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Our purpose was to review the clinical usefulness of the scratch collapse test (SCT) in the diagnosis of proximal entrapment of the median nerve in the forearm. Eighteen consecutive cases were reviewed. The diagnosis was based on the patient’s symptoms and signs. The SCT was positive in the affected forearm in all clinical assessments before surgery and it was negative in all after median nerve release. An anatomical reason for nerve compression was identified in all cases at operation. The SCT is a useful tool for the diagnosis of the proximal entrapment of the median nerve. Level of evidence: IV

Background: Management and indications for surgery in the tetraplegic patient are highly complex because of the substantial functional deficits that they present and their effect on their daily activity. Our purpose was to evaluate the functional outcome in tetraplegic patients who underwent biceps-to-triceps transfer surgery according to Zancolli’s modified technique. Methods: This is a retrospective study of 6 biceps-to-triceps transfers using Zancolli’s modified technique in 4 patients. Mean follow-up was 45 months. We evaluated each patient’s DASH (Disabilities of the Arm, Shoulder and Hand) score before surgery and 12 months later. Results: In the 6 arms that underwent surgery, full and active elbow extension against gravity at 12 months after surgery was achieved. The mean DASH score was 73.2 preoperatively and 20.8 twelve months postoperatively. One complication occurred. One patient reported loss of elbow flexion preventing thigh lift for transfers. This was resolved with a program of rehabilitation and specific muscle strengthening Conclusions: Zancolli’s modified technique is simple and effective, with few complications, whereby we can provide more autonomy for the tetraplegic patient.

Background: The anterior interosseous nerve (AIN) is a motor nerve innervating the deep muscles of the forearm. Its compression is rare, its diagnosis is not easy, and the existence of 2 really differentiated injuries (anterior interosseous syndrome and Pronator Teres syndrome) seems to be, at least, questionable from a clinical point of view. Purpose: The purpose of this study was to study the results obtained after surgical treatment of patients clinically diagnosed of AIN compression by the Scratch Collapse Test (SCT). Materials and Methods: From June 2013 to January 2016, 20 patients underwent surgery for proximal compression of the median nerve. The diagnosis was made based on the patient’s symptoms and positivity of the SCT in three consecutive consultations. In all patients, electromyogram (EMG) and magnetic resonance imaging (MRI) were performed to exclude other space-occupying injuries that could justify the symptoms. They were 13 men and 7 women. Average age at surgery was 32 (13-53) years and follow-up was 14 (1-32) months. All surgeries were carried out by the same surgeon and all areas of possible nerve compression were released. In 4 cases, the diagnosis of “double crush syndrome” was made and the carpal tunnel was also released. Results: EMG was reported as abnormal only in patients diagnosed of “double crush syndrome.” MRI showed any abnormality in 4 patients. In all patients, the SCT was negative at the first postoperative consultation. All patients returned to their normal activities without sequelae but 4 of them developed a keloid scar. Conclusions: Based on our results, we believe that the SCT is a useful test in clinical diagnosis and postoperative monitoring of anterior interosseous nerve compression.

Background: The coronoid process has not received much attention in the treatment of traumatic injuries of the elbow until recent years. In addition, there are few studies in the literature that explore the arthroscopic treatment thereof. Purpose: To study the feasibility of arthroscopically assisted treatment of coronoid process types I and II fractures. Materials and Methods: From February 2009 to October 2015, 11 patients underwent surgery for a coronoid process fracture associated with other injuries. There were all males with a mean age of 43 (28-61) years and follow-up of 14.5 (4-28) months. In all patients, arthroscopic reduction and transosseous fixation of the fracture were carried out using a FiberWire (Arthrex, Naples, Florida) suture, and the associated bony and ligamentous injuries were also repaired. After surgery, a splint was used for 18 days, and physical therapy was started after its removal. Range of motion was measured, function was assessed with the Mayo Elbow Performance Scoring (MEPS) questionnaire, pain by Visual Analogue Scale (VAS), and disability using the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire. Results: Ten fractures were type II and 1 fracture was type I. Nine patients had an associated injury of the radial collateral ligament, whereas 1 had an associated injury of the ulnar collateral ligament. Six had an associated fracture of the radial head (5 osteosynthesis and 1 fragment excision). Six patients were diagnosed as terrible triad of the elbow. Mean time to bone healing was 5 weeks. All patients had a stable elbow. The range of flexion and extension at the end of follow-up was 131.5° (120-140) to 9.5° (0-25), and pronosupination was 89° (80-90) to 86° (70-90). MEPS was 90.7 (70-100) points, VAS at rest 0 points, active VAS 0.6 (0-2), and force VAS 2.6 (0-5); finally, DASH questionnaire was 13.6 (4.5-20.5) points. No postoperative complications were reported. One patient developed mild residual pain. Conclusions: Although our series presents a limited number of cases, we believe this work shows the feasibility of an arthroscopically assisted treatment in fractures of the coronoid process using a high strength transosseous suture fixation and repairing the associated injuries when necessary.