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Nerve conduction studies have been carried out pre- and postoperatively on 26 hands of patients with a carpal tunnel syndrome. When examined six to eight weeks postoperatively, there had been no significant change in conduction velocity or action potential amplitude in the fingers distal to the compression. Velocity had increased over the carpal tunnel segment. When the patients were seen between 12 and 18 weeks postoperatively, velocity and amplitude had increased in the fingers. The group with marked electrical abnormalities had improved more than the group in which digital amplitude was originally within the control range. The improvement occurred too early to be due to regeneration after relief of compression. It is suggested that either maturation of regenerating fibres was delayed by the compression or a reversible change had occurred in surviving fibres. [ABSTRACT FROM AUTHOR]

The case is described of a patient with a squamous cell carcinoma of the skin of a finger which spread in an unusual manner, caused median nerve compression at the wrist, and infiltrated the median nerve in the forearm. [ABSTRACT FROM AUTHOR]

Clinical and electrophysiological assessment of recovery of function are reported on 20 patients with median or ulnar nerve sections up to 53 months after surgical repair. Maximum improvement of sensory function was apparent by both methods of assessment at 15 months after suture, and thereafter conduction velocities in sensory fibres averaged 80% of normal in median nerves and 70% of normal in ulnar nerves. Similarly, the mean amplitude of the sensory action potential at the wrist remained depressed at 15% of control values. The clinical recovery of motor function pursued a similar time course with, however, some evidence to indicate a continuing improvement in the neurophysiological maturation of the motor nerve fibres up to 47 months after repair. The results are discussed in relation to previous electrophysiological studies on animals. [ABSTRACT FROM AUTHOR]

Describes a patient who complained of numbness in the right hand. Surgical procedure done to correct the patient's carpal tunnel syndrome; Patient's complaint of lethargy and hoarseness following the procedure.

In 129 patients the diagnosis was defined over periods from 1 month to 2 years following the damage of the nerves with the help of myopotentials evoked through stimulation of the nerves with batches (charges) of a built-up current of varying frequency lasting for 1 second. With the lability of the neuro-muscular system falling from 35 down to 10 pulses/sec, a reduced amplitude of periliminal peak potentials, post-tetanic after-potentials and in the absence of pessimal inhibition of up to 1000 pulses/sec the operative treatment is, as a rule, not indicated. Late after injury and with a low amplitude of evoked myopotentials, falling down to 5--26 mug, an amplitude transformation from 2 up to 10 pulses/sec, the absence of periliminal rising peak potentials and post-tetanic after-potentials (spikes) surgery is commonly indicated. The operative intervention is also indicated in the absence of all types of the evoked myopotentials when this is combined with other factors.

In hands in which the superficial flexors of the fingers and thenar muscles of opposition are denervated, usually as the result of high median-nerve or brachial plexus injury, thumb opposition can be restored by transfer of the superficial flexor of the ring finger to the thumb through a dynamic pulley made from the distal segment of flexor carpi ulnaris which is attached to the proximal segment of flexor carpi ulnaris to the transferred paralyzed superficial ring-finger flexor tendon. Of sixteen patients treated by this method, twelve had good or satisfactory results; one had a poor result; and three were lost to follow-up.

A case of iatrogenic dissecting aneurysm in the cubital region causing secondary damage to the median nerve is reported. This aneurysm was caused by an attempted venipuncture, in what can be considered a minor procedure. Such a severe complication is very remarkable, for it has not been observed so far even in much more potentially hazardous procedures as, for instance, in the numerous arterial punctures in the cubital region being daily performed for retrograde angiography of the cerebral vessels. In this case the reduced blood coagulation is discussed as a causing factor of this unusual complication.

Entrapment of the brachial artery within a compound dislocated elbow joint seems not to have been reported previously. Brachial artery rupture is the usual vascular injury associated with a compound elbow dislocation. A review of the surgical literature suggests that wide spectrum of disability may follow interruption of brachial artery flow at the elbow. While most patients experience no immediate or late ischemic symptoms because of the rich collateral network about the elbow, intermittent claudication or gangrene of the hand is possible and has been well-documented in the literature. To assure adequate circulation to the hand and prevent potential complications, reanastomosis or venous graft replacement of the damaged arterial segment is recommended at the time of traumatic disruption of the brachial artery.

Compression syndromes of the radial nerve arise, for example, through pressure in the axilla from crutches or from pressure of the arm against a hard support during sleep. The mechanism is similar in lesions of the median nerves (irritation of the supracondylar apophysis, pronator syndrome). Lesions of the ulnar nerve usually arise from damage to the olecranon groove such as can be caused in manual workers in industry through constant flexion and extension of forearm. As treatment, a change of workplace is often sufficient. Anatomical changes must be removed surgically.

Operative as well as electrophysiologic experience with 213 major nerve injuries over the last 8 years and primate experiments form the basis of this reappraisal. Those lesions in continuity resected (58 of 172) usually had no response to stimulation or nerve action potential (NAP) at 8 weeks or longer after injury but were not necessarily complete lesions on clinical examination or electromyography. Axonal organization and maturity were of such poor quality that functional regeneration would not have resulted. Despite preoperative evidence of an incomplete lesion, operative studies confirmed a complete lesion in 21 instances. In 103 lesions NAP's could be recorded and, where neurolysis was done, recovery was acceptable in 91 percent. Many of these lesions had appeared complete on preoperative evaluation. Nerves transected by glass and repaired primarily had superior electrical and functional recovery to those repaired secondarily, although variations in clinical settings prevented statistical analysis. Experimental work in 20 primates with glass-wounded nerves favored primary repair, for NAP, evoked muscle action potential, and strain gauge studies of muscle power were superior in 14. Lesions in continuity should have exploration delayed until 8 weeks so that physiologic decisions regarding need for resection and repair can be made. Transecting injuries should be explored primarily, those without contusinve element repaired immediately, and those with contusion repaired 3 weeks after injury.

The author reports a case of partial section of the median nerve treated by inlay graft performed under the microscope. He insists on the opportunities offered by microsurgery in the field of the peripheral nerve.