ABSTRACT
Crushed Sciatic Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 448 20.4.3 Myelin Histomorphometry Reveals Remyelination of In Vivo
Crushed Sciatic Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 450
20.5 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451
20.6 Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 453
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 453
20.1 Introduction Peripheral nerve pathology, whether through direct injury (trauma) or chronic disease (carpal tunnel compressive neuropathy), results in a disability that has widespread repercussions for both personal and occupational rehabilitation. While complete division of a nerve can be directly observed and managed appropriately with standard microsurgery, the spectrum of injury related to crushed nerves or chronic neuropathies cannot be accurately assessed. e ability to observe the microarchitecture of the nerve, in particular its level of myelination, is limited at present to destructive histological techniques that are not appropriate in a clinical setting and therefore currently there is no method that can help a clinician assess nerve health in vivo following injury. Electrical studies, although a useful diagnostic technique, cannot in the early phase of injury distinguish between nerves with minor or severe internal disruption. Furthermore, only a‚er recovery has occurred over a period of several months can such a determination be made empirically. is “wait and see” approach prolongs the period of muscle denervation distally, lengthens the time to ultimate recovery if surgical reconstruction is required, and ultimately hastens the time a‚er which meaningful reconstruction, particularly of motor neuron lesions, is no longer possible. A technique that would provide information to allow for grading of the nerve injury would be a valuable clinical tool in terms of both a diagnostic and prognostic indication of functional recovery.
