Articles: peripheral-nerve-injuries.
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We review the literature on complication of arthroscopic shoulder surgery and their management. Computer data based searches were used to identify articles regarding complications of shoulder arthroscopy, as well as hand searches of Arthroscopy and Journal of Shoulder and Elbow Surgery over the last decade. Arthroscopic shoulder surgery has become a popular therapeutic and diagnostic procedure during the past two decades. ⋯ While the rate of complications especially with newer procedures remain elusive, most studies suggest that the rate is low, 5.8-9.5% in all recent review studies published. Underreporting complications makes assessment of incidence rates of complication difficult. Proper patient selection, attention to operative detail, and careful post-operative monitoring can minimize the morbidity associated with these complications.
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J Reconstr Microsurg · Feb 2002
Comparative StudyPre-, intra-, and postoperative electrophysiologic analysis of the recovery of old injuries of the peripheral nerve and brachial plexus after microsurgical management.
This prospective electrophysiologic study compares the analysis of the pre-, intra-, and postoperative results of 38 surgically treated patients suffering from old injuries of the peripheral nerve (n=28) and brachial plexus (n=10). The period from injury until surgery for the peripheral nerve group ranged from 1.2 to 50 years and, in the brachial plexus group, from 1.2 to 12 years. A statistical electrophysiologic analysis was done: 1) to compare intraoperative amplitude and latency changes of the compound muscle action potential (CMAP) at commencement and on completion of surgery; 2) to compare amplitude and latency changes of CMAP and recruitment (voluntary muscle activity) prior to and 1 year after surgery. ⋯ In the brachial plexus group, statistical analysis of recruitment showed voluntary muscle activity in 45 percent of muscles 1 year after neurolysis (7 patients) and in 42 percent of muscles after nerve graft and neurotization (3 patients). Intraoperative electrophysiologic findings provide useful information during surgery for old peripheral nerve and brachial plexus injury. Intraoperative and postoperative electrophysiologic analyses suggest that the viability of the old injured nerve tissue is longer than previously considered, thus providing a longer period of time in which nerve recovery can occur.
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The time-dependent decline in the ability of motoneurons to regenerate their axons after axotomy is one of the principle contributing factors to poor functional recovery after peripheral nerve injury. A decline in neurotrophic support may be partially responsible for this effect. The up-regulation of BDNF after injury, both in denervated Schwann cells and in axotomized motoneurons, suggests its importance in motor axonal regeneration. ⋯ We report that low doses of BDNF (0.5-2 microg/day for 28 days) had no detectable effect on axonal regeneration after immediate nerve repair, but promoted axonal regeneration of motoneurons whose regenerative capacity was reduced by chronic axotomy 2 months prior to nerve resuture, completely reversing the negative effects of delayed nerve repair. In contrast, high doses of BDNF (12-20 microg/day for 28 days) significantly inhibited motor axonal regeneration, after both immediate nerve repair and nerve repair after chronic axotomy. The inhibitory actions of high dose BDNF could be reversed by functional blockade of p75 receptors, thus implicating these receptors as mediators of the inhibitory effects of high dose exogenous BDNF.
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Contrary to the classical view of a pre-determined wiring pattern, there is considerable evidence that cortical representation of body parts is continuously modulated in response to activity, behavior and skill acquisition. Both animal and human studies showed that following injury of the peripheral nervous system such as nerve injury or amputation, the somatosensory cortex that responded to the deafferented body parts become responsive to neighboring body parts. Similarly, there is expansion of the motor representation of the stump area following amputation. ⋯ Changes over a longer time likely involve other additional mechanisms such as long-term potentiation, axonal regeneration and sprouting. While cross-modal plasticity appears to be useful in enhancing the perceptions of compensatory sensory modalities, the functional significance of motor reorganization following peripheral injury remains unclear and some forms of sensory reorganization may even be associated with deleterious consequences like phantom pain. An understanding of the mechanism of plasticity will help to develop treatment programs to improve functional outcome.