In-vivo imaging of sarcomere response to peripheral nerve injury

The majority of upper extremity nerve injuries are from blunt trauma and result in lesions-in-continuity. These lesions are particularly difficult to predict whether nerve recovery will occur and to what degree before irreversible atrophy of the muscle occurs. Changes in the muscle architecture and function dictate the timeline of surgery, but the ability to evaluate this muscular change in vivo does not currently exist. Our study is a prospective clinical study to evaluate changes in muscle architecture and contractile dynamics in response to nerve injury utilizing a new technology, the ‘Zebrascope’ SHG microendoscope system (Zebra Medical Technologies, Mountain View, CA). This new technology will give us the ability to evaluate these muscular changes over time in a minimally invasive fashion and correlate them with current standard practice electromyography (EMG) findings. We believe the Zebrascope can be used as an adjunct to EMG to guide surgical planning, helping surgeons decide if they should proceed with nerve surgery or continue to await nerve recovery. Our ultimate goal for this technology is to answer the following question: If surgeons can get the nerve input to the muscle, is the muscle capable of responding, and how do differences in surgical technique alter this response? The aim of this study is to obtain pilot data on the evolution of architectural and dynamic muscular changes at the sarcomere level for one year after peripheral nerve injury.