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Occipital nerve decompression is effective in reducing headache symptoms in select patients with migraine and occipital neuralgia. Eligibility for surgery relies on subjective symptoms and responses to nerve blocks and Onabotulinum toxin A (Botox) injections. No validated objective method exists for detecting occipital headache pathologies. The purpose of the study is to explore the potential of high-resolution Magnetic Resolution Imaging (MRI) in identifying greater occipital nerve (GON) pathologies in chronic headache patients. The MRI protocol included three sequences targeting fat-suppressed fluid-sensitive T2-weighted signals. Visualization of the GON involved generating 2-D image slices with sequential rotation to track the nerve course. Twelve patients underwent pre-surgical MRI assessment. MRI identified four main pathologies that were validated against intra-operative examination: GON entanglement by the occipital artery, increased nerve thickness and hyperintensity suggesting inflammation compared to the non-symptomatic contralateral side, early GON branching with rejoining at a distal point, and a connection between the GON and the lesser occipital nerve. MRI possesses the ability to visualize the GON and identify suspected trigger points associated with headache symptoms. This case series highlights MRI's potential to provide objective evidence of nerve pathology. Further research is warranted to establish MRI as a gold standard for diagnosing extracranial contributors in headaches. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of nerve decompression on pain in patients with lower extremity painful diabetic peripheral neuropathy (DPN). Background: Currently, no treatment provides lasting relief for patients with DPN. The benefits of nerve decompression remain inconclusive. Methods: This double-blinded, observation and same-patient sham surgery--controlled randomized trial enrolled patients aged 18 to 80 years with lower extremity painful DPN who failed 1 year of medical treatment. Patients were randomized to nerve decompression or observation group (2:1). Decompression-group patients were further randomized and blinded to nerve decompression in either the right or left leg and sham surgery in the opposite leg. Pain (11-point Likert score) was compared between decompression and observation groups and between decompressed versus sham legs at 12 and 56 months. Results: Of 2987 screened patients, 78 were randomized. At 12 months, compared with controls (n=37), both the right-decompression group (n= 22) and left-decompression group (n= 18) reported lower pain (mean difference for both: -4.46; 95% CI: -6.34 to -2.58 and -6.48 to -2.45, respectively; P < 0.0001). Decompressed and sham legs equally improved. At 56 months, compared with controls (n=m 14), pain was lower in both the right-decompression group (n=20; mean difference: -7.65; 95% CI: -9.87 to -5.44; P < 0.0001) and left-decompression group (n=16; mean difference: -7.26; 95% CI: -9.60 to -4.91; P < 0.0001). The mean pain score was lower in decompressed versus sham legs (mean difference: 1.57 95% CI: 0.46 to 2.67; P=0.0002). Conclusions: Although nerve decompression was associated with reduced pain, the benefit of surgical decompression needs further investigation as a placebo effect may be responsible for part or all of these effects. [ABSTRACT FROM AUTHOR]

Abstract Purpose To analyze and study the clinical efficacy and imaging indexes of oblique lateral lumbar interbody fusion (OLIF) in the treatment of lumbar intervertebral foramen stenosis(LFS) caused by different causes. Method 33 patients with LFS treated with OLIF from January 2018 to May 2022 were reviewed. Oswestry Dysfunction Index (ODI) and visual analogue scale (VAS) were calculated before and after operation. Segmental lordotic angle (SLA), lumbar lordotic angle (LLA) and segmental scoliosis angle (SSA), disc height (DH), posterior disc height (PDH), lateral disc height (LDH), foraminal height (FH), foramen width (FW) and foraminal cross-sectional area (FSCA) were measured before and after operation. Result The VAS and ODI after operation were significantly improved as compared with those before operation. Compared with pre-operation, the DH, PHD increased by 67.6%, 94.6%, LDH increased by 107.4% (left), 101.7% (right), and FH increased by 30.2% (left), 34.5% (right). The FSCA increased by 93.1% (left), 89.0% (right), and the FW increased by 137.0% (left), 149.6% (right). The postoperative SSA was corrected by 74.5%, the postoperative SLA, LLA were corrected by 70.2%, 38.1%, respectively. All the imaging indexes were significantly improved (p

Purpose: To analyze and study the clinical efficacy and imaging indexes of oblique lateral lumbar interbody fusion (OLIF) in the treatment of lumbar intervertebral foramen stenosis(LFS) caused by different causes. Method: 33 patients with LFS treated with OLIF from January 2018 to May 2022 were reviewed. Oswestry Dysfunction Index (ODI) and visual analogue scale (VAS) were calculated before and after operation. Segmental lordotic angle (SLA), lumbar lordotic angle (LLA) and segmental scoliosis angle (SSA), disc height (DH), posterior disc height (PDH), lateral disc height (LDH), foraminal height (FH), foramen width (FW) and foraminal cross-sectional area (FSCA) were measured before and after operation. Result: The VAS and ODI after operation were significantly improved as compared with those before operation. Compared with pre-operation, the DH, PHD increased by 67.6%, 94.6%, LDH increased by 107.4% (left), 101.7% (right), and FH increased by 30.2% (left), 34.5% (right). The FSCA increased by 93.1% (left), 89.0% (right), and the FW increased by 137.0% (left), 149.6% (right). The postoperative SSA was corrected by 74.5%, the postoperative SLA, LLA were corrected by 70.2%, 38.1%, respectively. All the imaging indexes were significantly improved (p < 0.01). Conclusion: The clinical efficacy and imaging data of OLIF in the treatment of LFS caused by low and moderate lumbar spondylolisthesis, intervertebral disc bulge and reduced intervertebral space height, degenerative lumbar scoliosis, articular process hyperplasia or dislocation have been well improved. OLIF may be one of the better surgical treatments for LFS caused by the above conditions. [ABSTRACT FROM AUTHOR]

Background: Double crush (DC) syndrome patients presenting with C6-7 radiculopathy and median nerve compression in the carpal tunnel report greater nerve irritability and weakness postdecompression than isolated peripheral nerve decompression. We hypothesize that patient-reported outcome is inferior following release at both cervical spine and wrist versus a single site of decompression. Methods: Patients that underwent either anterior cervical decompression and fusion (ACDF) for C6-C7 radiculopathy, carpal tunnel release (CTR), or both within 5 years (DC) were identified. A total of 477 patients were analyzed (157 DC, 203 CTR, and 117 ACDF). Post-operative outcome Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Neck Disability Index, and visual analog scale (VAS) scores were collected at an average of 2 years postoperatively. Results: QuickDASH scores were higher in the DC group versus CTR group (36 vs 22, P <.0002). Postoperative disability in the ACDF group was significantly higher than the DC group (50 vs 36, P <.017). There were no differences between ACDF and DC groups in arm pain intensity, but the CTR group demonstrated significantly greater arm pain intensity than the DC group (5.7 vs 3.6, 10-point scale, P <.01). Conclusions: Patients undergoing ACDF and CTR have greater postoperative disability than those undergoing CTR alone, but less postoperative functional disability and pain than ACDF alone, indicating cervical radiculopathy may contribute a greater proportion of long-term disability postoperatively. Additionally, CTR had greater postoperative arm pain than DC patients, potentially indicating high rates of undiagnosed cervical radiculopathy or other sources of arm pain in these patients. [ABSTRACT FROM AUTHOR]

Background Axillary nerve injury is the most common nerve injury affecting shoulder function. Nerve repair, grafting, and/or end-to-end nerve transfers are used to reconstruct complete neurotmetic axillary nerve injuries. While many incomplete axillary nerve injuries self-resolve, axonotmetic injuries are unpredictable, and incomplete recovery occurs. Similarly, recovery may be further inhibited by superimposed compression neuropathy at the quadrangular space. The current framework for managing incomplete axillary injuries typically does not include surgery. Methods This study is a retrospective analysis of 23 consecutive patients with incomplete axillary nerve palsy who underwent quadrangular space decompression with additional selective medial triceps to axillary end-to-side nerve transfers in 7 patients between 2015 and 2019. Primary outcome variables included the proportion of patients with shoulder abduction M3 or greater as measured on the Medical Research Council (MRC) scale, and shoulder pain measured on a Visual Analogue Scale (VAS). Secondary outcome variables included pre- and postoperative Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) scores. Results A total of 23 patients met the inclusion criteria and underwent nerve surgery a mean 10.7 months after injury. Nineteen (83%) patients achieved MRC grade 3 shoulder abduction or greater after intervention, compared with only 4 (17%) patients preoperatively (p = 0.001). There was a significant decrease in VAS shoulder pain scores of 4.2 ± 2.5 preoperatively to 1.9 ± 2.4 postoperatively (p < 0.001). The DASH scores also decreased significantly from 48.8 ± 19.0 preoperatively to 30.7 ± 20.4 postoperatively (p < 0.001). Total follow-up was 17.3 ± 4.3 months. Conclusion A surgical framework is presented for the appropriate diagnosis and surgical management of incomplete axillary nerve injury. Quadrangular space decompression with or without selective medial triceps to axillary end-to-side nerve transfers is associated with improvement in shoulder abduction strength, pain, and DASH scores in patients with incomplete axillary nerve palsy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Diabetic peripheral neuropathy has a high disability rate and is one of the most common chronic complications of diabetes. Because its pathogenesis is complex and diverse, there is no recognized treatment method currently. It is a challenge to treat and manage this chronic disease. However, there are few reviews in this area. OBJECTIVE: To explore the related pathogenesis of diabetic peripheral neuropathy and to review the application effect of different treatment methods in diabetic peripheral neuropathy. METHODS: The first author searched the relevant literature in CNKI, WanFang and PubMed databases. The Chinese search terms were “diabetic peripheral neuropathy, diabetic complications, pathogenesis, diagnosis, treatment, Chinese medicine, surgical treatment, surgery, electrical stimulation, nerve release, nerve decompression” and the English search terms were “DPN, diabetic peripheral neuropathy, pathogenesis, diagnosis, therapy, treatment, drug, surgery, nerve decompression, nerve electrical stimulation, gene, exosome.” The literature search time was limited from January 2000 to January 2022. The literature was initially screened by reading the abstracts of the articles and those unrelated to the theme of the article were excluded. Finally 88 articles were included for review. RESULTS AND CONCLUSION: Hyperglycemia is the root cause of diabetic peripheral neuropathy. Strengthening blood sugar control is the most basic and important step in the treatment of diabetic peripheral neuropathy. Analgesic drugs can significantly reduce pain symptoms of patients with diabetic peripheral neuropathy. α-Lipoic acid and epalrestat play an anti-oxidative stress role; mecobalamin and nerve growth factor can promote the recovery of nerve function. According to the pathogenesis of “double extrusion” of diabetic peripheral neuropathy, nerve decompression and nerve transferring can reduce the degree of neuropathy, relieve pain and increase nerve conduction velocity in patients with diabetic peripheral neuropathy. Gene and stem cell therapies are promising new therapies. They are targeted, but relevant clinical studies are currently lacking and there are also concerns on ethical and safety issues. [ABSTRACT FROM AUTHOR]

Objectives: Painful diabetic peripheral neuropathy (DPN) is often refractory to conventional medications. Triple-nerve decompression was proposed for painful DPN due to the frequent involvement of multiple nerve entrapments in diabetes. However, the role of decompressive surgery remains controversial. This trial aims to assess the efficacy of triple-nerve decompression for patients with painful DPN suggestive of nerve entrapment using a randomized controlled trial (RCT) design. Methods and analysis: This trial is a single-center RCT and will be conducted in Shanghai Ninth People's Hospital. Enrolled subjects (n = 74) with painful DPN due to nerve compression, which can be detected by nerve conduction studies, will be randomly allocated at a 1:1 ratio into surgical and non-surgical groups. The primary outcome will be measured by 50% responder rates, which is defined as the proportion of subjects with at least 50% reduction of the mean weekly visual analog score (VAS) of pain from baseline after 6 months of treatment. Mean weekly VAS will be additionally evaluated 1 week (W1), 1 month (M1), and 3 months (M3) after treatment to monitor the changes in pain intensity. The secondary outcomes include two-point discrimination (TPD), Toronto clinical scoring system (TCSS), electrophysiological indexes, hospital anxiety and depression scale (HADS), and the medical outcome study short-form 36-item questionnaire (SF-36). A quantitative analgesic questionnaire (QAQ) will be used as a secondary outcome to quantify the analgesic medication weekly. TPD and TCSS will be conducted at W1, M1, M3, and M6 after treatment. Electrophysiological tests, HADS, and SF-36 will be performed at M3 and M6. Ethics and dissemination: Ethics approval has been obtained from the Ethics Committee of Shanghai Ninth People's Hospital (SH9H-2-21-T323-2). It was registered on the Chinese Clinical Trial Registry website (http://www.chictr.org.cn) on 16 August 2021 with the number ChiCTR2100050049. Written informed consent will be obtained from all participants. The results of this trial will be disseminated via peer-reviewed journals, mass media, and presentations at national and international academic conferences. [ABSTRACT FROM AUTHOR]

Background: The optimal treatment of symptomatic Morton's neuroma remains unclear; conservative methods are sometimes ineffective and neurectomy has significant rates of patient dissatisfaction. The aim of this study was to evaluate the outcome of minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) and percutaneous release of the deep transverse metatarsal ligament (DTML) in patients with Morton's neuroma.Methods: Between January 2018 and November 2019, 27 patients (29 feet) diagnosed with Morton's neuroma after clinical and radiological evaluation underwent DMMO and percutaneous DTML release. The primary clinical outcomes were pain (VAS) and function (AOFAS score). Secondary outcomes included patient satisfaction, complications, and radiographic outcomes. Patients were followed up for a minimum of two years.Results: The median age of the participants was 66 years (range 48-79) and the follow-up time was 28 months (24-47). There was a decrease of 5.7 points in the VAS for pain (p < .001) and an increase of 19.9 in AOFAS (p < .001) after the surgical procedure. There was one case of superficial infection and one patient required resection of the neuroma (neurectomy). The majority of patients (89.7%) were satisfied and considered the procedure outcome as excellent or good.Conclusion: Treatment of Morton's neuroma with minimally invasive distal metatarsal metaphyseal osteotomy and percutaneous release of the deep transverse metatarsal ligament showed significant improvement in pain and function with a low incidence of complications and a high rate of personal satisfaction. [ABSTRACT FROM AUTHOR]

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Background: The effectiveness of operative treatments other than neurectomy for Morton's neuroma remains debatable despite several reported studies. This review aimed to evaluate the effects of operative treatments for Morton's neuroma other than neurectomy using an algorithmic approach and a structured critical framework to assess the methodological quality of reported studies.Methods: Several electronic databases were searched for articles published until August 2021 that evaluated the outcomes of operative treatments other than neurectomy in patients diagnosed with Morton's neuroma. Data searches, extraction, analysis, and quality assessments were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the clinical outcomes were evaluated using objective, subjective, and negative outcomes; complications; and reoperation rate and type.Results: After reviewing 11,213 studies, 22 studies were finally included. Although a number of studies with high level of evidence are limited, we divided them according to four categories: (1) neurolysis with or without nerve transposition, (2) minimally invasive nerve decompression, (3) metatarsal osteotomy, and (4) additional procedures after nerve transection or neurectomy. All categories showed reliable outcomes except minimally invasive nerve decompression. The proportion of postoperative neurogenic symptoms was lower with neurolysis than with neurectomy.Conclusion: Whether the alternative procedures were superior to neurectomy remains unclear as the number of good quality studies was limited. The proportion of postoperative neurogenic symptoms was lower with neurolysis than with neurectomy. Furthermore, performing simultaneous dorsal transposition of the nerve along with neurolysis is more recommended than neurolysis alone. Surgeons should be more careful with minimally invasive deep transverse intermetatarsal ligament release and metatarsal shortening osteotomy as their effectiveness remains inconclusive. Finally, we strongly recommend performing intramuscular embedding or intermuscular transposition of the nerve cutting end if neurectomy or nerve transection is inevitable.Level Of Evidence: Level III, systematic review. [ABSTRACT FROM AUTHOR]

Case: The case of an active 16-year-old adolescent girl who presented with rib malunion and 1 year of unremitting intercostal nerve pain after sustaining multiple rib fractures is presented. She underwent successful bony and soft-tissue decompression of her eighth and ninth intercostal nerves to relieve neurogenic symptoms. Conclusion: When conservative treatment fails, chronic intercostal nerve pain due to chest wall trauma may be effectively managed with surgical bony decompression of the offending intercostal bundle(s). Anatomic knowledge of the intercostal nerve and a critical history and physical examination were critical for accurate diagnosis and surgical decompression of the patient's intercostal nerve. [ABSTRACT FROM AUTHOR]

Urgent surgical intervention for amniotic band sequence (ABS) is currently indicated for concerns of vascular compromise and progressive lymphedema. Peripheral motor nerve palsies are rare, and reports of surgical intervention in these cases describe persistent motor dysfunction. We report band release and ulnar, median, and radial nerve decompression in a 1-week-old with a severe upper extremity constriction band and signs of ulnar nerve motor dysfunction. A literature review on nerve exploration and outcomes of patients with motor nerve palsy from ABS was performed. Early evidence of ulnar motor function was observed at 5.5-month follow-up. Previous reports of nerve decompression for upper extremity constriction bands with motor nerve palsy document poor recovery after interventions beginning at 3 months of age. In this case, band release and nerve decompression were undertaken at 7 days of age, and we observed early motor recovery. This finding suggests that very early surgical intervention in the neonate may facilitate nerve recovery in appropriate candidates. [ABSTRACT FROM AUTHOR]

Study Objective: To demonstrate a safe and reproducible surgical approach to the Alcock canal with a full decompression of the pudendal nerve., Design: The technique is demonstrated step-by-step with narrated video footage., Setting: Pudendal neuralgia, a condition causing debilitating pelvic pain, is traditionally managed through a transgluteal incision [1,2]. This surgical approach offers limited visualization and ability for nerve decompression [3]. With the current technique, a full exposure and decompression of the pudendal nerve was achieved., Interventions: A 44-year-old para 2 presented with burning vaginal pain radiating to the left groin that was aggravated with sitting. She underwent a robotic-assisted left sacrospinous ligament transection and fasciotomy of the obturator internus muscle for suspected pudendal neuralgia. The surgery was performed with 3 robotic ports using the da Vinci Xi robotic system., Conclusion: With the enhanced access to the pudendal nerve provided by the novel surgical technique demonstrated in this study, a more comprehensive nerve decompression can be performed. This technique was successfully applied to a patient with pudendal neuralgia. There were no immediate intra- or postoperative complications. In short-term follow-up, the patient had significant relief of preoperative symptoms. Although all surgical procedures for pudendal neuralgia have a risk of pudendal nerve and vessel injury [4], the presented technique has the potential to limit these risks by providing an enhanced view of the relevant anatomy. Future adaptation and refinement of this technique may contribute to the advancement of the surgical management of pudendal neuralgia. VIDEO ABSTRACT., (Copyright © 2024 AAGL. Published by Elsevier Inc. All rights reserved.)

Objective: This study aimed to report our surgical outcomes of thoracic long thoracic nerve (LTN) decompression in patients with isolated LTN palsy, using a clinical scoring system designed to facilitate the grading of scapular winging severity., Methods: This was a retrospective review of patients who had undergone decompression and neurolysis of the LTN for scapular winging. Each patient underwent needle electromyography of the serratus anterior for confirmation of diagnosis and were refractory to a minimum of 6 months of nonoperative management. Preoperatively and at final follow-up, shoulder range of motion and the Wrightington Winging Score (WWS) was used to objectively grade the dynamic and static components of winging., Results: Between 2014 and 2020, 29 patients who underwent thoracic neurolysis for scapular winging were analyzed. These were 16 males and 13 females with a mean age of 37 years. The injury mechanism was due to trauma in 19 cases and neuralgic amyotrophy in 10. The median duration between winging onset and surgery was 30 months. There were significant improvements in mean active shoulder abduction and forward flexion. Winging was noticeably improved in 22 patients. At presentation, the median WWS was 3, which improved to 1 at final follow-up., Conclusion: In patients with isolated LTN palsy causing persistent scapular winging which is not responsive to conservative treatment, neurolysis of the thoracic portion of the LTN can be considered., Level of Evidence: IV., (© 2024 Society for Indian Hand Surgery and Micro Surgeons. Published by Elsevier B.V. All rights reserved.)

Background: Leprous neuropathy is treatable but still a source of disability worldwide. Multidrug therapy (MDT) and oral steroids are the main stay of treatment. Ulnar nerve, at the elbow, is commonly involved. Nerve decompression may be required in selected cases by an epineurotomy (internal neurolysis). The preferred surface of ulnar nerve for performing this procedure to minimize iatrogenic vascular compromise is a matter of debate. Questions/purposes: We describe the epineural vessel arrangement on the medial and lateral surface of ulnar nerve around the medial epicondyle while performing epineurotomy for leprous neuropathy. Methods: We enrolled patients of symptomatic leprous ulnar neuropathy of less than one year duration on MDT that did not respond to steroids, for surgical decompression. Ten patients underwent epineurotomy of ulnar nerves (N = 11) around medial epicondyle. The epineural vessels were classified as per Sunderland's classification of arteriae nervorum. The number of epineural vessels was assessed on the medial and lateral surface of the ulnar nerve adjoining the medial epicondyle. The epineurotomy incision was placed over the surface of ulnar nerve having relatively less vessels. Results: The mean number of epineural vessels on the medial surface was 9.72 (range; 7–14) and on the lateral surface were 4.72 (range; 3–6). The average number of vessels per cm2 of the medial and lateral surface of the nerve was 0.94 and 0.48, respectively. The most common type of epineural vessel was type 3 on both medial and lateral surface of the nerve. Lateral epineurotomy was performed in all 11 cases. All the patients had relief from neuropathic pain. The mean VAS score improved from 3.20 ± 0.89 to 0.50 ± 0.34 at 2 years follow-up (p = 0.02). The mean motor score improved from 9.31 ± 4.12 to 15.42 ± 3.10 and sensory score improved from 40.0 ± 30.70 to 85 ± 9.90 at two years follow-up (p < 0.01). Conclusion: Lateral surface (facing the medial epicondyle) of ulnar nerve has a lesser density of epineural vessels in comparison to its medial (subcutaneous) surface. Clinical relevance: This anatomical understanding may be helpful in minimizing the iatrogenic vascular compromise of ulnar nerve while performing its epineurotomy around the medial epicondyle for leprous neuropathy. The findings may be extrapolated to other clinical indications of epineurotomy of ulnar nerve, for example, in cubital tunnel syndrome, traumatic ulnar neuroma in continuity, and benign ulnar nerve tumors. [ABSTRACT FROM AUTHOR]

Diabetic sensorimotor polyneuropathy (DSPN) is the commonest form of neuropathy which leads to insensate sole, diabetic foot ulcers (DFU) and its complications. We share our experience in recovery of sensation in the sole after prophylactic surgery such as nerve decompression (ND) or sensory neurotization by nerve transfer (NT) in patients having Diabetic sensorimotor polyneuropathy DSPN. 32 patients (46 feet) were selected for either nerve decompression or sensory neurotization depending upon presence or absence of Tinel's sign at tarsal tunnel. At 6 month post-operatively perception of touch and pain recovered in all feet; temperature and pressure perception recovered in ∼95% feet; average vibration perception threshold returned to normal range and 2-Point Discrimination came down significantly. There were no ulcers or amputation in operated limbs during follow up period of 6 months. Prophylactic surgery in the form of ND and NT can be offered with minimal complications which significantly improve sensations in the sole in selected cases of DSPN. These have the potential to improve the quality of life of patient and change the natural course of disease. [ABSTRACT FROM AUTHOR]

Background: Leprous neuropathy is a significant, yet preventable, cause of disability worldwide. Decompressive surgery and oral steroids have been used along with Multi Drug Therapy (MDT) for treating leprous neuropathy with varied success as reported in literature. Methods: We prospectively studied 16 peripheral nerves in 10 patients with leprous neuropathy of less than a year duration and not responding to steroid therapy in 3 weeks. The patients were divided into 2 groups: Group-A (decompressive nerve surgery was done within 12 weeks of onset of neurological deficit), and Group-B (nerve decompression was performed after 12 weeks from onset of neurological deficit). Post-operatively patients were assessed for regression of deformity, sensory, motor, vasomotor recovery and neuropathic pain. Results: Median age of patients was 32 years (range; 18 years to 46 years). Mean motor score and mean grip strength was significantly better for group A patients at 2 years follow-up (p < 0.05). Mean sensory score improved significantly in both the groups (p < 0.05). Similarly, mean VAS score for neuropathic pain improved significantly in both the groups (p < 0.05). Recovery of autonomic function was observed in 3 nerves in group A and 1 in group B. Conclusions: The cases who underwent nerve decompression surgery within 12 weeks had better functional outcomes, especially in terms of motor recovery, than those who were operated after that. Studies involving larger number of patients are required to draw firm conclusions. [ABSTRACT FROM AUTHOR]

Background: Opioid abuse is a major health concern in North America. Data have shown an alarming increase in opioid-related deaths and complications, which has shed light on current prescription practices across many specialties, including hand surgery. To that end, we sought to conduct a focused literature review to determine the available modalities to decrease postoperative pain and opioid consumption following upper-extremity nerve decompression procedures, taking advantage of the homogeneity and inherent pain pathways of this specific patient cohort. Methods: A systematic review of the literature was conducted. Primary studies evaluating perioperative and intraoperative modalities for postoperative pain reduction and analgesic consumption following upper-extremity nerve decompression procedures under local anesthesia were included. Studies implementing modalities requiring non–hand surgeon expertise (ie, intravenous sedation), as well as studies that include non–nerve decompression procedures, were excluded. Results: A total of 1478 studies were identified, and 9 studies were included after full-text review. Six studies evaluated intraoperative and 3 studies evaluated preoperative and postoperative modalities. Successful interventions included buffered anesthetic, the use of hyaluronidase, and varying techniques and mixtures for anesthetic administration. No successful preoperative or postoperative modalities were identified. Conclusion: Despite data reporting on the dangers associated with current opioid prescription practices, evidence-based modalities to decrease postoperative pain and opioid consumption are limited in general. Several intraoperative modalities do exist, and nonopioid oral analgesics, standardized opioid protocols, and reduced postoperative prescriptions can be used. Large randomized controlled trials evaluating perioperative modalities for pain reduction are needed to further address this issue. [ABSTRACT FROM AUTHOR]

First reported by Dellon et al. in 1992, nerve decompression by dissecting the deep transversal intermetatarsal ligament through a dorsal incision appears to be a reliable method for treating Morton's neuroma by addressing its underlying pathomechanism, since it should rather be considered as Morton's entrapment. As there are no current studies dealing with Dellon's surgical technique, we carried out a retrospective analysis with the aim of showing that nerve decompression is an effective method to treat Morton's neuroma, and one that considers its true pathology. All patients with a clinical diagnosis of Morton's neuroma, verified by MRI and treated by nerve decompression were included in this study in the years from 2010 to 2018 at our department. Follow-up was performed at least six months post-intervention; pain and function history were ascertained using the VAS (visual analogue scale) score and the German foot function index. Skin sensitivity testing was performed using Semmes-Weinstein monofilaments. A total of 12 patients were treated and followed-up during the study period. Postoperatively, there was significant improvement in the values of the VAS score both under strain (p-value: 0.0021) and at rest (p-value: 0.0062), as well as in the foot function index (p-value: 0.0022). There was no significant difference in skin sensitivity of the innervation areas of the interdigital nerves of the affected foot compared with the healthy reference foot (p-value: 0.0968). Dellon's decompression method yielded a highly positive outcome, and based on our findings, we consider it a reliable, technically simple and promising approach to treat Morton's neuroma. It is a minimally invasive technique that addresses the pathomechanism of peripheral nerve entrapment and has a low rate of complication as well as rapid patient recovery. [ABSTRACT FROM AUTHOR]

Diabetic sensorimotor polyneuropathy (DSPN) is the commonest form of neuropathy. Loss of sensations in sole leads to diabetic foot ulcers (DFU) and its complications. Surgical decompression has been used in the treatment of diabetic peripheral neuropathy, however; its effectiveness has been questioned. Purpose of this study was to evaluate the sensory recovery in sole after tarsal tunnel decompression (TTD) in patients having DSPN. Thirteen patients (Age28-70 years, average 35.57 years; 7 Males, 6 Females; 20 feet) with DSPN and positive Tinel's sign over the tarsal tunnel were included in the study. Pre and post-operative sensory tests performed on the sole included tests for touch, pain, temperature, pressure, vibration perception threshold (VPT) and two-point discrimination (2-PD). Results were classified as per British Medical Research Council (MRC) scoring system. –Sixteen feet were followed-up for 6 months. In all feet perception of touch, pain and pressure recovered. Temperature perception recovered in 75% feet. VPT came to normal range (16.81V) from 40.37 V and 2-PD came down to average of 6.0 mm from preoperative average of11.2 mm.MRC scale improved from S0 in 5 feet and S2 in 15 feet to S 3+ in all 16 feet.There were no ulcers or amputation in operated limbs during follow up period of 6 months. TTD improves plantar sensations in diabetic neuropathy and prevents ulcers and its related complications. [ABSTRACT FROM AUTHOR]

Chronic pain is something that any provider will see throughout their career, and it is very common following trauma and/or reconstructive surgery. Up until recently, there hasn't seemed to be too many advances in treatment options for patients with chronic nerve pain, and who have had all other potential sources of pain ruled out. Unfortunately, a good number of patients either choose to deal with their pain day to day, or get passed onto pain clinics. Presented is a case report of a patient who had previous hindfoot reconstructive surgery and chronic lower extremity pain since surgery. The patient had diagnostic, in office, local anesthetic blocks applied around specific nerve courses. He reported improvement in his symptoms with these blocks. He then underwent surgical neurolysis and neurectomy of his superficial peroneal nerve and sural nerve, with significant subjective pain reduction post-operatively. [ABSTRACT FROM AUTHOR]

Objective: To determine if the thread release technique can be applied to common peroneal nerve entrapment at the fibular neck. Methods: The thread common peroneal nerve release was performed on 15 fresh frozen cadaveric lower extremity specimens. All procedures were performed under ultrasound guidance and immediately underwent post-procedural gross anatomic inspection for completeness of decompression and presence or absence of iatrogenic neurovascular injury. Results: All 15 specimens demonstrated complete transection of the deep fascia of the peroneus longus overlying the common peroneal nerve. The transections extended to the bifurcation of the superficial peroneal and deep peroneal nerves. There was no evidence of any iatrogenic damage to the neurovascular bundle or adjacent tendons. The average operating time was less than 30 min. Conclusion: This cadaveric validation study demonstrates the accuracy of the thread common peroneal nerve release. Future pilot studies are warranted to ensure the safety of this procedure in the clinical setting. [ABSTRACT FROM AUTHOR]

The role of malformed or dilated branches of iliac vessels in causing pelvic pain is not well understood. Such vessels may entrap nerves of the lumbosacral (LS) plexus against the pelvic sidewalls, producing symptoms not typically encountered in gynecological practice, including sciatica and refractory urinary and/or anorectal dysfunction. We describe cases of sciatica in which laparoscopy revealed compression of the LS plexus by variant superior gluteal veins (SGVs). In demonstrating an improvement in patient symptoms after decompression, we identify this neurovascular conflict as a potential intrapelvic cause of sciatica. This study is a retrospective case series (Canadian Task Force Classification II-3). Nerve decompression laparoscopies were performed in São Paulo, Brazil. Thirteen female patients undergoing laparoscopy for sciatica with no clear spinal or musculoskeletal causes were included in this study. In all cases, we identified LS entrapment by aberrant SGVs, and performed decompression by vessel ligation. The average preoperative visual analog scale score of 9.62 ± 0.77 decreased significantly to 2.54 ± 2.88 post-operatively (P < 0.001). The success rate (defined as ≥ 50% improvement in visual analog scale score) was 92.3%, over a follow-up of 13.2 ± 10.6 months. Our case series demonstrates a high success rate and significant decrease in pain scores after laparoscopic intrapelvic decompression, thereby identifying pelvic nerve entrapment by aberrant SGVs as a potential yet previously unrecognized cause of sciatica. This intrapelvic neurovascular conflict—the SGV syndrome—should be considered in cases of sciatica with no identifiable spinal or musculoskeletal etiology. [ABSTRACT FROM AUTHOR]

Introduction: The suprascapular notch is a depression on the superior border of scapula which gives passage to the suprascapular nerve to enter the supraspinatus fossa. During its course there is a chance of entrapment of the nerve while in the notch due to its variant shapes and dimensions which leads to suprascapular nerve entrapment syndrome Aim: The purpose of the study was to determine the variations of the shape and dimensions of suprascapular notch of scapula because these parameters may be the causative factors in nerve compression. Materials and Methods: A total 110 dried human scapula of both sides were included in the study. First they were grossly examined for variations in shape of the notches. Then vertical and transverse dimensions of the notches were measured with the help of digital vernier calliper. Results: As per classification by shape we found 43 ‘J’ shaped (39.09%), 35 ‘U’ shaped (31.81%), 10 ‘V’ shaped (9.09%), indentation in eight cases (7.27%), absent in five (4.54%), partial ossification of STSL in four (3.63%) and complete ossification in five (4.54%) scapulae. The results were also analysed according to Natsis classification after excluding the Scapulae with indentation and partial ossification of ligament. Five (5.1%) scapulae Type I, sixty six scapulae (67.34%) had Type II, 14 scapulae (14.28%) had Type III, five (5.1%) had Type IV and none (0%) had Type V. We also found eight scapulae (8.16%) with transverse diameter equal to the vertical diameter (Td=Vl). Conclusion: The present study showed various types of suprascapular notches. Out of these Iqbal type ‘U’ and Natsis type II were most predominant. In both the cases chance of suprascapular nerve compression is less as more space is available to the nerve. The present study also showed five cases of completely ossified STSL where chances of impingement are higher. Since, these anatomical variations are not uncommon in population so there is a need for clinicians to have precise anatomical knowledge of SSN before making proper diagnosis and planning for surgical interventions of suprascapular nerve entrapment syndrome. We hope our study will be helpful in providing anatomical knowledge to the clinicians.

MicroRNA-9 (miR-9) has been shown to promote the differentiation of bone marrow mesenchymal stem cells into neuronal cells, but the precise mechanism is unclear. Our previous study confirmed that increased autophagic activity improved the efficiency of neuronal differentiation in bone marrow mesenchymal stem cells. Accumulating evidence reveals that miRNAs adjust the autophagic pathways. This study used miR-9-1 lentiviral vector and miR-9-1 inhibitor to modulate the expression level of miR-9. Autophagic activity and neuronal differentiation were measured by the number of light chain-3 (LC3)-positive dots, the ratio of LC3-II/LC3, and the expression levels of the neuronal markers enolase and microtubule-associated protein 2. Results showed that LC3-positive dots, the ratio of LC3-II/LC3, and expression of neuron specific enolase and microtubule-associated protein 2 increased in the miR-9 + group. The above results suggest that autophagic activity increased and bone marrow mesenchymal stem cells were prone to differentiate into neuronal cells when miR-9 was overexpressed, demonstrating that miR-9 can promote neuronal differentiation by increasing autophagic activity.

Phrenic nerve transfer is a major dynamic treatment used to repair brachial plexus root avulsion. We analyzed 72 relevant articles on phrenic nerve transfer to repair injured brachial plexus that were indexed by Science Citation Index. The keywords searched were brachial plexus injury, phrenic nerve, repair, surgery, protection, nerve transfer, and nerve graft. In addition, we performed neurophysiological analysis of the preoperative condition and prognosis of 10 patients undergoing ipsilateral phrenic nerve transfer to the musculocutaneous nerve in our hospital from 2008 to 201 3 and observed the electromyograms of the biceps brachii and motor conduction function of the musculocutaneous nerve. Clinically, approximately 28% of patients had brachial plexus injury combined with phrenic nerve injury, and injured phrenic nerve cannot be used as a nerve graft. After phrenic nerve transfer to the musculocutaneous nerve, the regenerated potentials first appeared at 3 months. Recovery of motor unit action potential occurred 6 months later and became more apparent at 12 months. The percent of patients recovering ′excellent′ and ′good′ muscle strength in the biceps brachii was 80% after 18 months. At 12 months after surgery, motor nerve conduction potential appeared in the musculocutaneous nerve in seven cases. These data suggest that preoperative evaluation of phrenic nerve function may help identify the most appropriate nerve graft in patients with an injured brachial plexus. The functional recovery of a transplanted nerve can be dynamically observed after the surgery.