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The development of the ulnar collateral ligament (UCL) guideline was undertaken in accordance with the British Society for Surgery of the Hand Evidence for Surgical Treatment (BEST) Process Manual, which has been accredited by the National Institute for Health and Care Excellence, UK. This review article serves as a summary of the systematic reviews and the final guideline. The group included two patients, a radiologist, a commissioner, an emergency medicine doctor, hand therapists and hand surgeons. The group's recommendations are that patients with acute UCL injuries should be assessed with a history, clinical examination and radiographs. Patients without significant joint laxity can be treated non-surgically. Patients with significant joint laxity on clinical examination may be treated with non-surgical joint immobilization or surgical repair and should reach a shared decision with their clinician about the definitive treatment within 2 weeks of presentation. [ABSTRACT FROM AUTHOR]

The aim of this study is to determine the maximum loss of median and ulnar nerve substances that can be treated by direct suture in elbow flexion and to quantify this elbow flexion. The other objective is to determine the participation of the wrist position in this direct suture in elbow flexion. We performed an experimental study on 6 ulnar nerve lesions and 6 median nerve lesions. For each defect, a direct tensionless suture was performed with elbow flexion and in three different positions of the wrist (wrist extension, neutral position, and wrist flexion). A 90° elbow flexion allowed direct suturing of defects up to 40 mm in the 3 positions of the wrist. A bowstringing effect (i.e., increase of the perpendicular distance of the nerve from the axis of rotation of the elbow) was noted starting from 25 mm of nerve defect. Wrist extension placed tension on the nerve suture for both nerves. The results of this first anatomical study clarified the conditions for direct suturing of ulnar and median nerve defects in the flexed elbow position and flexed wrist position. This is an approach to consider for limited nerve defects to the elbow or when allograft harvesting is to be avoided. [ABSTRACT FROM AUTHOR]

Ulnar-sided wrist pain remains a commonly encountered diagnostic challenge, and its successful management requires a comprehensive understanding of the multiple conditions that can present with this symptom. Midcarpal impaction syndromes in the form of Hamato-lunate and Triquetro-hamate impingement have both previously been reported as rare potential causes of ulnar-sided wrist pain. Despite this, they remain poorly recognized and incompletely understood. This article reviews existing literature that describes the diagnosis and management of these clinical entities. [ABSTRACT FROM AUTHOR]

Background: While initial reports of surgical repair are promising, literature detailing post-repair outcomes is lacking. This study explores the effectiveness of ulnar collateral ligament (UCL) repair in returning professional baseball players to their pre-injury level of play. Professional baseball players undergoing UCL repair will have successful outcomes and high return to sport rates after surgery. Methods: From 2016 to 2021, publicly available databases were utilized to search for professional baseball players who underwent UCL repair. Players were included if they underwent primary UCL repair with an internal brace. Players were excluded if they underwent revision UCL repair, UCL reconstruction, or were amateur baseball players. Results: Of the 11 pitchers that underwent UCL repair, MiLB pitchers returned to sport at an average of 17.5 months. MiLB pitchers had similar ERA, games played, innings pitched, and walks plus hits per inning pitched (WHIP) before and after surgery. Four MLB pitchers (80%) returned to sport at 9.55 months. MLB pitchers had fewer games played and innings pitched but similar ERA and WHIP in after versus before surgery. Pitch velocity and spin rates after surgery varied based on pitch type. The 7 positional players who underwent UCL repair showed no differences in batting or fielding performances before versus after surgery. Conclusions: UCL repair can successfully return both pitchers and positional players at both the MiLB and MLB level back to play at pre-injury levels. Repair can be considered as an option in the right type of injury for players hoping to maximize performance after surgery with minimal recovery time. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Objective: To compare performance in baseball pitchers before and after revision ulnar collateral ligament (UCL) surgery using performance metrics. Design: Case series. Setting: Public online database. Patients (or Participants): Players who underwent revision UCL surgery between 2015 and 2021 were identified. Players were included if they were Minor League (MiLB) or Major League (Major League baseball [MLB]) pitchers. Players were excluded if they were not pitchers, if they underwent their revision surgery as an amateur, or if there is no record of their primary reconstruction surgery. Interventions: Revision UCL surgery (repair or reconstruction). Main Outcome Measures: Return to sport (RTS) rate, RTS time, pitch velocity, and pitch spin rate. Results: Sixty-five pitchers underwent revision UCL surgery. MiLB pitchers had a shorter RTS time after their primary surgery (15.62 vs 20.77 months, P, 0.01) compared with MLB pitchers but similar RTS times after their revision reconstruction (19.64 vs 18.48 months, P 5 0.44). There was also no difference in return to play (RTP) rate overall after primary versus revision reconstruction (P 5 1.00). Major League baseball pitchers also had decreased RTS time after primary compared with revision reconstruction (15.62 vs 19.64 months, P, 0.01) but similar RTP rates (P 5 0.28). Finally, MLB pitchers had similar pitch breakdowns, velocities, and spin rates before and after their primary and revision repair or reconstruction. Conclusions: Both revision UCL repair and reconstruction can return pitchers to preinjury performance levels. Pitchers and teams should be properly counseled on realistic RTP times and postsurgery performance when discussing revision UCL surgeries. [ABSTRACT FROM AUTHOR]

Abstract Purpose This study investigated the clinical and functional outcomes of children with distal both-bone forearm fractures treated by fixation of the radius only compared to fixation of both the radius and ulna. Methods A total of 71 patients from two centres with distal both-bone forearm fractures (30 in the ulna-yes group, 41 in the ulna-no group) who underwent closed reduction and percutaneous pinning treatment were retrospectively analysed. Operation duration, number of fluoroscopic exposures, loss of reduction rate and angulation based on radiographic assessment were compared between the two groups. Evaluation of wrist function including Gartland-Werley Score and Mayo Wrist Score were compared at the last follow-up. Results Ulna angulation upon bone healing on the posteroanterior and the lateral plane of ulna-no group (6.11 ± 1.56°; 6.51 ± 1.69°) was significantly greater than that of ulna-yes group (4.49 ± 1.30°; 5.05 ± 2.18°) (p 0.05). At last follow-up, no significant difference was found between the Gartland-Werley Scores of the ulna-yes group (1.83 ± 3.25, range: 0–16) and ulna-no group (1.85 ± 2.72, range: 0-11.5) (p > 0.05). No significant difference was found between the Mayo Wrist Scores of the ulna-yes group (92.60 ± 6.20) and ulna-no group (92.15 ± 7.58) (p > 0.05). Conclusions For distal both-bone forearm fractures in children, fixation of only the radius appears to be a viable method with equivalent clinical outcomes compared to fixation of both the radius and ulna.

Purpose: This study investigated the clinical and functional outcomes of children with distal both-bone forearm fractures treated by fixation of the radius only compared to fixation of both the radius and ulna. Methods: A total of 71 patients from two centres with distal both-bone forearm fractures (30 in the ulna-yes group, 41 in the ulna-no group) who underwent closed reduction and percutaneous pinning treatment were retrospectively analysed. Operation duration, number of fluoroscopic exposures, loss of reduction rate and angulation based on radiographic assessment were compared between the two groups. Evaluation of wrist function including Gartland-Werley Score and Mayo Wrist Score were compared at the last follow-up. Results: Ulna angulation upon bone healing on the posteroanterior and the lateral plane of ulna-no group (6.11 ± 1.56°; 6.51 ± 1.69°) was significantly greater than that of ulna-yes group (4.49 ± 1.30°; 5.05 ± 2.18°) (p < 0.05). No significant difference was found in the loss of reduction rate between ulna-yes group (6.67%, 2/30) and the ulna-no group (4.88%, 2/41) (p > 0.05). At last follow-up, no significant difference was found between the Gartland-Werley Scores of the ulna-yes group (1.83 ± 3.25, range: 0–16) and ulna-no group (1.85 ± 2.72, range: 0-11.5) (p > 0.05). No significant difference was found between the Mayo Wrist Scores of the ulna-yes group (92.60 ± 6.20) and ulna-no group (92.15 ± 7.58) (p > 0.05). Conclusions: For distal both-bone forearm fractures in children, fixation of only the radius appears to be a viable method with equivalent clinical outcomes compared to fixation of both the radius and ulna. [ABSTRACT FROM AUTHOR]

The locoregional distribution patterns of lymphatic malformations (LM) in the upper extremity have not been described in the scientific literature. Twelve patients were diagnosed with a LM in their upper extremities between 1998 and 2021 at our center. In all cases, these were isolated malformations. Nine patients (75%) presented an ulnar distribution pattern of the LM, two (16.7%) presented a radial distribution pattern, and one (8.3%) presented involvement of both territories. We found no statistically significant differences in any sociodemographic or clinical variable between patients with ulnar or radial LM distribution patterns. In this work, we found that the ulnar distribution pattern was more frequent than the radial distribution pattern in upper extremity LM. Furthermore, we observed that LM in the radial territory appeared as lesions limited to the distal segment of the upper limb (thumb and distal radius). This is a small retrospective case series and therefore, these findings should be interpreted with caution. Larger sample size studies are necessary to validate and characterize this finding. [ABSTRACT FROM AUTHOR]

Performing an ultrasound-guided nerve block (UGNB) is now common practice in many emergency departments (EDs) and is considered a core skill according to the American College of Emergency Physicians (ACEP). Nerve blocks are mostly utilized for fractures and laceration repairs, however, these blocks have many other applications. We present a case of utilizing an ulnar UGNB in a patient with flexor tenosynovitis and a history of intravenous drug use (IVDU) when parental opiates proved to be ineffective.

Background While initial reports of surgical repair are promising, literature detailing post-repair outcomes is lacking. This study explores the effectiveness of ulnar collateral ligament (UCL) repair in returning professional baseball players to their pre-injury level of play. Professional baseball players undergoing UCL repair will have successful outcomes and high return to sport rates after surgery. Methods From 2016 to 2021, publicly available databases were utilized to search for professional baseball players who underwent UCL repair. Players were included if they underwent primary UCL repair with an internal brace. Players were excluded if they underwent revision UCL repair, UCL reconstruction, or were amateur baseball players. Results Of the 11 pitchers that underwent UCL repair, MiLB pitchers returned to sport at an average of 17.5 months. MiLB pitchers had similar ERA, games played, innings pitched, and walks plus hits per inning pitched (WHIP) before and after surgery. Four MLB pitchers (80%) returned to sport at 9.55 months. MLB pitchers had fewer games played and innings pitched but similar ERA and WHIP in after versus before surgery. Pitch velocity and spin rates after surgery varied based on pitch type. The 7 positional players who underwent UCL repair showed no differences in batting or fielding performances before versus after surgery. Conclusions UCL repair can successfully return both pitchers and positional players at both the MiLB and MLB level back to play at pre-injury levels. Repair can be considered as an option in the right type of injury for players hoping to maximize performance after surgery with minimal recovery time. Level of evidence IV.

Background: There are several methods developed for the treatment of high-level peripheral nerve injury (HLPNI) in the upper extremity. However, it causes significant loss of motor functions and sensory defects for the patients, and it is a challenging topic for surgeons. The purpose of our study is to analyze patient characteristics and long-term results of early and late repair of the HLPNI in the upper extremity. Patients and Methods: Patients who were operated from January 2016 to January 2022 due to HLPNI in the upper extremity are included. The characteristics of the patients, which are gender, age, affected nerve, time frame from the injury to operation time, mechanism of injury, whether nerve grafts are used during surgery, and mean follow-up time, are evaluated. Long-term functional results are assessed according to the British Medical Research Council scale during follow-up examinations. Results: The study included 24 patients, and the majority were male (79.1%). Sixteen patients were injured with sharp objects (66.6%). 41.6% of the patients are operated within 72 h after admission to the emergency room, whereas 58.4% of them are operated on after the outpatient clinic admission. The mean motor and sensory results of the patients who operated within the first 72 h after injury were M3S3+. The mean motor and sensory results of the patients who were operated on 72 h-1 month after the injury were M3S3, and for the patients who were operated on 1-5 months after the injury, the mean motor and sensory result was M2S2. The results of the injuries due to sharp objects were M3S3, whereas it was M2S2 for the patients who have been injured due to blunt trauma or firearms. Results of the patients under 20 years old were M3S3+; it was M3S2+ for the 20-50-year-old patients, whereas it was M2S2 for the patients older than 50 years old. Conclusion: Early repair is suggested for the HLPNI in the upper extremity, and gross motor function of the upper extremity is regained better, especially in young patients. Nerve graft necessity should be considered for the late repair. Early repair and secondary nerve repair with nerve graft are not always disappointing for the patient and the surgeon. [ABSTRACT FROM AUTHOR]

Background: There are several methods developed for the treatment of high-level peripheral nerve injury (HLPNI) in the upper extremity. However, it causes significant loss of motor functions and sensory defects for the patients, and it is a challenging topic for surgeons. The purpose of our study is to analyze patient characteristics and long-term results of early and late repair of the HLPNI in the upper extremity. Patients and Methods: Patients who were operated from January 2016 to January 2022 due to HLPNI in the upper extremity are included. The characteristics of the patients, which are gender, age, affected nerve, time frame from the injury to operation time, mechanism of injury, whether nerve grafts are used during surgery, and mean follow-up time, are evaluated. Long-term functional results are assessed according to the British Medical Research Council scale during follow-up examinations. Results: The study included 24 patients, and the majority were male (79.1%). Sixteen patients were injured with sharp objects (66.6%). 41.6% of the patients are operated within 72 h after admission to the emergency room, whereas 58.4% of them are operated on after the outpatient clinic admission. The mean motor and sensory results of the patients who operated within the first 72 h after injury were M3S3+. The mean motor and sensory results of the patients who were operated on 72 h–1 month after the injury were M3S3, and for the patients who were operated on 1–5 months after the injury, the mean motor and sensory result was M2S2. The results of the injuries due to sharp objects were M3S3, whereas it was M2S2 for the patients who have been injured due to blunt trauma or firearms. Results of the patients under 20 years old were M3S3+; it was M3S2+ for the 20–50-year-old patients, whereas it was M2S2 for the patients older than 50 years old. Conclusion: Early repair is suggested for the HLPNI in the upper extremity, and gross motor function of the upper extremity is regained better, especially in young patients. Nerve graft necessity should be considered for the late repair. Early repair and secondary nerve repair with nerve graft are not always disappointing for the patient and the surgeon.

Purpose: DTI characterizes tissue microstructure and provides proxy measures of nerve health. Echo‐planar imaging is a popular method of acquiring DTI but is susceptible to various artifacts (e.g., susceptibility, motion, and eddy currents), which may be ameliorated via preprocessing. There are many pipelines available but limited data comparing their performance, which provides the rationale for this study. Methods: DTI was acquired from the upper limb of heathy volunteers at 3T in blip‐up and blip‐down directions. Data were independently corrected using (i) FSL's TOPUP & eddy, (ii) FSL's TOPUP, (iii) DSI Studio, and (iv) TORTOISE. DTI metrics were extracted from the median, radial, and ulnar nerves and compared (between pipelines) using mixed‐effects linear regression. The geometric similarity of corrected b = 0 images and the slice matched T1‐weighted (T1w) images were computed using the Sörenson‐Dice coefficient. Results: Without preprocessing, the similarity coefficient of the blip‐up and blip‐down datasets to the T1w was 0·80 and 0·79, respectively. Preprocessing improved the geometric similarity by 1% with no difference between pipelines. Compared to TOPUP & eddy, DSI Studio and TORTOISE generated 2% and 6% lower estimates of fractional anisotropy, and 6% and 13% higher estimates of radial diffusivity, respectively. Estimates of anisotropy from TOPUP & eddy versus TOPUP were not different but TOPUP reduced radial diffusivity by 3%. The agreement of DTI metrics between pipelines was poor. Conclusions: Preprocessing DTI from the upper limb improves geometric similarity but the choice of the pipeline introduces clinically important variability in diffusion parameter estimates from peripheral nerves. [ABSTRACT FROM AUTHOR]

El síndrome del martillo hipotenar es una patología vascular poco frecuente que produce una degeneración aneurismática de la arteria cubital a su paso por el canal de Guyon. Se suele dar en trabajadores expuestos a microtraumatismos de repetición en eminencia hipotenar; por ello, algunos autores lo consideran una enfermedad profesional. La clínica varía según el tamaño del aneurisma y la inestabilidad de su contenido. Para el diagnóstico, es necesario realizar una adecuada anamnesis y exploración física del paciente, así como tener un elevado índice de sospecha. Su tratamiento varía desde el médico conservador hasta la cirugía reconstructiva, dependiendo de la permeabilidad y de la integridad vascular del arco palmar. Se presenta un caso clínico de varón de 67 años con aparición de tumoración pulsátil dolorosa en eminencia hipotenar tras realizar trabajos de reforma. Mediante angiorresonancia, se confirmó la sospecha clínica, y se procedió a la resección del aneurisma parcialmente trombosado con posterior reconstrucción arterial.

Peripheral nerve mucoid degeneration is a rare, non-neoplastic, localised degenerative condition of the peripheral nerve, characterised by endoneural deposit of mucoid matrix. Here, we present a rare case of peripheral nerve mucoid degeneration of the ulnar nerve which was clinically suspected to be of neoplastic aetiology. [ABSTRACT FROM AUTHOR]

Background: Upper limb traumatic injuries have a significant impact on social and professional life; however, there is still a paucity of studies focusing on the injuries of the ulnar border of the forearm, wrist and hand. Methods: We designed a retrospective single-blinded study, including all patients with deep traumatic wounds affecting the ulnar side of the forearm, wrist or hand, that received surgical treatment from 2006 until 2016. A characterisation of the sample, assessment of concomitant injuries and clinical outcomes, as well as neurological and functional evaluation were performed. Results: We obtained a sample of 61 patients, 69% with injuries affecting the wrist and 90% of patients with a neurological lesion, most frequently of the ulnar nerve lesion (UNL). Concomitant injuries included tendinous lesions, more frequently of the flexor carpi ulnaris (64%) and fractures (13%). And 39% of patients presented an ulnar artery lesion, without significant differences in outcomes regarding the completion of arteriorrhaphy or not. At the end of the 8.6 years follow-up, 34% of patients had no deficits; however, patients with UNL showed worse functional scores and greater risk of sequelae. Besides motor function compromise, sensory deficits were also associated with worst functional outcomes. Conclusions: The UNL subgroup showed important impairment of the first ray, probably related to the level of UNL. Furthermore, besides the implications of the motor sequelae, sensory deficits were also associated with worst functional scores. Due to the high percentage of neurovascular and tendinous lesions in ulnar-sided upper extremity wounds, the authors recommend surgical exploration of these lesions. Level of Evidence: Level IV (Therapeutic) [ABSTRACT FROM AUTHOR]

Objective To explore the clinical effects of wrist arthroscopy combined with oblique ulnar shortening osteotomy in the treatment of ulnar impaction syndrome. Methods This was a retrospective study of 60 patients with ulnar impaction syndrome who were admitted to our department from January 2016 to December 2019. According to different surgical methods, they were divided into an observation group and a control group, with 30 cases in each group. The control group was treated with oblique ulnar shortening osteotomy, and the observation group used wrist arthroscopy based on the control group. The two groups of patients were compared in terms of wrist function before and 12 months after surgery. We compared the Disabilities of the Arm, Shoulder, and Hand Score (DASH Score), Patient‐Rated Wrist Evaluation Score (PRWE Score), Visual Analog Score (VAS), and ulnar variation between the two groups at 12 months after surgery. The excellent and good rates by Mayo wrist score were compared between the two groups at the last follow‐up. Results All patients were followed up for 12–36 months, with an average of 14.5 months. Bone union was achieved at the oblique osteotomy of the ulna, with an average healing time of 13.6 weeks. The observation group was examined by wrist arthroscopy, and the triangular fibrocartilage complex (TFCC) Palmer classification was confirmed in three cases of type IIA, seven cases of type IIB, 14 cases of type IIC, and six cases of type IID. Compared with before surgery, the grip strength, flexion‐extension, ulnar radial deflection, and forearm rotation of the two groups of patients were significantly improved at 12 months after surgery. The DASH score, PRWE score, and VAS score of the observation group were better than those of the control group, and the difference in ulnar shortening length was not statistically significant between the two groups. The excellent and good rates of the observation group (93.3%) were better than those of the control group (87.5%) at the last follow‐up, and the difference was statistically significant. Conclusion Compared with oblique ulnar shortening osteotomy alone, combined wrist arthroscopy can better reduce the pain of patients with ulnar impaction syndrome, restore wrist function, and improve the excellent and good rates. Therefore, it is clinically worthy of promotion.

Ultrasound has been used previously in fracture identification, analgesia delivery, and fracture reduction for patients in the emergency department. It has not been previously described as a tool for the guidance of closed fracture reduction in fifth metacarpal neck fractures ("boxer's fractures"). A 28-year-old man presented with hand pain and swelling after punching a wall. Point-of-care ultrasound revealed a significantly angulated fifth metacarpal fracture, which was confirmed with a subsequent hand x-ray study. After an ultrasound-guided ulnar nerve block, closed reduction was performed. Ultrasound was used to assess reduction and ensure improvement in bony angulation during the closed reduction attempts. Post-reduction x-ray study confirmed improved angulation and adequate alignment. Why Should an Emergency Physician Be Aware of This? Point-of-care ultrasound has previously had efficacy in fracture diagnosis and anesthesia delivery for fifth metacarpal fractures. Ultrasound can also be used at the bedside to assist in the determination of adequate fracture reduction when performing closed reduction of a boxer's fracture. [ABSTRACT FROM AUTHOR]

Introduction: Periodontitis is a chronic inflammatory disease which affects the supporting tissues of the teeth and was initially thought to be environmental in origin. The difference in the disease prevalence among the population could not be attributed to environment alone. Limited studies have been done on diagnosing the future occurrence of periodontal diseases by recording the finger print patterns of the patients. Aim: To evaluate the relationship between finger prints patterns existing among patients with plaque induced gingivitis, chronic localised and generalised periodontitis. Materials and Methods: This was a cross-sectional observational study, carried out over a period of 6 months from January 2022 to July 2022) at Rajas Dental College and Hospital, Kavalkinaru. Subjects were equally divided into three groups including 100 patients under each group- Group-I as plaque induced gingivitis, group II as localised chronic periodontitis and group III as generalised chronic periodontitis based on 1999 classification system. The finger print patterns observed were loops, whorls and arches. The fingerprint patterns were compared within the group and also between the three groups. Boneferroni test and analysis of variance test were used for statistical analysis. Results: Total of 300 patients were included in this study, out of which 175 were males and 125 were females with the mean age 34.16±1.33 years. On comparison of the fingertip patterns within the groups, a significantly equal distribution of whorl and loop patterns with a value of 4.950±3.11 and 4.750±3.10 respectively were found among the Group-I subjects. A significantly increased prevalence of whorls with a value of 5.300±3.37 was found in Group-II subjects and significantly increased prevalence of loop pattern with a value of 5.800±2.72 was found among Group-III subjects. The arch pattern was more in Group-II and Group-III when compared to Group-I with a value of 1.450±2.21 and 1.200±1.33, respectively. Conclusion: It was concluded that a strong association between fingerprint patterns and chronic periodontitis existed. The present study proved that dermatoglyphics can be used as a powerful tool for early prediction and better prevention of periodontitis.

Abstract Background A major problem in surgery of peripheral nerve injuries of the upper extremities is the unpredictable final outcome. More insight and understanding of the proper methods of outcome assessment and the prognostic factors is necessary to improve functional outcome after repair of peripheral nerves. The objective of this study is to assess the outcome and identify possible prognostic factors for functional recovery of median and/or ulnar nerves repairs at wrist. Forty patients with median, ulnar or combined median-ulnar nerve injuries were included. Smoking, age, sex, repaired nerve, associated artery and/ or tendon repairs, joint stiffness and scar tissue were analyzed as prognostic factors for functional outcome after repair. Outcome parameters were medical research counsel (MRC) scoring for sensory and motor recovery, grip and pinch strength, disability of arm, shoulder and hand (DASH) questionnaire, electrophysiology and ultrasonographic evaluation. Results The mean age of the studied patients was 29.1 ± 8.3 and it was statistically correlated with grip strength (p = 0.045), DASH score (p = 0.046) and hyperesthesia score (p = 0.040). EMG results showed signs of regeneration in all patients in the form of small nascent MUAPs and polyphasic MUAPs. CMAP amplitudes of median and ulnar nerves positively correlated with the MRC scale for muscle strength (p = 0.001) There were statistically significant negative correlations between DASH score and MRC score for sensory evaluation (p = 0.016), grip (p = 0.001), and pinch strength (p = 0.001). There were statistically significant positive correlations between patient's opinion of recovery and MRC score for sensory evaluation (p = 0.029), grip (p = 0.001), and pinch strength (p = 0.001). The MRC score for muscle strength has statistical significant positive correlations with the MRC score for sensory evaluation, grip (p = 0.003), and pinch strength (p = 0.040) Conclusions It was concluded that; MRC scale for muscle power, MRC scale for sensory evaluation, functional scores, grip and pinch strength are valuable tools for evaluation of functional outcome. Age, smoking, associated tendon repair, damaged nerve, compliance to rehabilitation protocol, return to work, clinically visible wound adhesions, residual hand joint stiffness, and scar tissue detected by ultrasound were found to be prognostic factors for outcome after nerve repair.

Objective: To explore the clinical effects of wrist arthroscopy combined with oblique ulnar shortening osteotomy in the treatment of ulnar impaction syndrome. Methods: This was a retrospective study of 60 patients with ulnar impaction syndrome who were admitted to our department from January 2016 to December 2019. According to different surgical methods, they were divided into an observation group and a control group, with 30 cases in each group. The control group was treated with oblique ulnar shortening osteotomy, and the observation group used wrist arthroscopy based on the control group. The two groups of patients were compared in terms of wrist function before and 12 months after surgery. We compared the Disabilities of the Arm, Shoulder, and Hand Score (DASH Score), Patient‐Rated Wrist Evaluation Score (PRWE Score), Visual Analog Score (VAS), and ulnar variation between the two groups at 12 months after surgery. The excellent and good rates by Mayo wrist score were compared between the two groups at the last follow‐up. Results: All patients were followed up for 12–36 months, with an average of 14.5 months. Bone union was achieved at the oblique osteotomy of the ulna, with an average healing time of 13.6 weeks. The observation group was examined by wrist arthroscopy, and the triangular fibrocartilage complex (TFCC) Palmer classification was confirmed in three cases of type IIA, seven cases of type IIB, 14 cases of type IIC, and six cases of type IID. Compared with before surgery, the grip strength, flexion‐extension, ulnar radial deflection, and forearm rotation of the two groups of patients were significantly improved at 12 months after surgery. The DASH score, PRWE score, and VAS score of the observation group were better than those of the control group, and the difference in ulnar shortening length was not statistically significant between the two groups. The excellent and good rates of the observation group (93.3%) were better than those of the control group (87.5%) at the last follow‐up, and the difference was statistically significant. Conclusion: Compared with oblique ulnar shortening osteotomy alone, combined wrist arthroscopy can better reduce the pain of patients with ulnar impaction syndrome, restore wrist function, and improve the excellent and good rates. Therefore, it is clinically worthy of promotion. [ABSTRACT FROM AUTHOR]

Entrapment of peripheral nerves can occur as they travel through restrictive spaces. This nerve compression can result in a constellation of signs and symptoms, which are often called syndromes. Patients initially report pain, paraesthesia and numbness, followed by weakness and clumsiness and, ultimately, muscle wasting. The specific region of paraesthesia and pain and the specific muscle weakness is determined by the peripheral nerve involved and the location of the entrapment. Diagnosis is mainly based on history and examination. Further investigations are available for atypical presentations. Each syndrome has its own set of risk factors, but repetitive action and muscle overuse are commonly associated with most syndromes. The treatment is activity modification followed by steroid injection and finally surgical decompression for ongoing persistent symptoms or severe initial presentation. This article outlines the history, examination, possible investigations and management for common peripheral nerve entrapments of the median, ulnar and radial nerves. [ABSTRACT FROM AUTHOR]

The development of the ulnar collateral ligament (UCL) guideline was undertaken in accordance with the British Society for Surgery of the Hand Evidence for Surgical Treatment (BEST) Process Manual, which has been accredited by the National Institute for Health and Care Excellence, UK. This review article serves as a summary of the systematic reviews and the final guideline. The group included two patients, a radiologist, a commissioner, an emergency medicine doctor, hand therapists and hand surgeons. The group's recommendations are that patients with acute UCL injuries should be assessed with a history, clinical examination and radiographs. Patients without significant joint laxity can be treated non-surgically. Patients with significant joint laxity on clinical examination may be treated with non-surgical joint immobilization or surgical repair and should reach a shared decision with their clinician about the definitive treatment within 2 weeks of presentation., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Arterial tortuosity describes variation via bending of the arterial wall and has been noted in several arteries throughout the body. Tortuous blood vessels can cause nerve compression, as well as present difficulties to surgeons and radiologists. Here we present an unusual case of multi-vessel arterial tortuosity discovered in 78-year-old Hispanic male cadaver, independent of systemic pathology. The left ulnar and right tibial arteries were dissected, and using calibrated digital callipers, their external and internal diameters were measured both at the origin site and at the site of greatest dilation. Both wall thickness and the number of inflection points were also measured. Six bends were noticed in the ulnar artery and its diameter measured 8.11 mm at its widest, with a wall thickness of 0.88 mm. On the lower extremity, the right tibial artery had three bends and its diameter measured 4.86 mm at its widest, with a wall thickness of 1.32 mm. This uncommon tortuosity is not only more prone to laceration during surgery, but the bending and thickening can be mistaken for tumours. Finally, fluid dynamics can be altered, resulting in an impact on blood pressure in the extremities. Thus, raising awareness is crucial to prevent both symptoms and iatrogenic complications. [ABSTRACT FROM AUTHOR]

We report an extremely rare case of medium vessel thrombosis (ulnar and popliteal artery) in a 26-year-old female presenting with recurrent abortion and gangrenous right ring finger and pregangrenous toes of the left feet. Medium vessel thrombosis i.e. selective involvement of ulnar and popliteal vessels is an extremely rare phenomenon described in the literature of antiphospholipid antibody (APLA) syndrome. We conservatively managed the patient with antiplatelets and anticoagulants which substantially improved the ischemia of the finger and toes. Our case is a unique description of ulnar and popliteal artery thrombosis in APLA syndrome which has not been described in world literature so far.

Traumatic high ulnar nerve injuries have historically resulted in long-term loss of hand function due to the long re-innervation distance to the intrinsic muscles. Transfer of the anterior interosseous nerve (AIN) to the deep motor branch of the ulnar nerve (MUN) is proving promising in these patients. The purpose of this study was to evaluate the outcomes and efficacy of this procedure in our series. Eligible high ulnar nerve injury patients who underwent AIN to MUN nerve transfer were evaluated with a mean follow-up of 17 months. Data including demographics, injury details, surgical procedures, and outcomes were collected. A review of the current literature was performed for comparison. Sixteen patients had AIN to MUN transfer, mean age of 39.4 years, and a median delay from injury to nerve transfer of 0.8 months. The injury site was above the elbow in 5 cases, at the elbow in 8 cases, and in the proximal forearm in 3 cases. The majority were sharp transection, with the remaining from blast injuries, traumatic traction, and one post-traumatic neuroma resection. Transfer was performed end-to-end in 7 cases, hemi end-to-end in 7 cases, and supercharged end-to-side in 2 cases. Five patients achieved intrinsic muscle recovery of MRC 4+ and thirteen gained MRC 3 or above. The AIN to MUN nerve transfer provides meaningful intrinsic recovery in the majority of traumatic high ulnar nerve injuries. This procedure should be routinely considered, however, warrants further research to validate the optimum technique. [ABSTRACT FROM AUTHOR]

We performed a prospective observational study of 215 patients (58 ± 11 years) and compared the outcomes of ultrasound guided ulnar (n = 98, 45.6%) vs. radial (n = 117, 54.4%) cardiac catheterization and percutaneous coronary intervention (PCI) in patients selected by an ultrasound based algorithm. Primary endpoints included the number of access attempts and conversion to femoral access. Secondary endpoints included all-cause mortality, cardiac mortality, myocardial infarction, stroke, repeat revascularization, stent thrombosis, in-stent restenosis, and access site complications.No significant difference was found in the primary endpoints between radial or ulnar. Ulnar access showed no significant hematomas. Therefore, ulnar PCI is a feasible alternative.

To characterize pediatric gamekeeper's thumb injuries and to compare outcome data stratified by injury severity and treatment modality to identify possible recommendations for improved management of future pediatric gamekeeper's thumb patients. Retrospective chart review of the Nemours Children's Health database of pediatric gamekeeper's thumb patients receiving care at a Nemours location from 2005-2020. Injury, outcome, and demographic data was collected and analyzed stratified by grade of injury. Nemours Children's Health System database, including inpatient and outpatient patient records. Cases were identified using ICD-10 codes that may be used to indicate thumb UCL injuries. Codes yielded 179 cases, of which 34 were confirmed UCL injuries. Interventions compared in this study include conservative bracing vs surgical UCL repair. Primary outcome measures included time until full recovery (defined as patient being cleared for full return to activity) and any treatment complications. 15 injuries were grade I and all treated conservatively with average recovery time of 33.47±7.38 days. 11 injuries were grade II and all treated conservatively, with average recovery time of 80.09±30.48 days. 8 injuries were grade III, 2 received surgical treatment and healed with an average time of 67.5±18.62 days. 6 were initially treated conservatively, of these 3 healed successfully with an average of 44.67±18.81 days, while 3 failed treatment and required surgery with an average recovery time of 723.0±64.68 days. Variation in recovery time between grades of injury and initial treatments of grade III subgroups was statistically significant. Demographic data for these 34 patients showed average age of 14.03 years. 82.4% of injuries were sports related, with football the most common mechanism of injury for males and volleyball for females. In the pediatric population, gamekeeper's thumb injuries are most common in teenage athletes. The data from this study suggests conservative treatment is sufficient for grade I and II injuries, but grade III injuries may be better suited with initial surgical treatment. Further study with larger sample size is warranted. No conflicts of interest to declare. [ABSTRACT FROM AUTHOR]

Isolated ulnar head dislocation Is a rare and frequently misdiagnosed clinical entity, To our knowledge, few cases of volar ulnar dislocation have been reported in literature and a well-defined treatment does not exist. This case report describes the management of an acute isolated volar ulna dislocation in a 64-year-old patient. We also performed a systematic review of the available English literature in order to evaluate management of volar ulna dislocation. Among 86 eligible articles, 13 were included and fully evaluated. Isolated distal radioulnar joint (DRUJ) dislocation with only ligamentous involvement are uncommon injuries. If diagnosis is uncertain and X-ray are not informative, further imaging with CT or MRI can be performed because it is mandatory to recognise these lesions and to manage them properly. The first step is to reduce the DRUJ dislocation. The second is to evaluate the stability of the joint. If multidirectional instability is noted, direct repair of the ligament or Triangular Fibrocartilaginous Complex (TFCC) is indicated. Management of the acute lesion initially consists of an attempt of closed reduction, but if closed reduction is impossible in our opinion the only option is to restore the normal anatomy of the DRUJ with operative treatment. Herein, we summarise the available evidence on this lesion, based on this case and after a systematic review of the literature. We propose operative management for this lesion, with open reduction and reconstruction of ligaments to allow a rapid functional recovery and to avoid secondary complications. [ABSTRACT FROM AUTHOR]

Background: Percutaneous Coronary Interventions (PCI) of chronic total occlusions (CTOs) represent one of the most complex procedure in the whole spectrum of PCI. In the last years the success rate of CTO-PCI has improved because of the evolution in materials and in CTO-techniques. For most CTO operators, the choice of the vascular access has been driven by the desire to achieve a high success-rate. The trans-femoral access allows the use of larger caliber guide catheters with increased passive support and may help to achieve a better procedural success. Recently, the use of bi-radial approach has gained popularity, supported by evidence of non-inferiority versus the bifemoral/radial-femoral approach. At present, very limited data are available concerning the use of trans-ulnar access for this complex setting of PCI.Case Presentation: In the present manuscript, we describe in detail a case series of patients undergoing CTO PCI, with limited options in vascular access and resolved with trans-ulnar approach.Conclusions: Our case series shows the safety and feasibility of transulnar approach in CTO-PCI. [ABSTRACT FROM AUTHOR]

Objective To present a technical note on how to perform upper extremity peripheral nerve stimulators for three major nerves: median, ulnar, and radial. Design Literature review and expert opinion. Setting Single academic center. Results Peripheral nerve stimulation has recently become popular with the development and availability of peripheral nerve stimulators with an external pulse generator. Here, we describe ultrasound anatomy and technical details for peripheral nerve stimulation in the upper extremity for three major nerves: median, ulnar, and radial. Conclusions Upper extremity peripheral nerve stimulation can be considered as an option for refractory neuropathic upper extremity pain. [ABSTRACT FROM AUTHOR]

Although ulnar neuritis can occur secondary to ulnar collateral ligament pathology, stress fractures, and traction apophysitis, isolated ulnar nerve dysfunction can lead to medial elbow pain. The purpose of this study was to evaluate the short-term outcomes of overhead athletes undergoing anterior ulnar nerve transposition for ulnar neuropathy. All overhead athletes who underwent isolated ulnar nerve transposition between 2009 and 2016 for refractory ulnar neuritis were identified. The primary outcome was return to sport, and secondary outcome measures included the Kerlan-Jobe Orthopaedic Clinic score; Mayo Elbow Performance Score; Quick Disabilities of the Arm, Shoulder and Hand score; Single Assessment Numeric Evaluation score; and visual analog scale score for pain. Complication and reoperation rates were recorded. A total of 26 overhead athletes (21 male and 5 female athletes) underwent ulnar nerve transposition at an average age of 18.4 years (range, 11-25 years). Of the patients, 24 (92%) returned to their sporting activity at an average of 2.7 months postoperatively, including 16 (62%) at the previous level of play. The average visual analog scale pain score improved from 4.7 (±2.5) to 0.4 (±1.5) (P =.015). The average postoperative patient-reported outcome scores were as follows: Kerlan-Jobe Orthopaedic Clinic score, 80 (95% confidence interval [CI], 72.7-87.0); Single Assessment Numeric Evaluation score, 85 (95% CI, 75.4-94.7); Quick Disabilities of the Arm, Shoulder and Hand score, 5 (95% CI, 2.1-7.7); and Mayo Elbow Performance Score, 91 (95% CI, 86.8-96.0). Cubital tunnel syndrome can cause medial elbow pain in overhead athletes in the presence of a normal ulnar collateral ligament. At mid-term follow-up, 92% of overhead athletes returned to sport after ulnar nerve transposition, with 62% resuming their previous level of performance. [ABSTRACT FROM AUTHOR]

Aim: Peak or onset latency difference of the median and ulnar nerves can be used in the median-versus-ulnar digit 4 sensory comparison study (MUD4CS) for electrodiagnosis of carpal tunnel syndrome (CTS). This study aimed to investigate the differences in results while using peak or onset latency difference. Material and Methods: The hands of patients with clinical CTS diagnosis but normal median nerve conduction study (NCS) results were included retrospectively in this study. NCSs of the median and ulnar nerves with onset and peak latencies in MUD4CS were recorded. Onset and peak latency differences of the two nerves and also peak-onset latency difference of the median nerve in MUD4CS were calculated. The hands were divided into two groups according to MUD4CS findings: abnormal and normal. The hands in the abnormal group were also divided into peak and onset subgroups. Results: A total of 277 hands were included in this study. Abnormal MUD4CS results were observed in 103 hands; 77 hands based on onset latency difference, and in 76 hands based on peak latency difference. Median sensory conduction velocity was slower and amplitude was smaller in the abnormal group than in the normal group (p=0.003, p=0.027 respectively). Median peak-onset latency difference was significantly greater in the peak subgroup than in the onset subgroup (p=0.0001). Conclusion: It may be more useful to measure both peak and onset latency differences when diagnosing CTS because some cases may be overlooked by using a single latency difference. [ABSTRACT FROM AUTHOR]

Ulnar-sided wrist pain is a common problem in athletes that can be challenging owing to its frequent combination of overuse in conjunction with acute injury. Repetitive pronosupination, wrist flexion and extension, as well as radial and ulnar deviation can predispose the athlete to injury of ulnar structures. Careful understanding of the sport-specific injuries as well as the underlying biomechanics are key to understanding and treating the athlete. In this article, we discuss the most frequent causes of ulnar-sided wrist pain in the athlete and focus on anatomy and pathophysiology, presentation, and diagnosis, as well as nonoperative and operative treatment options. [ABSTRACT FROM AUTHOR]

Background: The underlying pathology of the vast majority of diabetic polyneuropathies is axonal degeneration. F wave study is one of the most sensitive indices of the severity of neuropathy. Objective: To test the validity of different F wave parameters including F minimum latency, F wave index and F Jitter in the diagnosis of diabetic axonal peripheral neuropathy. Methods: Eighty type 2 diabetics aged 52.57±5.62 years with disease duration of 1 to 18 years and 90 agedmatched healthy volunteers serve as the control group. Both groups were submitted to medical history, clinical neurological examination, and electrophysiological tests of both upper and lower limbs. Results: Tibial and ulnar F wave latencies were significantly prolonged in diabetic patients (p < 0.001). Tibial F index for male patients shows significantly lower value as compared to the control group. Ulnar F wave latency was 76.7% sensitive and 89.3% specific in female patients while tibial F wave latency was 80% sensitive and 81.3% specific in male patients. Conclusion: F wave is a precise parameter in detecting diabetic axonal peripheral neuropathy. Minimal F-wave latency is more sensitive than both F index and F Jitter in the diagnosis of axonal neuropathy in diabetic patients. [ABSTRACT FROM AUTHOR]

Ulnar nerve focal demyelination (FD) in the forearm [defined as conduction block (CB) and or temporal dispersion (TD)] has been described with immune-mediated neuropathy and with compression affecting the forearm segment of the nerve. The association of FD in the forearm with entrapment ulnar neuropathy at the elbow, as well as the intraoperative imaging of the abnormal ulnar nerve at the flexor carpi ulnaris muscle level (FCU), has not been reported before. We report a 33-years-old woman presented with only sensory symptoms of the right hand suggestive of right ulnar neuropathy for the last 10 years. On clinical examination, she had reduced pinprick sensation on the little and ring fingers with no motor deficit. Nerve-conduction study showed slowing of conduction velocity across the elbow on the right when recording at the abductor digiti minimi (ADM) and first dorsal interossei (FDI). There was 63% amplitude drop when stimulating below the elbow compared to distal stimulation at the wrist. Increment inching study localized the block at 5 cm distal to the medial epicondyle. During surgical transposition, the ulnar nerve was swollen, and edematous in the segment where the nerve enters the FCU muscle, which provides a physiological explanation for the electrophysiological findings. After the surgery, the patient reported complete resolution of the symptoms. This case demonstrate that ulnar nerve motor potential FD at the proximal forearm could be recorded and it is still compatible with ulnar-nerve entrapment at the elbow.

Ulnar nerve focal demyelination (FD) in the forearm [defined as conduction block (CB) and or temporal dispersion (TD)] has been described with immune-mediated neuropathy and with compression affecting the forearm segment of the nerve. The association of FD in the forearm with entrapment ulnar neuropathy at the elbow, as well as the intraoperative imaging of the abnormal ulnar nerve at the flexor carpi ulnaris muscle level (FCU), has not been reported before. We report a 33-years-old woman presented with only sensory symptoms of the right hand suggestive of right ulnar neuropathy for the last 10 years. On clinical examination, she had reduced pinprick sensation on the little and ring fingers with no motor deficit. Nerve-conduction study showed slowing of conduction velocity across the elbow on the right when recording at the abductor digiti minimi (ADM) and first dorsal interossei (FDI). There was 63% amplitude drop when stimulating below the elbow compared to distal stimulation at the wrist. Increment inching study localized the block at 5 cm distal to the medial epicondyle. During surgical transposition, the ulnar nerve was swollen, and edematous in the segment where the nerve enters the FCU muscle, which provides a physiological explanation for the electrophysiological findings. After the surgery, the patient reported complete resolution of the symptoms. This case demonstrate that ulnar nerve motor potential FD at the proximal forearm could be recorded and it is still compatible with ulnar-nerve entrapment at the elbow. [ABSTRACT FROM AUTHOR]

Open ulnar and radial shaft fractures refers to the simultaneous rupture and injury of the skin and subcutaneous soft tissue at the fracture, and is easy to cause wound infection, local soft tissue necrosis or osteomyelitis. The purpose of this paper is to observe the efficacy of external locking compression plate in the treatment of open fractures, so as to provide reference for clinical practice. From January 2019 to January 2020, 11 patients with open ulnar or radial shaft fractures underwent surgery by a single surgeon. Physical examination, radiography, and functional scores were performed before surgery and the average follow-up was 14 months (range, 12 to16 months) after surgery. Clinical outcome scores were recorded. Six patients obtained excellent Anderson Scores, four of satisfactory and one of Unsatisfactory. No surgical complications, reoperations, nonunion and implant breakage in this series and the fractures can be healed from 6 to 12 months after the operation. All implant removal was requested for all cases. Open ulnar and radial shaft fractures refers to the simultaneous rupture and injury of the skin and subcutaneous soft tissue at the fracture, which can connect the fracture site with the outside environment, and is easy to cause wound infection, local soft tissue necrosis or osteomyelitis. The open fracture mostly involves adjacent joints. If it is not treated in time, it is easy to lead to complications such as infection and nonunion. The locking plate is named as "internal fixation", which means the internal fixation is placed in the soft tissue, and is similar to the external fixator. However, its biomechanical properties still need to be verified, the appropriate screw position and number need to be further defined, and there is a lack of clinical validation of large number of cases. In this study, locking compression plate externaI fixation for technology for the treatment of open ulnar and radial shaft fractures has the advantages of minimal trauma, simple operation, reliable fixation, fewer postoperative complications, and restored stability and function of forearm joints. Level IV, therapeutic case series. • We adopted external locking plate fixation in the management of open ulnar and radial shaft fractures. • From January 2019 to January 2020, 11 patients with open ulnar or radial shaft fractures underwent surgery by a single surgeon. • Our results suggest that this reconstruction technique is a reliable and useful alternative treatment. [ABSTRACT FROM AUTHOR]

Axillary block is one of anesthesia technics for arm and hand surgery with varied success rates due to location variations of the targeted nerves. This has been proven by many prior studies under surface ultrasonography (USG) in many countries. Until currently, no similar study has been conducted in Indonesia. This descriptive observational–cross sectional study was performed on 75 volunteers in Dr. Hasan Sadikin General Hospital Bandung in November–December 2014 to describe the locations of radial, ulnar, median, and musculocutaneous nerves to the axillary artery using USG. The locations of those nerves at the axilla were converted into a 12-section pie-chart with the axillary artery as the axis. Data were analyzed using Sapiro-Wilk, Mann-Whitney, and Wilcoxon tests and processed using SPPS 21.0 version. Assessment of 150 USG scans revealed that the median nerves are located superior to the axillary artery, i.e. in sector 12 (75%), 11 (23%), and 1 (2%). Ulnar nerves are located in the medial, i.e. in sector 9 (67%), 8 (31%), and 10 (2%). Radial nerves are located in the infero-medial, i.e. in sector 7 (78%), 8 (16%), and 6 (6%). Musculocutaneous nerves are located in the lateral, i.e. in sector 4 (89%), 5 (8%), and 3 (3%). It is concluded from this study that varied locations of radial, ulnar, median nerves are found in a quarterof subjects whereas only one tenth of the subjects have varied muculocutaneous nerves locations.

Introduction: Timely diagnosis and treatment of traumatic injury to ulnar collateral ligament (UCL) of thumb is of special importance for preserving the full function of the hand. Therefore, the present study has been designed with the aim of evaluating the accuracy of ultrasonography in detection of these injuries. Methods: The present diagnostic accuracy study was performed on traumapatients over 15 years oldwho had clinical evidence of injury to UCL of thumb and were admitted to the emergency department. All patients were evaluated regarding injury to the mentioned ligament via ultrasonography and MRI and finally, the accuracy of ultrasonography in this regard was measured considering MRI as the reference test. Results: 20 individuals with the mean age of 38.60 § 13.45 (16 – 64) years were evaluated (60% male). Based on ultrasonography andMRI findings 7 (35%) individuals and 7 (35%), respectively had complete ligament rupture (kappa: 0.560 (95% CI: 0.179 – 0.942)). Sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio of ultrasonography in detecting injuries of the mentioned ligament were 71.42 (30.25 – 94.88), 84.61 (53.66 – 97.28), 71.42 (30.25 – 94.88), 84.61 (53.66 – 97.28), 2.5 (0.71 – 8.82), and 0.18 (0.04 – 0.67), respectively. Conclusion: Based on the findings of the present study, performance of ultrasonography by a radiologist in the emergency department has 80% accuracy in detecting traumatic injuries of UCL of the thumb.