Electrodiagnosis in cancer treatment and rehabilitation.

As cancer patients are living longer and the number of cancer survivors increases, more secondary complications related to cancer and its treatments are being recognized. A large number of neuromuscular processes, stemming from cancer itself, from secondary metabolic effects, from paraneoplastic syndromes, from preexisting conditions, or from adverse effects related to cancer treatments, can affect the peripheral nervous system at any level. Electrodiagnostic tools such as nerve conduction studies and needle electromyography are uniquely suited to assess the function of the peripheral nervous system and are valuable tools in confirming and defining neuromuscular dysfunction and in helping guide oncologic and physiatric treatment and prognosis for the cancer rehabilitation patient.

Neuromas of the hand and upper extremity.

The painful neuroma is an often debilitating sequela of nerve injury about the hand. The exact pathophysiology of this condition is poorly understood. After sharp trauma to a peripheral nerve, as nerve ends try to connect with their end organs and "find" the distal nerve stump, fascicular escape and scarring can lead to the development of a painful neuroma. Painful neuromas can even be associated with blunt trauma or retraction of a nerve when the nerve is not actually divided. Green's definition of a neuroma is "the inevitable, unavoidable, and biologic response of the proximal stump after it has been divided in situations where regenerating axons are impeded from re-entering the distal stump."(1) A number of unknown factors make certain patients more susceptible to neuroma formation. In addition, certain nerves such as the superficial radial nerve are more prone to the development of a painful neuroma. Treatment of neuromas of the hand is important because they can be quite debilitating and painful, often preventing patients from continuing with their normal daily activities. There are a number of approaches to the painful neuroma, and the treatment plan must be tailored to the individual patient.

Treatment of superficial and deep peroneal neuromas by resection and translocation of the nerves into the anterolateral compartment.

An approach to the treatment of dorsal foot pain of neuroma origin is described based upon principals demonstrated to be effective in the treatment of upper extremity dorsoradial neuromas: translocation of the appropriate nerves into a muscle environment away from the joint. In the lower extremity, this requires identification of the appropriate nerves by anesthetic block, resection of the dorsal foot neuroma(s), and translocation of the nerves into the muscles of the anterolateral compartment. This approach yielded excellent results in 9 of the 11 patients with a mean follow-up of 29 months.

Effect of pronation and supination orthosis on Morton's neuroma and lower extremity function.

Twenty-three adult patients with Morton's neuroma of one foot were randomized to receive in-shoe orthoses made from a hard, compressed, felt material that would either pronate or supinate both feet. The response of the neuroma pain was measured using subjective visual analogue scales, an objective examination, and the MACTAR patient-specific measure of maximal function. The development of any other lower limb symptoms was also recorded. The pain associated with Morton's neuroma was not significantly altered by changing the position of the foot with the compressed felt orthosis. Forcibly pronating the foot did not produce a significant incidence of lower limb symptoms in the short term.

[Total removal of acoustic neurinoma]. / O total'nom udalenii nevrinom slukhovogo nerva

The analysis is based on the results of a total removal of acoustic neurinomas in 120 patients operated on in 1967-1975. The facial nerve was preserved after surgery in 65 patients (54.2%). In the course of the recent 3 years the employment of microsurgical techniques permitted to preserve the VII nerve in 26 among 35 operated patients (74.3%). Among 103 examined postoperatively 96 retained their full or partial capacity for work (93.2%). Ten patients (8.3%) died after surgery. Within the recent 3 years 35 patients were operated on without a single mortality case.