50-year old man received a cut injury to the left forearm with involvement of median and ulnar nerves and consequent hand motor and sensory deficits. He underwent surgical revision of the wound, but 6 months later the patient did not present recovery. A following neurophysiological examination showed sporadic fibrillation potentials with reduced voluntary recruitment in the first dorsal interosseus muscle and complete denervation in muscles innervated by distal median nerve, indicating an axonal ulnar neuropathy and a possible median nerve axonotmesis or Neurotmesis. Ultrasound examination showed: median nerve Neurotmesis and amputation neuroma with a gap of about 7–8 cm between proximal and distal stumps; a slight focal increase in cross-sectional area of the ulnar nerve close to the scar. The patient newly underwent surgery. A reconstruction of the left median nerve by a sural nerve graft and neurolysis of the ulnar nerve were performed. In the following days the patient reported an improvement in the cold and hot sensitivity on the ulnar nerve distribution in the left hand. In conclusion ultrasound nerve examination played a key role in decision-making.
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Ultrasound study is useful to discriminate between axonotmesis and Neurotmesis also in very small nerves: a case of sensory digital ulnar branch study.
Medical ultrasonography, 2012Co-Authors: Renna Rosaria, Coraci Daniele, Paola De Franco, Carmen Erra, Massimo Ceruso, Luca PaduaAbstract:Discrimination between axonotmesis and Neurotmesis is crucial in traumatic nerve injury. We present the case of a 43-year-old woman which presented hypoesthesia in the fourth and fifth right fingers, started after surgery for Dupuytren syndrome. At ultrasound study, the ulnar digital sensory branch was identified. Before the division into the two terminal branches, a neuroma was observed, while Neurotmesis was excluded. This case shows the utility of ultrasonography in peripheral nervous system examination and the possibility of visualization of very small nerves and their terminal branches.
P. Houpt - One of the best experts on this subject based on the ideXlab platform.
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Uitval van de nervus radialis na een humerusfractuur
Nederlands Tijdschrift voor Traumatologie, 2013Co-Authors: W.b.w.h. Melenhorst, J.j. Kootstra, P. HouptAbstract:Bij uitval van de nervus radialis na een humerusfractuur is het essentieel om onderscheid te maken tussen neurapraxie enerzijds en axonotmesis of Neurotmesis anderzijds. Emg-onderzoek als diagnosticum voor dit onderscheid is pas zinvol na vier tot zes weken. Indien zenuwherstel of -genezing niet mogelijk is, dan is de toepassing van peestransposities een voorspelbare en succesvolle behandeling in het kader van functieherstel.
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Uitval van de nervus radialis na een humerusfractuur
Nederlands Tijdschrift voor Traumatologie, 2013Co-Authors: W.b.w.h. Melenhorst, J.j. Kootstra, P. HouptAbstract:In radial nerve palsy associated with fractures of the humerus, it is essential to discriminate neurapraxia on one hand and axonotmesis or Neurotmesis on the other. Electromyography as a diagnostic tool is helpful, yet only after 4-6 weeks. In the case of an irreparable nerve or a proven unsuccessful repair, tendon transpositions form a very reliable and predictable treatment for functional recovery. Bij uitval van de nervus radialis na een humerusfractuur is het essentieel om onderscheid te maken tussen neurapraxie enerzijds en axonotmesis of Neurotmesis anderzijds. Emg-onderzoek als diagnosticum voor dit onderscheid is pas zinvol na vier tot zes weken. Indien zenuwherstel of -genezing niet mogelijk is, dan is de toepassing van peestransposities een voorspelbare en succesvolle behandeling in het kader van functieherstel.
Jun Shen - One of the best experts on this subject based on the ideXlab platform.
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Magnetic resonance imaging of enhanced nerve repair with mesenchymal stem cells combined with microenvironment immunomodulation in Neurotmesis.
Muscle & nerve, 2020Co-Authors: Zehong Yang, Chushan Zheng, Fang Zhang, Binglin Lin, Minghui Cao, Xuwei Tian, Jingzhong Zhang, Xiao Zhang, Jun ShenAbstract:INTRODUCTION The immuno-microenvironment of injured nerves adversely affects mesenchymal stem cell (MSC) therapy for Neurotmesis. Magnetic resonance imaging (MRI) can be used noninvasively to monitor nerve degeneration and regeneration. The aim of this study was to investigate nerve repair after MSC transplantation combined with microenvironment immunomodulation in Neurotmesis by using multiparametric MRI. METHODS Rats with sciatic nerve transection and surgical coaptation were treated with MSCs combined with immunomodulation or MSCs alone. Serial multiparametric MRI examinations were performed over an 8-week period after surgery. RESULTS Nerves treated with MSCs combined with immunomodulation showed better functional recovery, rapid recovery of nerve T2, fractional anisotropy and radial diffusivity values, and more rapid restoration of the fiber tracks than nerves treated with MSCs alone. DISCUSSION Transplantation of MSCs in combination with immunomodulation can exert a synergistic repair effect on Neurotmesis, which can be monitored by multiparametric MRI.
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Preoperative Evaluation of Iatrogenic Spinal Accessory Nerve Palsy: What Is the Place for Electrophysiological Testing?
Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society, 2019Co-Authors: Jun Shen, Yan-qun Qiu, Xu Jing, Yi Zhu, Shen YundongAbstract:PURPOSE Electrophysiological testing has been used for the early diagnosis of iatrogenic spinal accessory nerve palsy in clinical practice. However, the presence of low-amplitude compound action potential in 70% to 90% of the patients suffering from iatrogenic nerve transection was reported in several studies. We have encountered the same issue and made minor modifications to the methods of electrophysiological testing. The purpose of this study was to retrospectively evaluate the reliability of our modified electrophysiological testing as preoperative examination in patients receiving surgical revision. METHODS In this study, we compared preoperative electrophysiological testing results with intraoperative diagnosis in the 24 patients with iatrogenic spinal accessory nerve palsy who were referred to our hospital from 2009 to 2018. RESULTS During operation, 20 patients were diagnosed with Neurotmesis and the remaining 4 patients were found axonotmesis depending on the results of surgical exploration and intraoperative electrophysiological examination. Six of the 20 patients with Neurotmesis demonstrated a low-amplitude compound muscle action potential of the upper trapezius during preoperative electrophysiological testing. Needle electromyography revealed voluntary motor unit potentials in 8 of the 20 patients. Meanwhile, concomitant great auricular nerve or dorsal scapular nerve injuries were preoperatively revealed in 7 of 24 patients. CONCLUSIONS The rate of low-amplitude compound muscle action potentials in these patients suffering from spinal accessory nerve Neurotmesis was about 30% with our modified electrophysiological testing. We should be aware of this pitfall before surgical nerve repair. Furthermore, electrophysiological testing is an informative preoperative examination revealing the concomitant nerve injuries.
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Assessment of the synergic effect of immunomodulation on nerve repair using multiparametric magnetic resonance imaging
Muscle & nerve, 2017Co-Authors: Chushan Zheng, Fang Zhang, Xiang Zhang, Yue-yao Chen, Xiaohui Duan, Meiwei Chen, Jun ShenAbstract:Introduction The immune system plays a pivotal role in nerve injury. The aim of this study was to determine the role of multiparametric magnetic resonance imaging (MRI) in evaluation of the synergic effect of immunomodulation on nerve regeneration in Neurotmesis. Methods Rats with sciatic nerve Neurotmesis and surgical repair underwent serial multiparametric MR examinations over an 8-week period after subepineurial microinjection of lipopolysaccharide (LPS) and subsequent subcutaneous injection of FK506 or subepineurial microinjection of LPS or phosphate-buffered saline (PBS) alone. Results Nerves treated with immunomodulation showed more prominent regeneration than those treated with LPS or PBS alone and more rapid restoration toward normal T2, fractional anisotropy (FA), and radial diffusivity (RD) values than nerves injected with LPS or PBS. Discussion Nerves treated with immunomodulation exert synergic beneficial effects on nerve regeneration that can be predicted by T2 measurements and FA and RD values. Muscle Nerve 57: E38–E45, 2018
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Enhanced Repair Effect of Toll-Like Receptor 4 Activation on Neurotmesis: Assessment Using MR Neurography
AJNR. American journal of neuroradiology, 2014Co-Authors: Xiang Zhang, Xue-hua Wen, Fu-jun Zhang, Jun ShenAbstract:BACKGROUND AND PURPOSE: Alternative use of molecular approaches is promising for improving nerve regeneration in surgical repair of Neurotmesis. The purpose of this study was to determine the role of MR imaging in assessment of the enhanced nerve regeneration with toll-like receptor 4 signaling activation in surgical repair of Neurotmesis. MATERIALS AND METHODS: Forty-eight healthy rats in which the sciatic nerve was surgically transected followed by immediate surgical coaptation received intraperitoneal injection of toll-like receptor 4 agonist lipopolysaccharide ( n = 24, study group) or phosphate buffered saline ( n = 24, control group) until postoperative day 7. Sequential T2 measurements and gadofluorine M-enhanced MR imaging and sciatic functional index were obtained over an 8-week follow-up period, with histologic assessments performed at regular intervals. T2 relaxation times and gadofluorine enhancement of the distal nerve stumps were measured and compared between nerves treated with lipopolysaccharide and those treated with phosphate buffered saline. RESULTS: Nerves treated with lipopolysaccharide injection achieved better functional recovery and showed more prominent gadofluorine enhancement and prolonged T2 values during the degenerative phase compared with nerves treated with phosphate buffered saline. T2 values in nerves treated with lipopolysaccharide showed a more rapid return to baseline level than did gadofluorine enhancement. Histology exhibited more macrophage recruitment, faster myelin debris clearance, and more pronounced nerve regeneration in nerves treated with toll-like receptor 4 activation. CONCLUSIONS: The enhanced nerve repair with toll-like receptor 4 activation in surgical repair of Neurotmesis can be monitored by using gadofluorine M-enhanced MR imaging and T2 relaxation time measurements. T2 relaxation time seems more sensitive than gadofluorine M-enhanced MR imaging for detecting such improved nerve regeneration.
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MR imaging and T2 measurements in peripheral nerve repair with activation of Toll-like receptor 4 of Neurotmesis.
European radiology, 2014Co-Authors: Xiang Zhang, Fang Zhang, Xue-hua Wen, Jun ShenAbstract:Objective To investigate the role of MR imaging in Neurotmesis combined with surgical repair and Toll-like receptor 4 (TLR4) activation.
Daniele Coraci - One of the best experts on this subject based on the ideXlab platform.
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Ultrasound is a useful tool to evaluate nerve involvement in children with supracondylar humerus fractures.
Muscle & nerve, 2017Co-Authors: Marina A Bellavia, Chiara Cambise, Daniele Coraci, Giulio Maccauro, Antonio Valassina, Luca PaduaAbstract:Supracondylar humerus fracture (SHF) is a common childhood injury and represents approximately 60% of all\ud elbow fractures in children. Nerve injures associated with this fracture are well-known, and may be a direct\ud consequence of the trauma itself or iatrogenic. Neurophysiological study is the gold standard to assess\ud peripheral nerve injuries but it is invasive and may be difficult to perform in children. Furthermore,\ud neurophysiology can best provide useful information 2-4 weeks post-injury, it does not show nerve anatomy,\ud and is not able to distinguish between axonotmesis and Neurotmesis. Nerve ultrasound (US) represents an\ud extension of clinical examination8 and can provide morphologic information. US is being used with increasing\ud frequency to visualize nerves and their surroundings in traumatic nerve lesion, because it helps localize and\ud define the peripheral nerve injury. In particular US can distinguish axonotmesis and neuroapraxia (in which there\ud is nerve continuity) from Neurotmesis (in which nerve continuity is absent) to provide information useful for\ud surgery, and it can also facilitate post-operative management
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Fibular nerve Neurotmesis after knee dislocation: Ultrasonographic findings.
Muscle & nerve, 2016Co-Authors: Daniele Coraci, Andrea Faiola, Ilaria Paolasso, Valter Santilli, Luca PaduaAbstract:N/
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Fibular nerve Neurotmesis secondary to knee trauma: a diagnosis requiring nerve ultrasound.
Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology, 2013Co-Authors: Maria Laura Ester Bianchi, Daniele Coraci, G. Granata, Luca PaduaAbstract:Peripheral nerve trauma may be the result of contusion, laceration, mechanical damage by bone fragments, stretching and traction, or iatrogenic causes. In closed trauma, it is often challenging to detect the site, mechanism, and severity of nerve damage (Padua et al., 2012).\ud \ud Ultrasound (US) is a relatively new, but useful tool in the diagnosis of peripheral nerve disease, complementing the electrodiagnostic (EDx) evaluation (Beekman and Visser, 2003). One of its most important contributions is the ability to differentiate axonotmesis from Neurotmesis soon after acute injury, providing detailed information useful for surgery (Padua et al., 2012)
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149. Clinical, neurophysiological and ultrasound assessment in post-surgical follow up of nerve injuries: A case report
Clinical Neurophysiology, 2013Co-Authors: A. Gagliardo, Daniele Coraci, Marcello Romano, E.m. Fernandez Marquez, H. Tsukamoto, P. De Franco, Luca PaduaAbstract:A 50-year old man received a cut injury to the left forearm with involvement of median and ulnar nerves and consequent hand motor and sensory deficits. He underwent surgical revision of the wound, but 6 months later the patient did not present recovery. A following neurophysiological examination showed sporadic fibrillation potentials with reduced voluntary recruitment in the first dorsal interosseus muscle and complete denervation in muscles innervated by distal median nerve, indicating an axonal ulnar neuropathy and a possible median nerve axonotmesis or Neurotmesis. Ultrasound examination showed: median nerve Neurotmesis and amputation neuroma with a gap of about 7–8 cm between proximal and distal stumps; a slight focal increase in cross-sectional area of the ulnar nerve close to the scar. The patient newly underwent surgery. A reconstruction of the left median nerve by a sural nerve graft and neurolysis of the ulnar nerve were performed. In the following days the patient reported an improvement in the cold and hot sensitivity on the ulnar nerve distribution in the left hand. In conclusion ultrasound nerve examination played a key role in decision-making.
M.t. Letsch - One of the best experts on this subject based on the ideXlab platform.
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Nervus ulnaris uitval na een gedislokeerde antebrachiifractuur bij een tienjarige jongen
Nederlands Tijdschrift voor Traumachirurgie, 2014Co-Authors: M.t. Letsch, A. Peters, A.j.h. Vochteloo, N. Hendriks-brouwer, R. Huis In ’t VeldAbstract:Nervus ulnaris uitval na een antebrachiifractuur is zeldzaam. De oorzaak kan berusten op contusie of compressie, maar ook een laceratie van de nervus ulnaris. De keuze voor behandeling bestaat uit het dilemma tussen vroegtijdige exploratie of een expectatief beleid, aangezien aanvullend onderzoek vaak onvoldoende uitsluitsel kan geven in het onderscheid tussen axonotmesis, Neurotmesis en neuropraxie. In deze casus beschrijven wij een tienjarige jongen met nervus ulnaris uitval na een antebrachiifractuur, waarbij vroegtijdige exploratie van de nervus ulnaris heeft plaatsgevonden.
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Nervus ulnaris uitval na een gedislokeerde antebrachiifractuur bij een tienjarige jongen
Nederlands Tijdschrift voor Traumachirurgie, 2014Co-Authors: M.t. Letsch, A. Peters, A.j.h. Vochteloo, N. Hendriks-brouwer, R. Huis In ’t VeldAbstract:Ulnar nerve palsy is a rare complication after an antebrachii fracture. The cause of this palsy can be explained by contusion or compression, but rupture of the nervus ulnaris is also possible. The choice of treatment is based on the dilemma between early exploration or observation, as additional tests are frequently inconclusive concerning the distinction between axonotmeses, Neurotmesis and neuropraxia. In this case report we present a ten year old boy with an ulnar nerve palsy who underwent early exploration of the nervus ulnaris. Nervus ulnaris uitval na een antebrachiifractuur is zeldzaam. De oorzaak kan berusten op contusie of compressie, maar ook een laceratie van de nervus ulnaris. De keuze voor behandeling bestaat uit het dilemma tussen vroegtijdige exploratie of een expectatief beleid, aangezien aanvullend onderzoek vaak onvoldoende uitsluitsel kan geven in het onderscheid tussen axonotmesis, Neurotmesis en neuropraxie. In deze casus beschrijven wij een tienjarige jongen met nervus ulnaris uitval na een antebrachiifractuur, waarbij vroegtijdige exploratie van de nervus ulnaris heeft plaatsgevonden.