Intraoperative Nerve Stimulation as a Functional Assessment of Acute Stretch Injury in the Rat Median Nerve

Authors

• Matthew Gluck, 1) Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 2)Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
• Pierce J. Ferriter Jr., Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
• Christoph A. Schroen, 1) Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 2) Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Hospital Ludwigshafen, Heidelberg University, Heidelberg, Germany
• Christina M. Beck, Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
• Zachary L. Bernstein, Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
• Todd A. Rubin, Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
• Michael R. Hausman, Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
• Paul J. Cagle, Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA

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.

Disclosure Statement

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.

Corresponding Author

Michael R. Hausman, MD

michael.hausman@mssm.edu

Recommended Citation

Gluck, Matthew; Ferriter, Pierce J. Jr.; Schroen, Christoph A.; Beck, Christina M.; Bernstein, Zachary L.; Rubin, Todd A.; Hausman, Michael R.; and Cagle, Paul J. (2024) "Intraoperative Nerve Stimulation as a Functional Assessment of Acute Stretch Injury in the Rat Median Nerve," Stony Brook Orthopaedic and Musculoskeletal Journal: Vol. 4, Article 6.
DOI: https://doi.org/10.31259/3065-2677.1026
Available at: https://commons.library.stonybrook.edu/orthomusculoskeletaljournal/vol4/iss1/6