THE EFFECT OF SENSORY RE–EDUCATION PROTOCOL AFTER LOW MEDIAN NERVE COMPLETE TRANSACTION AND MICROSURGICAL REPAIR: ANALYSIS OF 76 CASES

K. Raptis^1,2, C. Koutserimpas¹, D. Antonopoulos², M. Aggourakis³, G. Georgoudis^4,3,4

¹“251” Hellenic Air Force General Hospital of Athens, Department of Orthopaedics and Traumatology, Athens, Greece, ²KAT General Hospital, Department of Hand and Upper Extremity Surgery and Microsurgery, Athens, Greece, ³Physiopain Group, Pain Management & Rehabilitation Clinics, Athens - Pireaus, Greece, ⁴University of West Attica, Musculoskeletal Physiotherapy Research Laboratory, Athens, Greece

Background: Peripheral nerve injuries in the upper extremity treated without post-operative physical therapy and training protocol often result in long-lasting disability of the hand due to loss of fine sensory and motor function. The purpose of this study was to compare the sensory results of patients with low-median nerve complete transection and microsurgical repair, with and without sensory re-education protocol.

Purpose: The purpose of this study was to compare the sensory results of patients with low-median nerve complete transection and microsurgical repair, with and without sensory re-education protocol.

Methods: A total of 76 patients, aged 20 to 32 years, with low median nerve complete transection and epineural repair with microsurgical technique were enrolled in this study. At a mean of 3.5 months (range, 3–4 months) following surgery, when vibration sense (pallesthesia) was perceived at the fingertips of the 3.5 radial fingers, the patients were randomly assigned to 2 equal groups: group A patients were rehabilitated with a sensory re-education program, and group B patients had no further treatment. Protocol of sensory re-education was performed in 2 phases: the early phase included identification of familiar objects, first with the eyes open and then with the eyes closed and locognosia and the late phase included the Moberg’s pick-up test, locognosia exercises, and identification of different objects from similar objects. The technique of re-education was performed by a physical therapist 4 times per day, for 10-15 minutes each session. Clinical evaluation was performed at 18 months after surgery (range, 17.5–18.5 months) and included measurements of locognosia, the static and moving 2-point discrimination tests, and the Moberg’s pick-up test. Comparison between groups and time points was done with the nonparametric analysis of variance (Kruskal-Wallis analysis of variance).

Results: Static and moving 2-point discrimination were not statistically significant between groups. Locognosia was significantly improved in group A (p-value= 0.005), while the Moberg pick-up test was also improved in group A compared to group B (p-value=0.019).

Conclusions: The present study has shown that the specific sensory re-education physiotherapy protocol appeared to have significant value only in re-education of locognosia at 18 months after low median nerve complete transection and repair.

Implications: An important parameter after surgical repair of the median nerve tin order o improve locognosia is the implementation of a sensory re-education rehabilitation program, which will allow results to be significant even after 18 months post-operatively.

Funding acknowledgements: N/A

Keywords:
Post-operative rehabilitation nerve surgery
Sensory re-education
Nerve rehabilitation

Topics:
Musculoskeletal: upper limb
Sport & sports injuries
Musculoskeletal

Did this work require ethics approval? Yes

Institution: National & Kapodistrian University of Athens (EKPA)

Committee: ETHICAL COMMITTEE of EKPA

Ethics number: 21/30-01-2018