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James N. Campbell and Donlin M. Long

undergone a number of hand operations. He had two distinct types of pain, the worse being a sharp jabbing pain, and the other a burning dysesthesia. The stimulator relieved the former pain and allowed him to return to work. Subsequent to the stimulator implantation, he had a sympathectomy, and internal neurolysis of the median nerve, which has relieved his second type of pain. He is now able to resume a normal life without use of analgesics, but requires the use of the stimulator to control the sharp jabbing pain to which he is still subject. Another partial success was

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Susan E. Mackinnon, Alan R. Hudson, Faustino Llamas, A. Lee Dellon, David G. Kline and Dan A. Hunter

F , Hudson AR , Kline D , et al : Early changes following injection injury of peripheral nerves. Can J Surg 23 : 177 – 182 , 1980 Gentili F, Hudson, AR, Kline D, et al: Early changes following injection injury of peripheral nerves. Can J Surg 23: 177–182, 1980 9. Gentili F , Hudson AR , Kline DG , et al : Morphological and physiological alterations following internal neurolysis of normal rat sciatic nerve , in Gorio A , Millesi H , Mingrino S (eds): Posttraumatic

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Dean S. Louis, Thomas L. Greene and Raymond C. Noellert

her hand 6 months after the initial procedure. At the second operation an internal neurolysis was performed. The surgeon noted in the operative report that no unusual compression was seen, nor was a definite cause for her recurrent symptoms found. Following the second procedure the patient developed dysesthesias in the median nerve distribution of her right hand. The index and long finger tips were hypersensitive to touch and the palmar incision was exquisitely sensitive. At this point she consulted us because of her severe symptomatology. Upon examination the

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David G. Kline

the indication for surgery in 79 of the 90 operated cases. This was especially so if the loss was in the distribution of the upper roots (C-5, C-6, or C-7), upper and/or middle trunk(s), or lateral and/or posterior cord(s) or their peripheral outflows. There were occasional exceptions, particularly in five patients with incomplete functional loss in the distribution of one or more elements but with severe noncausalgic pain not manageable by pharmacological means. Three of these patients were helped by external and limited internal neurolysis of their relatively mild

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A. Lee Dellon, James N. Campbell and David Cornblath

beneath this thickened and scarred fascia. Dissection distally along the anterior border of the trapezius muscle at first appeared to demonstrate a nerve of normal dimension. Electrical stimulation of the spinal accessory nerve just after it emerged from the sternocleidomastoid muscle evoked weak contraction of the medial and inferior portions of the trapezius muscle. More distal stimulation of the nerve elicited no response. Microsurgical internal neurolysis of the spinal accessory nerve demonstrated an intact branch to the medial and inferior portions of the trapezius

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David M. Pagnanelli and Steven J. Barrer

of carpal tunnel syndrome has been debated widely in the literature. Complications of surgery have been attributed primarily to the type of incision rather than to the experience and skill of the surgeon. 7, 17, 18 The necessity for doing anything but simple division of the transverse ligament in the majority of patients has been investigated. Physiological studies of the nerve during carpal tunnel release and anatomical studies have shown that extensive dissection and internal neurolysis do more harm than good, apart from marginally better results in patients

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Kim J. Burchiel, Timothy J. Johans and Jose Ochoa

preliminary data indicate that the outcome may not be as successful. Internal Neurolysis Surgical intervention in cases of in-continuity neuromas of major proximal sensorimotor nerves with significant residual distal function has unavoidable attendant risks. Internal neurolysis (dissection in the plane of the investing internal epineurium 29, 33 may cause further damage to remaining axons. 51 Our first hypothesis was that it might be of benefit. In our series, five patients with proximal in-continuity neuromas of major sensorimotor nerves were treated by this

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John P. Laurent, Rita Lee, Saleh Shenaq, Julie T. Parke, Itzel S. Solis and Lisa Kowalik

, internal neurolysis, and/or neuroma excision were the available procedures. Once surgical repairs were accomplished, the wounds were closed with subcuticular sutures and the arm was placed in a shoulder sling, wrapped, and held closely to the body. The sling and body-wrap were changed daily and removed permanently 10 days postoperatively so that full physical therapy could proceed. Neurological assessment continued on a quarterly basis. Neuromas were excised and treated with an interpositional nerve graft or end-to-end anastomosis when a drop in the muscle action

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Patrick R. Yassini, Kent Sauter, Sydney S. Schochet, Howard H. Kaufman and Stephen M. Bloomfield

with the longest follow-up monitoring, no neurological changes were reported over an 8-year period following complete resection of the LHN lesions. 13 The average follow-up duration for the remaining 26 patients was only 9 months and most of these patients also displayed no neurological changes; however, one patient who underwent biopsy only experienced progressive weakness, 32 and three exhibited improvements in neurological function. 5, 17, 34 In one of the three cases with neurological improvements, internal neurolysis had been performed on a tibial nerve

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Thomas R. Donner, Rand M. Voorhies and David G. Kline

. The tumors were treated as follows: partial excision in two patients; internal neurolysis with gross total excision in one; internal neurolysis with subtotal excision in one; and division of the involved nerve proximal and distal to the tumor with lengthy graft repair in two. The two patients on whom the latter procedure was performed had only trace strength in the associated muscles preoperatively. Neither of these patients had recovered function at their last follow-up evaluation. The tumor recurred in each of the other four patients. The time to symptomatic