BASIC PRINCIPLES OF PERIPHERAL NERVE DISORDERS Edited by Seyed Mansoor Rayegani Basic Principles of Peripheral Nerve Disorders Edited by Seyed Mansoor Rayegani Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Romana Vukelic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published March, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Basic Principles of Peripheral Nerve Disorders, Edited by Seyed Mansoor Rayegani p. cm. ISBN 978-953-51-0407-0 Contents Preface IX Chapter 1 Pathophysiology of Peripheral Nerve Injury 1 Tomas Madura Chapter 2 Electrodiagnostic Medicine Consultation in Peripheral Nerve Disorders 17 S. Mansoor Rayegani and R. Salman Roghani Chapter 3 Galectin-1 as a Multifunctional Molecule in the Peripheral Nervous System After Injury 31 Kazunori Sango, Hiroko Yanagisawa, Kazuhiko Watabe, Hidenori Horie and Toshihiko Kadoya Chapter 4 Controlled Release Strategy Based on Biodegradable Microspheres for Neurodegenerative Disease Therapy 47 Haigang Gu and Zhilian Yue Chapter 5 Sensory Nerve Regeneration at the CNS-PNS Interface 63 Xiaoqing Tang, Andrew Skuba, Seung-Baek Han, Hyukmin Kim, Toby Ferguson and Young-Jin Son Chapter 6 Peripheral Nerve Reconstruction with Autologous Grafts 79 Fabrizio Schonauer, Sergio Marlino, Stefano Avvedimento and Guido Molea Chapter 7 Surgical Treatment of Peripheral Nerve Injury 93 Hassan Hamdy Noaman Chapter 8 Peripheral Nerve Surgery: Indications, Surgical Strategy and Results 133 Jörg Bahm and Frédéric Schuind Chapter 9 Neural - Glial Interaction in Neuropathic Pain 147 Homa Manaheji VI Contents Chapter 10 An Approach to Identify Nerve Injury-Evoked Changes that Contribute to the Development or Protect Against the Development of Sustained Neuropathic Pain 163 Esperanza Recio-Pinto, Monica Norcini and Thomas J.J. Blanck Chapter 11 Neuropathic Pain Following Nerve Injury 179 Stanislava Jergova Chapter 12 Contribution of Inflammation to Chronic Pain Triggered by Nerve Injury 203 S. Echeverry, S.H. Lee, T. Lim and J. Zhang Chapter 13 Neuropathy Secondary to Chemotherapy: A Real Issue for Cancer Survivors 215 Esther Uña Cidón Chapter 14 Basics of Peripheral Nerve Injury Rehabilitation 253 Reza Salman Roghani and Seyed Mansoor Rayegani Chapter 15 Median and Ulnar Nerves Traumatic Injuries Rehabilitation 261 Rafael Inácio Barbosa, Marisa de Cássia Registro Fonseca, Valéria Meirelles Carril Elui, Nilton Mazzer and Cláudio Henrique Barbieri Preface Peripheral nerve disorders are comprising one of the major clinical topics in neuromusculoskeletal disorders. Sharp nerve injuries, chronic entrapment syndromes, and peripheral neuropathic processes can be classified in this common medical topic. Different aspects of these disorders including anatomy, physiology, pathophysiology, injury mechanisms, and different diagnostic and management methods need to be addressed when discussing this topic. The goal of preparing this book was to gather such pertinent chapters to cover these aspects. Because different approaches are provided by different disciplines for managing peripheral nerve disorders, an overview of pertinent topics is needed. Basic topics such as pathophysiology, regeneration, degeneration, neuropathic pain, surgical intervention, electrodiagnosis and rehabilitation medicine were covered in this book. Multidisciplinary approach to the management of peripheral nerve disorders made participation of different specialties as a critical and mandatory task. I think this aspect has accomplished. The book includes contribution from an international well known group that are known for their teaching ability and commitments to these topics. I am grateful for their participation. S. Mansoor Rayegani, M.D Professor of Physical Medicine and Rehabilitation, Shahid Beheshti Medical University, Tehran, Iran [...]... application of sononography in peripheral nerve disorders is also given 2 Electrodiagnostic medicine consultation EDX is a specific branch of medicine practiced by a trained physician for diagnosis, treatment and prognostication of neuromuscular disorders In many instances of peripheral nerve disorders such as entrapment syndromes the only reliable and precise tool to 18 Basic Principles of Peripheral Nerve Disorders. .. 2 Basic Principles of Peripheral Nerve Disorders endoneurial space from possible contamination by toxic substances external to the epineural space Fig 1 Ultrastructure of the peripheral nerve (a) Toluidine blue stained transverse section through peripheral nerve of rat (b) Detail on thick epineurium enveloping the nerve (c) Detail on area with peri- and endoneurium Pathophysiology of Peripheral Nerve. .. and should be addressed 20 Basic Principles of Peripheral Nerve Disorders In addition to history, that is very important for establishing differential diagnosis, precise and detailed pertinent physical examination is very useful for providing clinical diagnosis of peripheral nerve disorders There is four basic and mandatory steps in physical examination of peripheral nerve disorders; Manual Muscle Testing... early behaviour of regenerating axons showed that this is not 8 Basic Principles of Peripheral Nerve Disorders happening Axons send several regenerative sprouts, which can grow in multitude of directions and encounter of up to 100 bands of Bungner (Witzel, Rohde, and Brushart 2005) Some of the axons then grow into them, whereas others may grow freely into the connective tissue of the nerve, or take... expression profiling reveals that peripheral nerve regeneration is a consequence of both novel injury-dependent and reactivated developmental processes.” Journal of Neurochemistry 96 (5) (March): 1441-1457 Brännström, T, L Havton, and J O Kellerth 1992a “Changes in size and dendritic arborization patterns of adult cat spinal alpha-motoneurons following permanent 12 Basic Principles of Peripheral Nerve Disorders. .. in experimental autoimmune 14 Basic Principles of Peripheral Nerve Disorders encephalomyelitis of the Lewis rat.” Journal of Neuroimmunology 91 (1-2) (November 2): 93-99 Jander, S, J Pohl, C Gillen, and G Stoll 1996 “Differential expression of interleukin-10 mRNA in Wallerian degeneration and immune-mediated inflammation of the rat peripheral nervous system.” Journal of Neuroscience Research 43 (2)... and M Schachner 1988 “Studies of adhesion molecules mediating interactions between cells of peripheral nervous system indicate a major role for L1 in mediating sensory neuron growth on Schwann cells in culture.” The Journal of Cell Biology 107 (1) (July): 341-351 16 Basic Principles of Peripheral Nerve Disorders Selander, D, and J Sjöstrand 1978 “Longitudinal spread of intraneurally injected local... Zhai et al 2003) The loss of microtubular structures then leads to impediment of axonal transport and further accelerates the degeneration process The disintegration of neurofilaments follows shortly and is usually completed within 7 – 10 days During this time, the partially disrupted neurofilaments can be detected in the axoplasma only to 4 Basic Principles of Peripheral Nerve Disorders completely disappear... and imaging studies By Peripheral EDX study, disorders of motor neuron, spinal roots, lumbosacral and Electrodiagnostic Medicine Consultation in Peripheral Nerve Disorders 19 brachial plexus, peripheral nerves, neuromuscular junction and muscles are diagnosed and classified according to the site of involvement, type and severity of the disorder Fig 2 Typical schematic picture of a motor unit Taking... Spencer 1975) 3 Classification of nerve injuries 3.1 Seddon’s classification Under normal circumstances, the nerves remain connected with their innervation targets during the whole life of an individual The most common disturbance to this status quo is a Pathophysiology of Peripheral Nerve Injury 9 nerve damage by mechanical forces, which results in a loss of ability of the nerve to transfer stimuli These . BASIC PRINCIPLES OF PERIPHERAL NERVE DISORDERS Edited by Seyed Mansoor Rayegani Basic Principles of Peripheral Nerve Disorders Edited by Seyed. Basic Principles of Peripheral Nerve Disorders 2 endoneurial space from possible contamination by toxic substances external to the epineural space. Fig. 1. Ultrastructure of the peripheral. behaviour of regenerating axons showed that this is not Basic Principles of Peripheral Nerve Disorders 8 happening. Axons send several regenerative sprouts, which can grow in multitude of directions