Erik T Walbeehm

HagaZiekenhuis van Den Haag

Background Treatment of nerve injuries proves to be a worldwide clinical challenge. Acellular nerve allografts are suggested to be a promising alternative for bridging a nerve gap to the current gold standard, an autologous nerve graft. Objective To systematically review the efficacy of the acellular nerve allograft, its difference from the gold s...

Background: Peripheral nerve injuries (PNI) are predominantly treated by anatomical repair or reconstruction with autologous nerve grafts or allografts. Motor nerve transfers for PNI in the upper extremity are well established; however, this technique is not yet widely used in the lower extremity. This literature review presents an overview of the...

Background The clinical results of conservative treatment options for ulnar compression at the elbow have not been clearly determined. The aim of this review was to evaluate available conservative treatment options and their effectiveness for ulnar nerve compression at the elbow. Methods In accordance with the Preferred Reporting Items for Systemat...

Background: Treatment of nerve injuries proves to be a worldwide clinical challenge. Acellular nerve allografts are suggested to be a promising alternative for bridging a nerve gap to the current gold standard, an autologous nerve graft. Objective: To systematically review the efficacy of the acellular nerve allograft, its difference from the gold...

Purpose Multiple studies report outcomes after 3-ligament tenodesis (3-LT) in treating traumatic scapholunate interosseous ligament injury (SLIL). However, investigators do not differentiate between patients with partial or complete SLIL injury. The relation between the extent of SLIL disruption and surgical outcomes and if this should be considere...

The median nerve can be compressed due to a tumor along the course of the median nerve, causing typical compression symptoms or even persistence or recurrence after an operation. The aim of this review is to provide a comprehensive overview of rare tumors described in recent publications that cause median nerve compression and to evaluate treatment...

Objective This study aimed to compare primary and revision carpal tunnel release outcomes in all patients with carpal tunnel syndrome and when corrected for baseline severity and demographics. Methods A total of 903 hands of primary and 132 hands of revision patients underwent carpal tunnel release and patients completed online questionnaires on d...

Purpose Although A1 pulley release is an effective treatment to reduce pain and improve hand function, complications may occur. More insight into risk factors for complications is essential to improve patient counseling and potentially target modifiable risk factors. This study aimed to identify factors associated with complications following A1 pu...

Background: Refracture after both bone forearm fracture fixation may vary with or without plate removal. We tested the null hypothesis that there is no difference in the rate of refracture in patients who have undergone open reduction and internal fixation of a diaphyseal forearm bone who have retained implants versus removed implants. We also stu...

Purpose To evaluate the patient-reported outcome measures of patients with primary cubital tunnel syndrome and to assess whether they are affected by preoperative symptom severity. Methods Patients who underwent simple decompression for primary cubital tunnel syndrome were selected from a prospectively maintained database. Outcome measurements con...

Background: Ulna shortening osteotomy (USO) for ulnar impaction syndrome (UIS) aims to improve pain and function by unloading the ulnar carpus. Previous studies often lack validated patient-reported outcomes or have small sample sizes. The primary objective of this study was to investigate patient-reported pain and hand function at 12 months after...

Background Treatment of nerve injuries proves to be a worldwide clinical challenge. Vascularized nerve grafts are suggested to be a promising alternative for bridging a nerve gap to the current gold standard, an autologous non-vascularized nerve graft. However, there is no adequate clinical evidence for the beneficial effect of vascularized nerve g...

Purpose Although multiple factors influencing return to work after a carpal tunnel release (CTR) have been identified, little is known about the influence of psychological patient factors on return to work. Therefore, this study aimed to identify the psychological factors that play a role in the return to work after a CTR surgery. Methods Patients...

Purpose Patients with triangular fibrocartilage complex (TFCC) injury report ulnar-sided wrist pain and impaired function. Open TFCC repair aims to improve the condition of these patients. Patients have shown reduction in pain and improvement in function at 12 months after surgery; however, results are highly variable. The purpose of this study was...

Background Treatment of nerve injuries proves to be a worldwide clinical challenge. Vascularized nerve grafts are suggested to be a promising alternative for bridging a nerve gap to the current gold standard, an autologous non-vascularized nerve graft. However, there is no adequate clinical evidence for the beneficial effect of vascularized nerve g...

We performed a systematic review on the success of different surgical techniques for the management of recurrent and persistent carpal tunnel syndrome. Twenty studies met the inclusion criteria and were grouped by the type of revision carpal tunnel release, which were simple open release, open release with flap coverage or open release with implant...

Objective: The median nerve can become compressed at multiple points in the arm, causing carpal tunnel-, pronator-, anterior interosseous-, or lacertus syndrome. Anatomical variations are potential reasons of persisting or recurrent symptoms of median nerve compression and are often recognized late. The objective of this study is to provide a comp...

Background: Depression and pain catastrophizing are aspects of the patient's mindset that have been shown to be important in relation to the outcome of carpal tunnel release. However, other factors of the patient's mindset have been understudied, such as treatment expectations and illness perceptions. The aim of the present study was to investigat...

Purpose: Previous studies indicate that patients with a more negative perception of their illness tend to respond less favorably to treatment, but little is known about whether illness perceptions differ based on the type of hand or wrist conditions. Therefore, we compared illness perceptions between patients scheduled to undergo surgery for 4 ill...

Carpal tunnel syndrome (CTS) is the most frequently operated neurological disorder of the hand. Incidence of patients remaining symptomatic has been reported up to 30% after primary release. Revision surgery remains challenging although multiple surgical options have been described. In this case series a simple novel technique, the palmaris longus...

Objective: To examine the influence of illness perceptions, pain catastrophizing and psychological distress on self-reported symptom severity and functional status in patients diagnosed with carpal tunnel syndrome (CTS). Methods: A total of 674 patients with CTS scheduled for surgery at an outpatient treatment center for hand and wrist condition...

Introduction: The British Orthopedic Association (BOA) and British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) updated the evidence-based guidelines for the treatment and care of open lower limb fractures (BOAST 4). Following this, a Dutch version has been developed. The main points are multidisciplinary care, planning,...

OBJECTIVE The aim of this study was to evaluate the self-reported outcome of revision surgery in patients with recurrent and persistent carpal tunnel syndrome (CTS) and to identify predictors of clinical outcome of revision surgery. METHODS A total of 114 hands in 112 patients were surgically treated for recurrent and persistent CTS in one of 10 s...

Introduction: Laxity in the trapeziometacarpal (TMC) joint is a debilitating condition usually affecting a young population. It can be treated operatively with ligament reconstruction. The purpose of this study was to determine the effectiveness of the Arthrex Mini TightRope® in reinforcing the stabilizing ligaments in an unstable TMC joint withou...

OBJECTIVE The clinical results of reoperation for recurrent or persistent ulnar nerve compression at the elbow have not been clearly determined. The aim of this review was to determine overall improvement, residual pain, and sensory and motor deficits following reoperation regardless of the type of primary surgery performed for this condition. MET...

Introduction: The Robert Mathys (RM) Finger is a hinged type of arthroplasty for the metacarpophalangeal and proximal interphalangeal (PIP) joint that compensates ligament instability. The aim of this study is to evaluate the outcomes and complications of RM Finger arthroplasty of the PIP joint. Materials and methods: A retrospective case series...

Purpose: Surgical costs are under scrutiny and surgeons are being held increasingly responsible for cost containment. In some instances, implants are the largest component of total procedure cost, yet previous studies reveal that surgeons' knowledge of implant prices is poor. Our study aims to (1) understand drivers behind implant selection and (2...

The skin's rewarming rate of diabetic patients is used as a diagnostic tool for early diagnosis of diabetic neuropathy. At present, the relationship between microvascular changes in the skin and diabetic neuropathy is unclear in streptozotocin (STZ) diabetic rats. The aim of this study was to investigate whether the skin rewarming rate in diabetic...

Skin innervation is a dynamic process that may lead to changes in nerve fiber density during pathological conditions. We have investigated changes in epidermal nerve fiber density in three different rat models that selectively produce either chronic itch (dry skin model) or itch and inflammation (dermatitis model) or chronic inflammation without it...

Mirror-image pain is a phenomenon in which unprovoked pain is detected on the uninjured contralateral side after unilateral nerve injury. Although it has been implicated that enhanced production of nerve growth factor (NGF) in the contralateral dorsal root ganglion is important in the development of mirror-image pain, it is not known if this is rel...

Object: Peripheral nerve injuries are a commonly encountered clinical problem and often result in long-term functional deficits. The current gold standard for transected nerves is an end-to-end reconstruction, which results in the intermittent appearance of neuropathic pain. Methods: To improve our understanding of the relation between this type...

A chronic ulcerating wound may turn malignant. The term 'Marjolin ulcer' is used to describe any skin malignancy which develops in an area of chronic ulceration, irritation or inflammation. It is generally a squamous cell carcinoma. A 66-year-old woman was admitted urgently due to pain and signs of infection in wounds on her back which she had had...

The superficial branch of the radial nerve (SBRN) is known for developing neuropathic pain syndromes after trauma. These pain syndromes can be hard to treat due to the involvement of other nerves in the forearm. When a nerve is cut, the Schwann cells, and also other cells in the distal segment of the transected nerve, produce the nerve growth facto...

Patients with the hypermobility type of Ehlers-Danlos (EDS-HT) often complain of wrist pain, usually originating from subluxations. As a result of the laxity, wrist function in these patients can be highly limited. This paper presents a surgical technique that stabilizes the lunocapitate joint with the use of an extensor carpi radialis brevis strip...

Purpose: To address the null hypothesis that surgeons shown radiographs of little finger metacarpal neck fractures with measured fracture angulation would recommend surgery as often as surgeons shown unmarked radiographs. Methods: Members of the Science of Variation Group, an international collaboration of fully trained orthopedic and trauma sur...

Although numerous studies investigate sensory regeneration and reinnervation of the hind paw of the rat after nerve damage, no comprehensive overview of its normal innervation is present in literature. The Evans Blue extravasation technique is a well-known technique to study patterns of skin innervation. This technique has been performed differentl...

In emergency medicine, damage to the superficial branch of the radial nerve (SBRN) is often seen in patients with distal radius fractures. Knowledge of the complex SBRN anatomy is paramount in recognizing nerve damage after distal radius fractures, or in preventing iatrogenic damage during surgical reconstruction. The SBRN is also known for its inv...

Conditioned pain modulation (CPM) is a phenomenon of 'pain inhibiting pain' that is important for understanding idiopathic pain syndromes. Because the pathophysiology of posttraumatic cold intolerance is still unknown but it could involve similar mechanisms as idiopathic pain syndromes, we evaluated the functioning of the CPM system in patients wit...

In an attempt to provide minimally invasive treatment for Dupuytren's disease, percutaneous disruption of the affected tissue followed by lipografting is being trialled. Contractile myofibroblasts drive this fibroproliferative disorder whereas stem cells have recently been implicated in preventing fibrosis. Therefore, we tested the role of stem cel...

Health-care costs associated with pressure sores are significant and their financial burden is likely to increase even further. The aim of this study was to analyse the direct medical costs of hospital care for surgical treatment of pressure sores stage III and IV. We performed a retrospective chart study of patients who were surgically treated for...

The effect of core suture geometry on the mechanical interaction with the epitenon suture in terms of gap prevention, failure strength and mode of failure was investigated in a flexor tendon repair model. A total of 48 porcine flexor tendons were repaired using three techniques with distinct core suture geometry: single Kessler; double Kessler; and...

Purpose: Cold-induced vasodilatation (CIVD) is a cyclic regulation of blood flow during prolonged cooling of protruding body parts. It is generally considered to be a protective mechanism against local cold injuries and cold intolerance after peripheral nerve injury. The aim of this study was to determine the role of the sympathetic system in init...

Background: Tendon transfers are essential for reconstruction of hand function in tetraplegic patients. To transfer the extensor carpi radialis longus (ECRL), the extensor carpi radialis brevis (ECRB) has to be sufficiently strong. However, there is currently no reliable clinical test to individually analyse both muscles. In order to develop a rel...

One of the sensory complications of traumatic peripheral nerve injury is thermal intolerance, which manifests in humans mainly as cold intolerance. It has a major effect on the quality of life and adequate therapy is not yet available. In order to better understand the pathophysiological background of thermal intolerance, we will focus first on the...

Object: The gold standard for reconstructing large nerve defects, the nerve autograft, results in donor-site morbidity. This detrimental consequence drives the search for alternatives. We used a vein filled with a small piece of fresh muscle to prevent the vein from collapsing and with bone marrow stromal cells (BMSCs) to enhance regeneration. Me...

The epidermis is innervated by fine nerve endings that are important in mediating nociceptive stimuli. However, their precise role in neuropathic pain is still controversial. Here, we have studied the role of epidermal peptidergic nociceptive fibers that are located adjacent to injured fibers in a rat model of neuropathic pain. Using the Spared Ner...

Introduction Cold intolerance remains an unresolved condition with variable symptoms. Quantitative Sensory testing is a valid and quantitative technique that allows for direct interpretation of the behavior of the different types of small ending nerve fibers and may elucidate changes in these nerve endings in cold intolerance. Methods Fifteen...

Cold intolerance is defined as pain after exposure to non-painful cold. It is suggested that cold intolerance may be related to dysfunctional thermoregulation in upper extremity nerve injury patients. The purpose of this study was to examine if the re-warming of a rat hind paw is altered in different peripheral nerve injury models and if these patt...

The purpose of this study was to compare the biomechanical properties of a novel wrap around tendon repair method with those of the standard Pulvertaft technique used for tendon reconstructions. Seventy-two porcine extensor tendons were used to create 36 reconstructions in six sets of six repairs, each using one of the two surgical techniques with...

Introduction The aim of nerve repair is to encourage the axons to reach the distal side of the lesion and to re-innervate the end organ after trauma. The primary choice of treatment for peripheral nerve laceration is end-to-end repair. However, if the nerve defect is too large for primary repair, a graft is required to bridge the defect. We inve...

Purpose Peripheral nerve fibers involved in nociception are small thinly myelinated (A-delta) and unmyelinated (C) fibers, containing several neuropeptides such as calcitonin gene-related peptide (CGRP), substance P (SP), and Isolectin-4 (IB4). These fibres are located in the outermost layer of the skin, epidermis. They are important for interpreta...

For innervated functional muscle transplant procedures, it is essential to have knowledge about the length of nerve pedicles available for nerve anastomosis. For the latissimus dorsi muscle, the thoracodorsal nerve divides into two funicles that separately innervate the medial and lateral portions of the muscle. This suggests the possibility of a m...

The use of ultrasound-guided electrode positioning in near-nerve myography was investigated. This is a minimally invasive technique that allows repeated measurements to increase accuracy and hence decreases animal numbers. Ultrasound imaging of the sciatic nerve was performed in nine rats using a 55 MHz high-end transducer. Once visualised, a monop...

Cold induced vasoconstriction (CIVC) is a way for mammals to reduce heat loss in an effort to maintain body core temperature. As blood flow to a cooled extremity is reduced, the amount of body heat lost at the cooled location is minimised. However, when the extremity temperature gets below a certain threshold, Cold induced vasodilatation (CIVD) occ...

The issue of 3 July discussed the problems with locums,1 2 but the question remains, Why is the locum system still alive?Locums used to be a way to advance your career, but since Calman they should have become obsolete. With the current fixed rotations, it should be …

It is difficult for surgical departments around Europe to abide by working time directives, but a solution has not been to bring in unknown locum doctors to fill the gaps.1 Judging surgical capabilities …

Repairs have been performed on porcine flexor tendons and subjected to tensile stress measurements to determine the effects and mechanism of core suture purchase (the length of the suture bite). Eighty-four pig trotter flexor profundus tendons were divided and repaired using four lengths of core suture purchase (1.33, 1, 0.66 and 0.33 cm) using a d...

Ultrasound-guided near-nerve neurography is a new tool that can be used to assess nerve regeneration before reinnervation occurs. In this study, ultrasound-guided near-nerve measurements were validated against axon diameter counts in rabbits during a 15-week regeneration period after a crush lesion of their peroneal nerve. The course of the nerve w...

The effects of core suture geometry on the mechanics of failure in flexor tendon surgery are investigated. Forty porcine flexor tendons were repaired using a Kessler; a Kessler-Pennington; a double Kessler; a continuous Kessler; and a cruciate repair. At maximum breaking strength, the cruciate repair gapped more then the double Kessler (12.8 mm vs...

For early assessment of axonal outgrowth after trauma, the nerve is surgically exposed to enable compound nerve action potential (CNAP) recordings across the lesion site. Near-nerve neurography, with needle electrodes placed transcutaneously near the nerve, could be a minimally invasive alternative if the needle placement procedure and low reproduc...

For early assessment of axonal outgrowth after trauma, the nerve is surgically exposed to enable compound nerve action potential (CNAP) recordings across the lesion site. Near-nerve neurography, with needle electrodes placed transcutaneously near the nerve, could be a minimally invasive alternative if the needle placement procedure and low reproduc...

Ultrasound imaging of peripheral nerves is increasingly used in the clinic for a wide range of applications. Although yet unapplied for experimental neuroscience, it also has potential value in this research area. This study explores the feasibility, possibilities and limitations of this technique in rabbits, with special focus on peripheral nerve...

The mechanical architecture of rat sciatic nerve has been described as a central core surrounded by a sheath, although the way in which these structures contribute to the overall mechanical properties of the nerve is unknown. We have studied the retraction responses of the core and sheath following transection, together with their tensile propertie...

The mechanical architecture of rat sciatic nerve has been described as a central core surrounded by a sheath,although the way in which these structures contribute to the overall mechanical properties of the nerve is unknown. We have studied the retraction responses of the core and sheath following transection, together with their tensile properties...

Mice homozygous for the autosomal recessive mutation claw paw (clp) are characterized by limb posture abnormalities and congenital hypomyelination, with delayed onset of myelination of the peripheral nervous system but not the central nervous system. Although this combination of limb and peripheral nerve abnormalities in clp/clp mice might suggest...

Biomechanical properties of nerve have been studied extensively. All neural matrix tissues have been suggested to be the main load-bearing component. Based on the ultrastructure it has been proposed that the architecture of the epineurium allows some degree of extensibility of the nerve. A role of the perineurium could be to withstand the positive...

The peripheral nervous system is designed to connect the orchestrations of brain and spinal cord to the rest of the body. In addition, it connects the outside world and that same brain, gathering information from numerous sensory organs in our skin and from our other “senses”. Injury to a nerve subsequently results in impairment of function as well...

In the evaluation of nerve regeneration using magneto-neurography (MNG), the proximal segment showed a reproducible decrease in peak-peak amplitude of the nerve compound action current's (NCAC) of 60%. To explain these changes, morphometry of myelinated axons in the proximal segment is compared to the MNG signals. A standardised nerve transection a...

Magnetoneurography (MNG) is a technique to record the biomagnetic action fields of peripheral nerves. The benefits of MNG in contrast to electroneurography include the decreased signal disturbance caused by surrounding biological tissues and the use of a calibration pulse, both of which contribute to high reproducibility. MNG has proven to be a val...

The POU domain transcription factor Oct-6 is a major regulator of Schwann cell differentiation and myelination. During nerve development and regeneration, expression of Oct-6 is under the control of axonal signals. Identification of the cis-acting elements necessary for Oct-6 gene regulation is an important step in deciphering the complex signallin...

The average axon diameter in the proximal segment of a transected and reconstructed peripheral nerve will decrease shortly after the transection and increase again when the regenerating axons make contact with their targets. The magnetically recorded nerve compound action current (NCAC) amplitude and the conduction velocity (CV) are directly relate...

The average axon diameter in the proximal segment of a transected and reconstructed peripheral nerve will decrease shortly after the transection and increase again when the regenerating axons make contact with their targets. The magnetically recorded nerve compound action current (NCAC) amplitude and the conduction velocity (CV) are directly relate...

In the carpal tunnel anatomical interconnections between the tendons of the musculus flexor digitorum profundus are systematically present. These interconnections limit the mutual tendon displacements, which decreases finger independence and may be problematic in a musician's hand. The present study investigates a possible role of the synovial shea...

The mechanical interactions of tendon loading and motion between FDS and FDP tendons and the distal edge of the A2-pulley (DEA2) were investigated in cadaveric hands. The FDP tendon showed a two-stranded contrarotational spiral of tendon fibres, their course parallel to the FDS fibres. On loading, the FDP tendon changed cross-sectional shape and th...