Background And Purpose: Fascicular targeting of longitudinal intrafascicular electrode (FAST-LIFE) interface enables hand dexterity with exogenous electrical microstimulation for sensory restoration, custom neural recording hardware, and deep learning-based artificial intelligence for motor intent decoding. The purpose of this technical report from a prospective pilot study was to illustrate magnetic resonance neurography (MRN) mapping of hand and nerve anatomy in amputees and incremental value of MRN over electrophysiology findings in pre-surgical planning of FAST-LIFE interface (robotic hand) patients.
Materials And Methods: After obtaining informed consent, patients with upper extremity amputations underwent pre-operative 3-T MRN, X-rays, and electrophysiology. MRN findings were correlated with electrophysiology reports. Descriptive statistics were performed.
Results: Five patients of ages 21-59 years exhibited 3/5 partial hand amputations, and 2/5 transradial amputations on X-rays. The median and ulnar nerve end bulb neuromas measured 10.1 ± 3.04 mm (range: 5.5-14 mm, median: 10.5 mm) and 10.9 ± 7.64 mm (2-22 mm, 9.75 mm), respectively. The ADC of median and ulnar nerves were increased at 1.64 ± 0.1 × 10 mm/s (range: 1.5-1.8, median: 1.64 × 10 mm/s) and 1.70 ± 0.17 × 10 mm/s (1.49-1.98 × 10 mm/s, 1.65 × 10 mm/s), respectively. Other identified lesions were neuromas of superficial branch of the radial nerve and anterior interosseous nerve. On electrophysiology, 2/5 reports were unremarkable, 2/5 showed mixed motor-sensory neuropathies of median and ulnar nerves along with radial sensory neuropathy, and 1/5 showed sensory neuropathy of lateral cutaneous nerve of the forearm. All patients regained naturalistic sensations and motor control of digits.
Conclusion: 3-T MRN allows excellent demonstration of forearm and hand nerve anatomy, altered diffusion characteristics, and their neuromas despite unremarkable electrophysiology for pre-surgical planning of the FAST-LIFE (robotic hand) interfaces.
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http://dx.doi.org/10.1007/s00256-022-04079-5 | DOI Listing |
Orphanet J Rare Dis
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Department of Physical Medicine and Rehabilitation, Facultad de Medicina, Universidad Nacional de Colombia, Carrera 30 No.45-03. Edificio 471, Piso 5to, Of. 513-A, Bogotá, Colombia.
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View Article and Find Full Text PDFJ Hand Surg Glob Online
November 2024
Department of Orthopedic Surgery, Texas Tech University of Health Sciences Center, Lubbock, TX.
Purpose: In the adult literature, allograft reconstruction of gapped peripheral nerve injuries has gained popularity over autologous nerve grafting. Allografts have demonstrated similar recovery while eliminating donor site morbidity. There is no well-defined incidence or treatment of such injuries in children.
View Article and Find Full Text PDFJ Hand Surg Glob Online
November 2024
1 Orthopaedic Department, Aristotle University of Thessaloniki, Papanikolaou Hospital, Thessaloniki, Greece.
Peripheral nerve neuromas may present significant therapeutic challenges especially when neuromas in continuity are scar-tethered to adjacent vital structures. We report a case of a patient who presented with delayed neurotmesis of median and ulnar nerves in the arm while extensive scarring of the median nerve was found in close proximity to the repaired brachial artery. For the surgical restoration of the continuity of the median nerve, the scarred segment was left in situ to avoid reinjury of the brachial artery and a "fly-over" nerve grafting technique with sural nerve autografts was employed.
View Article and Find Full Text PDFAnat Sci Int
December 2024
Department of Anatomy, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, Dalmau Road, Munshiganj, 229405, India.
The human upper limb has undergone various evolutionary myologic changes, accompanied by corresponding modifications in the anatomical course of neurovascular structures. In this study, we aimed to elucidate the emergence of the accessory head of the flexor pollicis longus (AHFPL) muscle as a beneficial biomechanical evolutionary development and its topographical relationship with adjacent neurovascular structures. In this pursuit to understand this phenomenon, dissections were conducted on sixty-two upper limbs from thirty-one cadavers.
View Article and Find Full Text PDFJ Clin Med
December 2024
Department of Medico-Surgical Sciences and Biotechnologies, Polo Pontino, Sapienza University of Rome, 04100 Latina, Italy.
: Chronic migraine with medication-overuse headache (CM-MOH) is neurophysiologically characterized by increased cortical excitability with sensitization at both the thalamocortical and the cortical levels. It is unclear whether the increased cortical excitability could be reverted by medication withdrawal (i.e.
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