Intraoperative Nerve Stimulation as a Functional Assessment of Acute Stretch Injury in the Rat Median Nerve | 51�� of Medicine at Stony Brook University

Authors, Author Information and Article Contact

Matthew J. Gluck^1,2, Pierce J. Ferriter Jr.¹, Christoph A. Schroen^1,3, Christina M. Beck¹, Zachary L. Bernstein¹, Todd A. Rubin¹, Michael R. Hausman¹, Paul J. Cagle¹

^{1Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA

2Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA

3Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Hospital Ludwigshafen, Heidelberg University, Heidelberg, Germany}

^{Acknowledgements}

^{We acknowledge Jill Gregory for her kind illustrational contributions.}

^{Conflicts of Interests}

^{Dr. Michael Hausman - Co-Founder of and Consultant for Checkpoint Surgical, Equity Ownership of Checkpoint Surgical. Dr. Paul Cagle - Consultant for Arthrex & Exactech. Matthew J. Gluck, Pierce J. Ferriter Jr., Christoph A. Schroen, Christina M. Beck, Zachary L. Bernstein, and Todd A. Rubin have nothing to disclose.}

^Funding

^{The work was supported by Checkpoint Surgical, LLC, through the donation of the intraoperative nerve stimulators utilized in this study. The remainder of the study was internally funded.}

^{Ethical Approval}

^{The institutional IACUC office approved the study protocol. We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.}

^{Level of Evidence}

^{This is a basic science research study.}

^Citation

Gluck MJ, Ferriter PJ, Schroen CA, et al: Intraoperative Nerve Stimulation as a Functional Assessment of Acute Stretch Injury in the Rat Median Nerve. 51�� Journal of Scholarship, Innovation, and Quality Improvement - Orthopaedics 2023-2024, 18:

Keywords

Alternating current (AC), hand-held surgical nerve stimulator, intraoperative nerve monitoring (IOM), electrodiagnostic evaluation, peripheral nerve injury (PNI), median nerve

Abstract

Introduction: Peripheral nerve injuries (PNIs) are common complications of upper extremity injuries, yet few clinical options exist to quickly and accurately assess motor nerve function
intraoperatively. PNIs are a significant source of not only disability to the patient, but also cost. This study’s purpose was to evaluate the utility of intraoperative nerve stimulation in an
animal model.

Methods: A 20% stretch injury was induced in right median nerves using a custom-made stretch applicator, while left median nerves served as a control. A Checkpoint surgical nerve
stimulator (Checkpoint Surgical, Cleveland, OH) was used to assess baseline nerve function in all subjects. The amount of stimulus required for muscle twitch and muscle contraction
before and after injury were recorded.

Results: In sham control (SC) nerves, no significant difference was observed between pre and post intervention. In high strain (HS) nerves, an average increase of 0.129 μC (p<0.0001) was required to induce a twitch, while an average increase of 0.1346 μC (p<0.0001) was required to induce a full paw contraction after injury.

Discussion: Our results suggest electric stimulation with a hand-held stimulator can be used to accurately detect an acute nerve stretch injury and diagnose PNI in rats in vivo based on the amount of stimulation needed compared to sham controls. This finding points to nerve stimulation’s potential in aiding surgeons with intraoperative assessment of nerve integrity and function.

Article

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