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Tissue pressure threshold for peripheral nerve viability.

R H Gelberman, R M Szabo, R V Williamson

    Clinical Orthopaedics and Related Research
    |September 1, 1983
    PubMed
    Summary
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    Peripheral nerve dysfunction occurs at a critical pressure threshold between 40 and 50 mm Hg. Complete nerve block happens at 50 mm Hg, indicating when compartment decompression may be necessary.

    Area of Science:

    • Neurology
    • Orthopedics
    • Biomedical Engineering

    Background:

    • Compression syndromes like carpal tunnel and compartment syndromes can lead to peripheral nerve dysfunction.
    • Understanding the precise pressure threshold for nerve injury is crucial for effective treatment and surgical intervention.

    Purpose of the Study:

    • To determine the pressure threshold at which peripheral nerve dysfunction occurs in compression syndromes.
    • To evaluate the efficacy of different tests in detecting nerve dysfunction under compression.

    Main Methods:

    • Normal volunteers underwent controlled elevation of carpal canal pressure to 40, 50, 60, and 70 mm Hg.
    • Median nerve motor and sensory responses were assessed during compression and recovery.
    • Tissue fluid pressure was measured using a wick catheter.

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    Main Results:

    • Some functional loss was observed at 40 mm Hg.
    • Complete motor and sensory block occurred at a threshold tissue fluid pressure of 50 mm Hg.
    • The Semmes-Weinstein monofilament and 256-cycle vibratory tests were more sensitive than two-point discrimination tests.

    Conclusions:

    • A critical pressure threshold exists between 40 and 50 mm Hg, where peripheral nerves are acutely jeopardized.
    • Compartment decompression may not be indicated if interstitial pressures remain below this critical threshold.