Surgical management of groin pain of neural origin.

Background: An approach to surgical management of the patient with groin pain is described based on our experience with 54 patients, six of whom had bilateral symptoms. History and physical examination are sufficient to relate the pain to one or more of the lateral femoral cutaneous (LFC), ilioinguinal (II), iliohypogastric (IH), or genitofemoral (GF) nerves.

Study Design: Retrospective analysis of patients with groin pain is reported, with emphasis on cause, involved nerves, and outcomes of operative management.

James R. Learmonth: the first peripheral nerve surgeon.

The life and education of James R. Learmonth are reviewed. His experimental and clinical activities place him historically as the first surgeon to devote himself to peripheral nerve surgery.

Management of peripheral nerve problems in the upper and lower extremity using quantitative sensory testing.

Elective microsurgery of the peripheral nervous system concerns nerve decompression, neurolysis, nerve repair, and forms of nerve reconstruction with grafts or tubes. Management skills for the peripheral nerve too often rely on antiquated assessment techniques and depend upon traditional electrodiagnostic testing. Quantitative sensory testing is an approach to the evaluation of peripheral nerve function that is available now to all physicians interested in managing peripheral nerve problems.

Cutaneous innervation of the medial ankle: an anatomic study of the saphenous, sural, and tibial nerves and their clinical significance.

The distribution and variability of the nerves innervating the skin overlying the medial ankle were determined in 22 human anatomic specimens using x3.5 loupe magnification for dissection. Five different types could be identified: (1) Type A received contributions from the saphenous (SP), sural (SR), and the tibial (TB) nerves (54%); (2) Type B received contributions from the SR and SP nerves (14%); (3) Type C received contributions from the TB and SP nerves (9%); (4) Type D was singularly innervated by the SP (14%); and (5) Type E received contributions only from the TB nerve (9%).

Relationship between cutaneous pressure threshold and two-point discrimination.

The amount of pressure that should be applied when doing the two-point discrimination test has always been a matter of controversy. The Pressure-specified Sensory Devices permits recording the pressure at which two-point discrimination (2 PD) occurs. The purpose of this study was to investigate the relationship between the cutaneous pressure threshold and 2PD in people with normal and abnormal peripheral nerve functions.

Effect of lipectomy on growth and development of hyperinsulinemia and hyperlipidemia in the Zucker rat.

The Zucker fat rat inherits obesity and hyperinsulinemia, exhibits insulin resistance, and is, therefore, a model of adult onset, or type II, diabetes. The purpose of this study was to determine if excision of fat depots from the infant Zucker (fa+/fa+) rat would affect growth, fat cell number, hyperinsulinism, and hyperlipidemia. In the experimental design, 10 percent of the total body weight (inguinal and interscapular depots) was excised at 6 weeks of age from 18 fat and 18 lean (fa+/fa-) litter mates, with 18 fat and 18 lean rats serving as nonoperated controls.

The anatomic basis for the innervated mylohyoid/digastric flap in facial reanimation.

This paper describes the anatomy of the neurovascular supply to the mylohyoid and digastric muscle and its potential use for a regional transposition to rehabilitate the paralyzed face and soft-tissue coverage in the head and neck area. The anatomy and the arc of rotation of this flap were determined in ten embalmed cadavers. To further demonstrate the vascular supply, the common carotid was injected with silicone in four additional fresh cadavers.

Nerve regeneration in diabetic rats.

This study evaluated the capacity of diabetic rats to recover the ability to walk after nerve repair or nerve graft of the posterior tibial nerve at thigh level. Functional recovery of the posterior tibial nerve was evaluated by walking track analysis during regeneration in streptozotocin-induced diabetic rats. Surgical procedures were performed 8 weeks after induction of diabetes.

Treatment of superficial and deep peroneal neuromas by resection and translocation of the nerves into the anterolateral compartment.

An approach to the treatment of dorsal foot pain of neuroma origin is described based upon principals demonstrated to be effective in the treatment of upper extremity dorsoradial neuromas: translocation of the appropriate nerves into a muscle environment away from the joint. In the lower extremity, this requires identification of the appropriate nerves by anesthetic block, resection of the dorsal foot neuroma(s), and translocation of the nerves into the muscles of the anterolateral compartment. This approach yielded excellent results in 9 of the 11 patients with a mean follow-up of 29 months.

Detection of submaximal effort with computer-assisted grip strength measurements.

The purpose of this study was to establish a simple observation to help in distinguishing patients who are giving their maximal effort during computer-assisted grip strength measurements from those who are not. Preliminary observations had suggested that maximal effort with this grip-strength device was characterized by greater force in the radial digits than the ulnar digits and a small variability in force between individual grasps. These observations were then prospectively analyzed in the following groups: (a) 178 assembly workers tested during a routine screening at a computer manufacturing company and during pre-placement physicals; (b) 196 workers with a hand injury or cumulative trauma disorder who were seeking consultation for medical treatment; (c) 55 workers with a hand injury or cumulative trauma disorder being measured to determine their return to work status or impairment rating; and (d) 58 asymptomatic volunteers.

Anatomical course of the lateral femoral cutaneous nerve and its susceptibility to compression and injury.

The anatomy of the lateral femoral cutaneous nerve was investigated through dissection of 52 human anatomic specimens. The variability of its course and locations as it exists the pelvis is described and related to soft-tissue and bony landmarks. Five different types are identified: type A, posterior to the anterior superior iliac spine, across the iliac crest (4 percent); type B, anterior to the anterior superior iliac spine and superficial to the origin of the sartorius muscle but within the substance of the inguinal ligament (27 percent); type C, medial to the anterior superior iliac spine, ensheathed in the tendinous origin of the sartorius muscle (23 percent); type D, medial to the origin of the sartorius muscle located in an interval between the tendon of the sartorius muscle and thick fascia of the iliopsoas muscle deep to the inguinal ligament (26 percent); and type E, most medial and embedded in loose connective tissue, deep to the inguinal ligament, overlying the thin fascia of the iliopsoas muscle, and contributing the femoral branch of the genitofemoral nerve (20 percent).

Brachial neuritis presenting as anterior interosseous nerve compression--implications for diagnosis and treatment: a case report.

Brachial plexus neuropathy may present as an isolated peripheral nerve lesion, suggesting local compression, when in fact the pathophysiology is a diffuse proximal inflammation. The type of management depends on an accurate diagnosis of the diffuse lesion with electromyography. A descriptive case of isolated anterior interosseus nerve palsy is presented and the literature is reviewed.

Computer-assisted quantitative sensorimotor testing in patients with carpal and cubital tunnel syndromes.

This study reports the use of computer-assisted sensorimotor testing in 75 patients with chronic peripheral nerve compression. Pinch and grip strength, and the cutaneous pressure threshold were measured. The reliability of this equipment for repeated measurements was excellent (r = 0.

Validation of cutaneous pressure threshold measurements for the evaluation of hand function.

The relationship of measures of pressure perception to hand function was evaluated by correlating the results of the Mayo Dexterity Test and a timed object recognition test with the one- and two-point static and moving touch thresholds for the index finger pulp of 44 hands. The Mayo Dexterity Test permits the use of vision, while the object recognition test does not. Quantitative sensory testing was done with the Pressure-specifying Sensory Device.

Restoration of lower-lip sensation: neurotization of the mental nerve with the supraclavicular nerve.

Trigeminal nerve palsy resulting from cerebrovascular accidents can result in significant disability for patients. Loss of lip and chin sensation may involve lip biting, impaired speech, and diminished salivary retention. Neurotization of the mental nerve with the supraclavicular nerve can restore sensibility to the lower lip for patients with central dysfunction of the trigeminal nerve.

Outcome of the operative management of nerve injuries in the ilioinguinal region.

Background: Injuries to the ilioinguinal, iliohypogastric, and genitofemoral nerves can result in pain in the inguinal region.

Study Design: A retrospective analysis of 13 patients with such injuries is reported, with emphasis on the cause of the injury, diagnosis, and the outcome of operative management.

Results: The causes of the injuries included appendectomy, inguinal herniorrhaphy, inguinal lymph node dissection, orchiectomy, total abdominal hysterectomy, abdominoplasty, iliac crest bone graft, and femoral catheter placement.

Evidence in support of collateral sprouting after sensory nerve resection.

The extent and time course of sensory recovery has been investigated in 13 patients who had resection of a cutaneous nerve. Seven patients were studied within 8 weeks of denervation; 6 others were studied more than 6 months after denervation. Touch sensation was evaluated using a computer-assisted measuring device that recorded the pressure thresholds for static and moving touch, and static and moving two-point discrimination within a continual range from 0.

Innervation of the human shoulder joint and its implications for surgery.

The distribution and variability of the nerves innervating the shoulder joint were determined in 25 fresh human adult cadavers using 3.5x magnification for dissection. The results showed that 100% of the specimens had dual innervation of the coracoclavicular ligaments, the subacromial bursa, and the acromioclavicular joint.

The internal topography of the axillary nerve: an anatomic and histologic study as it relates to microsurgery.

The topography of the fascicular groups of the axillary nerve throughout its course from the posterior cord until its passage through the quadrangular space was studied in dissections of 40 brachial plexuses under x3.5 loupe magnification. Additionally, 10 axillary nerves were excised in toto, and histologic serial sections were done to define fascicular arrangement.

Partial denervation for persistent neuroma pain around the knee.

The authors present the results of denervation procedures treatment for 70 patients with persistent knee pain after total knee replacement, trauma, or osteotomy. In patients with total knee arthroplasty, aseptic loosening, sepsis, ligamentous instability, malalignment, and polyethylene wear had to be systematically ruled out as the source of pain. In patients with nontotal knee arthroplasty, arthrosis, synovitis, ligamentous instability, and meniscal derangement had been excluded as a source of pain.

The operative treatment of peroneal nerve palsy.

We retrospectively reviewed the results of operative decompression for peroneal nerve palsy in thirty-one patients who had been managed between 1980 and 1990. All patients had been managed non-operatively for at least two months after they had initially been seen. Intraoperatively, we found epineurial fibrosis and bands of fibrous tissue constricting the peroneal nerve at the level of the fibular head and at the proximal origin of the peroneus longus muscle.

Effects of deferoxamine on ischemia/reperfusion injury after peripheral nerve compression.

We have demonstrated previously that acute nerve compression produces ischemia/reperfusion injury in rat sciatic nerve. In this study, we evaluated the effects of deferoxamine, an antioxidant, on recovery from ischemia/reperfusion injury after nerve compression. The sciatic nerves of male Sprague-Dawley rats, 370 to 430 g, were subjected to 24 hours of compression with Silastic tubing.