Recovery of sensory and motor function after nerve repair. A rationale for evaluation

Abstract

In order to identify an effective test for evaluating the results of nerve repair, 25 patients, age 10-53 years (mean 27 years), were evaluated two to five years after median or ulnar nerve repair at the distal forearm level. The initial assumption was that evaluation after nerve repair should reflect four aspects of recovery: reinnervation, tactile gnosis, integrated sensory and motor functions, and pain or discomfort. The evaluation included a number of assessment methods addressing these aspects. Attention was paid to the usefulness of the tests with reference to their relevance for assessing hand functions. Clinical utility and possibilities for standardization and quantification of the results were considered important. Statistical analysis showed no correlations between the results obtained in clinical tests for reinnervation and the results from neurophysiologic examination. Grip strength and cold intolerance together accounted for a significant 51% of the variance in activities of daily living (ADL) capacity. Tactile gnosis correlated weakly with ADL capacity and strongly with age. Based on these findings, the following design for evaluating the result after median and ulnar nerve repair is suggested. To assess reinnervation: Semmes-Weinstein monofilaments and manual muscle-testing; to assess tactile gnosis: classic 2PD and a test with the features of the used shape identification test; to assess integrated functions: selected parts of Sollerman's grip test and grip-strength test with Jamar dynamometer; to quantify pain and discomfort: a four-ranked scale for grading perceived problems from cold intolerance and hypersensitivity.