Clinical Evidence of Retrograde Axonal Growth in Chronic Brachial Plexus Injury.
| Autor: | Tahir M; Orthopaedic Surgery, Hospital Governador Celso Ramos, Florianopolis, BRA., Lanzarin LD; Orthopaedic Surgery, Hospital Governador Celso Ramos, Florianopolis, BRA., J BA; Trauma and Orthopaedics/Hand Surgery, Hospital Governador Celso Ramos, Florianopolis, BRA.; Surgery, Universidade Federal de Santa Catarina, Florianopolis, BRA. |
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| Jazyk: | angličtina |
| Zdroj: | Cureus [Cureus] 2024 Jun 15; Vol. 16 (6), pp. e62424. Date of Electronic Publication: 2024 Jun 15 (Print Publication: 2024). |
| DOI: | 10.7759/cureus.62424 |
| Abstrakt: | Nerve axons grow from proximal to distal after axonometric injury; however, they have been seen to regenerate via alternate routes, with some also demonstrating retrograde growth in neuromas. We present the case of a 33-year-old male with a 16-year-old traumatic brachial plexus injury presenting with neuropathic pain and isolated spontaneous recovery. Following a successful pre-operative anaesthetic block, a neurectomy of the median and ulnar nerves was planned for pain relief. Intraoperatively, median nerve stimulation resulted in muscle contractions in the pectoralis major (PM) and extensor carpi radialis brevis (ECRB). This was confirmed by electrical and mechanical stimuli. Histological analysis confirmed the presence of viable axons in the median nerve despite no distal nerve function. Post-surgery motor activity was preserved. A plausible explanation for the intraoperative observations, suggesting neural connectivity between the median nerve and PM and ECRB, would be retrograde growth into various nerve pathways. Alternative explanations such as axonal bifurcation, light anaesthesia, or anatomical variations were considered but the evidence favoured retrograde axonal regrowth. These findings challenge conventional understanding and offer potential new approaches to nerve reconstruction. Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Tahir et al.) |
| Databáze: | MEDLINE |
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