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Purpose: To evaluate functional outcomes after direct suturing of upper extremity nerve defects in high elbow or wrist flexion. Methods: A retrospective review was conducted in patients treated for median, ulnar, or radial nerve defects between 2011 and 2019. Inclusion criteria were a defect > 1 cm and a minimal follow-up period of 1 year. Nerve defects were bridged by an end-to-end suture in 90° elbow flexion or 70° wrist flexion for 6 weeks. Results: Nine patients with a mean age of 30.2 years were included. The patients presented with two ulnar nerve defects, four median nerve defects, and three radial nerve defects at various levels. The mean time to surgery was 13.5 weeks for recent injuries. The mean defect length was 2.9 cm, and the mean follow-up time was 22.4 months. Two patients had joint stiffness that was more likely related to the associated injuries than the 6-week immobilization. Successful outcomes were achieved in eight of the nine patients. Meaningful motor recovery was observed in seven patients, and all recovered meaningful sensation. Excellent nerve recovery was noted in pediatric patients and in those with distal nerve defects. Conclusion: Temporary high joint flexion allows for direct coaptation of upper extremity nerve defects up to 4 cm located near the elbow or wrist. In this small and heterogenous cohort, functional outcomes seemed to be comparable to those obtained with short autografting. [ABSTRACT FROM AUTHOR]

Background: Tendon and nerve transfers are used for functional reconstruction in cases of proximal radial nerve injury complicated by humeral fractures in patients who do not show functional recovery after primary nerve repair. The effectiveness of pronator teres (PT) nerve branch transfer to the extensor carpi radialis brevis (ERCB) nerve branch for wrist extension reconstruction was investigated and compared to the results of tendon transfer.Methods: This study included 10 patients with proximal radial nerve injury, who did not show functional recovery after primary nerve repair at our hospital between April 2016 and May 2019. The nerve transfer procedure included PT nerve branch transfer to the ECRB nerve branch to restore wrist extension and the flexor carpi radialis (FCR) nerve branch to the posterior interosseous nerve (PIN) to restore thumb and finger extension. Tendon transfer procedures included PT transfer to the ECRB for wrist extension, FCR transfer to the extensor digitorum communis (EDC) for finger extension and palmaris longus (PL) transfer to the extensor pollicis longus (EPL) for thumb extension.Results: Five patients recovered Medical Research Council grade M4 muscle strength in the ECRB and EPL in both tendon and nerve groups. Two patients recovered grade M3 strength and three patients recovered grade M4 strength in the EDC in the tendon transfer group, and all five patients recovered grade M4 strength in the EDC in the nerve transfer group. Limited wrist flexion was observed only in one patient in the tendon transfer group.Conclusion: PT nerve branch transfer to the ECRB nerve branch combined with FCR nerve branch transfer to PIN is a useful strategy for wrist and fingers extension reconstruction in patients with proximal radial nerve injuries. [ABSTRACT FROM AUTHOR]

Forearm fractures such as distal radius fractures are traditionally treated with a plaster or synthetic cast. Patients commonly report inconvenience of the cast, skin problems, and occasionally radial sensory nerve numbness. A known issue with casting is that the rate of secondary dislocation is high. As an alternative to casts, personalized 3D-printed braces are increasingly used. This review provides an inventory of current developments and experience with 3D-printed forearm braces. Main focus was on the design requirements, materials used, technical requirements, and preclinical and clinical results. Review of 12 studies showed that all printed braces used an open design. Fused Deposition Modelling is most commonly used 3D-printing technique (seven studies) and polylactic acid is the most commonly used material (five studies). Clinical evaluation was done in six studies, mainly involving distal radius fractures, and generally showed a low complication rate and high patient satisfaction with the printed brace. Whether or not the results obtained with 3D-printed braces are superior to results after casting requires further studies. [ABSTRACT FROM AUTHOR]

Introduction: Peripheral nerve injury due to animal bite is a rare phenomenon. Most animal bites are from dogs. Monkey bites constitute a common risk, second only to dog bites, among travelers. Peripheral nerve injuries may occur due to a combination of monkey's strong jaws and sharp long teeth penetrating deep into the soft tissues. Such injuries are associated with increased perineural fibrosis. Human amniotic membrane (HAM) wrap around the nerve repair site reduces fibrotic response, prevents adhesions and scar formation thereby improving outcome. We report a case of "High Radial nerve palsy due to monkey bite, treated by neurorrhaphy with HAM wrap".Method: A 3-year old boy presented with wrist drop, and inability to extend the fingers and thumb of his right dominant hand, following a monkey bite over the distal arm. The diagnosis of high radial nerve injury was corroborated by high frequency ultrasound and electrodiagnostic studies. On exploration the radial nerve was found to be transected. An end to end repair was performed, with HAM wrap around the neurorrhaphy.Results: Wrist dorsiflexion recovered at 2.5 months followed by active finger and thumb extension at 4 months with no infection or immune rejection.Conclusion: Nerve regeneration in our patient occurred at a faster rate as compared to the conventional 1 mm/day. This could be attributed to decreased perineural fibrosis, improved neurotropism due to the HAM wrap and neuronal plasticity in young brain in addition, the patient being a small child having better regenerative ability in comparison to an adult. [ABSTRACT FROM AUTHOR]

Accurate localization and characterization of peripheral nerve injuries adjacent to metallic hardware is difficult with magnetic resonance imaging (MRI) due to susceptibility artifact. This study sought to present the use of high‐resolution ultrasound (US) in accurate characterization of radial nerve injury adjacent to metallic hardware, using findings at the time of operative exploration as confirmation of the US assessment. A retrospective chart review of cases with clinically identified radial nerve injuries evaluated by the high‐resolution US was performed from January 2015 through December 2019. Preoperative clinical data, US reports, MRI reports, electrodiagnostic (EDx) reports, and operative reports were reviewed for each case. Preoperative US correctly characterized the affected nerve component, type, and location of injury in all 13 cases (100%), when correlated with intraoperative findings. Nerve injury was directly adjacent to metallic hardware in 12 cases (92%). Out of the seven cases evaluated by both US and MRI, US correctly accurately diagnosed radial nerve injuries in all cases, whereas MRI accurately diagnosed in four cases (57%). In 3/7 cases (43%) MRI was nondiagnostic due to susceptibility artifact. MRI evaluation of the nerve was limited to some degree by metallic artifact in 6/7 cases (85%). [ABSTRACT FROM AUTHOR]

Background: Most surgeons are unaware that idiopathic neuropathy, which occurs independently of mechanical injury, can present as postoperative peripheral neuropathy. The aim of this study was to reveal the presence of postoperative neuropathy considered to be induced by surgical stress and to make surgeons aware that idiopathic neuropathy can occur postoperatively.Methods: We conducted a survey among orthopedic surgeons regarding patients with postoperative neuropathies of unknown cause. For each case, the type of neuropathy, preceding surgery and anesthesia, patient background, clinical findings, and clinical course were investigated.Results: Seven patients were identified. The mean time from surgery to the onset of neuropathy was 9.3 days (range 1-15 days). Five of the patients fully recovered spontaneously within 1 year, while the remaining two underwent neurolysis. One patient presented with hourglass-like constrictions in the radial nerve. No inflammatory cells were found in the epineurium of the affected nerve.Conclusions: Although it is rare, postoperative idiopathic neuropathy occurs in clinical practice, and it is crucial that surgeons recognize the existence of this neuropathy to elucidate its pathogenesis as well as to reduce the risk of litigation. [ABSTRACT FROM AUTHOR]

Puma yagouaroundi is a wild felid with wide distribution on the American continent. This paper aims to describe the origin and motor distribution of the nerves of the brachial plexus of P. yagouaroundi and compare the findings with the available descriptions for the Carnivora order. Fourteen brachial plexuses of specimens collected dead on highways were dissected (five males and two females). In most cases (57%), the brachial plexus originated from the ventral spinal branches of C5, C6, C7, C8 and T1. The C7 branch was the one that most contributed to the formation of the plexus nerves (57.7%). Among all dissected nerves, 23.6% were unisegmental and 76.4% plurisegmental. The radial nerve was the thickest and innervated the largest number of muscles, while the caudal pectoral nerve showed the most varied formation. Intraspecific polymorphisms occurred in the plexus, although the distribution of the nerves to the muscles had an evident constancy among the individuals. Due to the similarities, locoregional blocking techniques may consider the same anatomical landmarks stipulated for domestic cats. Comparison with the descriptions of other carnivorans allows speculating a polymorphism at the plexus origin, in contrast to the conservative innervation of the muscles in the order Carnivora. [ABSTRACT FROM AUTHOR]

Injury to the central nervous system (CNS) results in permanent damage and lack of function in most vertebrate animals, due to their limited regenerative capacities. In contrast, echinoderms can fully regenerate their radial nerve cord (RNC) following transection, with little to no scarring. Investigators have associated the regenerative capacity of some organisms to the stress response and inflammation produced by the injury. Here, we explore the gene activation profile of the stressed holothurian CNS. To do this, we performed RNA sequencing on isolated RNC explants submitted to the stress of transection and enzyme dissection and compared them with explants kept in culture for 3 days following dissection. We describe stress-associated genes, including members of heat-shock families, ubiquitin-related pathways, transposons, and apoptosis that were differentially expressed. Surprisingly, the stress response does not induce apoptosis in this system. Other genes associated with stress in other animal models, such as hero proteins and those associated with the integrated stress response, were not found to be differentially expressed either. Our results provide a new viewpoint on the stress response in the nervous system of an organism with amazing regenerative capacities. This is the first step in deciphering the molecular processes that allow echinoderms to undergo fully functional CNS regeneration, and also provides a comparative view of the stress response in other organisms. [ABSTRACT FROM AUTHOR]

Background: Ultrasonography is a safe and cost-effective modality to assess gross morphological changes in nerves non-invasively. Early diagnosis will allow the early institution of therapy and arrest the progression of the disease thus, helping in decreasing disability grading. Aims and Objectives: The aim of the study was to assessing the role of highresolution ultrasonography (HRUS) in leprosy. The objectives of the study were to detect sonographic changes in nerves in leprosy patients, and to detect neural complications by sonography in leprosy patients. Materials and Methods: The study was conducted over 18 months from the year 2020-2021 at 'Teerthanker Mahaveer Medical College and Research Centre, Moradabad. A total of 37 patients were included in our study. HRUS was performed on the bilateral ulnar nerve (UN), median nerve (MN), radial nerve (RN), lateral popliteal (LPN) nerve, and posterior tibial nerve (PTN) to see the following parameters: Nerve thickening, echogenicity, color flow, and abscess. Results: The UN was most frequently involved followed by the PTN, MN, LPN, and RN. Diagnostic performance of HRUS for echogenicity was good with sensitivity, positive predictive value, and accuracy and was observed as 91.17%, 100%, and 91.17%, respectively. Conclusion: HRUS has several benefits in leprosy scanning; it is a reliable and non-invasive method of assessing alternations in the nerve at sites that may be difficult to be biopsied for histology. [ABSTRACT FROM AUTHOR]

Analysis of rodent muscles affords an opportunity to glean key insights into neuromuscular development and the detrimental impact of disease‐causing genetic mutations. Muscles of the distal leg, for instance the gastrocnemius and tibialis anterior, are commonly used in such studies with mice and rats. However, thin and flat muscles, which can be dissected, processed and imaged without major disruption to muscle fibres and nerve‐muscle contacts, are more suitable for accurate and detailed analyses of the peripheral motor nervous system. One such wholemount muscle is the predominantly fast twitch epitrochleoanconeus (ETA), which is located in the upper forelimb, innervated by the radial nerve, and contains relatively large and uniformly flat neuromuscular junctions (NMJs). To facilitate incorporation of the ETA into the experimental toolkit of the neuromuscular disease field, here, we describe a simple method for its rapid isolation (<5 min), supported by high‐resolution videos and step‐by‐step images. Furthermore, we outline how the ETA can be imaged in live, anaesthetised mice, to enable examination of dynamic cellular processes occurring at the NMJ and within intramuscular axons, including transport of organelles, such as mitochondria and signalling endosomes. Finally, we present reference data on wild‐type ETA fibre‐type composition in young adult, male C57BL6/J mice. Comparative neuroanatomical studies of different muscles in rodent models of disease can generate critical insights into pathogenesis and pathology; dissection of the wholemount ETA provides the possibility to diversify the repertoire of muscles analysed for this endeavour. [ABSTRACT FROM AUTHOR]

Electromyographic needle access to the flexor pollicis longus (FPL) is challenging because of the risk of injuries to the superficial radial nerve (SRN) or radial artery (RA), which run close to the FPL. This study aimed to investigate the safe electromyographic needle insertion point of the FPL using a newly proposed RA pulse palpation method. Fifty forearms of 25 healthy individuals were studied. At the junction of the middle and distal third of the forearm, an RA pulse was palpated, and 5 mm lateral to the pulse was determined as the preliminary needle insertion point. The distance from the vertical virtual needle pathway to the RA and SRN was measured using ultrasonography. In ultrasonography, the distances from the needle pathway to the RA and the SRN were 3.4 ± 0.8 (range, 2.1–6.0) and 5.9 ± 1.8 (range, 2.4–9.4) mm, respectively. The depth of the FPL muscle was 8.4 ± 1.7 mm. Electromyographic needle insertion into the FPL can be safely performed using the RA palpation method. The needle insertion point is 5 mm lateral to the RA pulse at the level between the middle and distal third of the forearm. [ABSTRACT FROM AUTHOR]

Background: Elbow arthroscopic surgery has been popularized and has made significant progress during the past 3 decades. The elbow joint is relatively small and is in close proximity to many neurovascular structures. These factors make elbow arthroscopic surgery technically demanding and liable to complications. Purpose: To evaluate the rate of complications after elbow arthroscopic surgery. Study Design: Systematic review; Level of evidence, 4. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review and meta-analysis. PubMed, Web of Science, and Embase were searched up to July 2021. All clinical studies that reported complications after elbow arthroscopic surgery were included; a total of 1208 articles were initially found. Case reports, reviews, abstracts, imaging studies, technique studies, nonclinical studies, and those not reporting postoperative complications were excluded. Complication rates were pooled across studies and reported as percentages. Complications were expressed as weighted proportions with 95% CIs. Results: A total of 95 studies (14,289 elbows) were included in the meta-analysis. The overall weighted complication rate was 11.0% (95% CI, 8.8%-13.5%), with postoperative stiffness being the most commonly encountered complication (4.5% [95% CI, 2.1%-7.6%]; 158/8818 procedures). The second most encountered complication was the need for subsequent surgery with a weighted proportion of 4.1% (95% CI, 2.9%-5.6%; 177/8853 procedures) followed by nerve injury with a weighted proportion of 3.4% (95% CI, 2.6%-4.3%; 267/13,725 procedures). The ulnar nerve was the most commonly injured nerve (2.6% [95% CI, 1.9%-3.4%]; 123/6290 procedures). Conclusion: The results of this study showed that elbow arthroscopic surgery is a relatively safe procedure with low complication rates. [ABSTRACT FROM AUTHOR]

Background and Objectives: Due to the rarity of radial nerve palsy in humeral shaft fractures in the paediatric population and the lack of data in the literature, the purpose of our study was to report the treatment results of six children who sustained a radial nerve injury following a humeral shaft fracture. Materials and Methods: We treated six paediatric patients with radial nerve palsy caused by a humeral shaft fracture in our department from January 2011 to June 2022. The study group consisted of four boys and one girl aged 8.6 to 17.2 (average 13.6). The mean follow-up was 18.4 months. To present our results, we have used the STROBE protocol designed for retrospective observational studies. Results: We diagnosed two open and four closed humeral shaft fractures. Two simple transverse AO 12A3c; one simple oblique AO 12A2c; two simple spiral AO 12A1b/AO 12A1c and one intact wedge AO 12B2c were recognized. The humeral shaft was affected in the distal third five times and in the middle third one time. In our study group, we found two cases of neurotmesis; two entrapped nerves within the fracture; one stretched nerve over the bone fragments and one case of neuropraxia. We found restitution of the motor function in all cases. For all patients, extensor muscle strength was assessed on the grade M4 according to the BMRC scale (except for a patient with neuropraxia—M5). The differences in patients concerned the incomplete extension at the radiocarpal and metacarpophalangeal (MCP) joints. Conclusions: In our small case series, humeral shaft fractures complicated with radial nerve palsy are always challenging medical issues. In paediatric patients, we highly recommend an US examination where it is possible to be carried out to improve the system of decision making. Expectant observation with no nerve exploration is reasonable only in close fractures caused by low-energy trauma. Early surgical nerve exploration related with fracture stabilisation is highly recommended in fractures after high-energy trauma, especially in open fractures and where symptoms of nerve palsy appear at any stage of conservative treatment. [ABSTRACT FROM AUTHOR]

Individuals with complete cervical spinal cord injury suffer from a permanent paralysis of upper limbs which prevents them from achieving most of the activities of daily living. We developed a neuroprosthetic solution to restore hand motor function. Electrical stimulation of the radial and median nerves by means of two epineural electrodes enabled functional movements of paralyzed hands. We demonstrated in two participants with complete tetraplegia that selective stimulation of nerve fascicles by means of optimized spreading of the current over the active contacts of the multicontact epineural electrodes induced functional and powerful grasping movements which remained stable over the 28 days of implantation. We also showed that participants were able to trigger the activation of movements of their paralyzed limb using an intuitive interface controlled by voluntary actions and that they were able to perform useful functional movements such as holding a can and drinking through a straw. [ABSTRACT FROM AUTHOR]

Background and Aims: The parasagittal ultrasound-guided infraclavicular block (ICB) aims to cover all the elements of brachial plexus for the surgeries at and below the elbow. Our aim was to demonstrate the spread of 20 ml latex in vicinity of brachial plexus cords after injecting posterior to the axillary artery in Thiel embalmed cadavers. Material and Methods: A blunt insulated needle was inserted posterior to the axillary artery in a traditional parasagittal infraclavicular in 2 Thiel embalmed cadavers, on both the sides (four specimens). A day later cadaver 1 was dissected and cadaver 2 was frozen at ‒20°C for 2 weeks and sectioned. Both cadavers were photographed. Results: In cadaver 1, dissection revealed a spread of red latex on the lateral cord extending onto the musculocutaneous nerve, the posterior cord engulfing the radial and axillary nerves distally. In cadaver 2, a cross-section revealed latex engulfed all three cords. Conclusion: Single injection of 20 ml latex aimed posterior to the axillary artery in the parasagittal infraclavicular approach engulfed the posterior, medial and lateral cord in Thiel embalmed cadavers. This needs to be investigated in patients who receive ICB clinically and using contrast studies. [ABSTRACT FROM AUTHOR]

Restoration of hand function after C8-T1 spinal nerve injury is challenging. We report a case of a young patient who underwent single-stage transfer of extensor carpi radialis brevis (ECRB) branch of radial nerve to flexor digitorum superficialis (FDS) branch of median nerve and transfer of brachialis branch of musculocutaneous nerve to anterior interosseous nerve (AIN), aiming for restoration of all finger flexion in iatrogenic C8-T1 spinal nerve injury after the resection of a dumbbell-shaped C8 neurofibroma. At 18 months after the operation, the fingers and thumb functions were successfully restored. The operation might be useful for restoration of hand function in selected patients with C8, T1 brachial plexus injury. From the literature review, this is the first case that the technique of double motor nerve transfer and the transfer of ECRB branch to FDS branch were used to restore finger flexion in a patient with brachial plexus injury. [ABSTRACT FROM AUTHOR]

Introduction and Objective: Proximal humerus fractures with metaphysodiaphyseal extension represent a challenge for the orthopedic surgeon due to their reduced incidence and the difficulty in the treatment decision. These can be treated with an intramedullary nail or using the MIPO technique, associating different advantages and complications depending on the procedure. The objective of this study was to compare metaphyseal-diaphyseal fractures of the humerus treated with antegrade intramedullary nailing and those operated using the MIPO technique to see if there were significant differences in terms of functional, clinical, and radiological results.Material and Methods: retrospective, analytical and unicentric review of 29 patients with proximal fracture with metaphyseal-diaphyseal extension treated by MIPO technique and 33 patients surgically treated by antegrade intramedullary nailing (IMN) in our hospital from 2014 to 2020. Demographic, functional, radiographic and clinical data were obtained..Results: No significant differences were observed between both groups in terms of fracture mechanism (p=0.34), fracture type (p=0.13) or Maresca classification (p=0.32). Surgical time was significantly shorter in the IMN group compared to the MIPO technique (p=0.014). No significant difference was observed regarding the need for blood transfusion (p=0.32). The mean consolidation in the MIPO group was 21 weeks compared to 21 weeks in the IMN, with no significant differences between both groups (p= 0.88). No significant differences were observed between CONSTANT test at one year in the MIPO group versus the IMN group (p=0.79), nor in radial nerve palsies (p=0.28).Conclusions: Proximal fractures with metaphyseal-diaphyseal extension are a challenge for the orthopedic surgeon due to the infrequency, the complexity of these fractures and the fact that there is no established consensus on the ideal treatment for this type of injury. Both the MIPO technique with the Philos plate and the intramedullary nail are valid options for the treatment of these fractures, with no differences observed in terms of fracture consolidation time or in terms of functional results. [ABSTRACT FROM AUTHOR]

Background: Postoperative radial nerve palsy (RNP) is a well-known complication of nonunion reconstruction of the humerus. The purpose of the current study is to determine if the surgical approach for nonunion reconstruction of the humerus influences the rate of postoperative radial nerve palsy.Methods: A retrospective case-control study of all humeral shaft and extraarticular distal humerus nonunion reconstructions performed between January 1, 2004, and August 31, 2021, was conducted. Patients included were over 18 years of age, had a non-pathologic humerus fracture nonunion and had intact radial nerve function prior to nonunion reconstruction. Exclusion criteria consisted of nonunions involving the proximal humerus, intraarticular fractures, and reconstructive treatment procedures with either intramedullary nail or external fixation methods. Perioperative variables were recorded and analyzed in regard to the development of postoperative RNP. A subgroup analysis was performed to assess the interaction of significant variables on the development of postoperative RNP.Results: The overall rate of postoperative RNP in this series was 6/53 (11%). However, no cases of postoperative radial nerve palsy were observed in patients who underwent nonunion reconstruction with a lateral paratricipital approach. A new RNP was seen in 4/9 (44%) of those patients who underwent a triceps splitting approach, which was significantly higher than those utilizing either an anterolateral approach (2/28, 7%) or a lateral paratricipital approach (0/16, 0%, p = 0.007).Discussion and Conclusion: Our data suggests that the lateral paratricipital exposure decreases the risk of radial nerve injury with nonunion reconstruction of the humerus. The lateral paratricipital exposure offers the benefit of radial nerve exploration, decompression, neurolysis and protection prior to fracture manipulation and instrumentation. This study shows conventional approaches may predispose patients to a high rate of postoperative RNP, similar to that in the literature. [ABSTRACT FROM AUTHOR]

Introduction: Radial neck fracture is a less common injury in childhood and many factors are associated with the final functional outcomes. This study aimed to describe the clinical and radiological results of the patients with radial neck fractures treated surgically and assess the potential risk factors for poor functional outcomes.Patients and Methods: This study enrolled 101 children with radial neck fracture and treated surgically at our department. Patients were followed up at least three years and assessed clinically and radiographically. The primary outcome of this study was the functional outcome assessed by using Metaizeau criteria and the secondary outcome was complications of radial head necrosis, postoperative radial nerve palsy, bone union, infection, and skin irritation. Related risk factors for unsatisfactory functional outcomes were recorded and analyzed by multivariable logistic regression.Results: In total, 101 patients with 101 elbows (44 on the left side, 57 on the right side) were evaluated in our study, including 55 females (54.5%) and 46 males (45.5%), with a mean age of 7.5±2.7 years old (range, 3 to 14 years). There were 65.3% excellent (66 cases), 18.8% good (19 cases), 11.9% fair (12 cases), and 4.0% bad (4 cases) results in these patients. The rate of satisfactory outcome was 65.3% (66/101) and the rate of "unsatisfactory outcome" was 34.7% (35/101). Complications included postoperative radial nerve palsies in 15 cases (14.9%), radial head necrosis in 4 cases (4.0%), skin irritation due to the nail-end in 5 cases (5.0%), infection in 2 cases (2.0%), and bone nonunion in 1 patient (1.0%). Only Judet type (OR, 5.78; CI, 1.72-19.39, p=0.005) and surgical method (OR, 12.68; CI, 2.55-63.06, p=0.002) were independent risk factors for the unsatisfactory functional outcomes.Conclusions: Closed reduction with intramedullary fixation is a primary treatment for type III and IV radial neck fractures in children. Fracture severity classified as Judet type IV and open surgical method were independent predictors for unsatisfactory functional outcomes. [ABSTRACT FROM AUTHOR]

Aim: To report the first UK experience of cryoablation in desmoid fibromatosis (DF) with particular focus on technique, safety, and efficacy.Materials and Methods: Patients were selected at multidisciplinary tumour board meetings at a specialist cancer hospital. Radiation dose, procedure duration, and number of cryoprobes were compared for small versus large tumours (>10 cm long axis). Response at magnetic resonance imaging (MRI) was evaluated using different criteria, and percentage agreement with clinical response as assessed in oncology clinic calculated.Results: Thirteen procedures were performed in 10 patients (eight women, median age 51 years, IQR 42-69 years) between February 2019 and August 2021. Procedures for large tumours had higher radiation dose (2,012 ± 1,012 versus 1,076 ± 519 mGy·cm, p=0.048) used more cryoprobes (13 ± 7 versus 4 ± 2, p=0.009), and were more likely to have residual unablated tumour (38 ± 37% versus 7.5 ± 10%, p=0.045). Adverse events were minor apart from one transient radial nerve palsy. Eight of 10 patients had symptomatic benefit at clinical follow-up (median 353 days, IQR 86-796 days), and three started systemic therapy mean 393 days later. All patients who had complete ablation demonstrated symptomatic response, with no instances of repeat treatment, recurrence, or need for systemic therapy during the study period. All progression occurred outside ablation zones.Conclusion: Cryoablation for symptomatic DF is a reproducible technique with low, transient toxicity, where one or two treatments can achieve a meaningful response. Where possible, the ablation ice ball should fully cover DF tumours. [ABSTRACT FROM AUTHOR]

Background: A stab incision and blunt dissection prior to wire placement are believed to decrease the risk of injury to underlying structures during percutaneous pinning of distal radius fractures (DRF). However, only a few studies have compared stab incision and blunt dissection to direct wire placement. The aim of this cadaveric study is to analyse the structures at risk during percutaneous pinning of DRF and compare the two methods of wire placement. Methods: A total of 10 cadavers (20 upper limbs) were divided into two groups of five each. Five 2.0 mm Kirschner (K)-wires were inserted into the distal radius under fluoroscopic control in a standard fashion to simulate percutaneous pinning of DRF. In group 1, the K-wires were inserted directly, whereas in group 2, the wires were inserted after making a stab incision and blunt dissection to reach the bone. Each cadaveric limb was then dissected carefully to measure the distance of the K-wires from the branches of the superficial radial nerve (SRN), the cephalic vein and the first dorsal compartment and to determine the structures injured (pierced or in close contact) by the K-wires. Results: Out of the 100 K-wires placed, 18 wires were in close contact or pierced an underlying structure. These included 11 wires injuring tendons, six wires injuring branches of the SRN and one wire injuring the cephalic vein. Direct wire placement (group 1) resulted in injury to eight structures (44.4%) while stab incision and blunt dissection prior to wire placement (group 2) resulted in injury to 10 structures (55.5%). This difference was not statistically significant. Conclusions: Percutaneous pinning of DRF is associated with a high risk of injury to the extensor tendons and branches of the SRN. This risk is not reduced by making a stab incision and blunt dissection prior to K-wire placement. [ABSTRACT FROM AUTHOR]

One of the rarer manifestations of constriction band syndrome (CBS) is peripheral nerve palsy. We report a 6-year-old child presenting with motor deficits of the median, ulnar and radial nerves and atrophy of the biceps and brachialis atrophy due to CBS. We were unable to find any similar reports in the literature. He had a constriction ring at the upper arm that had undergone multiple z-plasty by another surgeon. On examination, he had medical research council (MRC) grade 1 elbow flexion, weak flexion of fingers and absent extension of fingers and wrist. We used a pedicled pectoralis major myocutaneous flap to restore elbow flexion and the patient achieved M4 flexion of the elbow. Level of Evidence: Level V (Therapeutic) [ABSTRACT FROM AUTHOR]

Background: Injuries to the shafts of radius and ulna are one of the most common reasons for children to receive orthopedic care. The purpose of this study was to evaluate the radiological and clinical outcome of fracture both bone forearm in children treated by elastic nail. Patients and methods: This clinical trial was conducted on 18 patients with fracture shaft of both bone forearm treated by elastic stable intramedullary nail (ESIN) in Zagazig University Hospital, Egypt, and Emhamed Almaqrif Hospital Educational Center, Ajdabia, Libya. It was conducted to evaluate the radiological and clinical outcome of fracture both bone forearm in children treated by elastic stable intramedullary nail. Results: The mean time to union was 9.94 (SD 2.01) weeks with minimum 7 and maximum 14 weeks. According to the Mayo score majority were excellent 61.1%, then good 27.8% and finally fair 11.1%, and only 4 cases 22.2% had complication (2 surgical site infections, 1 superficial radial nerve injury, and 1 nonunion). Conclusion: ESIN is secure and suitable for young children for the treatment of displaced forearm fractures. [ABSTRACT FROM AUTHOR]

Cervical nerve root avulsion in brachial plexus injuries: magnetic resonance imaging classification and comparison with myelography and computerized tomography myelography. Conclusion Cervical nerve root avulsions and other devastating brachial plexus injuries are extremely rare in contact sports. Brachial plexus and cervical nerve injuries can be divided into "preganglionic" injuries, which affect the cervical nerve roots and spinal cord proximal to the dorsal root ganglion, and "postganglionic" injuries that affect the cervical spinal nerves and brachial plexus. Discussion Devastating brachial plexus injuries are exceedingly rare in the athletic population and our case represents one of five known cases of cervical nerve root avulsion associated with American football ([[3], [6]]). [Extracted from the article]

Although many textbooks reported the innervation of three heads of the triceps muscle with the radial nerve, some studies showed the axillary nerve supply to this muscle. Herein, we report a 21-year-old male patients with a traumatic injury to the axillary nerve associated with paralysis of his triceps muscle. Based on the electrophysiological findings, it could be reasonable to conclude that the main branch innervating all heads of the triceps muscle originated from the axillary nerve. It is vital to look for concomitant paralysis of the triceps in patients with an axillary nerve injury in terms of surgical management, prognosis, and nerve repair. [ABSTRACT FROM AUTHOR]

Context: Ultrasound is an excellent modality for the evaluation of the soft tissue structures as well as articular pathologies of the elbow joint. Higher resolution transducers along with the superficial location of the elbow structures make them amenable for easy visualisation However, the long learning curve and the operator dependency can limit its use. Aims: The aim of this article is to describe and demonstrate novel techniques to image distal biceps tendon, lateral ulnar collateral ligament and radial nerve at elbow joint with ease. Design: Technical advancement. Methods: The elbow joint ultrasound examination was performed on ten asymptomatic volunteers, 20–40 years old, using a linear probe of 3–13 MHz frequency. The scanning was started from the anterior elbow, the distal biceps tendon was visualised first with anterior to the medial approach followed by the lateral ulnar collateral ligament with one finger technique and radial nerve with first bone technique respectively. Conclusion: We consider our techniques as an easy approach to identify the distal biceps tendon, lateral ulnar collateral ligament and radial nerve.

Abstract Background The aim of this study was to discuss the treatment of extra-articular distal humeral shaft fractures using ultrasound-guided preoperative localization of radial nerve. Methods Between May 2010 and December 2019, 56 patients with extra-articular distal humeral shaft fractures were retrospectively reviewed. Twenty eight patients were received examination by using preoperative localization of radial nerve guided by ultrasound-guided preoperative localization (group A) and 28 control patients without ultrasound-guided (group B). All patients were treated surgically for distal humeral shaft fractures by posterior approach techniques. Operative time, radial nerve exposure time, intraoperative bleeding volume, union time and iatrogenic radial nerve palsy rate were compared between the two groups. Elbow function was also evaluated using the Mayo Elbow Performance Score (MEPS). Results A significant difference was observed between the two groups, Operative time (113.25 min vs 135.86 min) (P

Objective: To detail the neurovascular crossing patterns between the leash of Henry (LoH) and the deep branch of the radial nerve (DBRN) in supination and pronation of the forearm, using imaging methods with anatomic correlation.This cross-sectional study was performed ex vivo with HRUS and MRI with anatomic correlation on 6 samples and in vivo with HRUS with Doppler on 55 participants scanned bilaterally. The in vivo participants were enrolled over a 6-month period. The crossing patterns between the LoH and DBRN were assessed ex vivo and in vivo. Additional morphological features of the DBRN, LoH, and fat plane were assessed in vivo only. Biometric features of the participants were recorded. Statistical analyses were performed using Shapiro–Wilk, parametric and non-parametric tests.The most common neurovascular crossing pattern was the ascending branch of the radial recurrent artery (RRAab) crossing below (ex vivo: 83.3%, in vivo: 85.3%) and the muscular branch crossing above (ex vivo: 100%, in vivo: 63.2% %) the DBRN. Both the deep and superficial surfaces of the DBRN exhibited an intimate relationship with the vessels of the LoH. A positive correlation between vessel diameter and anthropometric factors was observed. In addition, the muscular branch exhibited a significantly smaller diameter than the RRAab.Our study detailed the relationship between the LoH and the DBRN and highlighted the high incidence of vessel crossing above the DBRN at the level of the muscular branch. Knowledge of neurovascular crossings is crucial for understanding neurovascular entrapment syndromes and planning interventional procedures to reduce vascular complications.Materials and methods: To detail the neurovascular crossing patterns between the leash of Henry (LoH) and the deep branch of the radial nerve (DBRN) in supination and pronation of the forearm, using imaging methods with anatomic correlation.This cross-sectional study was performed ex vivo with HRUS and MRI with anatomic correlation on 6 samples and in vivo with HRUS with Doppler on 55 participants scanned bilaterally. The in vivo participants were enrolled over a 6-month period. The crossing patterns between the LoH and DBRN were assessed ex vivo and in vivo. Additional morphological features of the DBRN, LoH, and fat plane were assessed in vivo only. Biometric features of the participants were recorded. Statistical analyses were performed using Shapiro–Wilk, parametric and non-parametric tests.The most common neurovascular crossing pattern was the ascending branch of the radial recurrent artery (RRAab) crossing below (ex vivo: 83.3%, in vivo: 85.3%) and the muscular branch crossing above (ex vivo: 100%, in vivo: 63.2% %) the DBRN. Both the deep and superficial surfaces of the DBRN exhibited an intimate relationship with the vessels of the LoH. A positive correlation between vessel diameter and anthropometric factors was observed. In addition, the muscular branch exhibited a significantly smaller diameter than the RRAab.Our study detailed the relationship between the LoH and the DBRN and highlighted the high incidence of vessel crossing above the DBRN at the level of the muscular branch. Knowledge of neurovascular crossings is crucial for understanding neurovascular entrapment syndromes and planning interventional procedures to reduce vascular complications.Results: To detail the neurovascular crossing patterns between the leash of Henry (LoH) and the deep branch of the radial nerve (DBRN) in supination and pronation of the forearm, using imaging methods with anatomic correlation.This cross-sectional study was performed ex vivo with HRUS and MRI with anatomic correlation on 6 samples and in vivo with HRUS with Doppler on 55 participants scanned bilaterally. The in vivo participants were enrolled over a 6-month period. The crossing patterns between the LoH and DBRN were assessed ex vivo and in vivo. Additional morphological features of the DBRN, LoH, and fat plane were assessed in vivo only. Biometric features of the participants were recorded. Statistical analyses were performed using Shapiro–Wilk, parametric and non-parametric tests.The most common neurovascular crossing pattern was the ascending branch of the radial recurrent artery (RRAab) crossing below (ex vivo: 83.3%, in vivo: 85.3%) and the muscular branch crossing above (ex vivo: 100%, in vivo: 63.2% %) the DBRN. Both the deep and superficial surfaces of the DBRN exhibited an intimate relationship with the vessels of the LoH. A positive correlation between vessel diameter and anthropometric factors was observed. In addition, the muscular branch exhibited a significantly smaller diameter than the RRAab.Our study detailed the relationship between the LoH and the DBRN and highlighted the high incidence of vessel crossing above the DBRN at the level of the muscular branch. Knowledge of neurovascular crossings is crucial for understanding neurovascular entrapment syndromes and planning interventional procedures to reduce vascular complications.Conclusion: To detail the neurovascular crossing patterns between the leash of Henry (LoH) and the deep branch of the radial nerve (DBRN) in supination and pronation of the forearm, using imaging methods with anatomic correlation.This cross-sectional study was performed ex vivo with HRUS and MRI with anatomic correlation on 6 samples and in vivo with HRUS with Doppler on 55 participants scanned bilaterally. The in vivo participants were enrolled over a 6-month period. The crossing patterns between the LoH and DBRN were assessed ex vivo and in vivo. Additional morphological features of the DBRN, LoH, and fat plane were assessed in vivo only. Biometric features of the participants were recorded. Statistical analyses were performed using Shapiro–Wilk, parametric and non-parametric tests.The most common neurovascular crossing pattern was the ascending branch of the radial recurrent artery (RRAab) crossing below (ex vivo: 83.3%, in vivo: 85.3%) and the muscular branch crossing above (ex vivo: 100%, in vivo: 63.2% %) the DBRN. Both the deep and superficial surfaces of the DBRN exhibited an intimate relationship with the vessels of the LoH. A positive correlation between vessel diameter and anthropometric factors was observed. In addition, the muscular branch exhibited a significantly smaller diameter than the RRAab.Our study detailed the relationship between the LoH and the DBRN and highlighted the high incidence of vessel crossing above the DBRN at the level of the muscular branch. Knowledge of neurovascular crossings is crucial for understanding neurovascular entrapment syndromes and planning interventional procedures to reduce vascular complications. [ABSTRACT FROM AUTHOR]

The brachioradialis muscle (BR) belongs to the lateral forearm muscle. Typically, the radial nerve innervates it. BR morphological variability, such as split muscular belly, split tendon, or accessory BR (ABR), has been described in the current literature. A 68-year-old female donated cadaver was routinely dissected for research and educational purposes. A variant muscle was identified extending at the right arm’s lateral and forearm compartments. It originated from the humerus lateral surface between the deltoid and the triceps brachii lateral head, joined the second muscular head from the brachialis muscle, and inserted into the radius styloid process. According to its origin, course, and insertion, the variant muscle probably corresponded to the BR accessory form. However, in the current literature, the ABR morphology corresponds to an accessory muscle originating adjacent to the typical BR and inserted into the radial tuberosity. At the same time, it was defined as “brachioradialis brevis.” In the current case, the variant muscle differed significantly from the current literature due to the origin, insertion, length, and relationship with the typical BR; therefore, the term “brachioradialis longus” seemed adequate to describe this variant muscle. [ABSTRACT FROM AUTHOR]

[Display omitted] • Multifunctional aerogel as a unique and advanced biomaterial for tissue regeneration and repair is reviewed. • Unique properties, advantages, preparation techniques, and classifications of aerogel-based biomaterials are summarized. • Aerogel-based strategies for tissue regeneration are overviewed. • The challenge and future perspectives of multifunctional aerogel for tissue regeneration and repair are prospected. Amidst the rapid advancements in materials science, the exploration of aerogel-based biomaterials has garnered extensive attention across diverse sectors, including biomedicine, energy, architecture, and sensing. Comprehensive studies have unveiled the utilization of organic, inorganic, and hybridized materials for aerogel preparation, catapulting aerogel-based biomaterials to global prominence. Endowed with distinctive properties, including low density, a hierarchical porous network, high porosity, and nanoscale micropores, aerogels have exhibited a broad spectrum of applications, particularly in the realm of tissue engineering. The deployment of aerogel-based biomaterials in tissue engineering is in a dynamic phase of development, with available reports indicating varying degrees of exploration in fields such as blood vessels, soft tissues, nerves, skin, muscles, heart, bronchial tubes, bone, and cartilage—an evolutionary process. This paper offers a comprehensive review of the evolution of aerogel properties and preparation processes, encapsulating strategic insights for the application of aerogel-based biomaterials in tissue engineering. It succinctly summarizes recent developments in tissue engineering research, emphasizing their significance. Additionally, the review outlines future prospects for the application of aerogels in tissue engineering and envisions challenges arising from current studies. Through this thorough exploration of aerogel-based biomaterials in tissue engineering, the paper aspires to make a profound impact on regenerative medicine, offering innovative and effective application strategies for biomedicine. [ABSTRACT FROM AUTHOR]

Some authors have proposed the potential role of the radial nerve in lateral epicondylalgia. The aims of this study were to investigate the presence of pressure pain hyperalgesia and nerve swelling (increased cross-sectional area) assessed with ultrasound imaging on the radial nerve in people with lateral epicondylalgia, and to investigate if an association exists between pressure pain sensitivity and cross-sectional area. A total of 37 patients with lateral epicondylalgia (43% women, age: 45.5 ± 9.5 years) and 37 age- and sex-matched pain-free controls were recruited for participation. Pressure pain thresholds (PPTs) were assessed bilaterally on the radial nerve at the spiral groove, the arcade of Frohse, and the anatomic snuffbox in a blinded design. Further, the cross-sectional area of the radial nerve at the spiral groove and antecubital fossa was also assessed. The results demonstrated lower PPTs on the radial nerve of the affected side in individuals with lateral epicondylalgia as compared with the unaffected side (p < 0.01) and with both sides in healthy controls (p < 0.001). Additionally, the cross-sectional area of the radial nerve on the affected side in patients was higher compared with the unaffected side (p < 0.01) and both sides in healthy controls (p < 0.001). The cross-sectional area of the radial nerve at the spiral groove was negatively associated with PPTs over the radial nerve at the spiral groove (r = −0.496, p = 0.002) and positively associated with function (r = 0.325, p = 0.045). Our findings revealed generalized pressure pain hyperalgesia and also nerve swelling of the radial nerve in people with lateral epicondylalgia, suggesting the presence of a widespread sensitization of nerve tissues in this population. The radial nerve could represent a potential peripheral drive to initial and maintain altered pain processing in lateral epicondylalgia.

Background: The posterior approach to the humeral shaft is commonly used for surgical procedures on the humeral shaft. We present our experiences using the modification of the surgical exposure described by Gerwin M. which we have found useful at the time of revision surgery. Methods: Between 2014 and 2019, six patients who underwent a revision surgical procedure for a nonunion of the humeral shaft where a prior surgical procedure was performed through a posterior incision were included. The approach used a modification of the posterior approach described by Gerwin M. where the lower lateral cutaneous nerve branch of the radial nerve is used to identify trace, mobilize, retract, and protect the radial nerve to achieve adequate exposure of the humeral shaft. Results and Discussion: None of the patients had a postoperative nerve deficit.Adequate exposure to aid hardware removal, osteosynthesis, and bone grafting was achieved in all patients. Conclusion: The modification of the posterior approach described by Gerwin M. is useful at the time of revision or redo surgery on the humeral shaft where other bony and soft tissue landmarks are altered to prevent an iatrogenic injury to the radial nerve while providing adequate exposure to treat a nonunion.

INTRODUCTION: The radial nerve danger zone (RNDZ) is an important anatomic consideration to anticipate or prevent injury in trauma assessment or surgical fixation. No published estimate currently exists for Filipinos. In this study, we sought to provide a local estimate and explore potential predictors of this anatomic region in Filipino adult cadavers. MATERIALS AND METHODS: Posterior dissection to expose and measure the radial nerve, from the lateral epicondyle to the lateral intermuscular septum, was performed in 60 upper limbs from 30 formalin-preserved cadavers in the laboratory of the Department of Anatomy, College of Medicine, University of the Philippines Manila. Univariate and multivariate linear regression modelling was performed with RNDZ as the dependent variable and age, sex, height and humeral length as potential independent variables individually and in combinations. RESULTS: The mean radial nerve length from the lateral epicondyle to the lateral intermuscular septum was estimated at 10.6 cm (95% confidence interval: 10.3 cm, 10.9cm). Height and humeral length were statistically significant univariate predictors in female cadavers, while only height was significant in male cadavers. In addition, all multivariate regression models were statistically significant and accounted for more than 57% of the variability in female RNDZ estimates. In comparison, only models that included height and age were statistically significant predictors of RNDZ and accounted for at most 22% of the variability of the estimate in males. CONCLUSION: The estimated length of the radial nerve danger zone generated in this study should be strongly considered over other published estimates in surgical fixation procedures performed in adult Filipinos.

However, the superficial branch of the radial nerve (SRN) lies in this area and the frequency of SRN injury after external fixator surgery is as high as 30% ([1]). Dear Editor, For comminuted distal radial fractures, a two-stage procedure, in which the fracture is first spanned with an external fixator before definitive treatment by open reduction and internal fixation, is an effective approach ([2]). [Extracted from the article]

Wrist position is known to affect the grip strength. We focused on the spinal reflex arc, which would support the movement, and investigated the effects of low‐threshold afferents from the extensor carpi radialis (ECR) on the excitability of the flexor digitorum superficialis (FDS) motoneurons using the post‐stimulus time‐histogram (PSTH) and electromyogram‐averaging (EMG‐A) methods. Electrical conditioning stimulation of an intensity below the motor threshold was applied to the radial nerve branch innervating the ECR. In the PSTH study, changes in the firing probability of single motor units after electrical conditioning stimulation were investigated in seven subjects. An early and significant peak (increase in the firing probability: facilitation) was recorded for 36/60 FDS motor units. The remaining 24 motor units did not show any effects. Weak mechanical conditioning stimulation of the ECR muscle belly induced a similar peak. The central latency of the facilitation was equivalent to that of the homonymous monosynaptic facilitation. In the EMG‐A study, changes in the rectified and averaged electromyograms of FDS induced by conditioning stimulation were examined in 12 subjects. An early and significant peak (facilitation) was induced by both electrical and mechanical conditioning stimulations. The facilitation decreased after withdrawal of the vibration to the ECR muscle belly. The facilitation was never induced by cutaneous nerve stimulation in the PSTH and EMG‐A studies. These findings suggest that Group Ia afferents from the ECR increase the excitability of FDS motoneurons through a monosynaptic path in the spinal cord. These reflex arcs likely facilitate hand grasping movements. [ABSTRACT FROM AUTHOR]

Case: A 53-year-old man sustained an injury to his left index finger and underwent presumably traumatic neuroma excision from the radial digital nerve 2 years ago. He presented with a painful mass distal to the prior site of neuroma excision with distinctly different symptoms from those that led to his index surgery. Thus, he underwent excisional biopsy of the mass which was adherent to his radial digital nerve consistent with a benign glomus tumor on histologic examination. Conclusion: Digital nerve glomus tumors are rare. In most of the cases, some portion of the digital nerve requires excision but decreased pain can be expected. [ABSTRACT FROM AUTHOR]

Schwannomas are the most common benign tumors of the peripheral nerves, but represents only 5%-8% of all soft tissue tumors. Their diagnosis is usually delayed due to their slow growth and the nervous adaptation to their increased volume. Ultrasound sonography and magnetic resonance imaging (MRI) images usually ease the diagnosis. Correct enucleation offers very good postoperative outcomes and avoids recurrences. We report an unusual case of schwannoma of the radial nerve (RN) that remained asymptomatic for one year and a half, and treated well, had good outcomes. [ABSTRACT FROM AUTHOR]

Abstract: This study analyzes the effectiveness of ultrasound-guided hydrodissection (HD) perineural as a treatment for radial tunnel syndrome (RTS). A literature search was performed along with retrospective analysis of local cases to assess outcomes and safety of this procedure. In the case series, surgical candidates, defined as cases with over 80% but temporary relief after diagnostic injection, were treated with ultrasound-guided HD. Of 22 patients who received ultrasound-guided diagnostic injections, 11 proceeded to HD. All HD patients experienced complete and lasting symptom resolution for a minimum of 2 years, and none required surgery. Thorough literature review provided seven studies, which fulfilled inclusion criteria. Sixty-one patients are represented in the literature. All studies reported significant benefit to pain symptoms with HD of radial nerve, with five specifying over 90% improvement. No adverse effects from HD were noted in any study. Ultrasound-guided HD of the radial tunnel has potential to be a surgery sparing treatment for RTS. [ABSTRACT FROM AUTHOR]

Objective Upper limb neurodynamic tests are used to evaluate the mechanical sensitivity of the peripheral nerves. However, very little is known about the reliability of upper limb neurodynamic tests, especially for the radial and ulnar nerves. This study aimed to evaluate the reliability of neurodynamic tests of the upper extremities to test median, radial, and ulnar nerves. Materials & Methods In this observational cross-sectional study, 25 asymptomatic subjects aged 19-45 years participated. They were selected using simple non-random sampling. Then two examiners performed the neurodynamic tests on them on two successive days. The goal was to assess the reliability of median, radial, and ulnar neurodynamic tests. During the neurodynamic tests, the participants reported the initial stretching pain and the moment of submaximal pain (substantially obvious pain) in related areas of the nerve distribution, including the anterior side of the elbow and forearm for the median nerve, posterolateral aspect of the elbow and forearm for radial nerve, and medial side of elbow and forearm for the ulnar nerve. At the starting point of painful stretching and the submaximal pain, the angle of elbow extension (for median and radial nerve tests) and shoulder abduction angle (for ulnar nerve test) were measured using a mechanical goniometer. The range between these two points was used to analyze the reliability. The intraclass correlation coefficient (ICC) and the standard error of measurement (SEM) were calculated to examine the relative and absolute reliability, respectively. Using t-test, the difference in the mean of the measurements was calculated. Results No significant difference was found between the mean measurements of the two testers in intra-session and inter-session reliability. For examiners 1 and 2, was obtained 0.94 (SEM:2°) and 0.89 (SEM:2.85°) for the median nerve, 0.56 (SEM:6.36° ) and 0.93 (SEM:1.82°) for radial nerve, and 0.42 (SEM:3.27°) and 0.79 (SEM:1.42°) for the ulnar nerve. Inter-tester intra-session reliability was obtained at 0.84 (SEM: 3.44°), 0.54 (SEM: 6.1°), and 0.55 (SEM: 2.75°), respectively, for median, radial, and ulnar nerves. Inter-tester inter-session reliability was obtained at 0.97 (SEM:1.43°), 0.69 (SEM:5.06°), and 0.51 (SEM: 2.8°), respectively, for median, radial, and ulnar nerves. Conclusion The upper limb neurodynamic tests and measurement of the range between the onset of stretching pain and the point of submaximal pain have moderate to excellent reliability. Therefore, these clinical tests can be used in diagnostic evaluations and treatment interventions. Also, the median nerve neurodynamic test has higher relative reliability than radial and ulnar nerve neurodynamic tests. [ABSTRACT FROM AUTHOR]

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A special word - and a pathology eponym Although not purely an ulnar nerve exam manoeuvre, the pathology of Klumpke's palsy is so intertwined with that of the ulnar nerve, and Augusta Klumpke's work so great that a special mention will be made here. Finally, it is important to note that the many communications between the ulnar and median nerves (four named eponyms in the forearm and hand), but possible proximal communications as well, may affect these physical exam findings ([29]; [36]; [37]). The ulnar nerve has a long and often misunderstood history with eponym usage, from anatomical terms to physical examination manoeuvres. They published a series of ten ulnar nerve lacerations and found the crossed-finger test in six patients in which the ulnar nerve was completely transected. [Extracted from the article]

(1) Background: Parkinson's disease (PD) is a neurodegenerative disorder represented by the progressive loss of dopamine-producing neurons, it decreases the individual's motor functions and affects the execution of movements. There is a real need to include quantitative techniques and reliable methods to assess the evolution of PD. (2) Methods: This cross-sectional study assessed the variability of wrist RUD (radial and ulnar deviation) and FE (flexion and extension) movements measured by two pairs of capacitive sensors (PS25454 EPIC). The hypothesis was that PD patients have less variability in wrist movement execution than healthy individuals. The data was collected from 29 participants (age: 62.13 ± 9.7) with PD and 29 healthy individuals (60.70 ± 8). Subjects performed the experimental tasks at normal and fast speeds. Six features that captured the amplitude of the hand movements around two axes were estimated from the collected signals. (3) Results: The movement variability was greater for healthy individuals than for PD patients (p < 0.05). (4) Conclusion: The low variability seen in the PD group may indicate they execute wrist RUD and FE in a more restricted way. The variability analysis proposed here could be used as an indicator of patient progress in therapeutic programs and required changes in medication dosage. [ABSTRACT FROM AUTHOR]

The projection pattern of low‐threshold afferents from the extensor carpi radialis (ECR) to motoneurons supplying intrinsic hand muscles was investigated using the post‐stimulus time‐histogram (PSTH) and electromyogram‐averaging (EMG‐A) methods. Electrical conditioning stimulation was applied to the radial nerve branch innervating the ECR. In the PSTH study, changes in the firing probability of single motor units following the stimulation were examined. An early and significant peak (facilitation) was induced in the motoneurons innervating the muscles, but the facilitation was induced infrequently. The central latency of the facilitation was equivalent to that of homonymous facilitation through monosynaptic path in the spinal cord. In the EMG‐A study, changes in the rectified and averaged electromyograms following the conditioning stimulation were examined. An early and significant peak (facilitation) was also induced. The facilitation disappeared after withdrawal of the vibration to the ECR muscle belly. Cutaneous nerve stimulation overlaying ECR never induced such facilitation in the PSTH and EMG‐A studies. These findings suggest that monosynaptic facilitation mediated by group Ia afferents of ECR to the motoneurons supplying intrinsic hand muscles exists in humans, but the connection seems to be weak. This weakness might allow manipulatory movements of the hand. [ABSTRACT FROM AUTHOR]

Background: Leprosy neuropathy is the most common peripheral neuropathy of infectious etiology worldwide; it is characterized as asymmetric and focal multiple mononeuropathy. Semmes-Weinstein monofilament (SWM) test is a simple method to assess sensory nerve function. Methods and findings: In this prospective cohort study, a dermatologist carried out hands and feet tactile sensation test with SWM in 107 multibacillary leprosy patients at diagnosis and in 76 patients at the end of treatment from 2016 to 2019. At diagnosis, 81/107 (75.7%) patients had some degree of functional disability, and 46 (43%) of them had altered SWM-test in the hands and 94 (87.9%) of them in the feet. After one year of multibacillary multidrug therapy, the disability decreasing to 44/76 patients (57.9%) and decreasing of the percentual of patients with altered SWM-test to 18% for the hands, and to 28.7% for the feet. At the end of treatment, the number of SMW-test points presented improvement in the hands of 22 (28.9%) patients, and in the feet of 47 (61.8%). In the hands, by SWM-test, only the radial nerve point demonstrated a significant asymmetry, while in the feet, the difference between the sum of altered SWM-test points showed significant asymmetry between both sides, highlighting the tibial nerve for the establishment of asymmetric leprosy neuropathy. In Spearman's correlation analysis, a positive correlation with statistical significance was observed between the number of hands and feet SWM altered points at diagnosis and the degree of disability at diagnosis (0.69) and at the end of the treatment (0.80). Conclusion: The patterns of hands and feet tactile sensation at diagnosis and their consequent modifications with the anti-leprosy drugs define the bacterial etiology of neuropathy, an important tool for the clinical diagnosis and follow up of the disease, highlighting the tibial nerve findings, the most affected nerve among leprosy patients by SWM-test, with significant asymmetry and focality impairments. [ABSTRACT FROM AUTHOR]