The optimization of peripheral nerve recovery using cortical reorganization techniques: A retrospective study of wrist level nerve repairs.

STUDY

DESIGN

Retrospective case series.

INTRODUCTION

Outcomes following peripheral nerve repairs have not significantly improved over the past few decades. A new protocol using cortical reorganization techniques was developed with the goal of improving nerve recovery in the hand.

PURPOSE OF THE STUDY: To determine if early sensory re-education using cortical reorganization techniques improved sensory outcomes in the hand after repair of wrist-level nerve injuries.

METHODS

A retrospective study was completed of wrist-level peripheral nerve repairs in patients who underwent a sensory re-education protocol which included cutaneous anesthesia, tactile stimulation, and sensory and motor imagery. Data for static 2-point discrimination, Semmes Weinstein monofilament assessments and the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were collected.

RESULTS

At four months post-repair, three of seven of the median nerve lacerations had static 2-point discrimination of 7 mm or less in at least one digit. Using the Semmes Weinstein monofilaments, 9 of 11 nerve repairs felt the 4.31 filament (protective) or better by eleven months with five able to perceive the 2.83 filament (normal) in that time frame.

CONCLUSIONS

This limited retrospective study suggests that early sensory re-education using cortical reorganization techniques may improve sensory outcomes. A larger scale study is indicated to confirm our findings.

LEVEL OF EVIDENCE: IV.