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Research Article| Volume 22, ISSUE 2, P193-199, March 1997

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Biomechanical effects of operative nerve mobilization and transposition in a canine ulnar nerve model

  • Author Footnotes
    1 From the Department of Orthopaedic Surgery, Northwestern University Medical School, Evanston, IL: the Department of Hand Surgery, Malmö allmanna Sjukhus, University of Lund, Malmö, Sweden; the Orthopedic Biomechanics Laboratory, Beth Israel Hospital and Harvard Medical School, Boston, MA; the Department of Orthopaedics, The Emory Clinic, Atlanta, GA; and the Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
    Craig S. Williams
    Footnotes
    1 From the Department of Orthopaedic Surgery, Northwestern University Medical School, Evanston, IL: the Department of Hand Surgery, Malmö allmanna Sjukhus, University of Lund, Malmö, Sweden; the Orthopedic Biomechanics Laboratory, Beth Israel Hospital and Harvard Medical School, Boston, MA; the Department of Orthopaedics, The Emory Clinic, Atlanta, GA; and the Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
    Affiliations
    Evanston, IL, USA
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  • Author Footnotes
    1 From the Department of Orthopaedic Surgery, Northwestern University Medical School, Evanston, IL: the Department of Hand Surgery, Malmö allmanna Sjukhus, University of Lund, Malmö, Sweden; the Orthopedic Biomechanics Laboratory, Beth Israel Hospital and Harvard Medical School, Boston, MA; the Department of Orthopaedics, The Emory Clinic, Atlanta, GA; and the Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
    Sven-Olof Abrahamsson
    Footnotes
    1 From the Department of Orthopaedic Surgery, Northwestern University Medical School, Evanston, IL: the Department of Hand Surgery, Malmö allmanna Sjukhus, University of Lund, Malmö, Sweden; the Orthopedic Biomechanics Laboratory, Beth Israel Hospital and Harvard Medical School, Boston, MA; the Department of Orthopaedics, The Emory Clinic, Atlanta, GA; and the Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
    Affiliations
    Malmö, Sweden, USA
    Search for articles by this author
  • Author Footnotes
    1 From the Department of Orthopaedic Surgery, Northwestern University Medical School, Evanston, IL: the Department of Hand Surgery, Malmö allmanna Sjukhus, University of Lund, Malmö, Sweden; the Orthopedic Biomechanics Laboratory, Beth Israel Hospital and Harvard Medical School, Boston, MA; the Department of Orthopaedics, The Emory Clinic, Atlanta, GA; and the Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
    Marie Shea
    Footnotes
    1 From the Department of Orthopaedic Surgery, Northwestern University Medical School, Evanston, IL: the Department of Hand Surgery, Malmö allmanna Sjukhus, University of Lund, Malmö, Sweden; the Orthopedic Biomechanics Laboratory, Beth Israel Hospital and Harvard Medical School, Boston, MA; the Department of Orthopaedics, The Emory Clinic, Atlanta, GA; and the Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
    Affiliations
    Boston, MA, USA
    Search for articles by this author
  • Author Footnotes
    1 From the Department of Orthopaedic Surgery, Northwestern University Medical School, Evanston, IL: the Department of Hand Surgery, Malmö allmanna Sjukhus, University of Lund, Malmö, Sweden; the Orthopedic Biomechanics Laboratory, Beth Israel Hospital and Harvard Medical School, Boston, MA; the Department of Orthopaedics, The Emory Clinic, Atlanta, GA; and the Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
    John G. Seiler III
    Footnotes
    1 From the Department of Orthopaedic Surgery, Northwestern University Medical School, Evanston, IL: the Department of Hand Surgery, Malmö allmanna Sjukhus, University of Lund, Malmö, Sweden; the Orthopedic Biomechanics Laboratory, Beth Israel Hospital and Harvard Medical School, Boston, MA; the Department of Orthopaedics, The Emory Clinic, Atlanta, GA; and the Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
    Affiliations
    Atlanta, GA, USA
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  • Author Footnotes
    1 From the Department of Orthopaedic Surgery, Northwestern University Medical School, Evanston, IL: the Department of Hand Surgery, Malmö allmanna Sjukhus, University of Lund, Malmö, Sweden; the Orthopedic Biomechanics Laboratory, Beth Israel Hospital and Harvard Medical School, Boston, MA; the Department of Orthopaedics, The Emory Clinic, Atlanta, GA; and the Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
    Wilson C. Hayes
    Footnotes
    1 From the Department of Orthopaedic Surgery, Northwestern University Medical School, Evanston, IL: the Department of Hand Surgery, Malmö allmanna Sjukhus, University of Lund, Malmö, Sweden; the Orthopedic Biomechanics Laboratory, Beth Israel Hospital and Harvard Medical School, Boston, MA; the Department of Orthopaedics, The Emory Clinic, Atlanta, GA; and the Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
    Affiliations
    Boston, MA, USA
    Search for articles by this author
  • Author Footnotes
    1 From the Department of Orthopaedic Surgery, Northwestern University Medical School, Evanston, IL: the Department of Hand Surgery, Malmö allmanna Sjukhus, University of Lund, Malmö, Sweden; the Orthopedic Biomechanics Laboratory, Beth Israel Hospital and Harvard Medical School, Boston, MA; the Department of Orthopaedics, The Emory Clinic, Atlanta, GA; and the Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
    Richard H. Gelberman
    Correspondence
    Reprint requests: Richard H. Gelberman, MD, Chairman, Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 S. Euclid Avenue, St. Louis, MO 63110-1093.
    Footnotes
    1 From the Department of Orthopaedic Surgery, Northwestern University Medical School, Evanston, IL: the Department of Hand Surgery, Malmö allmanna Sjukhus, University of Lund, Malmö, Sweden; the Orthopedic Biomechanics Laboratory, Beth Israel Hospital and Harvard Medical School, Boston, MA; the Department of Orthopaedics, The Emory Clinic, Atlanta, GA; and the Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
    Affiliations
    St. Louis, MO, USA
    Search for articles by this author
  • Author Footnotes
    1 From the Department of Orthopaedic Surgery, Northwestern University Medical School, Evanston, IL: the Department of Hand Surgery, Malmö allmanna Sjukhus, University of Lund, Malmö, Sweden; the Orthopedic Biomechanics Laboratory, Beth Israel Hospital and Harvard Medical School, Boston, MA; the Department of Orthopaedics, The Emory Clinic, Atlanta, GA; and the Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
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      The purpose of this study was to evaluate the effects that operative mobilization and transposition of the ulnar nerve have on both neural excursion and mechanical properties. Twelve dogs underwent ulnar nerve transposition and postoperative casting. Four animals were killed at 3 weeks and four animals were killed at 6 weeks. Four animals had their casts removed at 3 weeks, were allowed to ambulate, and were killed at 6 weeks. Operated and contralateral control nerves were compared. Neural excursion was measured near the elbow and 12 cm proximally. The nerves were harvested and their mechanical properties determined. Repeated measures analysis of variance revealed significant differences in longitudinal excursion between control and experimental groups at both sites. Ultimate strain, ultimate strength, and modulus were signficantly reduced in the experimental groups. No differences were seen in cross-sectional area or stiffness between control and experimental groups. Analysis revealed no independent effect of the rehabilitation method. Results of this study indicate that significant changes in neural excursion, ultimate strain, ultimate strength, and modulus occur following ulnar nerve mobilization and transposition and that these changes persist throughout the early postoperative period.
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      References

        • Apfelberg DB
        • Larson SJ
        Dynamic anatomy of the ulnar nerve at the elbow.
        Plast Reconstr Surg. 1973; 51: 76-81
        • Wilgis EFS
        • Murphy R
        The significance of longitudinal excursion in peripheral nerves.
        Hand Clin. 1986; 2: 761-766
        • McLellan DL
        Longitudinal sliding of median nerve during hand movements: a contributory factor in entrapment neuropathy.
        Lancet. 1975; 1: 633-634
        • Brown R
        • Pedowitz R
        • Rydevik B
        • et al.
        Effects of acute graded strain on efferent conduction properties of rabbit tibial nerve.
        Clin Orthop. 1993; 296: 288-294
        • Wall EJ
        • Massie JB
        • Kwan MK
        • et al.
        Experimental stretch neuropathy: changes in nerve conduction under tension.
        J Bone Joint Surg. 1992; 74B: 126-129
        • Kwan MK
        • Wall EJ
        • Massie J
        • Garfin SR
        Strain, stress, and stretch of peripheral nerve: Rabbit experiments in vitro and in vivo.
        Acta Orthop Scand. 1992; 63: 267-272
        • Kwan MK
        • Woo SL-Y
        Biomechanical properties of peripheral nerve.
        in: Belberman RH Operative nerve repair and reconstruction. JB Lippincott, Philadelphia1991: 47-54
        • Lundborg G
        • Rydevik B
        Effects of stretching the tibial nerve of the rabbit: a preliminary study of the intraneural circulation and the barrier function of the perineurium.
        J Bone Joint Surg. 1973; 55B: 390-401
        • Ogata K
        • Naito M
        Blood flow of peripheral nerve defects of dissection, stretching, and compression.
        J Hand Surg. 1986; 11B: 10-14
        • Clark WL
        • Trumble TE
        • Swiontkowski MF
        • Tencer AF
        Nerve tension and blood flow in a rat model of immediate and delayed repairs.
        J Hand Surg. 1992; 17A: 677-687
        • Eaton RG
        Anterior subcutaneous transposition.
        in: Gelberman RH Operative nerve repair and reconstruction. JB Lippincott, Philadelphia1991: 1077-1086
        • Eaton RG
        • Crowe JF
        • Parkes III, JC
        Anterior transposition of the ulnar nerve using a noncompressing fasciodermal sling.
        J Bone Joint Surg. 1980; 62A: 820-825
        • Leffert RD
        Anterior submuscular transposition of the ulnar nerves by the Learmouth technique.
        J Hand Surg. 1982; 7: 147-155
        • Broudy AS
        • Leffert RD
        • Smith RJ
        Technical problems with ulnar nerve transposition at the elbow: findings and results of reoperation.
        J Hand Surg. 1978; 3: 85-89
        • Gabel GT
        • Amadio PC
        Reoperation for failed decompression of the ulnar nerve in the region of the elbow.
        J Bone Joint Surg. 1990; 72A: 213-220
        • Ogata K
        • Manske PR
        • Leske PA
        The effect of surgical dissection on regional blood flow to the ulnar nerve in the cubital tunnel.
        Clin Orthop. 1985; 193: 195-198
        • Woo SL-Y
        • Danto MI
        • Ohland KJ
        • et al.
        The use of a laser micrometer system to determine the cross-sectional shape and area of ligaments: a comparative study with two existing methods.
        J Biomech Eng. 1990; 112: 426-431
        • Lundborg G
        • Dahlin LB
        Structure and function of peripheral nerve.
        in: Gelberman RH Operative nerve repair and reconstruction. JB Lippincott, Philadelphia1991: 1-18
        • Clarke E
        • Bearn JG
        The spiral nerve hands of Fontana.
        Brain. 1972; 95: 1-20
        • Seiler III, JG
        • Gelberman RH
        • Williams CS
        • et al.
        Autogenous flexor tendon grafts: a biomechanical and morphological study in dogs.
        J Bone Joint Surg. 1993; 75A: 1004-1014
        • Gelberman RH
        • Siegel DB
        • Woo SL-Y
        • et al.
        Healing of digital flexor tendons: importance of the interval from injury to repair. A biomechanical, biochemical, and morphological study in dogs.
        J Bone Joint Surg. 1991; 73A: 66-75
        • Haftek J
        Stretch injury of peripheral nerve: acute effects of stretching on rabbit nerve.
        J Bone Joint Surg. 1970; 52B: 254-365
        • Highet WB
        • Sanders FK
        The effects of stretching nerves after suture.
        Br J Surg. 1943; 30: 355-371
        • Hoen TI
        • Brackett CE
        Peripheral nerve lengthening: I.
        Experimental J Neurosurg. 1970; 13: 43-48
        • Liv CT
        • Benda CE
        • Lewey FH
        Tensile strength of human nerves: an experimental physical and histological study.
        Arch Neurol Psychiat. 1948; 59: 322-336
        • Rydevik BL
        • Kwan MK
        • Myers RR
        • et al.
        An in vitro mechanical and histological study of acute stretching on rabbit tibial nerve.
        J Orthop Res. 1990; 8: 694-701
        • Sutherland S
        • Bradley KC
        Stress-strain phenomena in denervated peripheral nerve trunks.
        Brain. 1961; 84: 125-127
        • Wall EJ
        • Kwan MK
        • Rydevik BL
        • et al.
        Stress relaxation by peripheral nerve.
        J Hand Surg. 1991; 16A: 859-863
        • Bora FW
        • Richardson S
        • Black J
        The biomechanical responses to tension in a peripheral nerve.
        J Hand Surg. 1980; 5: 21-25