2026 ASSH On Demand CME Webinar: Latest Advances in Nerve Surgery-Recording

Video Transcription

Video Summary

The webinar, moderated by Paige Fox and Dr. David Brogan, featured expert presentations on nerve-related topics, including neuropathic pain, imaging, spasticity, nerve transfers, coaptation techniques, and biologics in nerve recovery.<br /><br />Dr. Anna Luan from Stanford discussed neuropathic pain, categorizing it into compression neuropathy, symptomatic neuroma, phantom limb pain, and complex regional pain syndrome (CRPS). She emphasized the importance of distinguishing static versus dynamic nerve compressions using ultrasound, the surgical management of symptomatic neuromas (including excision and nerve transfer techniques like TMR and RPNI), and the role of diagnostic local anesthetic blocks in selecting surgical candidates. She noted that while surgery may not fully resolve pain, it often improves it.<br /><br />Dr. Samir Shah from UC San Diego presented on advanced ultrasound imaging for nerve injury, highlighting benefits of B-mode imaging and emerging quantitative techniques like elastography and spectral-based measures for assessing nerve structure and pathology. He advised that 5-10 MHz frequency ultrasound balances resolution and depth for upper limb nerves and encouraged standardized imaging protocols.<br /><br />Dr. Kitty Wu from Mayo Clinic outlined spasticity's neurological basis in reticulospinal tract injury, its clinical features, and differentiated spasticity from contractures. She described nerve-based surgical treatments (e.g., selective motor nerectomies) for spasticity and muscle/tendon lengthening procedures for contractures, advocating Botox as both diagnostic and therapeutic before surgery.<br /><br />Dr. Kyle Czepla discussed nerve transfers in tetraplegia, focusing on restoring elbow extension, hand opening, and closing. He detailed common transfers such as teres minor motor branch to triceps and supinator to PIN, stressing patient-specific, staged reconstructive approaches combined with functional electrical stimulation technologies to optimize outcomes.<br /><br />Dr. Sami Tufaha examined nerve coaptation optimization, balancing suture and fibrin glue use to ensure strength while minimizing inflammation, and shared innovative practices like autologous fascia nerve wraps. He challenged the dogma of strictly tension-free repair, advocating controlled tension with immobilization and gradual stretching to avoid grafts and improve regeneration.<br /><br />Finally, Dr. John Elifar from the University of Arizona reviewed biologics in nerve recovery, focusing on immunomodulatory drugs that enhance debris clearance by macrophages and Schwann cells, such as erythropoietin and 4-aminopyridine. He highlighted their role in improving remyelination and functional recovery after nerve injury and potential implications across tissue types.<br /><br />Overall, the webinar provided a comprehensive update on current concepts and innovative strategies in nerve pain management, diagnostic imaging, spasticity treatment, reconstructive surgery, and biologic therapies to enhance nerve regeneration and patient outcomes.

Keywords

neuropathic pain

nerve imaging

spasticity

nerve transfers

nerve coaptation

biologics in nerve recovery

ultrasound imaging

neuroma management

nerve compression

surgical nerve repair

functional electrical stimulation

immunomodulatory drugs

nerve regeneration