Highlights
- •A nerve fixation at the thoracic outlet induced traumatic conditions on the ulnar nerve, which were non-existent in the normal “control” anatomical situation and could favour the development of neuropathies.
- •The results of this study invite surgeons to consider nerve mobility as an essential parameter in decompression surgeries for entrapment syndromes.
- •For a physiotherapist, it seems crucial to treat the peripheral nerve in its entire path, and to assess its mobility with specific neurodynamic tests like ULNT to guide the rehabilitation.
Abstract
Study Design
A cross sectional cadaveric measurement study.
Introduction
The etiology of entrapment neuropathies, such as carpal tunnel syndromes or thoracic
outlet syndromes (TOS), is usually not only linked with the compressive lesion of
the nerve but can also be associated with fibrosis and traction neuropathy.
Purpose of the Study
This work studies the biomechanics of the ulnar nerve in a cadaveric model of thoracic
outlet syndrome (TOS). We explored the biomechanical impact of a restriction of mobility
of the ulnar nerve. We measured if it could significantly affect the deformation undergone
by the nerve on the rest of its path.
Methods
We studied 14 ulnar nerves from 7 embalmed cadavers. We opened three 6.5cm windows
(at the wrist, forearm, and arm), and two optical markers 2cm apart were sutured to
the ulnar nerve. We then studied the deformation of the ulnar nerve in three successive
tensioning positions inspired by the ULNT3 manoeuvre (Upper Limb Neural Test 3). We
then fixed the brachial plexus to the clavicle to mimic a nerve adhesion at the thoracic
outlet.
Results
Fixing the brachial plexus to the clavicle bone had significant effects on ulnar nerve
mobility. In the position of intermediate tension, the nerve deformation increased
by +0.68% / +1.43% compared to the control measure. In the position of maximum tension,
it increased by +1.16% / +1.94%, pushing the nerve beyond the traumatic threshold
of 8% of deformation causing reversible damage to axonal transport and vascularization.
Conclusions
Our nerve adhesion at the thoracic outlet showed significant effects on the mobility
of the ulnar nerve compared to the control situation, by significantly increasing
the deformation undergone throughout the rest of the nerve's course, and by taking
it over the 8% of physiological traumatic deformation.
Keywords
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Article info
Publication history
Published online: October 23, 2022
Accepted:
September 28,
2022
Received in revised form:
September 6,
2022
Received:
March 21,
2022
Publication stage
In Press Corrected ProofFootnotes
Conflict of Interest: The authors declare that they have no competing interest.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
