Determination of median, ulnar, and radial nerve innervation patterns

Yıl 2011, Cilt: 22 Sayı: 1, 11 - 16, 01.04.2011

Öz

Purpose: Peripheral nerves show differences in histological, morphological and physiological characteristics. The aim of this study was to determine the motor, sensory and autonomic differences of median, ulnar and radial nerves clinically. Material and method: Twenty-seven patients with 11 median, nine ulnar and seven radial nerve axonotmesis type lesion located at 1/3 distal forearm participated in the study. Autonomic (transepidermal water loss, skin elasticity, temperature, and moisture), sensory (Semmes Weinstein monofilament test, twopoint discrimination, pain threshold, and tolerance) and motor (rheobase, chronaxy, and faradic test) assessments were applied to affected and unaffected extremities. Autonomic, sensory and
motor assessments were performed by different physiotherapists. Results: In the unaffected side, a decreased transepidermal water loss and pain threshold and an increased rheobase and
faradic test values in radial nerve were found (p<0.05). On the lesion side, decreased skin elasticity and transepidermal water loss and increased rheobase were found in radial nerve (p<0.05). Conclusion: Radial nerve differs from median and ulnar nerves in terms of motor, sensory and autonomic functions. Recovery pattern of radial nerve may differ from median and
ulnar nerve. 

Anahtar Kelimeler

Median nerve , Radial nerve , Ulnar nerve , Electric stimulation

Median, ulnar ve radial sinirin inervasyon paternlerinin belirlenmesi

Öz

Amaç: Periferik sinirler histolojik, morfolojik ve fizyolojik yönden farklı özellikler gösterirler. Bu çalışmada, median, ulnar ve radial sinirin motor, duyu ve otonomik fonksiyonları arasındaki farkların belirlenmesi amaçlandı. Gereç ve yöntem: Çalışmaya önkol 1/3 distal seviyesinde aksonotmezis tip lezyonu olan, 11 median, 9 ulnar ve 7 radial sinir yaralanmalı 27 hasta alındı. Hastaların sağlam ve lezyon tarafına otonomik (transepidermal su kaybı, deri esnekliği, temparatürü ve nemi), duyu (Semmes Weinstein monofilament testi, iki nokta ayırımı, ağrı eşiği ve toleransı) ve motor (reobaz, kronaksi ve faradik test) ölçümler yapıldı. Otonomik, duyu ve motor değerlendirmeler farklı bir fizyoterapist tarafından uygulandı. Sonuçlar: Sağlam tarafta radial sinirin transepidermal su kaybı ve ağrı eşiğinde azalma, reobaz ve faradik test değerlerinde artış bulundu (p

Anahtar Kelimeler

Median sinir , Radial sinir , Ulnar sinir , Elektrik stimulasyonu

Kaynakça

• Sunderland S. The anatomy and physiology of nerve injury. Muscle Nerve. 1990;13:771-784
• Stewart J. Peripheral nerve fascicles: anatomy and clinical relevance. Muscle Nerve. 2003;28:525-541.
• Sunderland S, Bedbrook G. The cross-sectional area of peripheral nerve trunks occupied by the fibres representing individual muscular and cutaneous branches. Brain. 1949;72:613-624.
• Marx S, Kumar P. Histological and ultrasonographical study of the human superficial branch of the radial nerve at distal forearm and its clinical implications. Rom J Morphol Embryo. 2010;51:751-758.
• Chakravarthy Marx S, Kumar P, Dhalapathy S, et al. Microanatomical and immunohistochemical study of the human radial nerve at the antecubital fossa. Ann Anat. 2009;191:389-398.
• Kawai H. Anatomy of the brachial plexus. In: Kawai HK, ed., Brachial Plexus Palsy Singapore World Scientific. Singapore; World Scientific:2000:1-24.
• Kovacic U, Sketelj J, Bajrovic F. Age-related differences in the reinnervation after peripheral nerve injury. Int Rev Neurobiol. 2009;87:465-482.
• Spicher CJ. Handbook for Somatosensory Rehabilitation. Montpellier, Paris: Sauramps Medical; 2006.
• Gelberman R, Szabo R, Williamson R, et al. Sensibility testing in peripheral-nerve compression syndromes. An experimental study in humans. J Bone Joint Surg. 1983;65:632-638.
• Jette D. Effect of different forms of transcutaneous electrical nerve stimulation on experimental pain. Phys Ther. 1986;66:187-193.
• Wu Y, Wang X, Zhou Y, et al. Correlation between stinging, TEWL and capacitance. Skin Res Technol. 2003;9:90-93.
• Chakravarthy M, Kumar P, Dhalapathy S, et al. Distribution of sympathetic fiber areas of radial nerve in the forearm: an immunohistochemical study in cadavers. Surg Radiol Anat. 2010;32:865-871.
• Benatar M, Wuu J, Peng L. Reference data for commonly used sensory and motor nerve conduction studies. Muscle Nerve. 2009;40:772-794.
• Huang C, Chang W, Chang H, et al. Effects of age, gender, height, and weight on late responses and nerve conduction study parameters. Acta Neurologica Taiwanica. 2009;18:242-249.
• Balogh B, Auterith A, Behrus R, et al. The sympathetic axons of the nerves of the hand. Handchir Mikrochir P. 2002;34:369-373.
• Keller T, Kuhn A. Electrodes for transcutaneous (surface) electrical stimulation. Journal of Automatic Control. 2008;18:35-45.
• Griffin J, Pan B, Polley M, et al. Measuring nerve regeneration in the mouse. Exp Neurol. 2010;223:60- 71.