[An assessment of the sympathetic function within the hand in patients with partial laceration of the median nerve].

Chir Narzadow Ruchu Ortop Pol 2010 Mar-Apr;75(2):79-85

Klinika Chirurgii Ogólnej i Chirurgii Reki, Pomorska Akademia Medyczna w Szczecinie.

Unlabelled: The objective of this study was an assessment of sympathetic activity within the hand in patients with traumatic, incomplete nerve lacerations. In 12 patients, 1 female and 11 male in the mean age of 30 years with injuries of these nerves within forearm, the sympathetic skin response was obtained with index fingers of the affected and unaffected hand. Capillaroscopy examination of nail folds of the middle fingers was performed in affected and unaffected hand. Over and above, symptoms and signs attributed to the sympathetic function were registered.

Results: Mean values of the sympathetic skin response parameters: amplitude and area were statistically significantly reduced in the affected hand, comparing to the unaffected: amplitude 0.5 vs 1.0 mV, area 0.6 vs 1.2 mVms, respectively. Latency was not different between the hands; 1.4 vs. 1.5 ms. Qualitative analysis of the SSR graphs revealed no response in two patients, reduced SSR in 7 and normal SSR in 3 patients. Wide individual variability of the parameters of the sympathetic skin response was observed. Capillaroscopy. Mean diameters of afferent capillary vessels were greater in the affected (11.7 pm) than in the unaffected (10.7 microm) hand, but the difference was not significant. Mean diameters of efferent capillary vessels were statistically significantly greater in the affected (15.2 microm) than in the unaffected (14.2 microm) hand, what may be attributed to reduced sympathetic activity in the distribution of the examined nerve. All patients reported symptoms and signs attributed to sympathetic dysfunction, which majority of them were considered troublesome in their daily life. Results obtained in our study does not allow for a definitive conclusion regarding the severity of sympathetic dysfunction due to partial laceration of the median or median and ulnar nerves. The results indicate on limited ability of employed diagnostic techniques in detection of factual effect of the loss of sympathetic fibres in the median nerve on the activity of sympathetic system in the distribution of this nerve.

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September 2010
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