Nerve stretching: a history of tension

View More View Less
  • Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

Stretch injuries are among the most devastating forms of peripheral nerve injury; unfortunately, the scientific understanding of nerve biomechanics is widely and impressively conflicting. Experimental models are unique and disparate, victim to different testing conditions, and thus yield gulfs between conclusions. The details of the divergent reports on nerve biomechanics are essential for critical appraisal as we try to understand clinical stretch injuries in light of research evidence. These conflicts preclude broad conclusion, but they highlight a duality in thought on nerve stretch and, within the details, some agreement exists. To synthesize trends in nerve stretch understanding, the author describes the literature since its introduction in the 19th century. Research has paralleled clinical inquiry, so nerve research can be divided into epochs based largely on clinical or scientific technique. The first epoch revolves around therapeutic nerve stretching—a procedure known as neurectasy—in the late 19th century. The second epoch involves studies of nerves repaired under tension in the early 20th century, often the result of war. The third epoch occurs later in the 20th century and is notable for increasing scientific refinement and disagreement. A fourth epoch of research from the 21st century is just dawning. More than 150 years of research has demonstrated a stable and inherent duality: the terribly destructive impact of stretch injuries, as well as the therapeutic benefits from nerve stretching. Yet, despite significant study, the precise border between safe and damaging stretch remains an enigma.

Figure from Minchev et al. (pp 150–158).

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Abe Y, Doi K, Katoh Y, Yamamoto H, Kataoka H, Kawai S: The limit of low speed peripheral nerve elongation; neurological and circulatory aspects. J Neurol Sci 140:6166, 1996

    • Search Google Scholar
    • Export Citation
  • 2

    Alant JD, Kemp SW, Khu KJ, Kumar R, Webb AA, Midha R: Traumatic neuroma in continuity injury model in rodents. J Neurotrauma 29:16911703, 2012

    • Search Google Scholar
    • Export Citation
  • 3

    Alant JD, Senjaya F, Ivanovic A, Forden J, Shakhbazau A, Midha R: The impact of motor axon misdirection and attrition on behavioral deficit following experimental nerve injuries. PLoS One 8:e82546, 2013

    • Search Google Scholar
    • Export Citation
  • 4

    Babcock W: A standard technique for operations on peripheral nerves with special reference to the closure of large gaps. Surg Gynecol Obstet 45:364378, 1927

    • Search Google Scholar
    • Export Citation
  • 5

    Baron A, Schreiber W: Über die direkte Nervenvereinigung bei großen Nervendefekten. Munch Med Wochenschr 65:446449, 1918

  • 6

    Bell J: Nerve stretching in sciatica. Edinb Med J 23:308, 1877

  • 7

    Billroth T: General Surgical Pathology and Therapeutics, in Fifty Lectures: A Textbook for Students and Physicians. New York: D Appleton, 1872

    • Search Google Scholar
    • Export Citation
  • 8

    Birch R: Surgical Disorders of the Peripheral Nerves. New York: Springer, 2011

  • 9

    Bowlby AA: Injuries and Diseases of Nerves and Their Surgical Treatment. London: Churchill, 1889

  • 10

    Brown-Séquard C: On certain physiological effects of stretching of the sciatic nerve. Lancet 117:206, 1881

  • 11

    Callender G: Clinical lecture on a case of neuralgia treated by nerve stretching. Lancet 105:883886, 1875

  • 12

    Chuang TH, Wilson RE, Love JM, Fisher JP, Shah SB: A novel internal fixator device for peripheral nerve regeneration. Tissue Eng Part C Methods 19:427437, 2013

    • Search Google Scholar
    • Export Citation
  • 13

    Coppieters MW, Van de Velde M, Stappaerts KH: Positioning in anesthesiology: toward a better understanding of stretch-induced perioperative neuropathies. Anesthesiology 97:7581, 2002

    • Search Google Scholar
    • Export Citation
  • 14

    Da Costa JC: Diseases and injuries of nerves, in Modern Surgery, ed 4. Philadelphia: WB Saunders, 1903, pp 577594

  • 15

    de Rényi GS: The structure of cells in tissues as revealed by microdissection. III. Observations on the sheaths of myelinated nerve fibers of the frog. J Comp Neurol 48:293310, 1929

    • Search Google Scholar
    • Export Citation
  • 16

    Denny-Brown DD, Doherty MM: Effects of transient stretching of peripheral nerve. Arch Neurol Psychiatry 54:116129, 1945

  • 17

    Driscoll PJ, Glasby MA, Lawson GM: An in vivo study of peripheral nerves in continuity: biomechanical and physiological responses to elongation. J Orthop Res 20:370375, 2002

    • Search Google Scholar
    • Export Citation
  • 18

    Endo T, Nakayama Y: Histologic examination of peripheral nerves elongated by tissue expanders. Br J Plast Surg 46:421425, 1993

  • 19

    Erichsen JE: The Science and Art of Surgery: A Treatise on Surgical Injuries, Diseases, and Operations. Philadelphia: Henry C. Lea’s Son, 1885, Vol 2

    • Search Google Scholar
    • Export Citation
  • 20

    Fenger C, Lee E: Nerve stretching. J Nerv Ment Dis 8:263304, 1881

  • 21

    Gray JA, Ritchie JM: Effects of stretch on single myelinated nerve fibres. J Physiol 124:8499, 1954

  • 22

    Haftek J: Stretch injury of peripheral nerve. Acute effects of stretching on rabbit nerve. J Bone Joint Surg Br 52:354365, 1970

  • 23

    Hara Y, Nishiura Y, Ochiai N, Sharula , Nakajima Y, Kubota S, et al.: New treatment for peripheral nerve defects: reconstruction of a 2 cm, monkey median nerve gap by direct lengthening of both nerve stumps. J Orthop Res 30:153161, 2012

    • Search Google Scholar
    • Export Citation
  • 24

    Highet WB, Holmes W: Traction injuries to the lateral popliteal nerve and traction injuries to peripheral nerves after suture. Br J Surg 30:212233, 1943

    • Search Google Scholar
    • Export Citation
  • 25

    Highet WB, Sanders FK: The effects of stretching nerves after suture. Br J Surg 30:355369, 1943

  • 26

    Hoen TI, Brackett CE: Peripheral nerve lengthening. I. Experimental. J Neurosurg 13:4362, 1956

  • 27

    Jou IM, Lai KA, Shen CL, Yamano Y: Changes in conduction, blood flow, histology, and neurological status following acute nerve-stretch injury induced by femoral lengthening. J Orthop Res 18:149155, 2000

    • Search Google Scholar
    • Export Citation
  • 28

    Keane JR: Neurectasy: the short history of therapeutic nerve stretching and suspension. Neurology 40:829831, 1990

  • 29

    Kim DH, Murovic JA, Tiel RL, Kline DG: Management and outcomes in 318 operative common peroneal nerve lesions at the Louisiana State University Health Sciences Center. Neurosurgery 54:14211429, 2004

    • Search Google Scholar
    • Export Citation
  • 30

    Kim SD: Efficacy of tendon and nerve gliding exercises for carpal tunnel syndrome: a systematic review of randomized controlled trials. J Phys Ther Sci 27:26452648, 2015

    • Search Google Scholar
    • Export Citation
  • 31

    Kline DG, Hudson AR: Nerve Injuries: Operative Results for Major Nerve Injuries, Entrapments, and Tumors, ed 2. Philadelphia: WB Saunders, 2007

    • Search Google Scholar
    • Export Citation
  • 32

    Kodera N, Aoki T, Ito H: Electrophysiological and histological investigation on the gradual elongation of rabbit sciatic nerve. J Nippon Med Sch 78:166173, 2011

    • Search Google Scholar
    • Export Citation
  • 33

    Koehler PJ: Brown-Séquard’s spinal epilepsy. Med Hist 38:189203, 1994

  • 34

    Kwan MK, Wall EJ, Massie J, Garfin SR: Strain, stress and stretch of peripheral nerve. Rabbit experiments in vitro and in vivo. Acta Orthop Scand 63:267272, 1992

    • Search Google Scholar
    • Export Citation
  • 35

    Liu CT, Benda CE, Lewey FH: Tensile strength of human nerves; an experimental physical and histologic study. Arch Neurol Psychiatry 59:322336, 1948

    • Search Google Scholar
    • Export Citation
  • 36

    Lundborg G, Rydevik B: Effects of stretching the tibial nerve of the rabbit. A preliminary study of the intraneural circulation and the barrier function of the perineurium. J Bone Joint Surg Br 55:390401, 1973

    • Search Google Scholar
    • Export Citation
  • 37

    Mahan MA, Vaz KM, Weingarten D, Brown JM, Shah SB: Altered ulnar nerve kinematic behavior in a cadaver model of entrapment. Neurosurgery 76:747755, 2015

    • Search Google Scholar
    • Export Citation
  • 38

    Malathi S, Batmanabane M: Effects of immobilization of a limb on the maturation of a peripheral nerve in kittens. Acta Anat (Basel) 132:191196, 1988

    • Search Google Scholar
    • Export Citation
  • 39

    Malathi S, Batmanabane M: Effects of varying periods of immobilization of a limb on the morphology of a peripheral nerve. Acta Morphol Neerl Scand 21:185198, 1983

    • Search Google Scholar
    • Export Citation
  • 40

    Manvell N, Manvell JJ, Snodgrass SJ, Reid SA: Tension of the ulnar, median, and radial nerves during ulnar nerve neurodynamic testing: observational cadaveric study. Phys Ther 95:891900, 2015

    • Search Google Scholar
    • Export Citation
  • 41

    Marshall J: Bradshaw lecture on nerve-stretching for the relief or cure of pain. BMJ 2:11731179, 1883

  • 42

    Millesi H: Peripheral nerve injuries. Nerve sutures and nerve grafting. Scand J Plast Reconstr Surg Suppl 19:2537, 1982

  • 43

    Milner RH: The effect of tissue expansion on peripheral nerves. Br J Plast Surg 42:414421, 1989

  • 44

    Mitchell SW: Injuries of Nerves and Their Consequences. Philadelphia: JB Lippincott, 1872

  • 45

    Nakajima Y, Nishiura Y, Hara Y, Sharula , Ochiai N: Simultaneous gradual lengthening of proximal and distal nerve stumps for repair of chronic peripheral nerve defect in rats. Hand Surg 17:111, 2012

    • Search Google Scholar
    • Export Citation
  • 46

    Nishiura Y, Hara Y, Yoshii Y, Ochiai N: Gradual stretching of the proximal nerve stump induces the growth of regenerating sprouts in rats. J Orthop Res 26:10121017, 2008

    • Search Google Scholar
    • Export Citation
  • 47

    Ochs S, Pourmand R, Si K, Friedman RN: Stretch of mammalian nerve in vitro: effect on compound action potentials. J Peripher Nerv Syst 5:227235, 2000

    • Search Google Scholar
    • Export Citation
  • 48

    Ogata K, Naito M: Blood flow of peripheral nerve effects of dissection, stretching and compression. J Hand Surg Br 11:10–14, 1986

  • 49

    Pachter BR, Eberstein A: The effect of limb immobilization and stretch on the fine structure of the neuromuscular junction in rat muscle. Exp Neurol 92:1319, 1986

    • Search Google Scholar
    • Export Citation
  • 50

    Peabody GL: Supplement to Ziemssen’s Cyclopaedia of the Practice of Medicine. New York: William Wood & Co, 1881

  • 51

    Phillips JB, Smit X, De Zoysa N, Afoke A, Brown RA: Peripheral nerves in the rat exhibit localized heterogeneity of tensile properties during limb movement. J Physiol 557:879887, 2004

    • Search Google Scholar
    • Export Citation
  • 52

    Platt H: The Surgery of the Peripheral Nerve Injuries of Warfare: Being the Hunterian Lectures Delivered Before the Royal College of Surgeons of England on February 7th and 9th, 1921. Bristol, England: John Wright & Sons, 1921

    • Search Google Scholar
    • Export Citation
  • 53

    Ray WZ, Mahan MA, Guo D, Kliot M: An update on addressing important peripheral nerve problems: challenges and potential solutions. Acta Neurochir (Wien) 159:17651773, 2017

    • Search Google Scholar
    • Export Citation
  • 54

    Rydevik BL, Kwan MK, Myers RR, Brown RA, Triggs KJ, Woo SL, et al.: An in vitro mechanical and histological study of acute stretching on rabbit tibial nerve. J Orthop Res 8:694701, 1990

    • Search Google Scholar
    • Export Citation
  • 55

    Saijilafu , Nishiura Y, Hara Y, Yoshii Y, Ochiai N: Simultaneous gradual lengthening of both proximal and distal nerve stumps for repair of peripheral nerve defect in rats. Muscle Nerve 38:14741480, 2008

    • Search Google Scholar
    • Export Citation
  • 56

    Sanders F: The repair of large gaps in the peripheral nerves. Brain 65:281337, 1942

  • 57

    Silver JR, Weiner MF: Nerve-stretching in the 19th century. J Med Biogr 24:537545, 2016

  • 58

    Stiles HJ, Forrester-Brown M: Treatment of Injuries of the Peripheral Spinal Nerves. London: H Frowde, Hodder & Stoughton, 1922

  • 59

    Sunderland IR, Brenner MJ, Singham J, Rickman SR, Hunter DA, Mackinnon SE: Effect of tension on nerve regeneration in rat sciatic nerve transection model. Ann Plast Surg 53:382387, 2004

    • Search Google Scholar
    • Export Citation
  • 60

    Sunderland S: The intraneural topography of the radial, median and ulnar nerves. Brain 68:243299, 1945

  • 61

    Sunderland S, Bradley K: Stress-strain phenomena in human peripheral nerve trunks. Brain 84:102119, 1961

  • 62

    Symington J: The physics of nerve-stretching. BMJ 1:770771, 1882

  • 63

    Toby EB, Hanesworth D: Ulnar nerve strains at the elbow. J Hand Surg Am 23:992997, 1998

  • 64

    Topp KS, Boyd BS: Structure and biomechanics of peripheral nerves: nerve responses to physical stresses and implications for physical therapist practice. Phys Ther 86:92109, 2006

    • Search Google Scholar
    • Export Citation
  • 65

    Trombetta F: Nerve-stretching. Lancet 1:250, 1882 (Letter)

  • 66

    von Nussbaum J: Blosslegung und Dehnung der Rückenmarksnerven. Eine erfolgreiche Operation. Deutsche Z Chir 1:450, 1872

  • 67

    Wall EJ, Massie JB, Kwan MK, Rydevik BL, Myers RR, Garfin SR: Experimental stretch neuropathy. Changes in nerve conduction under tension. J Bone Joint Surg Br 74:126129, 1992

    • Search Google Scholar
    • Export Citation
  • 68

    Wang Y, Ma M, Tang Q, Zhu L, Koleini M, Zou D: The effects of different tensile parameters for the neurodynamic mobilization technique on tricipital muscle wet weight and MuRf-1 expression in rabbits with sciatic nerve injury. J Neuroeng Rehabil 12:38, 2015

    • Search Google Scholar
    • Export Citation
  • 69

    Wright TW, Glowczewskie F Jr, Cowin D, Wheeler DL: Ulnar nerve excursion and strain at the elbow and wrist associated with upper extremity motion. J Hand Surg Am 26:655662, 2001

    • Search Google Scholar
    • Export Citation
  • 70

    Wright TW, Glowczewskie F, Wheeler D, Miller G, Cowin D: Excursion and strain of the median nerve. J Bone Joint Surg Am 78:18971903, 1996

    • Search Google Scholar
    • Export Citation
  • 71

    Yamada H: [Studies of electrophysiological and morphological changes in the rabbit sciatic nerve under various types of stretch and relaxation.] Nippon Seikeigeka Gakkai Zasshi 61:217231, 1987 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 72

    Ziemessen H: Cyclopædia of the Practice of Medicine. New York: W. Wood, 1879, Vol 19

Metrics

All Time Past Year Past 30 Days
Abstract Views 3541 1727 117
Full Text Views 320 128 11
PDF Downloads 291 142 17
EPUB Downloads 0 0 0