Nerve Injury Clinical Trial
Official title:
MRI Diffusion Tensor Tractography to Track and Monitor Peripheral Nerve Recovery After Severe Crush or Cut/Repair Nerve Injury
NCT number | NCT02960516 |
Other study ID # | 160761 |
Secondary ID | |
Status | Completed |
Phase | |
First received | |
Last updated | |
Start date | October 2016 |
Est. completion date | July 29, 2021 |
Verified date | June 2022 |
Source | Vanderbilt University Medical Center |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Observational |
It is estimated that up to 5% of all admissions to level one trauma centers have a peripheral nerve injury. These peripheral nerve injuries may have devastating impacts on quality of life and require months or years to regain function. Neurotmesis, or peripheral nerve transection, is a common injury, with singly cut nerve lacerations accounting for over 60% of the peripheral nerve surgical interventions in civilian studies. For recovery to occur in these patients, axons must grow from the site of repair to the target tissues, a length of up to a meter in humans. By that time, revisional surgery may not be a viable option due to the onset of irreversible muscle atrophy - a transected nerve is estimated to induce a loss of achievable function of approximately 1% for every 6 days of delay. The scenario is even worse for more proximal nerve injuries, such as those that occur in the brachial plexus. The investigators aim is to longitudinally assess diffusion tensor tractography (DTI) in order to optimize, validate, and translate the ability of DTI to monitor and, more importantly, predict nerve regrowth following trauma and surgical repair. The overall objective of this study is to evaluate the ability of (DTI) to monitor and, more importantly, predict nerve regrowth following crush or cut with surgical repair. The investigators hypothesize that the additional information available via DTI will improve our ability to monitor and predict nerve regrowth following surgical repair or severe crush injury, guiding clinical management either toward or away from surgical intervention.
Status | Completed |
Enrollment | 19 |
Est. completion date | July 29, 2021 |
Est. primary completion date | July 29, 2021 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years to 64 Years |
Eligibility | Inclusion Criteria: subjects between ages of 18 and 64 year of age diagnosed with a Sunderland Class V traumatic neuropathy (transection injury) of the upper extremity nerves that require repair - Candidates for immediate operative repair of this injury and do not have significant medical comorbidities precluding immediate operative intervention - willing to comply with all aspects of the treatment (post-operative visits, occupational therapy) and evaluation schedule over the following 12 months - have peripheral nerve injuries complicated by significant vascular or orthopedic damage Exclusion Criteria: - Injuries exhibit gross contamination - soft tissue coverage is inadequate - planned staged repair - have diabetes - have a neuromuscular disease - undergoing chemotherapy, radiation therapy or other treatments known to affect the growth of the neural and vascular system - unlikely to complete occupational therapy - pregnant or breast-feeding - subject with any ferromagnetic objects that cannot be removed (cardiac pacemakers, aneurysm clips etc). - history of claustrophobia |
Country | Name | City | State |
---|---|---|---|
United States | Vanderbilt University Medical Center | Nashville | Tennessee |
Lead Sponsor | Collaborator |
---|---|
Vanderbilt University | United States Department of Defense |
United States,
McAllister RM, Gilbert SE, Calder JS, Smith PJ. The epidemiology and management of upper limb peripheral nerve injuries in modern practice. J Hand Surg Br. 1996 Feb;21(1):4-13. doi: 10.1016/s0266-7681(96)80004-0. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Michigan Hand Questionnaire (MHQ) in TPNI Subjects Post Surgery | Michigan Hand Questionnaire assesses hand function and well being of patients with hand injuries.
It is divided into 6 scales: Overall hand function, scored in a range of 5-25; Activities of daily living, scored in a range of 5-25; Work, scored in a range of 5-25; Pain, scored in a range of 5-25; Aesthetics, scored in a range of 4-16; Satisfaction, scored in a range of 6-30. For the pain scale, higher scores indicate more pain. For the other 5 scales, higher scores indicate better hand performance. These raw scores are then converted to a range of 0-100 based on the following equations: Overall hand function: -(raw score-25)/20*100; Activities of daily living: -(raw score-25) 20*100; Work: (raw score-5)/20*100; Pain: If question 1=5, then pain score =0; if question 1?5,then -(raw score-25)/20*100; Aesthetics:(raw score-4)/16*100; Satisfaction: -(raw score-30)/24*100. For every patient, an overall MHQ score is obtained by summing the scores for all 6 scales and dividing by 6. |
1, 3, 4, 6, and 9 months post surgery | |
Primary | Grip Strength in Subjects With TPNI Post Surgery | The grip strength test is performed by having the participant squeeze as hard as possible on a tool known as dynamometer.
Grip strength findings were compared between injured and uninjured hands in subjects with TPNI at 3,4, and 6 months post surgery. However not all participants were assessed at all time points. |
1, 3, 4, and 6 months post surgery | |
Primary | 9 Hole Peg Test in Subjects With TPNI | The Nine Hole Peg Test is used to evaluate patients' fine hand control or dexterity. The total time required to insert nine pegs into nine holes is recorded. The lower the number, the faster the time, the better the performance.
9HPT findings were compared between injured and uninjured hand at 3,4, and 6 months post surgery in subjects with TPNI. However not all participants were assessed at all time points. |
1, 3, 4, and 6 months post surgery | |
Primary | Diffusion Tensor Imaging (DTI) Diffusivity Metrics Post Surgery | Subjects underwent DTI at different time points post surgery; and the metrics analyzed were: Mean Diffusivity (MD), Axial Diffusivity (AD), and Radial Diffusivity (RD).
Imaging was done to the "healthy" median nerve in controls, injured and healthy (median or ulnar) nerves in patients with TPNI, and compressed median nerve in patients with Carpal Tunnel Syndrome (CTS). Imaging was done at multiple timepoints post surgery. Subjects with TPNI underwent imaging at time points falling between 1 and 9 months post surgery. Subjects with CTS underwent imaging at time points falling between 1 and 24 months post surgery. The values were then averaged for each group, as presented below. |
Subjects with TPNI underwent imaging at time points falling between 1 and 9 months post surgery. Subjects with CTS underwent imaging at time points falling between 1 and 24 months post surgery. | |
Primary | Diffusion Tensor Imaging (DTI) Fractional Anisotropy (FA) Metric Post Surgery | Subjects underwent DTI at different time points post surgery and the metric Fractional anisotropy (FA) was analyzed. FA is a scalar value between 0-1 that describe anisotropy of a diffusion process. A value of zero means that diffusion is unrestricted (or equally restricted) in all directions. A value of one means that diffusion occurs only along one axis and is fully restricted along all other directions.
Imaging was done to the "healthy" median nerve in controls, injured and healthy (median or ulnar) nerves in patients with TPNI, and compressed median nerve in patients with Carpal Tunnel Syndrome (CTS). Imaging was done at multiple timepoints post surgery. |
Subjects with TPNI underwent imaging at time points falling between 1 and 9 months post surgery. Subjects with CTS underwent imaging at time points falling between 1 and 24 months post surgery. |
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