Clinical and electrodiagnostic characteristicsof nerve damage from forearm injury

Đỗ Lập Hiếu, Nguyễn Trọng Hưng, Đào Quốc Tuấn

Main Article Content

Abstract

The purpose of this study is to describe the clinical symptoms and the degree of damage to the radial, median, and ulnar nerves from forearm injury including the assessment of abnormal nerve electrodiagnostic. The study was conducted in 30 patients with one or more nerves damage in the forearm area (ulnar, median, radial). All patients received surgical treatment including microsurgery, non - microsurgery and no nerve stitching. Patient condition was reviewed, clinical neurological examination was performed, nerve injury was assessed by the Quick DASH scale and diagnosed by measuring the nerve conduction rate and recording the needle electrodes. The results show that the left hand is more damaged than the right hand (60%); lesions are mainly found in the upper third of the forearm (46.7%). The clinical symptoms of the motor - sensory accounted for the highest percentage (74%). The lowest Quick DASH score is 16, the highest is 48 and the average is 31.4, of which the mild, moderate and severe, sequentially, are 20%, 40% and 40%. Electrodiagnostics features confirmed the latency, conduction velocity or amplitude ware markedly decreased in patients with damage to the radial, median, and ulnar nerves at forearm. Denervation accounts for a low percentage that in the group of no nerve stitching. There were no difference in conduction velocites, amplitudes and latencies between the injured hand and the normal hand on 3 groups (microsurgery, non - microsurgery and no nerve stitching). In conclusion, the left hand is more damaged than the right hand. The main damaged nerves are radial and ulnar nerves. The degree of functional damage to the forearm is moderate and severe (the Quick DASH scale). Nerves in the affected forearm are damaged by the axon - myelin and there was no difference between the 3 groups. There was low percentage of denervation in group of no nerve stitching.

Article Details

References

1. Lê Xuân Trung. Chấn thương và vết thương dây thần kinh ngoại vi. Bài giảng bệnh học ngoại khoa, tập III, ĐHYD HCM. 1987; 90 - 105.
2. Stalberg E and Falck B. Clinical Motor Nerve Conduction Studies. Methods in Clinical Neurophysiology. 1993; Vol 4, No 3.
3. Privat JM, Finiels PJ. Traumatismes des nerfs peripheriques. Neurochirurgie. Paris: Ellipses. 1995; 610 - 621.
4. Miranda GE. Epidemiology of Traumatic Peripheral Nerve Injuries Evaluated with Electrodiagnostic Studies in a Tertiary Care Hospital Clinic. P R Health Sci J. 2016; 35 (2): 76 - 80.
5. Kimura J. Electrodiagnosis in diseases of nerver and muscle. 2013; 163 - 177.
6. Kouyoumdjian JA: Peripheral nerve injuries: A retrospective survey of 456 cases. Volume 34, 2006; Issue 6, 785 - 788.
7. Robinson LR: Traumatic injury to peripheral nerves, Muscle Nerve 23, 2000; 863 - 873.
8. Toshihiko Imaeda: Validation of the Japanese Society for Surgery of the Hand Version of the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH - JSSH) questionnaire. J Orthop Sci. 2006; 11 (3): 248 - 253.
9. Germann GL, G Wind, A Harth. The DASH (Disability of Arm - Shoulder - Hand) Questionnaire - a new instrument for evaluating upper extremity treatment outcome. Handchir Mikrochir Plast Chir. 1999; 31 (3):149 - 152.
10. De Smet L. The DASH questionnaire and score in the evaluation of hand and wrist disorders. Acta Orthop Belg. 2008; 74 (5): 575 - 581.
11. Gummesson C, Atroshi I, Ekdahl C. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self - rated health change after surgery. BMC Musculoskelet Disord. 2003; 11.
12. Herup LA, Søren Merser, Michel Boeckstyns. Validation of questionnaire for conditions of the upper extremity. Ugeskr Laeger. 2010; 172 (48): 3333 - 3336.
13. Drummond AS, Sampaio RF, Mancini MC, Kirkwood RN, Stamm TA. Linking the Disabilities of Arm, Shoulder, and Hand to the International Classification of Functioning, Disability, and Health. J Hand Ther Oct - Dec. 2007; 20 (4): 336 - 343.
14. Bộ Y tế. Một số giá trị thăm dò chức năng thần kinh. Các giá trị sinh học người việt nam bình thường thập kỷ 90 - Thế kỷ XX, Nhà xuất bản Y học. 2003; 164 - 172.