Intraneural haematoma with extrinsic compression:
experimental study in rats and therapeutic options
Authors: Gean Paulo Scopel, MD, Marcus Castro Ferreira, MD,
PhD, José Carlos Marques Faria, MD, Simone Cristina Orpheu,
MD, Helio R N Alves, MD, Julia Peres, MD, and Izumi Hayashi,
MD.
Introduction: An intraneural haematoma in median nerve at
carpal tunnel can result after trauma or in relation to
clotting disturbances. The decision for clinical observation
or descompressive surgical thecniques is still controversial.
The authors developed an experimental study in sciatic nerves
of rats to simulate a carpal tunnel and study the effects of
intraneural haematoma and to analyse the results of the
surgical treatment.
Materials and methods: Forty male rats Wistar were divided in
4 groups. The sciatic nerve were covered with a silastic
device, like the median nerve through the flexor retinaculum.
In the group A (CONTROL) the sciatic nerve was just covered
by the silastic. The same procedure was performed in group B,
with intraneural injection of 0,2 ml of autologous blood. In
group C , after haematoma we have removed the silastic device
and performed an epineurotomy. In group D, we just have
removed the silastic device after the haematoma.
Recovering of nerve function was analysed for 61 days by the
walking track and sciatic function index (SFI) of BainMackinnon-Hunter. The SFI varies from 0 to -100, and zero is
the normal function of nerve and -100 is total loss of
function.
At the end of the study we have performed a histological
assessment of the nerves in the middle point to compressive
site.
Results: Group A (control) presented function deficit of 21%
(SFI=-21) and returned to initial values at third post
operative day. Group B (haematoma and extrinsic compression)
exhibited the worst function (SFI= - 83) after surgery and
has recovered in 23 days. Group C (remove of silastic band
and epineurotomy) had 44% of function loss
(SFI = -44)
and it became normal at 5 th post operative day. Group D (just
remove of silastic device) presented SFI -26 and it was
recovered at fifth post operative day (Graphic 1).
Statistic data of SFI exhibited differences between expectant
option versus descompressives procedures (p<0,001).
Conclusion : The intraneural haematoma with extrinsic
compression provokes functional deficit with recovery of the
function in 23 days. Surgical treatment by the remove of the
compression presents fast functional recovery in 5 days.
Epineurotomy associated to descompressive surgery showed
functional gain in relation to conservative procedure and so
fast as extrinsic compression removal isolated.
SCIATIC FUNCTION INDEX (SFI)
0
Pre operative
-10
-20
GROUP A (Control)
-30
-40
GROUP B
-50
-60
-70
GROUP C
-80
-90
GROUP D
-100
1
3
5
7
11
15
19
23
27
31
46
61
dias
Graphic 1. Evolution of Sciatic Function Index (SFI) through the postoperative time.
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