Nerve conduction velocity, microscopic, and electron microscopy studies comparing repaired adult and baby monkey median nerves

doi:10.1016/S0363-5023(83)80199-3

The Journal of Hand Surgery

Volume 8, Issue 4, July 1983, Pages 406-410

https://doi.org/10.1016/S0363-5023(83)80199-3 Get rights and content

Three to three and a half years after repair of monkey nerves, comparison of total myelinated nerves, electron microscopic sections, and nerve conduction velocities delineated no significant difference between nerves sutured in adult life and those sutured in infancy. Extrapolating these results to the human clinical situation, central nervous system adaption in young patients could explain the better clinical results.

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Cited by (46)

Evaluation of pediatric upper extremity peripheral nerve injuries
2015, Journal of Hand Therapy
Citation Excerpt :
This may contribute to better outcomes.16,19 However, it was Almquist et al20 that conducted the landmark study that highlighted how central plasticity plays a significant role in sensory functional recovery after nerve injuries. This study demonstrated in monkeys that axonal count and conduction velocity did not differ between nerves repaired in infancy and adulthood.20
The evaluation of motor and sensory function of the upper extremity after a peripheral nerve injury is critical to diagnose the location and extent of nerve injury as well as document functional recovery in children.
The purpose of this paper is to describe an approach to the evaluation of the pediatric upper extremity peripheral nerve injuries through a critical review of currently used tests of sensory and motor function.
Outcome studies on pediatric upper extremity peripheral nerve injuries in the Medline database were reviewed.
The evaluation of the outcome in children less than 10 years of age with an upper extremity peripheral nerve injury includes careful observation of preferred prehension patterns, examination of muscle atrophy and sudomotor function, provocative tests, manual muscle testing and tests of sensory threshold and tactile gnosis.
The evaluation of outcome in children with upper extremity peripheral nerve injuries warrants a unique approach.
Conditions Affecting Accuracy of Peripheral Nerve Reinnervation and Functional Recovery
2015, Neural Regeneration
For successful regeneration to occur, axons not only need to grow past the lesion, but they also must be targeted to their appropriate synaptic locations. Here we review the basic response of a peripheral neuron to injury, emphasizing the communication of the injury response to the cell body and the initially robust cell body response to injury that often stands in contrast to the injury response of central nervous system neurons. However, despite the high potential for regeneration, patients with peripheral nervous system (PNS) injuries often recover poorly. Failure of PNS regeneration arises not only because of the time and distance over which axon growth must occur but also because of misdirected axon growth even if regenerative potential remains robust. This is more evident with increasing disruption of the nerve integrity by the injury, which progressively decreases the functional outcome. For example, a crush injury shows the highest levels of function recovery, whereas complete transection and nerve excision lesions show the lowest. The low probability of a good outcome after any transection lesion is primarily caused by the misdirected regeneration of motor and sensory axons to inappropriate peripheral targets. However, some preferential re-formation of appropriate synapses after injury exists. Furthermore, modulation of both spinal cord plasticity in response to erroneous motor reinnervation and treatments to increase the specificity of axon regeneration at an injury site have improved regenerative recovery in some cases. Together these observations suggest the possibility of rational strategies to improve recovery of PNS injuries.
Chondroitinase ABC promotes plasticity of spinal reflexes following peripheral nerve injury
2012, Experimental Neurology
Citation Excerpt :
It has been reported that children recover better than adults after surgical repair of a peripheral nerve (Jerosch-Herold, 2003; Lundborg and Rosen, 2001; Rosen et al., 2000). Studies comparing outcomes after nerve repair in adult or infant monkeys found that regeneration success was not different, even though functional outcomes were better in the younger group (Almquist et al., 1983). This suggests that the immature central nervous system (CNS) has a greater capacity for central reorganisation.
Peripheral nerve transection, even with optimal repair, can result in an extensive disruption of central connectivity, which can lead to long-lasting impairments in motor and sensory function. We hypothesised that removal of spinal cord chondroitin sulphate proteoglycans (CSPGs) would promote plasticity in the spinal cord, allowing compensation for inaccurate peripheral reinnervation. In adult rats, the median and radial nerves were cut and repaired, either correctly (median to median and radial to radial), or incorrectly (median to radial and vice versa). This produced two levels of inaccuracy of peripheral reinnervation. Whole nerve recordings from a third brachial plexus nerve, the ulnar, were made during median or radial nerve stimulation. Low and high threshold reflexes were characterised in uninjured animals and a clear difference in the pattern of ulnar response to flexor (median) or extensor (radial) stimulation was established. This included the phenomenon of wind-up, where repetitive median nerve stimulation at supramaximal C-fibre threshold leads to a progressive increase in the number of spikes recorded. To achieve digestion of CSPGs a lentiviral vector expressing ChABC was delivered to the spinal cord via intraspinal injection. Following ChABC treatment, we found several indicators of reorganisation of central connections. Firstly, we found that the amplitude of a low threshold, polysynaptic reflex could be increased after nerve injury, only following treatment with ChABC. Secondly, wind-up of motor responses in the ulnar nerve to supramaximal stimulation of afferents in the median nerve, which collapses after nerve injury (to ~ 25% of uninjured value), could be restored by ChABC after correct repair (to ~ 90% of uninjured value). Thirdly, wind-up in ulnar motor axons to stimulation of radial nerve afferents, which is minimal in the uninjured state, becomes significantly stronger after nerve injury and ChABC treatment (a 10 fold increase). We propose that application of a plasticity-promoting treatment to the spinal cord allows the amplification of adaptive changes in response to inaccurate wiring in the periphery.
Cognitive capacity: No association with recovery of sensibility by Semmes Weinstein test score after peripheral nerve injury of the forearm
2010, Journal of Plastic, Reconstructive and Aesthetic Surgery
Citation Excerpt :
In childhood, the altered sensory impulses given by the hand are much easily interpreted by the somatosensory brain cortex than in adult age. It is thought that this is the result of reduced brain plasticity with age or the other way around, due to the active learning processes and not yet static schemes of interpretation in young children.27 Research with fetal monkeys led to the conclusion that this active sensory rehabilitation by children is of more importance than the accuracy of nerve realignment.11
In the recovery process of sensibility after repair of a peripheral nerve injury of the forearm, not only age but also surgical repair techniques are of importance. If regenerating axons are misdirected, reorganisation or other adaptic processes are needed at the level of the somatosensory brain cortex. These processes are thought to be dependent on the patient's cognitive capacity. We conducted a prospective multicentre study to assess the association between cognitive capacity and recovery of sensibility after peripheral nerve damage of the forearm.
Patients with a traumatic peripheral nerve lesion of the forearm and consecutive surgical repair were included. After 12 months, the patients were assessed with respect to recovery of sensibility (Semmes–Weinstein monofilaments) and cognitive capacity, with four tests assessing different aspects of cognitive functioning.
Twenty-eight patients (25 male, three female; median age: 28.5 years; range: 15–79 years) with median and/or ulnar nerve injury of the forearm were included in the study. Younger age showed a positive association with sensory recovery (β = −0.845, 95% CI: −1.456 to −0.233; p = 0.01). No association was found between the cognitive-capacity tests used and sensory recovery.
The present prospective study did not reveal any association between recovery of sensibility measured by Semmes–Weinstein test score and cognitive capacity. Further studies should be performed to confirm these results.
Peripheral Nerve Injuries
2007, Physical Rehabilitation: Evidence-Based Examination, Evaluation, and Intervention
Peripheral Nerve Injuries
2007, Physical Rehabilitation

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: Presented at the Twenty-eighth Annual Meeting of the American Society for Surgery of the Hand, Jan. 31, 1973, Las Vegas, Nevada.

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Nerve conduction velocity, microscopic, and electron microscopy studies comparing repaired adult and baby monkey median nerves

J Hand Surg

Sensory-nerve-conduction velocity and two-point discrimination in sutured nerves

J Bone Joint Surg [Am]

Nerve injuries in children

Br Med J