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Background: After upper extremity nerve repair, there occurs impairment in hand functions which represents a major problem in activities of daily living (ADL) for the patient. Therefore, the patients after peripheral nerve repair needs rehabilitation to improve their functional status. This study was conducted to determine the efficacy of modified constraint-induced movement therapy in subjects after nerve repair in upper extremity. Methodology: 27 post-surgical subjects of ulnar and/or median nerve repair, aged 18-60 years, were included in the study as per the selection criteria. The subjects were randomly divided into two groups, Group A (n=14) and Group B (n=13) and were assessed for functional disability, integrated hand function, pain and muscle strength using DASH questionnaire, SHFT, VAS and BMRC muscle strengthening grading system respectively. Group A received Modified constraint-induced movement therapy along with conventional therapy. Group B received Conventional therapy alone. The subjects were given a total duration of intervention of 8 weeks, with 5 weekly sessions and were reassessed after 8 weeks. Conclusion: The results of this study conclude that modified constraint induced movement therapy combined with Conventional physiotherapy is more effective when compared to Conventional therapy alone in improving muscle strength and integrated hand function, reducing pain and disability in subjects with nerve repair in upper extremity. [ABSTRACT FROM AUTHOR]

Purpose: Several experimental studies have investigated the effects of hyperbaric oxygen therapy (HBOT) on peripheral nerve regeneration. However, to the best of our knowledge, clinical studies to evaluate the effects of HBOT on peripheral nerve recovery are seldom performed. The aim of our study was to investigate the efficacy of HBOT following primary nerve repair in patients with upper extremity nerve injuries. Methods: Patients admitted to our hospital between 2015 and 2019 with ulnar and median nerve injuries were included in the study. Patients were randomized based on their application dates and divided into two different groups. Patients who received HBOT following standard epineural nerve repair were included in group 1, while patients who only underwent epineural nerve repair were included in group 2. All patients were followed up at 3, 6, and 12 months post-treatment and evaluated through electroneuromyography analysis of the traumatized nerve, injured nerve-related muscle strength, and two-point discrimination test. Results: Impulse transmission of injured nerves to the end organ was faster in group 1. Further, ENMG parameters demonstrated that injured nerves of patients in group 1 recovered faster. Patients in group 1 also reached higher power score and had significantly more rapid motor recovery than patients in group 2. Conclusion: This prospective study of upper extremity injuries demonstrated the favorable effects of HBOT on nerve recovery both clinically and electrophysiologically following nerve repair. One HBOT session each day for 5 days after surgical treatment can decrease morbidity and facilitate recovery. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. A 53-year-old right-handed female weightlifter presented to our clinic for evaluation of left elbow pain and intermittent numbness in her first 3 digits. She reported an elbow injury while weight lifting and carrying heavy planters 6 months earlier. A magnetic resonance imaging obtained previously was interpreted as bicipital-radial bursitis, and she had previously undergone a comprehensive nonoperative management program for her pain and numbness. A diagnostic ultrasound performed in clinic revealed distal biceps tendinopathy, bicipital-radial bursitis, and "pseudotumor," which was dynamically compressed between the biceps tendon and radius with pronation and also caused a mass effect on the median nerve at the level of the pronator teres. Surgical excision of the mass resulted in near-complete resolution of her symptoms, and histology was consistent with scar tissue. This is the first case to the best of our knowledge to describe point-of-care ultrasound diagnosis of a biceps tendon "pseudotumor," as well as demonstrating dynamic impingement of this pseudotumor causing mass effect on the median nerve. [ABSTRACT FROM AUTHOR]

Carpal tunnel syndrome being the most common entrapment neuropathy and can be managed with hydrodissection of the median nerve when conservative treatment options fail in mild-moderate disease cases. The principle behind hydrodissection is to free up the nerve from entrapment by separating the nerve from surrounding tissue. Fenestration of the flexor retinaculum can also help in the release of mechanical compression of the entrapped nerve, but poorly described in the literature and not routinely used. Here we present a case of a 72-year-old female patient with carpal tunnel syndrome managed with ultrasound-guided fenestration of the flexor retinaculum and hydrodissection of the median nerve with significant symptomatic and functional improvement over 2-month follow-up. [ABSTRACT FROM AUTHOR]

Background: The incidence of median nerve injuries in pediatric elbow dislocations is approximately 3% and avulsion of the open medial epicondylar epiphysis in the pediatric population is one predisposing factor that may explain this age predilection. These lesions can be difficult to diagnose in the acute phase because symptoms tend to be mild or delayed, consequently their management can be challenging and functional outcome poorer.Methods: We present the case of an unrecognized median nerve entrapment in a 16-year-old boy with posterior dislocation of the elbow and a medial epicondyle fracture, treated initially with close reduction and open stabilization with a cannulated screw. Assessment is supported by a review of similar reported cases available in literature.Results: We discuss the diagnostic approach and the surgical options that can be used for this type of injury.Conclusions: High clinical suspicion of entrapment is imperative in presence of signs of damage to the median nerve in the pediatric patient immediately after the reduction of an elbow dislocation. If diagnosis of entrapment is made the therapeutic choice between neurolysis and nerve graft depends on the lesion severity. In the presence of a Fourrier's type 4 lesion, neurolysis should be avoided, while nerve resection and grafting are recommended. [ABSTRACT FROM AUTHOR]

Introduction: The technique of radiofrequency neurotomy (RFN) of the facet joints has been used for decades to treat persistent low back pain to good effect in carefully selected patients. Traditionally, the target is the medial branches of the dorsal root supplying the facet joint. An alternative denervation target is the facet joint capsule. Capsule‐targeting techniques may spare the multifidus muscle, a possible unintended target of traditional RFN that is thought to be important in recovering from low back pain, and have shown promising results. Methods: A modified RFN technique that targets the capsule and spares the multifidus (multifidus‐sparing RFN) is described here, along with a brief report of its application in patients with symptomatic facet joint low back pain as compared to traditional medial branch RFN (MBRF). Results: Over a 2‐year period, a total of 401 initial multifidus‐sparing RFN and 94 initial MBRF procedures were performed on patients attending a multidisciplinary pain clinic. The proportion of repeat procedures was similar: 28.4% of multifidus‐sparing procedures and 23.4% of MBRF procedures. The median repeat interval was 12 months for both groups and interquartile range was 10 months (8–18 months) for multifidus‐sparing RFN and 4 months (11–15 months) for MBRF. Effectiveness and safety profiles appear to be similar, although limited, retrospective outcome information prevented robust analysis. Conclusion: Multifidus‐sparing RFN represents an intriguing technique to denervate the facet joint pain generator while maintaining normal multifidus function. Further study is warranted, particularly in order to identify the appropriate patient criteria and long‐term outcomes. [ABSTRACT FROM AUTHOR]

Posttraumatic acute carpal tunnel syndrome is a not a usual complication in traumatic hand injuries but requires more urgent and aggressive management. Compression of the median nerve should be systematically sought when there is a major and painful swelling of the hand, associated with one or several hand and wrist fractures. In rare case, a single metacarpal fracture or dislocation can be the only cause of median nerve compression and requires urgent diagnosis. If missed or neglected irreversible damage could occur to the median nerve. If surgery is perform in a timely manner outcomes are excellent, with complete recovery in most of the cases. We present the case of a 24-year-old man with an acute compression of the median nerve due to an intra-articular fracture of the 2nd metacarpal base. A bony fragment shifting from the base of 2nd metacarpal was found in the carpal tunnel participating, at least in part, in the compression of the median nerve. [ABSTRACT FROM AUTHOR]

Background: Median nerve (MN) variation in the carpal tunnel has been well documented by Lanz. Encountering rarely documented variants, that do not fit into existing classifications, increases the risk of iatrogenic injury.Methods: The random occurrence of two unclassifiable anatomical variants of the MN in the carpal tunnel gives motivation to search the literature for similar and identical cases.Case Reports: This article presents two cases of very rare anatomical variants of high division of the MN. First case is a pure high branching of the 3rd space common digital nerve (CDN). The second case is a high division of the MN to a thicker lateral component and a thinner medial component. The lateral component of the MN gives off the palmar cutaneous branch (PCB), the thenar motor branch (TMB), the 1st and 2nd space CDN's and contributes medially with a branch to the 3rd space CDN. The medial component of the MN bifurcates distally into a medial and lateral branch. The lateral branch from the medial component of the MN distally unites with the medial branch of the lateral component of the MN to form the 3rd space CDN. The medial branch from the medial component of the MN has a major contribution to the 4th space CDN from the ulnar nerve. In both cases, the medial component of the MN has a transmuscular course through the flexor digitorum superficialis (FDS) muscle.Discussion: Finding similar case reports from worldwide suggests the need to improve current classification of the MN variants in the carpal tunnel.Conclusions: One cannot rely entirely on the existing anatomical classifications of the MN in the carpal tunnel. There is an underappreciated risk of iatrogenic injury, especially in endoscopic carpal tunnel release, and a chance of missing out on repair of important anatomical structures in trauma cases. There is a possibility of augmenting group 3 of Lanz's classification by adding subgroup "3D High division of the MN with the medial component having a transmuscular course through the FDS muscle", stating the different distal branching patterns. [ABSTRACT FROM AUTHOR]

Background: Upper extremity injuries have a significant impact on social and professional life. They represent about 10% of visits to emergency departments. Nerve lacerations are one of the biggest problem because loss of innervation results in muscle atrophy, decreased sensibility, and therefore permanent dysfunction. Appropriate treatment is very important for patients to regain function.Materials and Methods: The study included 41 patients, 30 men and 11 women who underwent nerve repair surgery in the middle and distal forearm level in the years 2001-2017. The patients' age ranged from 9 to 73 years with an average of 37 years. They were divided into 3 groups with repaired median, ulnar and both nerves. We determined time from injury to nerve repair, assessed sensitivity in index and little finger with a two-point discriminator, and muscle strength by measuring adduction of the little finger and palmar abduction of the thumb.Results were rated based on Medical Research Council Scale (MRC). In addition, general hand disability was assessed according to the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH).Results: There was a statistically significant (p = 0.0197), positive correlation (r > 0) between the period from injury to surgery and the DASH score, and statistically significant difference (p = 0.0001) in return of muscular function between groups with median, ulnar and both nerves injury. Also correlation between patients age and score of DASH was statistically significant (p = 0.0140) with positive correlation (r > 0). There was no statistically significant difference in the return of sensitivity (p = 0.4337) and the DASH score (p = 0.3831) between these three groups.Conclusions: Patients with shorter time from injury to repair and at a younger age had better DASH results. The median nerve had the best motor function between the groups. There was no difference in sensitivity or DASH scores between groups. [ABSTRACT FROM AUTHOR]

The article reports on the use of dynamic ultrasound (US) to visualize and document the abnormal tethering of the MN to the ulnar head of the pronator teres (UHPT) was also well delineated. Topics include abnormal tethering is caused by abnormal adhesion or friction between the posterior surface; and physical examination of weakness or motor atrophy, and has abnormal electrodiagnostic studies.

Objective To determine the effectiveness of cervical medial branch thermal radiofrequency neurotomy in the treatment of neck pain or cervicogenic headache based on different selection criteria. Design Comprehensive systematic review. Methods A comprehensive literature search was conducted, and the authors screened and evaluated the studies. The Grades of Recommendation, Assessment, Development, and Evaluation system was used to assess all eligible studies. Outcome Measures The primary outcome measure assessed was the success rate of the procedure, defined by varying degrees of pain relief following neurotomy. Data are stratified by number of diagnostic blocks and degree of pain relief. Results Results varied by selection criteria, which included triple placebo-controlled medial branch blocks, dual comparative medial branch blocks, single medial branch blocks, intra-articular blocks, physical examination findings, and symptoms alone. Outcome data showed a greater degree of pain relief more often when patients were selected by triple placebo-controlled medial branch blocks or dual comparative medial branch blocks, producing 100% relief of the index pain. The degree of pain relief was similar when triple or dual comparative blocks were used. Conclusions Higher degrees of relief from cervical medial branch thermal radiofrequency neurotomy are more often achieved, to a statistically significant extent, if patients are selected on the basis of complete relief of index pain following comparative diagnostic blocks. If selected based on lesser degrees of relief, patients are less likely to obtain complete relief. [ABSTRACT FROM AUTHOR]

Background Cervical medial branch radiofrequency ablation (CMBRFA) is an effective treatment for facetogenic pain in patients selected by Spine Intervention Society (SIS) guidelines of 100% symptom improvement with dual medial branch blocks (MBBs) ± placebo block. Patient selection for CMBRFA using ≥80% symptom improvement after dual concordant MBBs is common; however, this has not been studied. Objective To evaluate the effectiveness of CMBRFA and compare outcomes in individuals selected by 80–99% vs 100% symptom improvement with dual concordant MBBs. Design Cross-sectional cohort study. Methods Medical records of 87 consecutive patients were reviewed; 50 met inclusion criteria. A standardized telephone survey was performed at six or more months post-CMBRFA to query numerical rating scale (NRS) pain and patient global impression of change (PGIC) scores. The primary outcomes were the proportion of patients reporting ≥50% reduction of index pain. Results At a mean follow-up time of 16.9 ± 12.7 months, 54% (95% confidence interval [CI] = 35–73%) and 54% (95% CI = 32–74%) of the 80–99% and 100% MBBs groups, respectively, reported ≥50% pain reduction. Between-group comparison showed a relative risk of 0.99 (95% CI = 0.59–1.66) for meeting the primary outcome. Seventy percent (95% CI = 56–81%) of patients reported a PGIC score consistent with "improved or very much improved" at follow-up. Conclusions CMBRFA is an effective treatment in patients who report ≥80% symptom relief with dual concordant MBBs. The present study demonstrated an overall ≥50% pain reduction rate of 54% and no significant difference between those selected by 80–99% vs 100% symptom relief with dual concordant MBBs. [ABSTRACT FROM AUTHOR]

Background: Compound muscle action potential (CMAP) scan and MScanFit have been used to understand the consequences of denervation and reinnervation. This study aimed to monitor these parameters during Wallerian degeneration (WD) after acute nerve transections (ANT).Methods: Beginning after urgent surgery, CMAP scans were recorded at 1-2 day intervals in 12 patients with ANT of the ulnar or median nerves, by stimulating the distal stump (DS). Stimulus intensities (SI), steps, returners, and MScanFit were calculated. Studies were grouped according to the examination time after ANT. Results were compared with those of 27 controls.Results: CMAP amplitudes and MScanFit progressively declined, revealing a positive correlation with one another. SIs were higher in WD groups than controls. Steps appeared or disappeared in follow-up scans. The late WD group had higher returner% than the early WD and control groups.Conclusions: MScanFit can monitor neuromuscular dysfunction during WD. SIs revealed excitability changes in DS. [ABSTRACT FROM AUTHOR]

Background: Reliable measurement of functional recovery is critical in translational peripheral nerve regeneration research. Behavioral functional assessments such as volitional grip strength testing (vGST) are limited by inherent behavioral variability. Isometric tetanic force testing (ITFT) is highly reliable but precludes serial measurements. Combining elements of vGST and ITFT, stimulated grip strength testing (sGST) involves percutaneous median nerve stimulation to elicit maximal tetanic contraction of digital flexors, thereby allowing for consistent measurement of maximal grip strength.Methods: We measured side-to-side equivalence of force using sGST, vGST, and ITFT to determine relative reliability and repeatability. We also performed weekly force measurements following median nerve repair.Results: sGST demonstrated greater reliability and inter-trial repeatability than vGST and similar reliability to ITFT, with the added benefit of serial measurements.Conclusions: sGST is a valid method for assessing functional recovery that addresses the limitations of the currently available modalities used in translational peripheral nerve regeneration research. [ABSTRACT FROM AUTHOR]

Prospective controlled study. Previous studies evaluated the effectiveness of sensory reeducation (SR) after peripheral nerve injury and repair. However, evidence for long-term clinical usefulness of SR is inconclusive. The purpose of this study is to compare the sensory results of patients with low-median nerve complete transection and microsurgical repair, with and without SR at long term. We prospectively studied 52 consecutive patients (mean age, 36 years; range, 20-47 years) with low-median nerve complete transection and microsurgical repair. When reinnervation was considered complete with perception of vibration with a 256-cycles per second tuning fork (mean, 3.5 months after nerve injury and repair), the patients were sequentially allocated (into 2 groups [group SR, 26 patients, SR; group R, 26 patients, reassured on recovery without SR). SR was conducted in a standardized fashion, in 2 stages, as an independent home-based program: the first stage was initiated when reinnervation was considered complete, and included instruction in home exercises to identify familiar objects and papers of different roughness, and localization of light touch (eyes open and closed); the second stage was initiated when the patients experienced normal static and moving 2-point discrimination (2PD) at the index fingertip of injured hand, and included instruction in home exercises for stereognosia, supplementary exercises for localization of light touch, and identification of small objects (eyes open and closed). Exercises were prescribed for 5-10 minutes, 4 times per day. At 1.5, 3, and 6 years after nerve injury and repair, we evaluated the static and moving 2PD, stereognosia with the Moberg's pick-up test, and locognosia with the modified Marsh test. Comparison between groups and time points was done with the nonparametric analysis of variance (Kruskal-Wallis analysis of variance). Static and moving 2PD and stereognosia were not significantly different between groups at any study period. Locognosia was significantly better at 1.5 and 3 years in group SR; locognosia was excellent in 17 patients of group SR vs 5 patients of group R at 1.5-year follow-up and in 14 patients of group SR vs 5 patients of group R at 3-year follow-up. Locognosia was not different between the study groups at 6-year follow-up. A 2-stage home program of SR improved locognosia at 1.5 and 3 years after low-median nerve complete transection and repair without significant differences in other modalities or the 6-year follow-up of a small subsample. [ABSTRACT FROM AUTHOR]

Introduction. The aim of this research was to test, in an animal model, the nerve regeneration technique with a hypoallergenic acellular dermal matrix used to wrap the microsurgical neural suture. Materials and Methods. Two groups of rats received the cut of limb right median nerves. The regeneration technique considers for both groups an end-to-end nerve suture. In the experimental group (A) was used also a wrapping protocol by a conduit of collagen matrix currently used in oral surgery. The animals underwent functional grasping tests (at 1, 3, 5, and 7 months) and a histological and quantitative analysis of distal nerve was performed at the end of experimental time. Result. After seven months, the grasping test reveals functional recovery in each tested animal; this improvement is more evident in Group A. The fibers appear well organized with restored myelin sheaths in both groups. Group A showed a great quantity of connective tissue surrounding the nerve. The quantitative morphology analysis in both groups shows a similar fibers density, fiber diameter, and myelin thickness. The differences between the groups in axon mean diameter are significant. In Group A M/d, D/d, and g-ratio is significantly higher compared to control group. Conclusions. Histological and functional assessments show a functional recovery of the injured nerve in the test groups, stressed by the results of the grasping tests and the meaningful increasing in fiber diameter and higher g-ratio. Moreover, a connective tissue cuff distinguishes the distal portion of the injured nerve. Considering the easy availability and handling of the material used in this study we can conclude that this experimental technique can be considered as a valid alternative to protect nerves in nerve wrap surgery. [ABSTRACT FROM AUTHOR]

Introduction: The recovery of recurrent motor branch of the median nerve might be delayed in high level median nerve injuries due to the long reinnervation distance. The aim of this study is to define a novel nerve transfer to restore the opposition and pinch.Methods: Two fresh frozen hand cadavers were used for the study. The motor branch of the first palmar interosseous muscle of the ulnar nerve was identified and dissected. Thenar branch of the median nerve was dissected from its insertion site. The motor branch of the first palmar interosseous muscle of the ulnar nerve was transferred to the thenar motor branch of the median nerve. Axon counts were examined histopathologically. Clinically this nerve transfer was performed for two female patients with a high-level median nerve injury. Mehta opposition scores were 21 and 20, respectively and the results were satisfactory six months after the surgery.Discussion: Although exploration and repair are recommended as the first treatment for median nerve injuries, the waiting time until the motor branch is reinnervated is critical in high level lesions. Nerve transfers become very important for fast recovery.Conclusions: This new nerve transfer proposal may be an important step in nerve transfer surgery. [ABSTRACT FROM AUTHOR]

"Common habits develop into rare syndromes." This idiom holds true when one such colorful rubber band put on the wrist of a child gets forgotten, burrows through the skin, and presents with a swollen paralyzed hand with a circumferential scar on the wrist. We present two cases of rubber band syndrome (Dhaga syndrome) who presented with painful, swollen, complete claw hand. Until 2019, only 15 cases were reported with predominance of Indian children. MRI is the gold standard investigation where a high degree of clinical suspicion is diagnostic. Surgical exploration with removal of the constricting band and excision of neuroma in continuity of ulnar and median nerves for preventing neurological deficit and tenolysis of tendons depending on the depth of the band is unambiguous treatment of choice. Where history is not forthcoming, a circumferential scar on the wrist of a child demands exploration. [ABSTRACT FROM AUTHOR]

Hereditary neuropathy with liability to pressure palsy (HNPP) often manifests via peripheral nerve entrapment including median nerve compression at the carpal tunnel. However, there are few reports on surgical interventions for focal compression of the median nerve at the wrist in patients with HNPP. We report a case of a patient with HNPP who improved clinically, electrophysiologically, and ultrasonographically after carpal tunnel release (CTR). A 56-year-old woman presented with an 18-month history of pain in both thumbs. Nerve conduction study (NCS) revealed bilateral median neuropathy at the wrist. Ultrasonography demonstrated a markedly increased cross-sectional area (CSA) of both median nerves. Gene analysis revealed a deletion of the PMP22 gene. She received bilateral CTR. Follow-up NCS at one year demonstrated the improvement of motor and sensory conduction; follow-up ultrasonography revealed significantly reduced CSA. Our case suggests that surgical decompression can be applicable to well-selected patients with HNPP. [ABSTRACT FROM AUTHOR]

Ultrasound‐guided carpal tunnel release was performed on 14 patients (18 wrists) using dynamic expansion of the transverse safe zone. Our patient population included able‐bodied patients and those with impairments. The first 8 cases (12 wrists) underwent the procedure in an operating room, the remainder in an outpatient setting. No complications occurred, and all patients were able to immediately resume use of their hands without therapy. Improvements in the Quick Form of the Disabilities of the Arm, Shoulder, and Hand Index and Boston Carpal Tunnel Questionnaire at 3 months were comparable to results reported with mini‐open and endoscopic release. Our results show that ultrasound‐guided carpal tunnel release can be safely and effectively performed in an outpatient setting. [ABSTRACT FROM AUTHOR]

Background/Aims: Mirror visual feedback is an intervention that focuses on watching the movements of the intact hand in the mirror to restore the movements of the injured hand. This method is developed based on the concept of the central reflection of the amputated or injured limb. This study aims to determine the effect of mirror visual feedback as a complementary method on the outcomes of sensory relearning in patients following median/ulnar nerve repair. Methods: This randomised clinical trial was conducted on 20 patients with median/ulnar nerve damage who were selected through convenience sampling and were then randomly assigned to a treatment and a control group. Both groups received traditional rehabilitation in three 40-minute sessions a week. In addition, the treatment group received mirror visual feedback 15 minutes a day, 5 days a week, for 8 weeks. The patients' sensory status was assessed using Semmes-Weinstein Monofilaments and two-point discrimination tests and their sensory function was assessed using stereognosis both before and after the intervention. Findings: The final analysis was performed on a total of 20 patients. The Semmes-Weinstein Monofilaments test and two-point discrimination scores obtained showed significant improvements following therapy in both groups. The changes in Semmes-Weinstein Monofilaments test (P=0.000], two-point discrimination (P=0.000) and stereognosis (active: P=0.001, passive: P=0.000) scores were significantly greater in the mirror therapy group compared to the controls. Conclusions: Mirror visual feedback in conjunction with traditional sensory retraining programmes led to greater improvements in superficial sensation and touch discrimination of the hand in the first phase of the sensory relearning programme. This may be due to the use of the neuroplasticity potential, the stimulation of the somatosensory areas and motor networks, the adjustment of early cortical reorganisation and the prevention of further changes. [ABSTRACT FROM AUTHOR]

Carpal tunnel syndrome is the most common entrapment neuropathy, resulting in 500,000 carpal tunnel release (CTR) surgeries and a total cost of more than 2 billion dollars annually in the United States. Although initially performed via a large (3-5 cm) palmar incision, CTR techniques have continually evolved to reduce incision size, recovery times, postoperative pain, and improve cosmesis and clinical outcomes. More recently, multiple authors have reported excellent results after ultrasound-guided carpal tunnel release (USCTR) using a variety of techniques, and one prospective randomized trial reported faster recovery after USCTR compared with traditional mini-open CTR. However, there is a paucity of data with respect to changes in the median nerve after USCTR. This case report presents the functional outcomes and pre- and postprocedure ultrasound images of a patient after USCTR with 3-month follow-up. LEVEL OF EVIDENCE: V. [ABSTRACT FROM AUTHOR]

While the success or failure of carpal tunnel release ultimately depends on the interplay of a wide array of factors, a broad understanding of the normal anatomy of the carpal tunnel accompanied by awareness of the possible variations of the individual structures that make up its contents is crucial to optimizing surgical outcomes. While anatomic variants such as extension of the flexor digitorum muscle bellies have been described as a cause of primary carpal tunnel syndrome (CTS), there have been no reports depicting its association with recurrent CTS following initially successful carpal tunnel release, a finding with potentially significant prognostic implications that can aid in operative planning. In such cases where muscle extension is identified preoperatively, careful debulking of the muscle belly may be beneficial in improving long-term surgical outcomes. [ABSTRACT FROM AUTHOR]

Objective: Remarkable progress has been made in the surgical treatment of capral tunnel syndrome recently. Popularity of endoscopic and minimally invasive techniques has been increased in particular. The aim of this study was to present the short-term outcomes of patients undertaken median nerve decompression surgery with palmar mini-incision using carpal tunnel knife with light (Blade-X®, Mavera Medical Devices, Ankara, Turkey). Material and Method: A total of 50 patients who were operated by using carpal tunnel knife, were retrospectively evaluated. Among those, 40 were female and 10 were male. Five patients had bilateral capral tunnel syndrome. Mean age was 59.75 (33-81 y). Mean duration of follow-up was 11,2 months (6-18 m). Preoperative clinical diagnosis was confirmed via electroneuromyography in all patients. Surgery was performed under local anesthesia without tourniquet with minimal palmar incision. Simple bandage was performed postoperatively and no immobilization was performed. Results: Mean duration of operation was 13 minutes (10-17 min). No complication was observed in any of the patients. Patients were able to use their hands for self-care after a mean of 7 days (5-13 d). Mean time to get back to work was 25 days (18-35 d) for those who are employed. All patients were satisfied except two patients experiencing scar pain. Conclusion: The most remarkable outcome of this minimally invasive method was rapid usage of the hands postoperatively and the functional recovery observed in the short-term. [ABSTRACT FROM AUTHOR]

Summary: Background and Aim: Trigger thumb is a common hand disability in children and is primarily treated with open surgery. A conscious median nerve block can usually meet the requirements for trigger thumb‐releasing surgery in adults; however, its effectiveness in children requires further clarification. The present study aims to demonstrate whether ultrasound‐guided lower forearm median nerve blockade is a viable option for children undergoing open surgery for trigger thumb. Methods: A prospective randomized study was designed to compare median nerve blocks guided by ultrasonography with those guided by anatomic landmarks. Following induction of general anesthesia, the children received a median nerve block performed either by ultrasound‐guided block of the lower forearm (group U) or landmark‐based blocking at the proximal wrist crease level (group T) with a 0.2% ropivacaine injection. The success rates were compared between groups as the primary endpoint; additional sufentanil and propofol administration, anesthesia recovery time, and other secondary endpoints were also compared. Results: A total of 100 children (age 1‐3 years) with ASA status I who were scheduled for open surgery for trigger thumb were included in this study (n = 50 per group). Thirty‐seven children in group T and 50 children in group U underwent successful blocks. The rate of unsuccessful blockade was significantly lower in group U than group T (0% and 26%, respectively), and rate of additional sufentanil and propofol administration was also lower in group U than in group T. Conclusion: Ultrasound‐guided lower forearm median nerve block can provide more effective analgesia, a higher success rate, and lower general and local anesthetic dosages than the anatomic landmark‐based blocking method in children undergoing open surgery for trigger thumb. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to assess alterations in median nerve (MN) biomechanics within the carpal tunnel resulting from ultrasound-guided hydrodissection in a cadaveric model.Methods: Twelve fresh frozen human cadaver hands were used. MN gliding resistance was measured at baseline and posthydrodissection, by pulling the nerve proximally and then returning it to the origin. Six specimens were treated with hydrodissection, and 6 were used as controls.Results: In the hydrodissection group there was a significant reduction in mean peak gliding resistance of 92.9 ± 34.8 mN between baseline and immediately posthydrodissection (21.4% ± 10.5%; P = 0.001). No significant reduction between baseline and the second cycle occurred in the control group: 9.6 ± 29.8 mN (0.4% ± 5.3%; P = 0.467).Discussion: Hydrodissection can decrease the gliding resistance of the MN within the carpal tunnel, at least in wrists unaffected by carpal tunnel syndrome. A clinical trial of hydrodissection seems justified. Muscle Nerve 57: 25-32, 2018. [ABSTRACT FROM AUTHOR]

The median nerve is the most important nerve in the upper extremity, as it is responsible for most of the sensation of the hand, the fine motor functions of the thumb, and finger grasping. Median neuropathies most commonly occur as compressive neuropathy or entrapment neuropathy, but sometimes as neuritis without any compressive lesion. Carpal tunnel syndrome (CTS), anterior interosseous nerve syndrome, and pronator teres syndrome are the subtypes of median nerve neuropathies, of which CTS is the most common. Median neuropathies can be diagnosed clinically by careful history-taking and a physical examination. Typical symptoms of CTS include night pain (crying), a tingling sensation of the radial digits, numbness or paresthesia, clumsiness, and atrophy of the thenar muscles. Electrophysiologic testing can be used for confirmation of the diagnosis and for documentation before surgical treatment. Imaging modalities including ultrasonography or magnetic resonance imaging can be used to ensure diagnostic accuracy and to detect unusual causes of compression. Conservative treatments include rest, bracing, nerve stretching, non-steroidal anti-inflammatory drugs, and steroid injections. If nonsurgical approaches are unsatisfactory or the nerve damage is severe, surgical treatment should be considered. Carpal tunnel release for CTS is a relatively simple procedure that involves division of the transverse carpal ligament and decompression of the median nerve. Early diagnosis and proper management are important, as muscle atrophy and sensory loss may persist when surgical release is delayed in patients with advanced disease. [ABSTRACT FROM AUTHOR]

Objective: To determine the natural history of the morphology of the median nerve after carpal tunnel decompression. Methods: Between October and December 2014, patients with suspected carpal tunnel were prospectively enrolled and underwent pre- and postoperative (3 and 6 months) high-definition ultrasonography, electrophysiology, and clinical testing. Results: A total of 81 patients were enrolled in the study; 75 (93%) could be reached for the 6-month follow-up, and 100% were clinically better at the 6-month follow-up. The mean cross-sectional area decreased from 14.3 ± 4.4 mm2 to 9.6 ± 2.3 mm2 (mean ± standard deviation [SD]). The mean distal motor latency decreased from 6.5 ± 2.2 msec to 4.4 ± 0.8 msec (mean ± SD). Distal motor latency improved statistically significantly after surgical decompression as well, but sooner. Conclusion: We present the second largest series of patients with sonographic followup after surgical decompression of the carpal tunnel. [ABSTRACT FROM AUTHOR]

The pre-ligamentous variant of the thenar motor branch (TMB) of the median nerve is extremely rare. In all previously reported cases, the branch arose from the radial or antero-radial aspect of the median nerve in the distal forearm and then pierced the antebrachial fascia to reach the thenar muscles. We report on a case in which the pre-ligamentous TMB not only arose from the ulnar side of the median nerve but it also remained deep to both the antebrachial fascia and the transverse carpal ligament until it reached the thenar muscles. The course of this variant puts the TMB at significant risk of injury during both open and endoscopic carpal tunnel release. Level of Evidence: Level V, risk study. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study is to assess the functional connectivity of the motor cortical network in patients with brachial plexus avulsion injury (BPAI) after contralateral C7 nerve transfer, using resting-state functional magnetic resonance imaging (RS-fMRI). Methods: Twelve patients with total brachial plexus root avulsion underwent RS-fMRI after contralateral C7 nerve transfer. Seventeen healthy volunteers were also included in this fMRI study as controls. The hand motor seed regions were defined as region of interests in the bilateral hemispheres. The seed-based functional connectivity was calculated in all the subjects. Differences in functional connectivity of the motor cortical network between patients and healthy controls were compared. Results: The inter-hemispheric functional connectivity of the M1 areas was increased in patients with BPAI compared with the controls. The inter-hemispheric functional connectivity between the supplementary motor areas was reduced bilaterally. Conclusions: The resting-state inter-hemispheric functional connectivity of the bilateral M1 areas is altered in patients after contralateral C7 nerve transfer, suggesting a functional reorganization of cerebral cortex. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the prognostic value of B-mode and Power Doppler (PD) ultrasound of the median nerve for the short- and long-term clinical outcomes of patients with carpal tunnel syndrome (CTS). Methods: Prospective study of 135 patients with suspected CTS seen 3 times: at baseline, then at short-term (3 months) and long-term (15–36 months) follow-up. At baseline, the cross-sectional area (CSA) of the median nerve was measured with ultrasound at 4 levels on the forearm and wrist. PD signals were graded semi-quantitatively (0–3). Clinical outcomes were evaluated at each visit with the Boston Questionnaire (BQ) and the DASH Questionnaire, as well as visual analogue scales for the patient’s assessment of pain (painVAS) and physician’s global assessment (physVAS). The predictive values of baseline CSA and PD for clinical outcomes were determined with multivariate logistic regression models. Results: Short-term and long-term follow-up data were available for 111 (82.2%) and 105 (77.8%) patients, respectively. There was a final diagnosis of CTS in 84 patients (125 wrists). Regression analysis revealed that the CSA, measured at the carpal tunnel inlet, predicted short-term clinical improvement according to BQ in CTS patients undergoing carpal tunnel surgery (OR 1.8, p = 0.05), but not in patients treated conservatively. Neither CSA nor PD assessments predicted short-term improvement of painVAS, physVAS or DASH, nor was any of the ultrasound parameters useful for the prediction of long-term clinical outcomes. Conclusions: Ultrasound assessment of the median nerve at the carpal tunnel inlet may predict short-term clinical improvement in CTS patients undergoing carpal tunnel release, but long-term outcomes are unrelated to ultrasound findings. [ABSTRACT FROM AUTHOR]

Introduction: Ultrasound measurement of the cross-sectional area (CSA) of the median nerve can give information about regeneration of the nerve after carpal tunnel release (CTR), but the changes at selected follow-up points up to 1 year compared to electrodiagnostic findings are not known. We postoperatively measured the CSA of the median nerve with ultrasound and compared the measurements with electrophysiological findings over 12 months after open CTR.Materials and Methods: In 21 hands that underwent open CTR, the CSA of the median nerve was measured at the inlet (proximal CSA) and outlet (distal CSA) of the carpal tunnel at 3- 6- and 12-month follow-up. The respective ratios [(CSA postoperatively/CSA preoperatively) × 100] were calculated and correlated with distal motor latency (DML) and sensory nerve conduction velocity (SCV).Results: The proximal CSA ratio was 88.9, 84.5, and 78.4 % at 3-, 6-, and 12-month follow-up, respectively. Each value was significantly lower than that before surgery. The distal CSA ratio was 104.3, 99.1, and 91.8 % at 3-, 6-, and 12-month follow-up, respectively. The values were not significantly different compared to preoperative values.Conclusions: The proximal CSA of the median nerve decreased continuously over the time after CTR while the distal CSA increased up to 3 months before it decreased continuously, too. [ABSTRACT FROM AUTHOR]

Early diagnosis of acromegaly prevents irreversible comorbidities and facilitates surgical cure. Carpal tunnel syndrome (CTS) is common in acromegaly and patients have often undergone surgery for CTS prior to the diagnosis of acromegaly. We hypothesized that screening CTS-patients for acromegaly could facilitate active case-finding. We prospectively enrolled 196 patients [135 women, 56.9 (range 23-103) years] who presented with CTS for surgery. Patients were asked about 6 symptoms suggestive of acromegaly using a questionnaire calculating a symptom score (0-6 points), and insulin-like-growth factor 1 (IGF-1) was measured. If IGF-1 was increased, IGF-1 measurement was repeated, and random growth hormone (GH) and/or an oral glucose tolerance test (OGTT) with assessment of GH-suppression were performed. The mean symptom score was 1.7 ± 1.3 points. Three patients reported the maximal symptom score of 6 points, but none of them had an increased IGF-1. There was no correlation between the symptom score and IGF-1-SDS (standard deviation score) (r = 0.026; p = 0.71). Four patients had an IGF-1 > 2 SDS. In 2 patients acromegaly was ruled out using random GH and OGTT. One patient had normal IGF-1 and random GH at follow-up. One patient refused further diagnostics. In this prospective cohort of patients with CTS, the observed frequency of acromegaly was at most 0.51% (95% CI 0.03 to 2.83%). In this prospective study, none of the 196 patients with CTS had proven acromegaly. Thus, we see no evidence to justify general screening of patients with CTS for acromegaly. [ABSTRACT FROM AUTHOR]

Purpose: Our aim was to study the dynamics of the post-surgical canal and nerve volumes and their relationships to objective [electromyoneurography (EMNG)] and subjective (pain) outcomes.Methods: Forty-seven patients with carpal tunnel syndrome (CTS) (median age 52, range 23-75 years) with a prominent narrowing of the median nerve within the canal (observed during carpal tunnel release) were evaluated clinically using EMNG and magnetic resonance imagining (MRI) before and at 90 and 180 days post-surgery.Results: Canal and nerve volumes increased, EMNG findings improved and pain resolved during the follow-up. Increase in tunnel volume was independently associated with increased nerve volume. A greater post-surgical nerve volume was independently associated with a more prominent resolution of pain, but not with the extent of EMNG improvement, whereas EMNG improvement was not associated with pain resolution.Conclusions: Data confirm that MRI can detect even modest changes in the carpal tunnel and median nerve volume and that tunnel release results in tunnel and nerve-volume increases that are paralleled by EMNG and clinical improvements. Taken together, these observations suggest that MRI could be used to objectivise persistent post-surgical difficulties in CTS patients. Level of evidence 3 (follow-up study). [ABSTRACT FROM AUTHOR]

The effects of changes to cold, mechanical, and heat thresholds following median nerve transection with repair by sutures (Su) or Rose Bengal adhesion (RA) were compared to sham-operated animals. Both nerve-injured groups showed a transient, ipsilateral hyposensitivity to mechanical and heat stimuli followed by a robust and long-lasting hypersensitivity (6–7 weeks) with gradual recovery towards pre-injury levels by 90 days post-repair. Both tactile and thermal hypersensitivity were seen in the contralateral limb that was similar in onset but differed in magnitude and resolved more rapidly compared to the injured limb. Prior to injury, no animals showed any signs of aversion to cold plate temperatures of 4–16 °C. After injury, animals showed cold allodynia, lasting for 7 weeks in RA-repaired rats before recovering towards pre-injury levels, but were still present at 12 weeks in Su-repaired rats. Additionally, sensory recovery in the RA group was faster compared to the Su group in all behavioural tests. Surprisingly, sham-operated rats showed similar bilateral behavioural changes to all sensory stimuli that were comparable in onset and magnitude to the nerve-injured groups but resolved more quickly compared to nerve-injured rats. These results suggest that nerve repair using a sutureless approach produces an accelerated recovery with reduced sensorimotor disturbances compared to direct suturing. They also describe, for the first time, that unilateral forelimb nerve injury produces mirror-image-like sensory perturbations in the contralateral limb, suggesting that the contralateral side is not a true control for sensory testing. The potential mechanisms involved in this altered behaviour are discussed. [ABSTRACT FROM AUTHOR]

The article informs about dynamic examination and guided hydrodissection in ultrasonography in pronator teres syndrome. Topics include regarding the benefits of U.S. guided hydrodissection for management of peripheral entrapment neuropathy; and andomized controlled trial to investigate the effectiveness of this combinational injection technique for pronator teres syndrome.

A case study of a 25-year-old male was seen for pain and weakness in his right hand first and second fingers. Topics include sensory deficit over the right palm and fingers, and the medical history was otherwise noncontributory; and Physical examination revealed weakness of the pincer movement of the right thumb and index fingers.

Theoretical framework: Carpal Tunnel Syndrome (CTS) is a musculoskeletal disorder affecting the functionality of the upper limbs. Objective: To assess symptom severity and functional status, using the Boston Carpal Tunnel Questionnaire (BCTQ), and quality of life, using the SF-36 v2, in the preoperative period and two months after surgery. Methodology: Prospective study of 50 patients (60.7±11.7 years) who underwent decompression surgery. Participants were mostly women (52 %), with 62 % of them being post-menopausal women. Diabetes (8%), overweight (48%), and class I (26%) and class II obesity (4%) were found to be risk factors for CTS. Results: In the preoperative period, the affected hand had significantly less grip and pinch strength than the contralateral hand. The follow-up results suggest a decrease in symptom severity and an increase in functional status. Conclusion: Significant changes towards improving health-related quality of life were observed in the SF-36 v2 subscales: physical functioning, bodily pain, mental health, role-emotional, social functioning and vitality. [ABSTRACT FROM AUTHOR]

HISTORY: A 20 year old left handed male motorcyclist sustained a 3cm left volar wrist laceration closing a mirrored cabinet that shattered. He presented to the ED, where the laceration was irrigated and sutured, and he was given antibiotics. No imaging was done. Three days later, he went to UC for left palm numbness, swelling of fingers, and impaired wrist rotation. Patient was prescribed steroids and referred to Sports Medicine for follow up. Three days later at the Sports Medicine visit he reported constant numbness and tingling along the volar side of the left index, second finger, and thumb, inability to flex digits, and weakness and severe pain with specific movements of the left hand. He felt "something moving" inside his wrist when trying to move his thumb. PHYSICAL EXAMINATION: Inspection: Swelling along left digits 1-3, most noticeable along volar aspect, with stitches intact on volar wrist.Palpation: No tenderness or palpable foreign body. ROM: PROM intact. AROM revealed inability to make a closed fist, reduced flexion at first 3 digits, and intact flexion at 4th/5th digits. Strength: 3/5 flexor strength at left thumb and digits 1-3 and inability to maintain pincer grasp. Neurovascular: Decreased sensation along median nerve distribution and 2+ left radial pulse. DIFFERENTIAL DIAGNOSIS: Left median nerve injury Left flexor tendon injuryRetained foreign body TEST AND RESULTS: Left wrist xray:Density projecting volar to the thumb CMC joint, possibly reflecting a retained foreign body.MRI left wrist: Foreign body within the volar tissues of the wrist corresponding to anomaly seen on xrays. This extends through the transverse carpal ligament and lies immediately adjacent to the flexor pollicus longus tendon, the flexor digitorum superficialis tendon to the index finger, and the median nerve. There is abnormal signal within the median nerve concerning for nerve injury. FINAL WORKING DIAGNOSIS: Left median nerve laceration with retained foreign body. TREATMENT AND OUTCOMES:Left wrist removal of foreign body, left carpal tunnel release, left wrist median nerve repair. Wrist splint with three weeks of immobilization followed by slow advancement of activity. At 5 month follow-up he was exercising and riding a motorcycle without restriction. He had persistent mild sensory changes over left median nerve distribution. [ABSTRACT FROM AUTHOR]

Peripheral nerve injuries are devastating injuries and can result in physical impairments, poor functional outcomes and high levels of disability. Advances in our understanding of peripheral nerve regeneration and nerve topography have lead to the development of nerve transfers to restore function. Over the past two decades, nerve transfers have been performed and modified. With the advancements in surgical management and recognition of importance of cortical plasticity, motor-reeducation and perioperative rehabilitation, nerve transfers are producing improved functional outcomes in patients with nerve injuries. This manuscript explores the recent literature as it relates to current nerve transfer techniques and advances in post-operative rehabilitation protocols, with a focus on indications, techniques and outcomes. [ABSTRACT FROM AUTHOR]

Background: Carpal tunnel syndrome is a common condition in which the median nerve passes through the carpal tunnel is compressed. Then, gradual paralysis occurs. This study aimed to compare patient outcomes after surgery for carpal tunnel syndrome in both groups with and without splint.. Methods: This study was conducted in Isfahan University of Medical Sciences, Iran, in Kashani hospital during 2011. 64 patients underwent surgery for carpal tunnel syndrome were selected and randomly divided into two groups of 32. For the first group, splints were considered after the surgery and for the second group, as the control group, splint was not given. Patients within 3, 6 and 12 weeks after surgery were followed and healing in the sense of motion and pain based on the visual analogue scale (VAS) measures were examined. Findings: Sensory conflict scores at the 3rd and 6th weeks in the group with splint were higher than the group without it; but, 12 weeks after the treatment, the results were identical. In any cases, motor involvement was not seen. At the 3rd week after the treatment, the mean pain score in the group without splint was higher than with splint group. The results of the 6th week after the treatment in both groups were almost identical; but, at the 12th week after the treatment, changes in pain intensity was not significantly different between the two groups (P = 0.97). Conclusion: Splinting after the surgical release of the median nerve probably causes a delay in the recovery of sensory, motor and pain; but due to the effect of material of used splint, the result is still uncertain and further broader interventions needs to be done in this regard. [ABSTRACT FROM AUTHOR]

Histological and physiological basis of the therapeutic efficacy of the vascularized autologous nerve graft in facial nerve regeneration remains poorly understood because of no established rat model. The left median nerve and median artery/vein of Lewis rats were collectively ligated, and harvested as a vascularized island median nerve, which was transplanted to a 7-mm gap in the left buccal branch of facial nerve. Nerve regeneration was investigated. The numbers of myelinated fibers, axon diameter, and myelin thickness were significantly higher in the vascularized nerve graft group than in the nonvascularized nerve graft group. Compound muscle action potential measurement showed that the parameters of vascularized group were similar to those in the intact control group. A vascularized median nerve graft resulted in better facial nerve regeneration outcomes. [ABSTRACT FROM AUTHOR]

The article discusses the study of "True" Lateral Imaging for Cervical Medial Branch Radiofrequency Neurotomy. Topics discussed include the effective use of radiofrequency thermal energy for the palliative relief of cervical facet pain has been known for decades; and the radiofrequency cannula is ideally placed in an exact manner both parallel to and as close as possible to the targeted cervical medial branch nerve before lesioning.

Knowing of anatomical variations is very important during surgery, autopsy and cadaver dissection in the axillary region. In this study, a unilateral variation of the brachial nerve plexus, which is characterized by the absent of the musculocutaneous nerve (MCN), was found in the right arm of a male cadaver. The MCN normally originates from the lateral cord of the brachial nerve plexus and innervates the anterior brachial compartment muscles and lateral coetaneous of the forearm. In this case, the lateral cord of the brachial plexus was joined to the median nerve at the level of coracoid process with no evidence of any nerve braches from lateral cord to the anterior brachial compartment muscles. These muscles were innervated from some branches of median nerve directly. [ABSTRACT FROM AUTHOR]

Purpose: To investigate digital nerve regeneration following implantation of collagen tubes in a prospective study. Methods: Forty-five digital nerve defects (≤ 2.6 cm) in the hand were reconstructed in 35 patients (6 female, 29 male; mean age, 47 y). Nerve regeneration was evaluated at 3, 6, and 12 months after surgery by applying a sum score comprising static 2-point discrimination, sensory threshold with Semmes-Weinstein monofilament mechanical stimuli, warm/cold sensation, vibration sense, sharp/dull recognition, recognition of numbers, and subjective estimation of the patient. Electroneurography and ultrasound were also performed. Results: In the distribution of 60% of the operated nerves, very good or good recovery was found. In contrast to basic sensory function, the more complex static 2-point discrimination was more frequently impaired after 1 year. After 6 months, the sum score correlated with electroneurography. The type of injury altered the final sensory nerve function. Circular saw and iatrogenic injuries showed a negative correlation with final sensory nerve function. Complications (infection) were observed in 2 patients. Conclusions: Owing to the good functional outcome in the majority of cases, the use of collagen tubes is useful to span digital nerve defects up to 2.6 cm. Type of study/level of evidence: Therapeutic IV. [ABSTRACT FROM AUTHOR]

Purpose: To report reconstruction of proper digital nerve (PDN) defects using a nerve transfer from the dorsal branch of the uninjured PDN and compare the results with those of nerve grafting. Methods: A retrospective study was conducted with 17 consecutive patients who had PDN defects treated with a nerve transfer from the dorsal branch of the PDN from May 2007 to July 2009. The patients included 14 male and 3 female patients, with an average age of 32 years. There were 21 PDN defects in 20 fingers. The injured fingers included 5 index, 8 long, 5 ring, and 2 little fingers. The average length of the nerve defects was 2.3 cm (range, 1.4–3.5 cm). The uninjured dorsal branch of the other PDN of the same digit or the dorsal branch of the PDN of the adjacent digit was selected as a donor nerve. Neurorrhaphy was performed between the dorsal branch and the distal end of the PDN. For comparison, we collected a series of 31 patients with PDN defects treated with conventional sural nerve grafting. Results: At a mean follow-up of 25 months (range, 20–26 mo), the mean static 2-point discrimination (2PD) and Semmes-Weinstein monofilament (SWM) scores on the finger pulp of the nerve transfer were 6.4 mm and 3.63, respectively. In the comparison group (mean follow-up, 23 mo; range, 19–27 mo), the mean static 2PD and SWM scores on the pulp were 9.2 mm and 4.10 mm. Significant differences were found in static 2PD and SWM results. Conclusions: Nerve transfer with the digital nerve dorsal sensory branch was useful for reconstruction of the PDN defect located between the proximal interphalangeal joint and the common digital nerve bifurcation. Sensory recovery using local nerve transfer was superior to conventional sural nerve graft. Type of study/level of evidence: Therapeutic III. [ABSTRACT FROM AUTHOR]

This case study report demonstrates the use of motion analysis with a modification of the Box and Blocks test. The goal was to quantify observed improvements in compensatory movements and simultaneous control in a subject using different prostheses before and after targeted muscle reinnervation (TMR) surgery. This is a single case study with data collection using a body-powered prosthesis pre-TMR surgery and 6 mo postfitting with a TMR myoelectric prosthesis. The Box and Blocks test was modified for cyclical motion within a motion capture laboratory. With the TMR myoelectric prosthesis, the subject was able to simultaneously activate the hand and elbow. Task performance was slower, but there was improved elbow flexion and less trunk compensatory motion than with the body-powered prosthesis. There are several limitations to the case study because there is no direct comparison of myoelectric performance before and after TMR surgery; however, the current report presents a potential method to quantify quality of motion and compensatory movements of prosthetic users. With further study, this test procedure has the potential to be a useful outcome measure for future standardized assessments of upper-limb prosthetic function. [ABSTRACT FROM AUTHOR]

In infraclavicular lesions of brachial plexus, severe lesions of the posterior cord often occur when medial and lateral cord function is preserved to a greater or lesser extent. In these cases, shoulder function may be preserved by activity of the muscles innervated by the suprascapular nerve, but complete paralysis exists in the deltoid, triceps, and brachioradialis, and all wrist and finger extensors. Classical reconstruction procedures consist of nerve grafts, but their results in adults are disappointing. We report an approach transferring: (1) an ulnar nerve fascicle to the motor branch of the long portion of the triceps brachii muscle, (2) a median nerve branch from the pronator teres to the motor branch of the extensor carpi radialis longus, and (3) a median nerve branch from the flexor carpi radialis to the posterior interosseous nerve. We describe the procedure and report 2 clinical cases showing the effectiveness of this technique for restoring extension of the elbow, wrist, and fingers in the common infraclavicular lesions of the brachial plexus affecting the posterior cord. [ABSTRACT FROM AUTHOR]

The article discusses the recent advances in neuroscience and neuroimaging techniques that have led to a revision of Sensory Reeducation (SR) techniques and the timing when SR should be initiated. SR can be viewed in two phases: phase 1 and phase 2. It mentions that a literature search of the electronic bibliographic databases Medline, CINAHL, AMED and EMBASE was undertaken and provides assessment of methodological quality, results and interventions. It suggests the effect of SR programs need to be evaluated using validated impairment based measures of sensibility and patient rated outcome questionnaires of activities and participation.

The present study was done to examine the effectiveness of sensory reeducation in patients after median or ulnar nerve repair at the wrist level. 22 male patients with peripheral nerve injury and repair at the wrist level were divided equally into experimental (mean age = 26.45 yrs) and control group (mean age = 32.09 yrs). The control group received only the home program, while the experimental group received additionally sensory reeducation therapy. The therapy was given in6 sessions per week for 3 months. The outcome measures were checked in terms of touch-pressure,two-point discrimination - static and dynamic, level of paresthesia and the number objects identified in Object Recognition Test. Parametric statistics was used to compute data of the above outcome measures. The experimental group showed significant change (p < 0.05) in the five parameters than the control group.The findings suggest that sensory reeducation when added with home program enhances better recovery of sensation. [ABSTRACT FROM AUTHOR]