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Cutaneous Nerve (cutaneous + nerve)
Kinds of Cutaneous Nerve Selected AbstractsDiabetic and nondiabetic lumbosacral radiculoplexus neuropathies: New insights into pathophysiology and treatmentMUSCLE AND NERVE, Issue 4 2002P. James B. Dyck MD Abstract Diabetic lumbosacral radiculoplexus neuropathy (DLRPN) (also called diabetic amyotrophy) is a well-recognized subacute, painful, asymmetric lower-limb neuropathy that is associated with weight loss and type II diabetes mellitus. Nondiabetic lumbosacral radiculoplexus neuropathy (LRPN) has received less attention. Comparison of large cohorts with DLRPN and LRPN demonstrated that age at onset, course, type and distribution of symptoms and impairments, laboratory findings, and outcomes are similar. Both conditions are lumbosacral radiculoplexus neuropathies that are associated with weight loss and begin focally with pain but that evolve into widespread, bilateral paralytic disorders. Although both are monophasic illnesses, patients have prolonged morbidity from pain and weakness, and many patients become wheelchair-dependent. Although motor-predominant, there is unequivocal evidence that autonomic and sensory nerves are also involved. Cutaneous nerves from patients with DLRPN and LRPN show pathological evidence of ischemic injury (multifocal fiber loss, perineurial thickening and degeneration, neovascularization, microfasciculation, and swollen axons with accumulated organelles) and microvasculitis (mural and perivascular inflammation, separation and fragmentation of mural smooth muscle layers of microvessels and hemosiderin-laden macrophages). Controlled trials with immune-modulating therapies in DLRPN are in progress, and preliminary data suggest that such therapy may be beneficial in LRPN. It is likely that DLRPN and LRPN are immune-mediated neuropathies that should be separated from chronic inflammatory demyelinating polyneuropathy and from systemic necrotizing vasculitis. © 2002 Wiley Periodicals, Inc. Muscle Nerve 25: 000,000, 2002 [source] Excess target-derived neurotrophin-3 alters the segmental innervation of the skinEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 3 2001Amy M. Ritter Abstract It is thought that dermatomes are established during development as a result of competition between afferents of neighbouring segments. Mice that overexpress neurotrophins in the skin provide an interesting model to test this hypothesis, as they possess increased numbers of sensory neurons, and display hyperinnervation of the skin. When dermatomal boundaries were mapped in adult mice, it was found that those in nerve growth factor and brain-derived neurotrophic factor overexpressers were indistinguishable from wild-type animals but that overlap between adjacent segments was greatly reduced in neurotrophin-3 (NT-3) overexpressers. However, dermatomes in heterozygous NT-3 knockout mice displayed no more overlap than wild-types. In order to quantify differences across strains, innervation territories of thoracic dorsal cutaneous nerves were mapped and measured in adult mice. Overlap between adjacent dorsal cutaneous nerves was normal in nerve growth factor overexpressing mice, but much reduced in NT-3 overexpressers. However, this restriction was not reflected in the central projection of the dorsal cutaneous nerve, creating a mismatch between peripheral and central projections. Dorsal cutaneous nerve territories were also mapped in neonatal mice aged postnatal day 7,8. In neonates, nerve territories of NT-3 overexpressers overlapped less than wild-types, but in neonates of both strains the amount of overlap was much greater than in the adult. These results indicate that substantial separation of dermatomes occurs postnatally, and that excess NT-3 enhances this process, resulting in more restricted dermatomes. It may exert its effects either by enhancing competition, or by direct effects on the stability and formation of sensory endings in the skin. [source] Anterior sciatic nerve block , new landmarks and clinical experienceACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2005M. Wiegel Background: Anterior sciatic nerve blocks can be complicated by several problems. Pain can be caused by bony contacts and, in obese patients, identification of the landmarks is frequently difficult. Methods: In a first step, 100 normal anterior-posterior pelvic X-rays were analyzed. The landmarks of the classical anterior approach were drawn on these X-rays and assessed for their sufficiency. Then, in a prospective case study, 200 consecutive patients undergoing total knee replacement were investigated. These patients received femoral and sciatic nerve catheters for postoperative pain management. Using modified anatomical landmarks, sciatic nerve catheters were inserted 5 cm distal from the insertion site of the femoral nerve block perpendicularly in the midline of the lower extremity. This midline connected the insertion site of the femoral nerve catheter to the midpoint between the medial and lateral epicondyle. Correct catheter positioning was verified by magnetic resonance imaging (MRI) in six patients. Results: Evaluation of pelvic X-rays showed that puncture following the classical landmarks pointed in 51% at the lesser trochanter, in 5% medial to the lesser trochanter and in 42% directly at the femur. In the latter patients, location of the sciatic nerve would have been difficult or even impossible. Using our modified anterior approach, the sciatic nerve could be blocked in 196 patients (98%). In nine patients (4.5%) blockade of the posterior femoral cutaneous nerve failed. Vascular puncture happened in 10 (5%) and bony contact in 35 patients (17.5%). Median puncturing depth was 9.5 (7.5,14) cm. Correct sciatic nerve catheter positioning was verified in all patients who underwent MRI. Conclusion: Our landmarks for locating the sciatic nerve help to avoid bony contacts and thereby reduce pain during puncture. Our method reliably enabled catheter placement. [source] Effect of size and pressure of surface recording electrodes on amplitude of sensory nerve action potentialsMUSCLE AND NERVE, Issue 2 2004Antoon A. Ven MSc Abstract The influence of electrode size on sensory nerve action potential (SNAP) amplitude of the lateral antebrachial cutaneous nerve (LACN) and sural nerve (SN) was studied in 63 healthy volunteers. The SNAP amplitudes were measured using surface recording electrodes of three different sizes, positioned across the nerve. Mean amplitudes using a 5-mm electrode were 9.0% (SN) and 15.3% (LACN) higher than with a 20-mm electrode and 19.4% (SN) and 25.8% (LACN) higher than using a 40-mm electrode. To study the influence of pressure on surface recording electrodes, studies were performed on the LACN in 31 healthy volunteers. Light pressure of the recording electrodes on the skin gave lower amplitudes (15.3%) than did greater pressure or pressure applied between active and reference electrodes. These studies demonstrate that standardized surface recording electrode size and pressure are imperative for obtaining valid and reliable results in experimental studies or in clinical follow-up of patients undergoing nerve conduction studies. Muscle Nerve 30: 234,238, 2004 [source] Distal sensory nerve conduction of the superficial peroneal nerve: New method and its clinical applicationMUSCLE AND NERVE, Issue 5 2001Shin J. Oh MD Abstract The superficial peroneal nerve subserves sensation on the entire surface of the dorsum of the foot, except in small areas. All previously reported techniques for evaluating nerve conduction along this nerve tested a proximal portion of the nerve. We report a new method for evaluating sensory nerve conduction of the four branches of the distal superficial peroneal nerve. Two branches to the second and third toes of the medial dorsal cutaneous nerve and two branches to the fourth and fifth toes of the intermediate dorsal cutaneous nerve were studied orthodromically and antidromically in 37 feet of 21 normal volunteers using surface stimulating and recording electrodes and with a distance of 10 cm between the stimulating and recording electrodes. Maximum nerve conduction velocities (NCV) ranged from 41.8 to 46.9 m/s, and mean response amplitude ranged from 6.5 to 7.6 ,V with the orthodromic technique. Values for NCV were almost identical when elicited by antidromic and orthodromic techniques, but response amplitudes were higher with the antidromic technique. Mean amplitudes of the distal superficial peroneal nerve were about 50% of the proximal superficial peroneal, and the conduction velocity in the distal superficial peroneal was slower than that in the proximal superficial peroneal nerve, by 8,14 m/s. In seven cases, distal superficial peroneal neuropathy was confirmed with this technique: two with proper digital neuropathy, two with medial dorsal cutaneous neuropathy, and three with intermediate dorsal cutaneous neuropathy. © 2001 John Wiley & Sons, Inc. Muscle Nerve 24: 689,694, 2001 [source] Paresthesia and hypesthesia in the dorsum of the foot as the presenting complaints of a ganglion cyst of the footCLINICAL ANATOMY, Issue 5 2010Diogo Casal Abstract Although ganglion cysts of the foot represent a substantial amount of lumps in this region, they rarely cause peripheral nerve symptoms. We describe the clinical case of a 43-year-old female with complaints in the previous three months of hypesthesia and paresthesia in the anterior portion of the medial half of the dorsum of her left foot that extended into the first interdigital cleft. She associated the start of her neurological symptoms to the appearance of a lump in the dorsum of the foot. A presumptive diagnosis of compression of the medial branch of the deep fibular nerve and of the medial dorsal cutaneous nerve in the dorsum of the foot by a ganglion cyst was made. Ultrasonography confirmed the cystic nature of the lesion and surgery allowed complete excision of a mass arising from the joint between the medial and intermediate cuneiform bones that was compressing the deep fibular nerve and the medial dorsal cutaneous nerve. Pathological examination confirmed that the lesion was a cystic ganglion. As far as the authors know, the simultaneous compression of the medial branch of the deep fibular nerve and of the medial dorsal cutaneous nerve in the dorsum of the foot by a ganglion cyst has not been described before. Clin. Anat. 23:606,610, 2010. © 2010 Wiley-Liss, Inc. [source] Anatomy of the lateral femoral cutaneous nerve related to inguinal ligament, adjacent bony landmarks, and femoral arteryCLINICAL ANATOMY, Issue 8 2008Porames Doklamyai Abstract Lateral femoral cutaneous nerve (LFCN) generally emerges from the pelvis behind the inguinal ligament (IL) to the thigh. Because of its proximity to the anterior superior iliac spine (ASIS) and hip joint, the LFCN is prone to injuries during various procedures. Anatomy of this nerve is highly variable among studies. Moreover, measurement data regarding its branches including the differences between genders and sides are still lacking. This study was, therefore, done to clarify these issues. Eighty-five thighs from 43 cadavers of both genders were dissected at the inguinal region. Distances from each branch of the LFCN to palpable landmarks: the ASIS, pubic tubercle (PT) and femoral artery (FA) were measured along the IL. Up to four branches of the LFCN were found; however, the single trunk was the most common form (>65%). The common site of this pattern on the IL was within 2 cm medial to the ASIS but could be present at over 6 cm. The distances in case of bifurcation were mostly comparable to those of the single trunk. In contrast, the values varied considerably in the cases with three or more branches (three cases). Regarding side and gender, asymmetry in the branching pattern was found in one fourth of specimens. However, only some minor differences between genders or sides in the measurement data were seen. These findings suggest that asymmetry and multiple branches of the LFCN should be concerned. The measurement data are also useful for localizing the LFCN with higher accuracy. Clin. Anat. 21:769,774, 2008. © 2008 Wiley-Liss, Inc. [source] Three-headed biceps brachii muscle associated with duplicated musculocutaneous nerveCLINICAL ANATOMY, Issue 5 2005Marwan F. Abu-Hijleh Abstract A unilateral three-headed biceps brachii muscle coinciding with an unusual variant of the musculocutaneous nerve was found during routine dissection of a 79-year-old male cadaver. The supernumerary bicipital head originated from the antero-medial surface of the humerus just beyond the insertion of the coracobrachialis, and inserted into the conjoined tendon of biceps brachii. Associated with this muscular variant was a duplicated musculocutaneous nerve. The proximal musculocutaneous nerve conformed to the normal pattern only in its proximal part, and terminated after innervating the coracobrachialis and biceps brachii muscles. The distal musculocutaneous nerve arose from the median nerve in the lower arm, then passed laterally between the supernumerary bicipital head and the brachialis muscles, supplying both and terminating as the lateral cutaneous nerve of the forearm. The supernumerary bicipital head and the accompanying anomaly of the musculocutaneous nerve seem to be unique in literature. Clin. Anat. 18:376,379, 2005. © 2005 Wiley-Liss, Inc. [source] Axillary vein perforation by the medial cutaneous nerve of the forearmCLINICAL ANATOMY, Issue 4 2004T.S. Roy Abstract Variation in the venous pattern in the arm is common. In this study, a rare variant of the axillary vein and its association with the median cutaneous nerve of the forearm is described. In the axilla, the medial cutaneous nerve of the forearm penetrated the axillary vein, thereby creating two narrow venous channels at the site of passage. Such variations are important because a large number of diagnostic and therapeutic invasive procedures are carried out on veins. A possible mode of origin and the clinical importance of this variation are discussed. Clin. Anat. 17:300,302, 2004. © 2004 Wiley-Liss, Inc. [source] Anatomical variations of the sural nerveCLINICAL ANATOMY, Issue 4 2002Pasuk Mahakkanukrauh Abstract An anatomical study of the formation of the sural nerve (SN) was carried out on 76 Thai cadavers. The results revealed that 67.1% of the SNs were formed by the union of the medial sural cutaneous nerve (MSCN) and the lateral sural cutaneous nerve (LSCN); the MSCN and LSCN are branches of the tibial and the common fibular (peroneal) nerves, respectively. The site of union was variable: 5.9% in the popliteal fossa, 1.9% in the middle third of the leg, 66.7% in the lower third of the leg, and 25.5% at or just below the ankle. One SN (0.7%) was formed by the union of the MSCN and a different branch of the common fibular nerve, running parallel and medial to but not connecting with the LSCN, which joined the MSCN in the lower third of the leg. The remaining 32.2% of the SNs were a direct continuation of the MSCN. The SNs ranged from 6,30 cm (mean = 14.41 cm) in length with a range in diameter of 3.5,3.8 mm (mean = 3.61 mm), and were easily located 1,1.5 cm posterior to the posterior border of the lateral malleolus. The LSCNs were 15,32 cm long (mean = 22.48 cm) with a diameter between 2.7,3.4 mm (mean = 3.22 mm); the MSCNs were 17,31 cm long (mean = 20.42 cm) with a diameter between 2.3,2.5 mm (mean = 2.41 mm). Clinically, the SN is widely used for both diagnostic (biopsy and nerve conduction velocity studies) and therapeutic purposes (nerve grafting) and the LSCN is used for a sensate free flap; thus, a detailed knowledge of the anatomy of the SN and its contributing nerves are important in carrying out these and other procedures. Clin. Anat. 15:263,266, 2002. © 2002 Wiley-Liss, Inc. [source] Excess target-derived neurotrophin-3 alters the segmental innervation of the skinEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 3 2001Amy M. Ritter Abstract It is thought that dermatomes are established during development as a result of competition between afferents of neighbouring segments. Mice that overexpress neurotrophins in the skin provide an interesting model to test this hypothesis, as they possess increased numbers of sensory neurons, and display hyperinnervation of the skin. When dermatomal boundaries were mapped in adult mice, it was found that those in nerve growth factor and brain-derived neurotrophic factor overexpressers were indistinguishable from wild-type animals but that overlap between adjacent segments was greatly reduced in neurotrophin-3 (NT-3) overexpressers. However, dermatomes in heterozygous NT-3 knockout mice displayed no more overlap than wild-types. In order to quantify differences across strains, innervation territories of thoracic dorsal cutaneous nerves were mapped and measured in adult mice. Overlap between adjacent dorsal cutaneous nerves was normal in nerve growth factor overexpressing mice, but much reduced in NT-3 overexpressers. However, this restriction was not reflected in the central projection of the dorsal cutaneous nerve, creating a mismatch between peripheral and central projections. Dorsal cutaneous nerve territories were also mapped in neonatal mice aged postnatal day 7,8. In neonates, nerve territories of NT-3 overexpressers overlapped less than wild-types, but in neonates of both strains the amount of overlap was much greater than in the adult. These results indicate that substantial separation of dermatomes occurs postnatally, and that excess NT-3 enhances this process, resulting in more restricted dermatomes. It may exert its effects either by enhancing competition, or by direct effects on the stability and formation of sensory endings in the skin. [source] In vitro interactions between sensory nerves, epidermis, hair follicles and capillaries in a tissue-engineered reconstructed skinEXPERIMENTAL DERMATOLOGY, Issue 9 2004V. Gagnon Recent findings have established that cutaneous nerves modulate both skin homeostasis and various skin diseases, by influencing cell growth and differentiation, inflammation and wound healing. In order to study the influence of epidermis, hair follicles and capillaries on sensory neurons, and vice-versa, we developed a tissue-engineered model of innervated endothelialized reconstructed skin (MIERS). Mouse dorsal root ganglia neurons were seeded on a collagen sponge populated with human fibroblasts and human endothelial cells. Keratinocytes or mice newborn immature hair follicle buds were then seeded on the opposite side of the MIERS to study their influence on sensory nerves growth, and vice versa. A vigorous neurite elongation was detected inside the reconstructed dermis after 14 and 31 days of neurons culture. The presence of endothelial cells induced a significant increase of the neurite elongation after 14 days of culture. The addition of human keratinocytes totally avoided the twofold decrease in the amount of neurites observed between 14 and 31 days in controls. We have successfully developed the MIERS that allowed us to study the effects of epidermis and capillaries on nerve growth. This model will be a useful tool to study the modulation of sensory nerves on wound healing, angiogenesis, hair growth and neurogenic inflammation in the skin. [source] Willan's itch and other causes of pruritus in the elderlyINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 4 2005Jon R. Ward MD Itch in the elderly presents a diagnostic and therapeutic challenge. A thorough history, review of systems, and physical examination are critical to determining its cause. Examination of the skin may be misleading. There are frequently only secondary lesions, eczematous changes, lichenification, and excoriation, which may be misdiagnosed as a primary dermatitis. Xerosis may be the cause, but it is sometimes merely coincidental. If primary lesions are present, a skin biopsy can enable a diagnosis to be made. Systemic causes of itch, such as cholestasis, uremia, hyperthyroidism, medications, or lymphoma, must be considered. If the cause remains elusive, idiopathic itching of the elderly or so-called "senile pruritus" may be considered. However, we propose to discard the term "senile pruritus", which can be offensive and frightening. We propose to replace it with "Willan's itch". Robert Willan (1757,1812) is honored as one of the founders of modern dermatology thanks to his book, On Cutaneous Diseases, and its morphological approach to skin disease. He was probably the first to give a good clinical description of itching in the elderly. The diagnosis of Willan's itch should be reserved for generalized pruritus in the absence of xerosis or other recognizable cause. The pathophysiology of this form of pruritus is poorly understood, but it is likely that age-related changes of the skin, cutaneous nerves, and other parts of the nervous system play a role. Anecdotal and limited data suggest that gabapentin, cutaneous field stimulation, serotonin antagonists, and ultraviolet B phototherapy may attenuate itch in some of these patients. [source] Single stimulation of the posterior cord is superior to dual nerve stimulation in a coracoid blockACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2010J. RODRÍGUEZ Background: Both multiple injection and single posterior cord injection techniques are associated with extensive anesthesia of the upper limb after an infraclavicular coracoid block (ICB). The main objective of this study was to directly compare the efficacy of both techniques in terms of the rates of completely anesthetizing cutaneous nerves below the elbow. Methods: Seventy patients undergoing surgery at or below the elbow were randomly assigned to receive an ICB after the elicitation of either a single radial nerve-type response (Radial group) or of two different main nerve-type responses of the upper limb, except for the radial nerve (Dual group). Forty milliliters of 1.5% mepivacaine was given in a single or a dual dose, according to group assignment. The sensory block was assessed in each of the cutaneous nerves at 10, 20 and 30 min. Block performance times and the rates of complete anesthesia below the elbow were also noted. Results: Higher rates of sensory block of the radial nerve were found in the Radial group at 10, 20 and 30 min (P<0.05). The rates of sensory block of the ulnar nerve at 30 min were 97% and 75% in the Radial and in the Dual groups, respectively (P<0.05). The rate of complete anesthesia below the elbow was also higher in the Radial group at 30 min (P<0.05). Conclusions: Injection of a local anesthetic after a single stimulation of the radial nerve fibers produced more extensive anesthesia than using a dual stimulation technique under the conditions of our study. [source] What happens when cutaneous nerves are injured during venipuncture?MUSCLE AND NERVE, Issue 4 2005Steven H. Horowitz MDArticle first published online: 9 FEB 200 No abstract is available for this article. [source] Opportunities afforded by the study of unmyelinated nerves in skin and other organsMUSCLE AND NERVE, Issue 6 2004William R. Kennedy MS Abstract Neurological practice is mainly focused on signs and symptoms of disorders that involve functions governed by myelinated nerves. Functions controlled by unmyelinated nerve fibers have necessarily remained in the background because of the inability to consistently stain, image, or construct clinically applicable neurophysiological tests of these nerves. The situation has changed with the introduction of immunohistochemical methods and confocal microscopy into clinical medicine, as these provide clear images of thin unmyelinated nerves in most organs. One obvious sign of change is the increasing number of reports from several laboratories of the pathological alterations of cutaneous nerves in skin biopsies from patients with a variety of clinical conditions. This study reviews recent methods to stain and image unmyelinated nerves as well as the use of these methods for diagnosing peripheral neuropathy, for experimental studies of denervation and reinnervation in human subjects, and for demonstrating the vast array of unmyelinated nerves in internal organs. The new ability to examine the great variety of nerves in different organs opens opportunities and creates challenges and responsibilities for neurologists and neuroscientists. Muscle Nerve 756,767, 2004 [source] Antiprogesterone therapy uncouples axonal loss from demyelination in a transgenic rat model of CMT1A neuropathyANNALS OF NEUROLOGY, Issue 1 2007Gerd Meyer zu Horste MD Objective Charcot,Marie,Tooth disease (CMT) is the most common inherited neuropathy, and a duplication of the Pmp22 gene causes the most frequent subform CMT1A. Using a transgenic rat model of CMT1A, we tested the hypothesis that long-term treatment with anti-progesterone (Onapristone) reduces Pmp22 overexpression and improves CMT disease phenotype of older animals, thereby extending a previous proof-of-concept observation in a more clinically relevant setting. Methods We applied placebo-controlled progesterone-antagonist therapy to CMT rats for 5 months and performed grip-strength analysis to assess the motor phenotype. Quantitative Pmp22 RT-PCR and complete histological analysis of peripheral nerves and skin biopsies were performed. Results Anti-progesterone therapy significantly increased muscle strength and muscle mass of CMT rats and reduced the performance difference to wildtype rats by about 50%. Physical improvements can be explained by the prevention of axon loss. Surprisingly, the effects of anti-progesterone were not reflected by improved myelin sheath thickness. Electrophysiology confirmed unaltered NCV, but less reduced CMAP recordings in the treatment group. Moreover, the reduction of Pmp22 mRNA, as quantified in cutaneous nerves, correlated with the clinical phenotype at later stages. Interpretation Progesterone-antagonist treatment. Pmp22 overexpression to a degree at which the axonal support function of Schwann cells is better maintained than myelination. This suggests that axonal loss in CMT1A is not caused by demyelination, but rather by a Schwann cell defect that has been partially uncoupled by anti-progesterone treatment. Pmp22 expression analysis in skin may provide a prognostic marker for disease severity and for monitoring future clinical trials. Ann Neurol 2007;61:61,72 [source] The applied anatomy of anterior approach for minimally invasive hip joint surgeryCLINICAL ANATOMY, Issue 2 2009Li Hua Chen Abstract The anterior approach for minimally invasive hip joint surgery is one of the common approaches utilized in hip joint surgery. Here, we report the results of dissections in 60 sides of human adult cadavers. We observed and measured the branches of the superficial circumflex iliac artery, the lateral femoral cutaneous nerves, the lateral circumflex femoral artery, and the superior gluteal nerves in the experiment via the anterior approach for minimally invasive hip joint surgery. The relationship between these structures and the anterior approach was studied. The present study provides important data demonstrating the location, path of dominant structures that might be encountered during the surgery and their relationships with the surgical incision. These data may allow surgeons performing the anterior approach for hip joint surgery to minimize the risk of neurovascular injury. Clin. Anat. 22:250,255, 2009. © 2008 Wiley-Liss, Inc. [source] | |||||||||||||||||||||||||