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Forced elbow flexion and pressure during bicycling result in ulnar nerve traction and pressure exerted in Guyon's canal or the nerve's distal branches. The compression of the nerves causes a change in their stiffness related to edema and eventually gradual fibrosis. This study aimed to evaluate the elastography of terminal branches of the ulnar nerve in cyclists. Cross-sectional study. Thirty cyclists, 32 healthy individuals, and 32 volunteers with ulnar nerve entrapment neuropathies participated in the study. Each participant underwent a nerve examination of the cubital tunnel, Guyon's canal and the deep and superficial branches of the ulnar nerve using shear wave elastography. The cyclist group was tested before and after a 2-hour-long workout. Before cycling workouts, the ulnar nerve stiffness in the cubital tunnel and Guyon's canal remained below pathological estimates. Cycling workouts altered nerve stiffness in the cubital tunnel only. Notably, the stiffness of the ulnar terminal branches in cyclists was increased even before training. The mean deep branch stiffness was 50.85 ± 7.60 kPa versus 20.43 ± 5.95 kPa (p < 0.001) in the cyclist and healthy groups, respectively, and the mean superficial branch stiffness was 44 ± 12.45 kPa versus 24.55 ± 8.05 kPa (p < 0.001), respectively. Cycling contributed to a further shift in all observed values. These observations indicate the existence of persistent anatomical changes in the distal ulnar branches in resting cyclists that result in increased stiffness of these nerves. The severity of these changes remains, however, to be determined. These data show elastography values of the ulnar terminal branches in healthy individuals and cyclists where despite lack of clinical symptoms that they seem to be elevated twice above the healthy range. • Elastography of the ulnar nerve terminal branches. • A group of 30 cyclists compared to 32 healthy and 32 nerve entrapment volunteers. • Resting stiffness of the ulnar nerve distal branches had twice the increased value. • Cycling inducing a further increase in stiffness and confirms its irritating effect. • Presented range of normal and strongly increased values may be useful for clinicians. [ABSTRACT FROM AUTHOR]

Purpose The posterior interosseous nerve (PIN) is closely related to the proximal radius, and it is at risk when approaching the proximal forearm from the ventral and lateral side. This anatomic study analyzes the location of the PIN in relation to the proximal radius depending on forearm rotation by means of a novel investigation design. The purpose of this study is to define landmarks to locate the PIN intraoperatively in order to avoid neurological complications. Methods We dissected six upper extremities of fresh-frozen cadaveric specimens. The mean donor age at the time of death was 81.2 years. The PIN was dissected and marked on its course along the proximal forearm with a 0.3-mm flexible radiopaque thread. Three-dimensional (3D) X-ray scans were performed, and the location of the nerve was analyzed in neutral rotation, supination, and pronation. Results In the coronal view, the PIN crosses the radial neck/shaft at a mean of 33.4 (±5.9) mm below the radial head surface (RHS) in pronation and 16.9 (±5.0) mm in supination. It crosses 4.9 (±2.2) mm distal of the most prominent point of the radial tuberosity (RT) in pronation and 9.6 (±5.2) mm proximal in supination. In the sagittal view, the PIN crosses the proximal radius 61.8 (±2.9) mm below the RHS in pronation and 41.1 (±3.6) mm in supination. The nerve crosses 29.2 (±6.2) mm distal of the RT in pronation and 11.0 (±2.8) mm in supination. Conclusion With this novel design, the RT could be defined as a useful landmark for intraoperative orientation. On a ventral approach, the PIN courses 10 mm proximal of it in supination and 5 mm distal of it in pronation. Laterally, pronation increases the distance of the PIN to the RT to approximately 3 cm. [ABSTRACT FROM AUTHOR]

In order to achieve a satisfactory functional and aesthetic result a thin skin flap is often required in surgical reconstruction of various body regions. Perforator flaps based on either the superficial or deep branch of the superficial circumflex iliac artery (SCIA) have been used for this purpose mainly in the Asian population. Recently the superficial plane has been established as a new way of elevating the flap. Anatomical studies and details of this new flap are lacking. Wide areas were harvested subfascially from the groin of Thiel-fixated cadavers. Both deep and superficial branches of the superficial circumflex iliac artery were carefully dissected and individually injected with μAngiofil. After CT-imaging the flaps were raised on the superficial plane, perforators were marked and the flaps subsequently rescanned. High-resolution images of regions of interest were taken using micro-CT. A total of 21 flaps were harvested and analyzed. Both the deep and superficial branch provided more than three perforators per branch, however, the deep branch based flap was significantly larger (202 vs. 112 cm2, p < 0.01) and had a longer pedicle (9.1 vs. 6.6 cm, p < 0.01). Raising the flap in the superficial plane reliably reduces bulk and increases homogeneity. The SCIP flap appears to have a reliable vascular blood supply. The SCIA and its main branches and perforators have a consistent vascular pattern. The deep branch of the SCIA has the anatomic potential to be the preferred pedicle in case larger flaps with longer pedicles are necessary. [ABSTRACT FROM AUTHOR]