The most common and destructive form of clinical peripheral nerve injury is due to rapid-stretch trauma, such as that experienced in motor vehicle collisions, blasts, falls, and even the trauma of birth. Neuroma-in-continuity (NIC) is a pathophysiological outcome frequently associated with these traumatic injuries, and is hallmarked by frustrated axonal regeneration paired with profuse collagen deposition. Functional outcomes are meager at best while persistent pain often prevents complete engagement in therapy and tertiary dangers of opioid dependence/addiction. Collectively, patient quality of life is severely compromised and at significant societal cost as the young patient demographic is deprived many years of fruitful contribution.
Traditional research models of crush, transection, and compression injuries have been utilized to investigate the key components in successful nerve regeneration. However, they fail to produce the unique and severe clinical pathophysiology from stretch injuries, and further demonstrate recoverable functional outcomes.
To address this translational lapse from bench to clinic, we aim to:
- Develop a laboratory model which recapitulates the most common form of devastating peripheral nerve injury encountered in clinic: rapid-stretch.
- Elucidate the tissue properties of nerves subject to rapid-stretch injury and determine biomechanical thresholds for nerve stretch compliancy.
- Correlate biomechanical injury grades to neurologic and pathologic outcomes. Does our laboratory model recapitulate functional deficits and neuroma development encountered in clinic?
- Elucidate the persistent inflammatory species of the neuroma and determine mechanisms which drive frustrated as opposed to successful regeneration.
It is lamentable that there remain such inferior outcomes following rapid-stretch nerve injury when regeneration and recovery is possible—it has simply failed to be examined in depth. Accomplishing these aims will establish treatment options to improve functional outcomes for patients and diminish excruciating pain---thus facilitating a return to normal activities and surmounting an otherwise devastating injury.