Inducing Ulnar Nerve Function while Eliminating Claw Hand and Reducing Chronic Neuropathic Pain
Ulnar nerve injury induces chronic neuropathic pain and is frequently devastating due to loss of cupping the hand around objects (finger clawing) and diminished grip strength. There is little chance of restoring good function, eliminating finger clawing, or reducing the pain. A novel technique was t...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2023-04-01
|
| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004927 |
| _version_ | 1797840179300401152 |
|---|---|
| author | Christian A. Foy, MD William F. Micheo, MD Damien P. Kuffler, PhD |
| author_facet | Christian A. Foy, MD William F. Micheo, MD Damien P. Kuffler, PhD |
| author_sort | Christian A. Foy, MD |
| collection | DOAJ |
| description | Ulnar nerve injury induces chronic neuropathic pain and is frequently devastating due to loss of cupping the hand around objects (finger clawing) and diminished grip strength. There is little chance of restoring good function, eliminating finger clawing, or reducing the pain. A novel technique was tested for its efficacy in promoting ulnar nerve function and reducing finger clawing and chronic neuropathic pain. A 25-year-old subject presented 5.7 months after a wrist gunshot that created three nerve gaps proximal to the deep ulnar nerve branch. He sought restoration of function due to developing ulnar nerve injury-induced claw hand and increasingly severe chronic neuropathic pain. After resection of the scarred nerve tissue, each gap was 10 cm long. The gaps were bridged with two nonreversed sural nerve grafts within a PRP-filled NeuroMend collagen tube (Collagen Matrix, Oakland, N.J.). Some axons regenerated entirely across all three 10-cm-long repaired nerve gaps, restoring excellent topographically correct sensitivity of S4, including two-point discrimination of 4 mm, good M4 motor function, and full ROM. The ulnar nerve injury-induced finger clawing was eliminated, and the chronic neuropathic pain of 7 was reduced to 0 on a 0–10 validated scale and did not return over the following 3.75 years. Thus, this novel technique induces good sensory and motor function, despite repairing three 10-cm-long nerve gaps while eliminating ulnar nerve injury-induced hand clawing and chronic neuropathic pain. Further studies are required to determine whether the effects were due to PRP. |
| first_indexed | 2024-04-09T16:10:35Z |
| format | Article |
| id | doaj.art-f8eefd01568c4399ab5c5eac984324d7 |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-04-09T16:10:35Z |
| publishDate | 2023-04-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-f8eefd01568c4399ab5c5eac984324d72023-04-24T10:07:51ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742023-04-01114e492710.1097/GOX.0000000000004927202304000-00024Inducing Ulnar Nerve Function while Eliminating Claw Hand and Reducing Chronic Neuropathic PainChristian A. Foy, MD0William F. Micheo, MD1Damien P. Kuffler, PhD2From the * Section of Orthopedic Surgery, Institute of Neurobiology, Medical School, University of Puerto Rico, San Juan, Puerto Rico† Department of Physical Medicine and Rehabilitation, Institute of Neurobiology, Medical School, University of Puerto Rico, San Juan, Puerto Rico.† Department of Physical Medicine and Rehabilitation, Institute of Neurobiology, Medical School, University of Puerto Rico, San Juan, Puerto Rico.Ulnar nerve injury induces chronic neuropathic pain and is frequently devastating due to loss of cupping the hand around objects (finger clawing) and diminished grip strength. There is little chance of restoring good function, eliminating finger clawing, or reducing the pain. A novel technique was tested for its efficacy in promoting ulnar nerve function and reducing finger clawing and chronic neuropathic pain. A 25-year-old subject presented 5.7 months after a wrist gunshot that created three nerve gaps proximal to the deep ulnar nerve branch. He sought restoration of function due to developing ulnar nerve injury-induced claw hand and increasingly severe chronic neuropathic pain. After resection of the scarred nerve tissue, each gap was 10 cm long. The gaps were bridged with two nonreversed sural nerve grafts within a PRP-filled NeuroMend collagen tube (Collagen Matrix, Oakland, N.J.). Some axons regenerated entirely across all three 10-cm-long repaired nerve gaps, restoring excellent topographically correct sensitivity of S4, including two-point discrimination of 4 mm, good M4 motor function, and full ROM. The ulnar nerve injury-induced finger clawing was eliminated, and the chronic neuropathic pain of 7 was reduced to 0 on a 0–10 validated scale and did not return over the following 3.75 years. Thus, this novel technique induces good sensory and motor function, despite repairing three 10-cm-long nerve gaps while eliminating ulnar nerve injury-induced hand clawing and chronic neuropathic pain. Further studies are required to determine whether the effects were due to PRP.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004927 |
| spellingShingle | Christian A. Foy, MD William F. Micheo, MD Damien P. Kuffler, PhD Inducing Ulnar Nerve Function while Eliminating Claw Hand and Reducing Chronic Neuropathic Pain Plastic and Reconstructive Surgery, Global Open |
| title | Inducing Ulnar Nerve Function while Eliminating Claw Hand and Reducing Chronic Neuropathic Pain |
| title_full | Inducing Ulnar Nerve Function while Eliminating Claw Hand and Reducing Chronic Neuropathic Pain |
| title_fullStr | Inducing Ulnar Nerve Function while Eliminating Claw Hand and Reducing Chronic Neuropathic Pain |
| title_full_unstemmed | Inducing Ulnar Nerve Function while Eliminating Claw Hand and Reducing Chronic Neuropathic Pain |
| title_short | Inducing Ulnar Nerve Function while Eliminating Claw Hand and Reducing Chronic Neuropathic Pain |
| title_sort | inducing ulnar nerve function while eliminating claw hand and reducing chronic neuropathic pain |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004927 |
| work_keys_str_mv | AT christianafoymd inducingulnarnervefunctionwhileeliminatingclawhandandreducingchronicneuropathicpain AT williamfmicheomd inducingulnarnervefunctionwhileeliminatingclawhandandreducingchronicneuropathicpain AT damienpkufflerphd inducingulnarnervefunctionwhileeliminatingclawhandandreducingchronicneuropathicpain |