Properties of cutaneous mechanosensitive afferents during the early stages of regeneration in man.

The technique of percutaneous microneurography was used to record single unit activity from 75 regenerated primary afferents innervating the glabrous skin of the human hand. Thirteen patients were studied, who had suffered complete transection, with subsequent suture or graft, of the median or ulnar nerves. The recordings were obtained from 7 to 23 months postoperatively (early regeneration). Three types of mechanoreceptive afferents (RA, SAI, SAII) and many deep units of unknown origin were found. No regenerated PC units could be identified. The reinnervated receptors were predominantly located in the palm and proximal fingers, comparable to those found 3 years or more postoperatively (late regeneration). Response thresholds and in general, discharge and receptive field characteristics of the majority of afferents were largely comparable to late regeneration and normal. The properties of SAII units were like normal in all respects. However, several distinct abnormalities were encountered early during regeneration: multiple receptive fields innervated by a single afferent (2/9 RA and 2/9 SAI), unusually small or large receptive fields (RA and SAI), pronounced fatigue on repetitive stimulation (7/15 SAI, 4/6 deep). Responses of reinnervated skin to sustained and repeated indentations were found to be similar to those of normal skin, and therefore, could not account for the abnormal discharge behavior. It is suggested that the transitional properties of regenerating afferents reflect unstable axon-end organ connections and immature axonal properties. Both factors would contribute to the slow course of sensory recovery, making prognosis on tactile recovery unpredictable.