Thesis (Ph. D.)--University of Wisconsin--Madison, 1969. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Made available in DSpace on 2014-06-11T19:23:43Z (GMT). No. of bitstreams: 0 Previous issue date: 2004-02-09Bitstream added on 2014-06-13T19:09:52Z : No. of bitstreams: 1 guimaraes_gc_me_jabo.pdf: 563420 bytes, checksum: a8ce8c937ab1384b5abf3b62e9caaf30 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Estudou-se a origem, a distribuição e a ramificação do nervo radial de 35 gatos domésticos adultos, 17 machos e 18 fêmeas, sem raça definida, mediante dissecações macro e mesoscópicas, após a fixação dos espécimes em solução aquosa de formaldeído a 10 %, e também realizou-se o exame histológico do referido nervo. O nervo radial mostrou-se polifasciculado desde sua origem até a divisão em ramos superficial e profundo. Originou-se do C6 ao T1 em 30 % dos exemplares e do C7 ao T1 em 70 % dos exemplares. Cedeu ramos musculares em todos os animais para os músculos tensor da fáscia antebraquial, tríceps braquial (cabeças longa, acessória, medial e lateral) e ancôneo, emitindo de 14 a 25 ramos nervosos nesta região. O ramo ventral do sexto nervo espinhal cervical difere significativamente (p<0,05) quando confrontado o sexo dos animais, além dos fascículos nervosos, de acordo com a região estudada. A estrutura histológica do nervo radial exibe três tecidos conjuntivos de sustentação. O epineuro é formado por tecido conjuntivo denso modelado e não modelado, e também por conjuntivo frouxo. Do epineuro partem septos epineurais, constituídos por conjuntivo denso não modelado e frouxo, rico em células adiposas. O perineuro reveste grupo de feixes nervosos formando os fascículos, possuindo de duas a quinze células justapostas concêntricas com núcleo fusiforme, citoplasma fino e alongado, diferenciando duas camadas, uma externa e outra interna. O espaço interlaminar da camada externa é preenchido por fibrilas colágenas e o da camada interna por fibrilas colágenas e reticulares. O endoneuro é constituído por tecido conjuntivo frouxo que circunda axônios predominantemente mielinizados, apresentando fibras colágenas e reticulares. / The origin, distribution and ramification of the radial nerve was studied in thirty-five(35) adult unknown domestic cats from both sexes(18 females and 17 males). The samples were fixed in 10 % formaldehyde solution. There were made macroscopical and mesoscopical dissections and a histological examination of the radial nerve. The radial nerve revealed itself polifasciculated from its origin until his division in superficial branch and deep branch. In 30 % of the samples the radial nerve starts from the C6 until the T1 and from the C7 until the T1 in 70 % of the samples. In all animals studied the radial nerve lends muscular branches to the m. tensor fasciae antebrachii, to the m. triceps brachii (long head, accessory head, medial head and lateral head) and the m. anconeus, emitting from 14 to 25 nervous branches in this region. Besides, according to the studied region, the nervous fascicules and the ventral branch of the sixth cervical spinal nerve differs significantly (p<0.05) between males and females. The histological structure of the radial nerve has three conjunctive tissues for sustentation. The epineurium is formed by dense modeled conjunctive tissue and by dense non-modeled conjunctive tissue and also by loose conjunctive tissue. Epineural septum break up from the epineurium. They are rich in adipose cells and are formed by dense non-modeled conjunctive tissue and by loose conjunctive tissue. The perineurium revests a group of nervous bundles. The perineurium has from two to fifteen juxtaposed cells. These cells are concentric and they have a fusiform nucleus, a thin and prolonged cytoplasm that is divided in two layers-an external and an internal. The interlaminar space is filled by collagen fibers in the external layer and by collagen and reticular fibers in the internal layer. The endoneurium is formed by loose conjunctive tissue that embraces predominantly myelinated axons...(Complete abstract, click electronic access below)

Orientadora: Márcia Rita Fernandes Machado / Banca: André Luiz Quagliatto Santos / Banca: Marcos Lania de Araújo / Resumo: Estudou-se a origem, a distribuição e a ramificação do nervo radial de 35 gatos domésticos adultos, 17 machos e 18 fêmeas, sem raça definida, mediante dissecações macro e mesoscópicas, após a fixação dos espécimes em solução aquosa de formaldeído a 10 %, e também realizou-se o exame histológico do referido nervo. O nervo radial mostrou-se polifasciculado desde sua origem até a divisão em ramos superficial e profundo. Originou-se do C6 ao T1 em 30 % dos exemplares e do C7 ao T1 em 70 % dos exemplares. Cedeu ramos musculares em todos os animais para os músculos tensor da fáscia antebraquial, tríceps braquial (cabeças longa, acessória, medial e lateral) e ancôneo, emitindo de 14 a 25 ramos nervosos nesta região. O ramo ventral do sexto nervo espinhal cervical difere significativamente (p<0,05) quando confrontado o sexo dos animais, além dos fascículos nervosos, de acordo com a região estudada. A estrutura histológica do nervo radial exibe três tecidos conjuntivos de sustentação. O epineuro é formado por tecido conjuntivo denso modelado e não modelado, e também por conjuntivo frouxo. Do epineuro partem septos epineurais, constituídos por conjuntivo denso não modelado e frouxo, rico em células adiposas. O perineuro reveste grupo de feixes nervosos formando os fascículos, possuindo de duas a quinze células justapostas concêntricas com núcleo fusiforme, citoplasma fino e alongado, diferenciando duas camadas, uma externa e outra interna. O espaço interlaminar da camada externa é preenchido por fibrilas colágenas e o da camada interna por fibrilas colágenas e reticulares. O endoneuro é constituído por tecido conjuntivo frouxo que circunda axônios predominantemente mielinizados, apresentando fibras colágenas e reticulares. / Abstract: The origin, distribution and ramification of the radial nerve was studied in thirty-five(35) adult unknown domestic cats from both sexes(18 females and 17 males). The samples were fixed in 10 % formaldehyde solution. There were made macroscopical and mesoscopical dissections and a histological examination of the radial nerve. The radial nerve revealed itself polifasciculated from its origin until his division in superficial branch and deep branch. In 30 % of the samples the radial nerve starts from the C6 until the T1 and from the C7 until the T1 in 70 % of the samples. In all animals studied the radial nerve lends muscular branches to the m. tensor fasciae antebrachii, to the m. triceps brachii (long head, accessory head, medial head and lateral head) and the m. anconeus, emitting from 14 to 25 nervous branches in this region. Besides, according to the studied region, the nervous fascicules and the ventral branch of the sixth cervical spinal nerve differs significantly (p<0.05) between males and females. The histological structure of the radial nerve has three conjunctive tissues for sustentation. The epineurium is formed by dense modeled conjunctive tissue and by dense non-modeled conjunctive tissue and also by loose conjunctive tissue. Epineural septum break up from the epineurium. They are rich in adipose cells and are formed by dense non-modeled conjunctive tissue and by loose conjunctive tissue. The perineurium revests a group of nervous bundles. The perineurium has from two to fifteen juxtaposed cells. These cells are concentric and they have a fusiform nucleus, a thin and prolonged cytoplasm that is divided in two layers-an external and an internal. The interlaminar space is filled by collagen fibers in the external layer and by collagen and reticular fibers in the internal layer. The endoneurium is formed by loose conjunctive tissue that embraces predominantly myelinated axons...(Complete abstract, click electronic access below) / Mestre

Having detailed anatomical knowledge when performing surgeries, is crucial to ensure a successful outcome. This is especially true when undertaking relatively new procedures. Even though nerve transfers and nerve grafts have been performed on the different parts of the brachial plexus for some time, nerve transfer and grafting procedures involving the axillary and radial nerves using a newly proposed axillary approach has not yet been fully studied. This study provides some enlightenment to the anatomy surrounding the axillary approach, with special regard to the axillary and radial nerves and their branches. The axillae of 51 (26 female and 25 male) formalin fixed cadavers were bilaterally dissected using a simulation of the axillary approach, which has been described to gain access to the brachial plexus in a clinical setting. Following which, various distances between easily identifiable anatomical landmarks and relevant neurovascular structures were measured, and observations regarding the relationship of these structures to the landmarks were recorded. This study found that the axillary nerve and its anterior and posterior divisions, as well as the radial nerve with its nerve to the long head of triceps brachii muscle could be easily identified however, their proximal parts were situated fairly deep and therefore were difficult to expose. Methods such as the musculo-arterial triangle described by Bertelli et al., which was designed to aid in identification on localization of the axillary nerve was also assessed; it was found to be relatively successful, however more consistent landmarks might be considered. In conclusion this study found that the axillary approach may serve as a reliable and safe method to reach the axillary and radial nerves, as well as their branches, allowing for adequate exposure when considering a nerve transfer or graft. / Dissertation (MSc)--University of Pretoria, 2019. / Anatomy / MSc / Unrestricted

<p>Neurography is the most objective and reliable measure of the peripheral nerve function, and it is used to diagnose both local and generalized neuropathies. Neurography can measure both motor and sensory nerve functions. The principle for sensory neurgraphy is to stimulate over the nerve and record proximal or distal from the stimulated electrode.</p><p>At the Department of Clinical Neurophysiology, University Hospital Uppsala, a problem has been identified, in that young adult patients tend to show unexpected abnormal neurography values in relation to the expected, indicated by the reference limits, without clinical correlates. This concerns foremost the sensory amplitudes in median and ulnar nerves. The hypothesis is that the requirement of young adults’ amplitudes is too high. A reference material better including more subjects in this age group may solve the problem.</p><p>Sensory nerve conduction studies were performed in 33 subjects, aged 15-30. The nerve functions were tested on median, ulnar and radial nerves. Surface electrodes were used for both recording and stimulation.</p><p>The result shows that the presently used reference material for some nerves indeed has too high requirement for young adults. After increasing the reference material for younger age groups, the new reference limits has been changed and this should cause fewer false positive findings.</p>

Base teórica A síndrome do túnel do carpo (STC) é uma lesão compressiva nervosa mais comum que afeta o nervo mediano observada na prática clínica. Existem muitas técnicas eletrofisiológicas para diagnosticar a STC, mas a maioria dispende muito tempo, é dolorosa e tem sensibilidade variada. Objetivo Avaliar a acurácia de um método eletrofisiológico de investigação da STC e correlaciona-lo com aspectos clínicos. Métodos Pacientes do ambulatório de Neurologia com critérios clínicos para STC foram submetidos a uma bateria de testes clínicos e neurofisiológicos. Primeiramente, nós aplicamos o Questionário de Síndrome do túnel do Carpo de Boston e Escala visual analógica (EVA). Após, realizamos o método eletrofisiológico convencional de avaliação sensitiva do nervo mediano e ulnar. Posteriormente, outro médico eletrofisiologista, cegado para as avaliações anteriores, realizou a técnica de estimulação simultânea dos nervos mediano e radial no polegar com registro simultâneo de ambos potenciais na região punho. Os dados foram agrupados em STC leve, moderada e grave, baseados na latência motora do nervo mediano. Resultados A latência entre picos (LEP), obtida pela técnica em estudo, foi diferente entre os grupos baseados na classificação de gravidade da STC (Bonferroni; p<0.001). A velocidade de condução nervosa sensitiva do nervo mediano, obtida através da técnica standard, apresentou também diferentes valores entre os grupos. Houve correlação entre LEP e velocidade de condução nervosa sensitiva do mediano (Sperman; r=-0.52; p<0.01), bem como entre LEP e velocidade de condução nervosa sensitiva do mediano com o desconforto causado pela STC mensurado pela Escala visual analógica (EVA). A duração e o desconforto causado pela técnica de estimulação simultânea do nervo mediano e radial estão reduzidos quando comparados com a técnica padrão (t Student; p< 0.001 para as duas comparações). Conclusão A técnica de estimulação simultânea do nervo mediano e radial é acurada, sensível, tolerável e não somente útil no diagnóstico da STC, mas também na definição da gravidade. Então, seu uso deve ser encorajado na prática clínica. / Background Carpal tunnel syndrome (CTS) is the most common nerve entrapment observed in clinical practice affecting the median nerve at the wrist level. There are many electrophysiological ways to diagnose CTS, but most of them are time consuming, painful and have variable sensitivity. Objective To evaluate the accuracy of an electophysiologic method of CTS investigation and to correlate it with clinical symptoms. Methods Patients at the clinic outpatient Neurology with CTS clinical criteria underwent a battery of clinical and neurophysiological tests. First, we applied the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and Visual analogue scale (VAS). After, we performed a standard method of analysis of the median and ulnar nerves. Posteriorly, a blinded neurophysiologist performed an orthodromic median-radial nerve simultaneous stimulation at the thumb with recording of both action potentials at the lateral aspect of the wrist. Data were grouped for mild, moderate and severe CTS, based on median motor latency. Results The interpeak latency (IPL), obtained with study technique, was different in groups based on CTS classification severity (Bonferroni. p<0.001). The median nerve conduction velocity, obtained with the standard approach, was also of different level among groups. There were correlation between IPL and median nerve conduction velocity (Sperman; r=-0.52; p<0.01), as well as, there was a significant correlation between IPL and median nerve conduction velocity with the discomfort caused by CTS and measured with VAS. However, the duration and unpleasantness caused by median-radial nerve simultaneous stimulation technique were reduced when compared to standard approach (t Student <0.001 for both comparisons). Conclusion The orthodromic median-radial nerve simultaneous stimulation technique is accurate, sensitive, tolerable and not only useful for CTS diagnosis but also for its severity assessment. Therefore, its use should be encouraged in clinical practice.

Base teórica A síndrome do túnel do carpo (STC) é uma lesão compressiva nervosa mais comum que afeta o nervo mediano observada na prática clínica. Existem muitas técnicas eletrofisiológicas para diagnosticar a STC, mas a maioria dispende muito tempo, é dolorosa e tem sensibilidade variada. Objetivo Avaliar a acurácia de um método eletrofisiológico de investigação da STC e correlaciona-lo com aspectos clínicos. Métodos Pacientes do ambulatório de Neurologia com critérios clínicos para STC foram submetidos a uma bateria de testes clínicos e neurofisiológicos. Primeiramente, nós aplicamos o Questionário de Síndrome do túnel do Carpo de Boston e Escala visual analógica (EVA). Após, realizamos o método eletrofisiológico convencional de avaliação sensitiva do nervo mediano e ulnar. Posteriormente, outro médico eletrofisiologista, cegado para as avaliações anteriores, realizou a técnica de estimulação simultânea dos nervos mediano e radial no polegar com registro simultâneo de ambos potenciais na região punho. Os dados foram agrupados em STC leve, moderada e grave, baseados na latência motora do nervo mediano. Resultados A latência entre picos (LEP), obtida pela técnica em estudo, foi diferente entre os grupos baseados na classificação de gravidade da STC (Bonferroni; p<0.001). A velocidade de condução nervosa sensitiva do nervo mediano, obtida através da técnica standard, apresentou também diferentes valores entre os grupos. Houve correlação entre LEP e velocidade de condução nervosa sensitiva do mediano (Sperman; r=-0.52; p<0.01), bem como entre LEP e velocidade de condução nervosa sensitiva do mediano com o desconforto causado pela STC mensurado pela Escala visual analógica (EVA). A duração e o desconforto causado pela técnica de estimulação simultânea do nervo mediano e radial estão reduzidos quando comparados com a técnica padrão (t Student; p< 0.001 para as duas comparações). Conclusão A técnica de estimulação simultânea do nervo mediano e radial é acurada, sensível, tolerável e não somente útil no diagnóstico da STC, mas também na definição da gravidade. Então, seu uso deve ser encorajado na prática clínica. / Background Carpal tunnel syndrome (CTS) is the most common nerve entrapment observed in clinical practice affecting the median nerve at the wrist level. There are many electrophysiological ways to diagnose CTS, but most of them are time consuming, painful and have variable sensitivity. Objective To evaluate the accuracy of an electophysiologic method of CTS investigation and to correlate it with clinical symptoms. Methods Patients at the clinic outpatient Neurology with CTS clinical criteria underwent a battery of clinical and neurophysiological tests. First, we applied the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and Visual analogue scale (VAS). After, we performed a standard method of analysis of the median and ulnar nerves. Posteriorly, a blinded neurophysiologist performed an orthodromic median-radial nerve simultaneous stimulation at the thumb with recording of both action potentials at the lateral aspect of the wrist. Data were grouped for mild, moderate and severe CTS, based on median motor latency. Results The interpeak latency (IPL), obtained with study technique, was different in groups based on CTS classification severity (Bonferroni. p<0.001). The median nerve conduction velocity, obtained with the standard approach, was also of different level among groups. There were correlation between IPL and median nerve conduction velocity (Sperman; r=-0.52; p<0.01), as well as, there was a significant correlation between IPL and median nerve conduction velocity with the discomfort caused by CTS and measured with VAS. However, the duration and unpleasantness caused by median-radial nerve simultaneous stimulation technique were reduced when compared to standard approach (t Student <0.001 for both comparisons). Conclusion The orthodromic median-radial nerve simultaneous stimulation technique is accurate, sensitive, tolerable and not only useful for CTS diagnosis but also for its severity assessment. Therefore, its use should be encouraged in clinical practice.

Base teórica A síndrome do túnel do carpo (STC) é uma lesão compressiva nervosa mais comum que afeta o nervo mediano observada na prática clínica. Existem muitas técnicas eletrofisiológicas para diagnosticar a STC, mas a maioria dispende muito tempo, é dolorosa e tem sensibilidade variada. Objetivo Avaliar a acurácia de um método eletrofisiológico de investigação da STC e correlaciona-lo com aspectos clínicos. Métodos Pacientes do ambulatório de Neurologia com critérios clínicos para STC foram submetidos a uma bateria de testes clínicos e neurofisiológicos. Primeiramente, nós aplicamos o Questionário de Síndrome do túnel do Carpo de Boston e Escala visual analógica (EVA). Após, realizamos o método eletrofisiológico convencional de avaliação sensitiva do nervo mediano e ulnar. Posteriormente, outro médico eletrofisiologista, cegado para as avaliações anteriores, realizou a técnica de estimulação simultânea dos nervos mediano e radial no polegar com registro simultâneo de ambos potenciais na região punho. Os dados foram agrupados em STC leve, moderada e grave, baseados na latência motora do nervo mediano. Resultados A latência entre picos (LEP), obtida pela técnica em estudo, foi diferente entre os grupos baseados na classificação de gravidade da STC (Bonferroni; p<0.001). A velocidade de condução nervosa sensitiva do nervo mediano, obtida através da técnica standard, apresentou também diferentes valores entre os grupos. Houve correlação entre LEP e velocidade de condução nervosa sensitiva do mediano (Sperman; r=-0.52; p<0.01), bem como entre LEP e velocidade de condução nervosa sensitiva do mediano com o desconforto causado pela STC mensurado pela Escala visual analógica (EVA). A duração e o desconforto causado pela técnica de estimulação simultânea do nervo mediano e radial estão reduzidos quando comparados com a técnica padrão (t Student; p< 0.001 para as duas comparações). Conclusão A técnica de estimulação simultânea do nervo mediano e radial é acurada, sensível, tolerável e não somente útil no diagnóstico da STC, mas também na definição da gravidade. Então, seu uso deve ser encorajado na prática clínica. / Background Carpal tunnel syndrome (CTS) is the most common nerve entrapment observed in clinical practice affecting the median nerve at the wrist level. There are many electrophysiological ways to diagnose CTS, but most of them are time consuming, painful and have variable sensitivity. Objective To evaluate the accuracy of an electophysiologic method of CTS investigation and to correlate it with clinical symptoms. Methods Patients at the clinic outpatient Neurology with CTS clinical criteria underwent a battery of clinical and neurophysiological tests. First, we applied the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and Visual analogue scale (VAS). After, we performed a standard method of analysis of the median and ulnar nerves. Posteriorly, a blinded neurophysiologist performed an orthodromic median-radial nerve simultaneous stimulation at the thumb with recording of both action potentials at the lateral aspect of the wrist. Data were grouped for mild, moderate and severe CTS, based on median motor latency. Results The interpeak latency (IPL), obtained with study technique, was different in groups based on CTS classification severity (Bonferroni. p<0.001). The median nerve conduction velocity, obtained with the standard approach, was also of different level among groups. There were correlation between IPL and median nerve conduction velocity (Sperman; r=-0.52; p<0.01), as well as, there was a significant correlation between IPL and median nerve conduction velocity with the discomfort caused by CTS and measured with VAS. However, the duration and unpleasantness caused by median-radial nerve simultaneous stimulation technique were reduced when compared to standard approach (t Student <0.001 for both comparisons). Conclusion The orthodromic median-radial nerve simultaneous stimulation technique is accurate, sensitive, tolerable and not only useful for CTS diagnosis but also for its severity assessment. Therefore, its use should be encouraged in clinical practice.

Neurography is the most objective and reliable measure of the peripheral nerve function, and it is used to diagnose both local and generalized neuropathies. Neurography can measure both motor and sensory nerve functions. The principle for sensory neurgraphy is to stimulate over the nerve and record proximal or distal from the stimulated electrode. At the Department of Clinical Neurophysiology, University Hospital Uppsala, a problem has been identified, in that young adult patients tend to show unexpected abnormal neurography values in relation to the expected, indicated by the reference limits, without clinical correlates. This concerns foremost the sensory amplitudes in median and ulnar nerves. The hypothesis is that the requirement of young adults’ amplitudes is too high. A reference material better including more subjects in this age group may solve the problem. Sensory nerve conduction studies were performed in 33 subjects, aged 15-30. The nerve functions were tested on median, ulnar and radial nerves. Surface electrodes were used for both recording and stimulation. The result shows that the presently used reference material for some nerves indeed has too high requirement for young adults. After increasing the reference material for younger age groups, the new reference limits has been changed and this should cause fewer false positive findings.

Introduction Lateral elbow pain is a common disorder and affects 1-3 % of the population each year. Beside the typical characterization with pain in restricted dorsal and radial deviation of the wrist and local tenderness of the lateral epicondyle, a neurodynamic dysfunction of the radial nerve can co-exist with the tendon dysfunction.  Purpose The aim of the study was to evaluate the effects of individualized neurodynamic treatment in combination with neurodynamic self-treatment in patient with persistent lateral elbow pain with a neurodynamic dysfunction of the radial nerve on grip strength, pain, disability, and function.  Method A single subject experimental design with A-B-A design was conducted. Seven participants with lateral elbow pain and a neurodynamic dysfunction of the radial nerve were recruited for the study. Five participants completed the study which consisted of individualized neurodynamic treatment directed to the neurodynamic dysfunction in combination with home exercises which included self-mobilization with sliders and/or tensioners in combination of the strengthening- and stretching exercises. The treatment was evaluated by pain-free and maximal grip strength, the Disabilities of the Arm, Shoulder and Hand (DASH) and Patient-rated Tennis Elbow Evaluation (PRTEE) questionnaires and range of motion of the upper limb neurodynamic test (ULNT) biased n. radialis.   Results The result of this SSED shows that neurodynamic treatment with manual mobilization and self-mobilization improves the ROM of the ULNT n. radialis in all five participants. Neurodynamic treatment also improved outcomes of DASH and PRTEE in 3 of the 5 participants.  Conclusion Neurodynamic treatment including manual mobilization and self-mobilization in combination with individual strength exercises tends to improve self-rated pain and disability, function and mechanosenstivity of the radial nerve in patients with persistent lateral elbow pain.