Floor plan - 2013 Annual Meeting - American Association for Hand ...

Reversal of Distal Symmetric Polyneuropathy by Microsurgical Decompression of Localized
Nerve Entrapments
Institution where the work was prepared: International Neuropathy Microsurgery Institute, Sonora, CA, USA
Michael Charles Edwards, MD/PhD; Joseph Paul Day, PhD; International Neuropathy Microsurgery Institute
BACKGROUND:
Current medical guidelines recommend non-surgical care of distal symmetric polyneuropathy (Chaudhry, Stevens et al. 2006). We
hypothesize that intra-operative electromyography to identify localized nerve entrapments will validate nerve decompression surgery
(Dellon 2006; Dyck 2007). The increasing population of neuropathy patients need effective treatments (Papanas, Maltezos et al. 2006).
Lost productivity costs the United States $61 billion annually (Henig, Ephron et al. 2007).
METHODS:
Our 1.5 year study integrated intra-operative electromyography with standard nerve decompression techniques of the lower extremity
treating a wide population of patients with well defined distal symmetric polyneuropathy (England, Gronseth et al. 2005). Placebo surgeries
were considered unethical with 17 years of empirical data (Chaudhry, Stevens et al. 2006) (Siemionow, Alghoul et al. 2006). Nerve
entrapments were objectively identified; in contrast to human studies and on-going clinical application (Dellon 2006; Dyck 2007).
RESULTS:
Distal symmetric polyneuropathy was reversed by nerve decompression surgery at the tarsal tunnel, fibular tunnel, and pedal dorsum.
Intra-operative electromyography objectively identified local entrapments. 433 lower extremity muscle groups in 111 patients were tested
intra-operatively. High post nerve decompression increase in motor unit action potential correlated with an improved post-operative
sensibility (P