PubMed Health⌕ Search

Biomedical subjects

S E Mackinnon

Publications and source records attributed to S E Mackinnon.

At least 91 records · Page 5Linked to original sources
PubMed1996

Hand sensibility measures used by therapists.

Sensory evaluations are frequently used to assess patients with functional loss resulting from nerve injury. The results of these tests are routinely utilized by hand surgeons as an indication for conservative management or surgical intervention in the evaluation of surgical outcome and in the determination of disability ratings. Reports in the literature regarding specific tests for sensibility show variation in their application. The purpose of this study was to evaluate which tests are used to evaluate hand sensibility and the techniques of application currently used by hand therapists. Two hundred members of the American Society of Hand Therapists were randomly selected and a survey was sent to these members. The results of this study identify the need to develop standardized protocols for sensory evaluations and the need for therapists to follow the standardized methods for administration of moving and static two-point discrimination, and Semmes-Weinstein monofilaments, if comparisons of results between centers are to be meaningful.

Disability Evaluation↗
PubMed1996

Iatrogenic injury to the ilioinguinal and iliohypogastric nerves in the groin: a case report, diagnosis, and management.

A case of right-sided ilioinguinal and iliohypogastric neuralgia following laparoscopic repair in a 52-year-old man is presented. Significant pain persisted despite conservative measures and was successfully treated with resection of the ilioinguinal and iliohypogastric nerves in the retroperitoneal space. The anatomy, mechanisms of injury, and management of postherniorrhaphy neuropathy are reviewed.

Female↗
PubMed1996

Injection injury to the median nerve.

A case of injection injury to the median nerve is presented and the literature reviewed with respect to pathogenesis, prevention, and outcome. At the present time, all injectable anesthetic agents are neurotoxic. As this case illustrates, direct intrafascicular injection of these agents can result in devastating and permanent impairment. All clinicians must take steps in order to prevent these iatrogenic injuries from occurring.

Aged↗
PubMed1996

The effect of age on peripheral motor nerve function after crush injury in the rat.

OBJECTIVE: To determine the ontogeny of functional recovery after peripheral nerve crush injury. DESIGN: Comparative study in rats of varying ages. MATERIAL AND METHODS: Sixty-second crush injury was performed on the left posterior tibial nerve. Control animals underwent either nerve transection or sham procedure. Nerve function was evaluated 2, 4, and 8 weeks following injury by walking track analysis. Print length ratio (PLR), (ratio of normal right-sided print length to experimental left-sided print length), was used to evaluate functional recovery. MEASUREMENTS AND MAIN RESULTS: Two weeks after crush injury, adult rats experienced significantly greater functional impairment than both 4-day-old and 3-week-old animals (p < 0.05). Four weeks after injury, the difference in function between 4-day-old and adult rats and between 3-week-old and adult rats became insignificant. Complete recovery had been achieved by 8 weeks in all groups. CONCLUSIONS: These results demonstrate faster functional recovery after nerve injury in immature rats than in adults.

Afferent Pathways↗
PubMed1996

Reduction in peripheral nerve allograft antigenicity with warm and cold temperature preservation.

Lymphocyte migration into fresh and preserved peripheral nerve allografts was assessed to determine the effects of preservation time, preservation temperature, and graft harvest technique on the immunologic response to the peripheral nerve allograft. Peroneal nerve was harvested from either live or cadaveric (tissue) donors and stored as 1.5-cm segments at 5 degrees C or 37 degrees C for 1, 3, 5, or 7 days. Each of nine outbred ewes then received multiple segments of peroneal autograft, fresh allograft, and preserved nerve allograft implants. Lymphocyte migration was studied 7 days after implantation by intravenous injection of autologous 111In-labeled lymphocytes and quantified by gamma counter. Lymphocyte migration into fresh allografts (7212 +/- 1575) increased an average of 4.1 times over fresh autograft tissue (1758 +/- 421; p < 0.05). Short-term preservation (24 hours) at both temperatures enhanced lymphocyte migration into pretreated allograft tissue (12684 +/- 2575 at 5 degrees C, 8751 +/- 1577 at 37 degrees C) as compared with fresh allograft (7212 +/- 1575). Conversely, 7 days of pretreatment at both 5 degrees C (3586 +/- 1421) and 37 degrees C (1570 +/- 414) resulted in migration values not significantly different from autograft. No statistically significant difference was seen between grafts harvested from live (5710 +/- 1651) versus cadaveric (tissue) donors (4013 +/- 832) after 5 days of cold preservation.

Analysis of Variance↗
PubMed1996

Establishing normal values of moving two-point discrimination in children and adolescents.

To establish normal values of moving two-point discrimination (2pd) in children and adolescents, bilateral median and ulnar nerve distribution in 313 subjects aged 4 to 18 years was evaluated. A moving 2pd of 2 to 3mm for both the median and ulnar nerve distributions bilaterally was found in 270 subjects. 2% (N = 5) had moving 2pds of 4mm for both right and left median nerve distributions. There was a significant increase in mean age with 2, 3 and 4mm of moving 2pd for median and ulnar nerves bilaterally. There was no significant difference between sexes for ulnar nerves bilaterally or left median nerve. A borderline difference was found between the sexes for the right median nerve. Multivariate logistic regression revealed age as a significant predictor of discrimination for all variables. Significantly more subjects had a moving 2pd of 4mm in the ulnar nerve distribution than in the median nerve distribution.

Adolescent↗
PubMed1996

Nerve allotransplantation following severe tibial nerve injury. Case report.

The successful recovery of sensibility across a long peripheral nerve allograft in a 12-year-old boy who sustained a severe posterior tibial nerve injury is reported. The historical clinical experience with nerve allotransplantation is also reviewed. It is concluded that in the carefully selected patient with severe nerve injury, consideration for nerve allotransplantation can be given.

Child↗
PubMed1996

Wire mesh as a post-operative physiotherapy assistive device following peripheral nerve graft repair in the rat.

Traditional methods of assessing nerve recovery following injury, including histomorphometry and electrophysiology, do not necessarily correlate with return of motor and sensory function. Accordingly, many investigators have used walking track analysis as an assessment of global functional recovery following sciatic, peroneal or tibial nerve injury. However, walking track reliability may be compromised by the development of flexion contractures secondary to neurologic loss. To prevent this, regular manual physiotherapy is recommended which is a time-consuming and often frustrating process for both the animal and investigator. We report the use of a wire mesh as a simple post-operative assistive device to provide constant physiotherapy. Twelve Lewis rats were randomized to one of two experimental groups. Each rat received a 2 cm posterior tibial nerve autograft. Postoperatively, animals in group 1 received manual physiotherapy, consisting of repeated flexion and extension exercises of the ankle, knee and hip every two weeks. Group 2 rats were permitted to climb freely on a 30 x 18 cm piece of wire mesh placed at a 45 degree angle within their cage. Group 2 rats received no manual physiotherapy throughout the course of the study. Serial walking tracks were performed every four weeks until sacrifice at sixteen weeks. There was no development of flexion contractures in the injured hind limbs of either group. There was no morbidity such as blisters associated with the use of the wire mesh. There was no statistical difference in walking track recovery between groups at any time period. However, a trend towards better functional recovery was seen in the group receiving constant physiotherapy via the wire mesh. The use of a wire mesh as a post-operative assistive device is an inexpensive, simple and reliable method to provide continuous physiotherapy to animals following denervation.

Animals↗
PubMed1996

Thoracic outlet syndrome: a current overview.

Thoracic outlet syndrome and the surgery associated with this diagnosis have a controversial reputation. The majority of patients with thoracic outlet syndrome seen in the context of the work place will have a multiplicity of components to their symptomatology, including multilevel nerve compression and muscle imbalance of the neck, shoulder, and back. Identification and conservative management of these problems make the necessity for surgery for thoracic outlet syndrome a rare event. Decompression of the brachial plexus, with or without first rib resection, is a technically demanding surgical procedure requiring expertise in peripheral nerve, vascular and thoracic surgery. Evaluation of these patients requires an understanding of neuromuscular physiology and chronic pain syndromes.

Cumulative Trauma Disorders↗
PubMed1996

Evaluation of the patient with thoracic outlet syndrome.

Clinical evaluation is paramount in making the diagnosis of thoracic outlet syndrome. Complaints of paresthesia and numbness will relate to the nerve compression component of thoracic outlet syndrome, whereas the pain associated with this syndrome is largely caused by muscle imbalance in the neck, shoulders, and upper back. Utilization of a pain evaluation scale assists in assessing a functional overlay to the pain complaints. Detailed sensory testing at rest and after provocation of the patient's symptoms with overhead activity will assist in the diagnosis. Radiographic test results are frequently normal in this patient population. By contrast, vascular testing results are frequently abnormal in a normal patient population. Electrodiagnostic tests are useful in ruling out other, more distal nerve entrapments.

Evoked Potentials, Somatosensory↗
PubMed1996

Supraclavicular first rib resection.

A supraclavicular approach will facilitate brachial plexus decompression and first rib resection. It allows the surgeon a complete visualization of all the neurovascular elements and removal of the first rib. In particular, under direct vision, the most posterior aspects of the first rib can be easily visualized and removed. During this dissection, care is taken to preserve the supraclavicular nerves. The technique of opening the pleura to allow drainage into the pleural cavity rather than around the brachial plexus will decrease postoperative scarring around the neural elements. Similarly, gentle but early postoperative movement of the head, neck, and upper extremity is encouraged in order to minimize scar formation around the brachial plexus.

Humans↗
PubMed1996

Thoracic outlet syndrome.

Thoracic outlet syndrome (TOS) is the term commonly used to describe patients with symptoms attributed to compression of the brachial plexus and subclavian vein and artery in the region of the thoracic inlet/outlet. TOS remains extremely controversial with respect to its existence, diagnosis, conservative management, and surgical treatment. The diagnosis is based upon clinical evaluation, reproduction of patient symptoms with arm elevation, and the absence of other relevant pathology. Conservative management should be directed towards correction of postural abnormalities and muscle imbalance in the cervicoscapular region. Patient education compliance to a home exercise program and behavioral modification at home, work, and sleep is necessary for a successful outcome. Surgical decompression of the brachial plexus is best achieved through a supraclavicular approach and should be reserved for the few patients in which conservative management has failed to improve symptoms.

Electrodiagnosis↗
PubMed1996

Reflex sympathetic dystrophy. The controversy continues.

The chronic pain syndrome encompassed by the term RSD is poorly understood. The confusion is caused in large part by frequent misdiagnosis and excessive use of sympatholytic procedures in inappropriate circumstances. Recently, pain specialists have redefined the specific criteria for regional pain syndromes having sympathetic maintaining factors, emphasizing application of placebo testing in diagnosis and attention to anatomic principles in pharmacologic and surgical treatment. The authors believe that three-phase bone scanning is a valuable adjunct to clinical judgment in making the proper diagnosis. Current thinking suggests that sympathetic maintained pain exists but that it may comprise only approximately 10% of regional pain cases. Once the appropriate diagnosis is made, classically described sympatholytic procedures are reasonably used. Alternative techniques, such as spinal cord stimulation, may have an important role in refractory cases of sympathetically maintained pain.

Hand↗
PubMed1996

Endoscopic carpal tunnel release. The voice of polite dissent.

It is ironic for us that our own studies, showing that neurolysis of the median nerve does not confer benefit in the primary OCTR, have been cited frequently as a reason for not needing to visualize the median nerve and that this indirectly has supported ECTR. Our recognition that even OCTR can cause significant complications that may not be able to be corrected, however, makes us very respectful of carpal tunnel release, a procedure that has been called the simplest of all operations. We, therefore, reject any modification that in any way presents more risk to even a single patient.

Arthroscopy↗
PubMed1996

Management of neuromas in the hand.

Injury to a peripheral nerve in the hand can result in loss of motor and sensory function. In addition, incomplete or abnormal regeneration can cause painful sequelae. The approach to neuromas in the hand requires familiarity with the basic aspects of nerve regeneration as well as the neurophysiology of pain mechanisms.

Hand↗
PubMed1995

Immunosuppressive effect of monoclonal antibodies to ICAM-1 and LFA-1 on peripheral nerve allograft in mice.

This study evaluated the immunosuppressive effect of monoclonal antibodies against cell surface molecules in a murine peripheral nerve allograft model. After nerve allografting, 18 recipients were treated with both anti-intercellular adhesion molecule-1 (ICAM-1) and anti-lymphocyte function-associated molecule-1 (LFA-1) monoclonal antibodies in low or high dose. Nerve allografts were harvested at 8 weeks for histologic and morphometric evaluation. Recipients were subsequently challenged with skin grafts at 9 weeks and a cytotoxic assay at 12 weeks. The majority of the antibody-treated allografts (13 of 18) showed excellent regeneration comparable to the autografts with preservation of the normal nerve architecture and scant cellular infiltrate. All untreated allografts demonstrated severe structural disorganization with cellular infiltrate consistent with acute rejection. In the high dose group, the mean skin graft survival time from nerve donor mice, but not third-party mice, was significantly prolonged. (17.5 vs. 11.3 days). Similarly, the cytotoxic activity against nerve donor alloantigen was significantly suppressed. These preliminary findings suggest that antibody therapy alone can facilitate nerve regeneration in a murine nerve allograft model.

Animals↗