Intraoperative Electrical Nerve Stimulation as a Prognostic Tool in Patients Undergoing Peripheral Nerve Neurolysis
Purpose: Functional recovery from peripheral nerve injuries remains unpredictable and continues to pose a major clinical challenge to surgeons. This study sought to investigate the utility of intraoperative nerve stimulation following neurolysis surgery as a prognostic indicator of functional recove...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-01-01
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| Series: | Journal of Hand Surgery Global Online |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589514124002123 |
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| author | Christoph A. Schroen, BS Yufan Yan, MD Christian E. Awah, MD Unwana Abasi, MD Paul J. Cagle, MD Michael R. Hausman, MD Steven M. Koehler, MD |
| author_facet | Christoph A. Schroen, BS Yufan Yan, MD Christian E. Awah, MD Unwana Abasi, MD Paul J. Cagle, MD Michael R. Hausman, MD Steven M. Koehler, MD |
| author_sort | Christoph A. Schroen, BS |
| collection | DOAJ |
| description | Purpose: Functional recovery from peripheral nerve injuries remains unpredictable and continues to pose a major clinical challenge to surgeons. This study sought to investigate the utility of intraoperative nerve stimulation following neurolysis surgery as a prognostic indicator of functional recovery. Methods: A retrospective chart review of adult patients who underwent peripheral nerve neurolysis between September 2021 and December 2022 was performed. A handheld nerve stimulator was used intraoperatively before and after neurolysis. Patients with preoperative motor deficits corresponding to the nerve that underwent neurolysis, intraoperative nerve stimulation, and postoperative follow-up length of at least 3 months were included. Muscle strength as measured by the Medical Research Council scale was used to evaluate nerve function. A scale grade of 0 or 1 meant “no recovery,” between 2 and 4 was classified as “partial recovery,” and 5 was classified as “full recovery.” Fisher exact tests were employed to test for an association between stimulation thresholds and functional recovery. Results: A total of 27 patients and 45 nerves were included in the study, with a mean follow-up of 8.0 months. Intraoperative stimulation at 0.5 mA was observed in 73% (33/45) of nerves, with 76% achieving full recovery, 18% partial recovery, and 6% no recovery. Two nerves stimulated at 2 mA and one at 20 mA, with both showing partial recovery. In contrast, 22% (10/45) of nerves showed no stimulation, leading to full recovery in 20%, partial recovery in 30%, and no recovery in 50% of cases. A significant (P < .001) association was found between stimulation thresholds and functional recovery. Conclusions: Intraoperative nerve stimulation is strongly linked to functional recovery postneurolysis, demonstrating its potential as a prognostic tool for guiding surgical decisions. Type of study/level of evidence: Prognostic, IV. |
| format | Article |
| id | doaj-art-9b16aeea25c24ca1b2bf5b1557e27600 |
| institution | Kabale University |
| issn | 2589-5141 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Hand Surgery Global Online |
| spelling | doaj-art-9b16aeea25c24ca1b2bf5b1557e276002025-01-26T05:04:40ZengElsevierJournal of Hand Surgery Global Online2589-51412025-01-01716165Intraoperative Electrical Nerve Stimulation as a Prognostic Tool in Patients Undergoing Peripheral Nerve NeurolysisChristoph A. Schroen, BS0Yufan Yan, MD1Christian E. Awah, MD2Unwana Abasi, MD3Paul J. Cagle, MD4Michael R. Hausman, MD5Steven M. Koehler, MD6Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, GermanyDepartment of Surgery, Division of Plastic and Reconstructive Surgery, Montefiore Einstein, Bronx, NYDepartment of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NYDepartment of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NYDepartment of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NYDepartment of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NYDepartment of Orthopaedic Surgery, Division of Hand Surgery, Montefiore Einstein, Bronx, NY; Corresponding author: Steven M. Koehler, MD, Department of Orthopaedic Surgery, Montefiore Einstein, 1250 Waters Place, Tower 1, 11th Floor, Bronx, NY 10461.Purpose: Functional recovery from peripheral nerve injuries remains unpredictable and continues to pose a major clinical challenge to surgeons. This study sought to investigate the utility of intraoperative nerve stimulation following neurolysis surgery as a prognostic indicator of functional recovery. Methods: A retrospective chart review of adult patients who underwent peripheral nerve neurolysis between September 2021 and December 2022 was performed. A handheld nerve stimulator was used intraoperatively before and after neurolysis. Patients with preoperative motor deficits corresponding to the nerve that underwent neurolysis, intraoperative nerve stimulation, and postoperative follow-up length of at least 3 months were included. Muscle strength as measured by the Medical Research Council scale was used to evaluate nerve function. A scale grade of 0 or 1 meant “no recovery,” between 2 and 4 was classified as “partial recovery,” and 5 was classified as “full recovery.” Fisher exact tests were employed to test for an association between stimulation thresholds and functional recovery. Results: A total of 27 patients and 45 nerves were included in the study, with a mean follow-up of 8.0 months. Intraoperative stimulation at 0.5 mA was observed in 73% (33/45) of nerves, with 76% achieving full recovery, 18% partial recovery, and 6% no recovery. Two nerves stimulated at 2 mA and one at 20 mA, with both showing partial recovery. In contrast, 22% (10/45) of nerves showed no stimulation, leading to full recovery in 20%, partial recovery in 30%, and no recovery in 50% of cases. A significant (P < .001) association was found between stimulation thresholds and functional recovery. Conclusions: Intraoperative nerve stimulation is strongly linked to functional recovery postneurolysis, demonstrating its potential as a prognostic tool for guiding surgical decisions. Type of study/level of evidence: Prognostic, IV.http://www.sciencedirect.com/science/article/pii/S2589514124002123Brachial plexusHand surgeryNerve stimulationNeuromaPeripheral nerve injury |
| spellingShingle | Christoph A. Schroen, BS Yufan Yan, MD Christian E. Awah, MD Unwana Abasi, MD Paul J. Cagle, MD Michael R. Hausman, MD Steven M. Koehler, MD Intraoperative Electrical Nerve Stimulation as a Prognostic Tool in Patients Undergoing Peripheral Nerve Neurolysis Journal of Hand Surgery Global Online Brachial plexus Hand surgery Nerve stimulation Neuroma Peripheral nerve injury |
| title | Intraoperative Electrical Nerve Stimulation as a Prognostic Tool in Patients Undergoing Peripheral Nerve Neurolysis |
| title_full | Intraoperative Electrical Nerve Stimulation as a Prognostic Tool in Patients Undergoing Peripheral Nerve Neurolysis |
| title_fullStr | Intraoperative Electrical Nerve Stimulation as a Prognostic Tool in Patients Undergoing Peripheral Nerve Neurolysis |
| title_full_unstemmed | Intraoperative Electrical Nerve Stimulation as a Prognostic Tool in Patients Undergoing Peripheral Nerve Neurolysis |
| title_short | Intraoperative Electrical Nerve Stimulation as a Prognostic Tool in Patients Undergoing Peripheral Nerve Neurolysis |
| title_sort | intraoperative electrical nerve stimulation as a prognostic tool in patients undergoing peripheral nerve neurolysis |
| topic | Brachial plexus Hand surgery Nerve stimulation Neuroma Peripheral nerve injury |
| url | http://www.sciencedirect.com/science/article/pii/S2589514124002123 |
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