Peripheral nerve damage : diagnosis and prediction of recovery

Abstract

This thesis contains studies concerning diagnostic aspects

of peripheral nerve damage and

the prediction of its recovery. We focussed on diffuse nerve pathology as in distal, symmetrical, polyneuropathies (DSPN) and local nerve compression syndromes, and on possible combinations of both. We studied the diagnostic value of Neuropads® and water immersion skin wrinkling (WISW) in 35 patients. Neuropad® had a high specificity when applied for 15 minutes and can thus be used in daily practice to confirm small fiber neuropathy. We studied the diagnostic value of Tinel’s sign and we concluded that Tinel’s sign occurs commonly and did not indicate nerve entrapment in a heterogeneous group of 91 patients nor in a subgroup of patients with DSPN. We critically reviewed the results of revision surgery after failure of neurolysis for ulnar nerve entrapment and these showed to be modest. This should be mentioned when counselling patients with failed neurolysis to manage patients’ expectations. Patients, especially those who are elderly, might even consider not undergoing a secondary procedure. We studied the relation between depression and outcome of carpal tunnel release (CTR) and showed that depression was not an independent predictor of residual CTS symptoms or satisfaction after one year.