Branch Of Radial Nerve Research Articles

English

BACKGROUND Arcade of Frohse (AF) is a tendinous superior margin of superficial layer of supinator muscle which was first described by Frohse and Frankel in 1908. Since then it has been studied by many authors and held accountable as one of the essential components for compression of deep branch of radial nerve (DBRN) which leads to radial tunnel syndrome. Considering AF as an important element of compression, we made an attempt to classify it on the basis of its shape and to find out if any particular shape has a predominant role in compression of the nerve. We also observed the structure of superior and inferior margin of the supinator muscle. METHODS This study was conducted among 80 (70 males and 10 females) formalin fixed upper limbs present in the Department of Anatomy. The limbs were maintained in supine with slightly flexed position and dissection was performed to expose the supinator muscle. The proximal and distal borders of supinator muscles were examined meticulously with the help of magnified lens. The morphometric measurements were taken with the help of a digital caliper. RESULTS The FA is classified into four categories as loop, high arc, low arch and linear shaped. The most frequent shape observed was arch shaped (high and low arch) about 66%, followed by loop shaped (30%) and least was linear shaped (2.5%). On the basis of structure, the proximal and distal margin of supinator muscle was reported to be tendinous in majority of the cases. The distance of the AF from the fixed reproducible anatomical landmark like inter epicondylar line (IEL) was measured and the average distance found was 3.36 cm. CONCLUSIONS Knowledge of different shapes would aid surgeons and radiologists for better approach towards diagnosis and management of supinator syndrome. The morphometric finding can be useful for surgeons to locate the superior margin of supinator (AF) in surgical procedures for decompression of DBRN in supinator syndrome. KEY WORDS Arcade of Frohse, Inter Epicondylar Line, Supinator Muscle, Deep Branch of Radial Nerve and Radial Tunnel Syndrome

Open Reduction and Internal Fixation of Intra-articular Distal Radius Fracture by Buttress Plate: An Outcome Assessment

This study aims to evaluate the surgery outcomes of distal radius fractures using open reduction and internal fixation (ORIF) with buttress plate in our hospital. 200 patients were included with age above 18 years, having distal radius fractures and who were treated by ORIF buttress plate. The patients who had intraarticular distal radius fractures were included in this study. Data was collected from hospital records. Mean age of our patients was 38.5 ± 8.3 years. Patients were assessed functionally using Gartland and Werley point system and anatomically (radiologically) using Sarmiento’s modification of Lindstrom criteria. Among study participants, 140 patients had excellent restoration (70%), 20 patients had good restoration (10%) and the rest had fair restoration. There were some complications among patients like superficial infection and injury to superficial branch of radial nerve. In the follow up, we notice stiffness in one case with reduced range of movement of wrist and fingers. In our study, we had good to excellent results in 80% cases, anatomically and functionally. We conclude from our study ORIF using buttress plate is the best method for managing displaced intra-articular distal radius fractures.

Defining the Reliability of Deltoid Reanimation by Nerve Transfer When Using Abnormal but Variably Recovered Triceps Donor Nerves.

Upper brachial plexus injuries to the C5/6 roots or axillary nerve can result in severe deficits in upper limb function. Current techniques to reinnervate the deltoid muscle utilise the well-described transfer of radial nerve branches to triceps to the axillary nerve. However, in around 25% of patients, there is a failure of sufficient deltoid reinnervation. It is unclear in the literature if deltoid reanimation should be attempted with a nerve transfer from a weak but functioning triceps nerve. The authors present the largest series of triceps to axillary nerve transfers for deltoid reanimation in order to answer this clinical question. Seventy-seven consecutive patients of a single surgeon were stratified and analysed in four groups: (1) normal triceps at presentation, (2) abnormal triceps at presentation recovering to clinically normal function preoperatively, (3) abnormal triceps at presentation remaining abnormal preoperatively, and lastly (4) where pre-operative triceps function was deemed insufficient for use, requiring alternative reconstruction for deltoid reanimation. The authors considered deltoid re-animation of ≥ M4 as successful for the purpose of this study. Median Medical Research Council (MRC) values demonstrate group 1 achieves this successfully (M5), while median values for groups 2–4 result in M4 power (albeit with decreasing interquartile ranges). Median post-operative shoulder abduction active range of motion (AROM) values were represented by 170° (85–180) in group 1, 117.5° (97.5–140) in group 2, 90° (35–150) in group 3, and 60° (40–155) in group 4. For both post-operative assessments, subgroup analyses demonstrated statistically significant differences when comparing group 1 with groups 3 and 4 (p < 0.05), while all the other group to group pairwise comparisons did not reach significance. The authors postulated that triceps deficiency can act as a surrogate marker of a more extensive plexus injury and may predict poorer outcomes if the weakness persists representing the trending differences between groups 2 and 3. However, given no statistical differences were demonstrated between groups 3 and 4, the authors conclude that utilising an abnormal triceps nerve that demonstrates sufficient strength and redundancy intraoperatively is preferable to alternative transfers for deltoid reanimation. Lastly, in group 4 patients where triceps nerves are damaged and unusable for nerve transfer, alternative operations can also achieve sufficient outcomes and should be considered for restoration of shoulder abduction.

Multimodal evaluation of donor site morbidity in transgender individuals after phalloplasty with a free radial forearm flap: a case-control study

In phalloplasty, there is a lack of standardized follow-up examinations of motor function and strength after harvesting oversized radial forearm free flaps (RFFF). We evaluated the donor site of 20 transmen after phalloplasty, using a multimodal, standardized approach, assessing the following parameters: opposition of the thumb, composite range of motion of the finger joints, grip strength, mobility of the wrist, lesion of the superficial branch of the radial nerve, the dorsal branch of the ulnar nerve, the sensation of pain, and cold intolerance. The contralateral, nonoperated forearm was used as a control. No impairment of the mobility of the thumb (Kapandji score median 10, range 5-10) or fingers (all fingers at both sides pulp-to-palm 0 cm, nail-to-table 0 cm) were detected. Grip strength (median 36,3kg, p=0.629) and wrist extension (62.5°vs.70°, p=0.357), flexion (70°vs.70°, p=0.535), pronation (90°vs.90°), supination (90°vs.90°), radial (30°vs.30°, p=0.195), and ulnar deviation (40°vs.50°, p=0.125) did not statistically differ between donor and control hand. Injury of the dorsal branch of the ulnar nerve was uncommon (0% hypoesthesia, 10% positive Tinel's sign). We did not observe any persistent pain of the donor forearm (NRS median 0, range 0-9). We did observe irritation of the superficial branch of the radial nerve (hypoesthesia 40%, neuroma 45%). The harvest of an oversized RFFF for phalloplasty does not cause any significant difference in motor function or strength between the donor and nonoperated hand. A potential risk of injuring the radial nerve branch is to be avoided. An aesthetic impairment could be addressed in future studies.

Anatomical characterization of acupoint large intestine 4.

Large intestine 4 (LI4) is a major acupoint used in various treatments in acupuncture and Traditional Chinese Medicine. There are structures associated within the region of LI4 that have three-dimensional anatomical relationship that needs further characterization. The aims of this study were: (a) to observe the anatomical variation of structures around LI4; (b) to observe specific overlap of structures around LI4. A 1256 mm2 area was dissected in 25 cadaveric hands around LI4. Nondissected areas were marked with pins as reference points. Dissections were photographed with a fixed camera. Subsequently, images were imported to Adobe Photoshop 2020 and analyzed. Descriptive statistics and graphs were compiled using Graphpad Prism 2020. The tributaries of the dorsal venous plexus (22.3%), branches of superficial radial nerve (18.9%), first dorsal interosseous muscle (52.4%), arterial branches in the first interosseous space (10.2%), and deep ulnar nerve (4.0%) were observed in the area of LI4. One branch of the superficial radial nerve passed through LI4. The deep ulnar nerve was found in the bulk of the first dorsal interosseous muscle. Several structures observed intersected at LI4. The superficial radial nerve interweaved with the dorsal venous plexus superficially. The deep ulnar nerve passed anterior to the second palmar metacarpal artery before entering into the first dorsal interosseous muscle. These results provide anatomical evidence and variation into the vascular contributions at LI4.

Long Thoracic Nerve Transfer for Children With Brachial Plexus Injuries.

The transfer of intraplexal and extraplexal nerves for restoration of function in children with traumatic and birth brachial plexus palsies has become well accepted. Little has been written about using the long thoracic nerve (LTN) as a donor in reanimation of the upper extremity. The authors present a case series of nerve transfers using the LTN as a donor in brachial plexus injury. A retrospective chart review was performed over a 10-year period at a single institution. The primary outcome measure was the active movement scale. Fourteen patients were included in the study: 10 birth injury patients and 4 blunt trauma patients. Average follow-up time was 21.3 and 10.75 months, respectively. The best outcomes were seen when the LTN was used for reinnervation of the obturator nerve in free functioning muscle transfers. The next most successful recipients were the musculocutaneous and axillary nerves. Outcomes were poor in transfers to the posterior interosseous fascicles of the radial nerve and the radial nerve branches to the triceps. The LTN may be a potential nerve donor for musculocutaneous or axillary nerve reinnervation in patients with brachial plexus injuries when other donors are not available during a primary plexus reconstruction. However, the best use may be for delayed neurotization of a free functioning muscle transfer after the initial plexus reconstruction has failed and no other donors are available. Level IV-therapeutic study.

Anatomical Variation of Superficial Branch of Radial Nerve in Gujrat Region

Introduction: Radial nerve carried fibres entirely roots fifth cervical roots to first thoracic of brachial plexus.It supplies posterior (extensors compartment) of upper limb.Material and Method: The current study were escort working 30 human anatomy cadavers 9i (bilateral) fromanatomy department, Government. Medical college, vadodara of Gujarat region. The procedure dissectioncarry out in the course of post graduation work, anatomy department to exit out the anatomical variations ofbifurcation of superficial branch of radial nerve in relation with lateral epicondyle of Humerus.9iResults: 9i The current study notice anatomical variations of bifurcation of superficial branch of radial nervein relation with lateral epicondyle of Humerus.9iBoth side right and left dissections carried out. In sixteen specimen shows that level of bifurcation of radialnerve at level of lateral epicondyle.In six specimen shows that level of bifurcation of radial nerve above the level of lateral epicondyle.In eight specimen shows that level of bifurcation of radial nerve below the level of lateral epicondyle.Pictures variations of radial nerve taken with.Conclusion: Afterwards the study tasks of thirty human anatomy cadaveric upper limbs the dissimilaranatomical variations in the level of bifurcation distribution of superficial branch of radial nerve were cameacross. The external branch of the radial nerve is frequently damaged peripheral nerve succeeding the spinalaccessory , common peroneal nerves &amp; controllable to restoration.

Anatomical Assessment of Cephalic Vein and Superficial Branch of Radial Nerve Using High-Resolution Ultrasound Imaging

Introduction The superficial branch of the radial nerve (SBRN) has a risk of nerve injury during cephalic vein (CV) cannulation. Due to the lack of imaging study regarding SBRN and CV relationship, we analyzed the anatomical relationship between the SBRN and the CV using ultrasound (US) imaging.Materials and Methods In total, 82 upper limbs of 41 healthy volunteers were analyzed. The SBRN and CV were identified at the following three points in the elbow extension and pronation position: at the radial styloid process (point 1), 5 cm proximal to point 1 (point 2), and 10 cm proximal to point 1 (point 3).Results The distance between the SBRN and CV was 1.1 ± 1.0 mm at point 1, 1.3 ± 1.3 mm at point 2, and 2.1 ± 1.6 mm at point 3. The depth of the SBRN from the surface of the skin was 2.7 ± 0.9 mm at point 1, 3.5 ± 1.1 mm at point 2, and 5.5 ± 1.9 mm at point 3. The percentage of the SBRN that ran beneath the CV was 17.5%, 53.5%, and 92.4% at points 1, 2, and 3, respectively.Conclusion Ultrasonography can reveal the anatomical relationship between the SBRN and CV.

Surgical denervation of the thumb CMC joint: anatomy, technique

Surgical denervation of the thumb carpometacarpal (CMC) joint is a theoretical surgical option for thumb CMC arthritis. Some authors have described the nerve branches of thumb CMC joint. We present the innervation of the thumb CMC joint (thenar – recurrent – branch of median nerve, palmar branch of median nerve, superficial branch of radial nerve, lateral cutaneous nerve of forearm, deep branch of ulnar nerve) and the surgical techniques to achieve optimal denervation of this joint. While the results have been disappointing, this technique may be combined with conservative surgical procedures (synovectomy, ligament reconstruction) and it allows more invasive surgery in the future if necessary.

The Sensory Collateral Nerve-Pull Technique: A Viable Maneuver to Aid Harvesting the Pedicle of the Moschella Flap.

Moschella and Cordova originally reported the utility of the reverse dorsoradial flap for thumb soft-tissue reconstruction. To ensure success with this procedure, special attention should be paid not to visualize the dorsoradial digital artery during pedicle dissection because this carries the risk of damaging the tiny perivascular venules.1 As visualizing the vascular anatomy in the pedicle area is not advisable, what anatomical landmark can be used to locate the vascular axis and ensure including these vessels in the flap pedicle, especially when a narrow pedicle is harvested? Although designing the pedicle wide enough can reduce the probability of not harboring these vessels, an excessively bulky pedicle may result in poor aesthetic appearance.2 Alternatively, as described in previous studies, a Doppler probe could be used to identify the dorsoradial digital artery preoperatively. However, this device is generally not available in basic level hospitals, and such a small vessel is not always easily detectable. Previous well-conducted anatomical study has demonstrated that the dorsoradial digital artery runs in close approximation to the dorsal collateral branch of the superficial radial nerve.3 Understanding this anatomy is key to locating the flap pedicle in a different manner and making appropriate adjustments. In this communication, we would like to propose a simple nerve-pull technique for locating the vessels in a pedicle area. Intraoperatively, the incision is initiated along the proximal edge of the flap to dissect the sensory collateral nerve. Once the entire flap is raised, a longitudinal pull is applied gently and repeatedly in line with the nerve enclosed in the flap, and movements of the distal part can be observed. [See Video 1 (online), which demonstrates the sensory collateral nerve-pull technique to locate the vascular axis.] By doing so, the nerve embedded in the pedicle area can be easily and precisely identified; in other words, the vessels are safely “visualized,” while avoiding skeletonizing the pedicle. Then, the pedicle is harvested along this vascular axis with a cuff of the surrounding fatty tissue and the tourniquet is deflated to confirm flap circulation. [See Video 2 (online), which shows robust blood supply immediately after surgery.] {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 1.","caption":"This video demonstrates the sensory collateral nerve-pull technique to locate the vascular axis.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_4byrpeg8"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 2.","caption":"This video shows robust blood supply immediately after surgery.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_cijotxgl"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} We believe that this nerve-pull technique is extremely helpful in locating the vessels within the pedicle. The most prevalent complication with this flap is venous congestion caused by excessive compression of the pedicle. In our experience, the circumference of the pedicle can be safely narrowed with the precise location of the dorsoradial digital artery, and there has been no evidence that a narrow flap pedicle (<0.9 cm) can result in venous insufficiency. From an aesthetic standpoint, unnecessary width of the flap pedicle may prevent easy primary closure without skin grafts or skin bridge,4 thus producing a less aesthetically pleasing result. In conclusion, the sensory collateral nerve pull technique can be safely and effectively used in harvesting the pedicle of the Moschella flap. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Cryoneurotomy to Reduce Spasticity and Improve Range of Motion in Spastic Flexed Elbow: A Visual Vignette.

The flexed-elbow pattern of spasticity causes pain and reduced function and greater caregiver burden.1 Genet et al.1 reported the brachialis as the dominant muscle limiting extension. The musculocutaneous nerve (MSCN)–innervated brachialis and biceps brachii as well as the radial nerve–innervated brachioradialis are all implicated.1 Refractory spasticity after rehabilitation and chemodenervation with botulinum toxin type A may require selective surgical or neurolytic interventions to improve outcomes. The diagnostic anesthetic nerve block (DNB) has been used to assist in the evaluation of a muscle’s contribution to spasticity.1 The DNB can differentiate between spasticity and contracture and predict the outcome of surgical neurotomy. It was proposed in 2019 that cryoneurotomy is a safe percutaneous treatment for refractory spasticity.2 Long used in the anesthetic literature, cryoneurotomy is a mini-invasive technique that introduces a hand-held cryoprobe to a peripheral nerve and using the expansion of gas at the cannula tip to create an ice ball, which disrupts the nerve structure, causing axonotmesis. The distal fibers undergo Wallerian degeneration while the basal lamina and endoneurium are preserved, providing a scaffold for regeneration. A hallmark of the procedure is the lack of neuritis or neuroma formation.3 This retrospective chart review identified 11 adult patients with a flexed-elbow spasticity who had previously undergone a screening DNB then a subsequent cryoneurotomy from February 1, 2018, to February 28, 2020, in one clinic (Table 1). All patients had spasticity of at least grade 2 on the Modified Ashworth Scale (MAS), improvement in elbow range of motion, and/or reduction in spasticity after DNB to the MSCN ± radial nerve. All had previously been treated with botulinum toxin type A for their flexed-elbow spasticity with nine of our patients with ongoing botulinum toxin type A at a relatively high average dose of 444 U, with 231 U in the upper extremity. Images were hosted on a secure cloud server. This study was approved by the local institutional ethics board, with patient consent to participate. TABLE 1 - Patient demographics (N = 11) Age at first DNB, mean (SD), yr 53 (15) Sex, female/male, n 4/7 Etiology of spasticity, n Spinal cord injury 2 Stroke (hemorrhagic/ischemic) 7 (4/3) Multiple sclerosis 1 Traumatic brain injury 1 Affected side, right/left, n 4 / 7 Disease onset to first DNB, mean (SD), yr 9 (5) Our video presentation provides an illustration of the interventional techniques, the reduction in spasticity, and increased range of motion over a mean follow-up of 12.5 mos. Each patient was screened with a DNB to the brachialis branch of the MSCN and three patients with additional radial nerve blocks to the brachioradialis. The MSCN and radial nerves were localized with ultrasound guidance. A small bore, Teflon-coated hypodermic needle was inserted. Needle placement was confirmed with ultrasound guidance and electrical stimulation at less than 1 mA causing brachialis or brachioradialis contraction. One millilitre of 2% lidocaine was injected around the target nerve. A positive response was determined by a reduction in MAS, an improvement in passive ± active range of motion, no adverse outcomes, and no loss of function, on DNB. All patients in this study had positive DNB results and went on to cryoneurotomy of the MSCN with three additional to the radial nerve branch to the brachioradialis with the technique described by Winston et al.2 Documenting outcomes in spasticity remain a challenge for research. Our vignette illustrates the changed range of motion and spasticity.

Thumb Carpometacarpal Suspension Arthroplasty With Flexor Carpi Radialis Ligament Reconstruction and Tendon Interposition Using An Absorbable Interference Screw: A Volar Approach Technique.

The goal of operative intervention for pantrapezial arthritis is to relieve pain, maintain or improve motion, stability, and strength, and restore function. The purpose of this article is to present a volar approach to thumb carpometacarpal suspension arthroplasty using an absorbable interference screw for flexor carpi radialis ligament reconstruction and tendon interposition in the treatment of pantrapezial arthritis. This technique allows for visualization of the volar beak and avoidance of the radial artery and the branches of the superficial radial nerve while allowing optimal surgical manipulation for suspensionplasty with interference screw fixation and tendon interposition at the carpometacarpal joint.

Hierarchical structure of Five-shu points and Source-point of Triple Energizer Meridian in rabbits

To study the position and hierarchical structure of Five-shu points, i．e., "Guanchong" (TE1), "Yemen" (TE2), "Zhongzhu" (TE3), "Yangchi" (TE4) and "Zhigou" (TE6), and the Source-point "Tianjing" (TE10) of the Triple Energizer (TE) Meridian in the rabbit. Based on WHO Standard Acupuncture Point Locations in the Western Pacific Region (WHO Standard) and National Standard (GB/T 22103-2008) for Acupuncture Point Locations in human body, and combined with X-ray images, the hierarchical structure of Five-shu points and Source-point of the TE Meridian were observed in ten New Zealand rabbits. The acupoint locations were determined by comparing the same name tissues of the rabbits and human body after dissecting the above-mentioned acupoints. After inserting acupuncture needles into the aforementioned acupoints, the relationship between the acupuncture needle and adjacent structure were dissected and measured. "Guanchong" (TE1) was located on the lateral side of the 4th terminal phalanx, and behind the corner of the onyx root. When needled, the penetrated tissues of the acupuncture needle are skin, superficial fascia, deep fascia, and the root region of the 4th phalanx, respectively. "Yemen" (TE2) was located between the 4th and 5th onyxes, at the depression of intersection of coat hair superior to the fingerweb edge. When needled, the penetrated tissues of the acupuncture needle are the superficial fascia, deep fascia and lumbrical muscles of the forepaw, respectively. "Zhongzhu" (TE3) was located between the 4th and 5th metacarpal bones, at the depression proximal to the 4th metacarpophalangeal joint. When needled, the penetrated tissues are skin, superficial fascia, deep fascia, and lumbrical muscle, respectively. "Yangchi" (TE4) was positioned at the dorsal side of the forepaw, and the surface connection line between the accessory and radial bones intersected with the depression of the extensor digitorum communis on the ulnar side. When needled, the penetrated tissues are skin, superficial fascia, deep fascia, and the ulnar side of the common extensor tendon, respectively. "Zhigou" (TE6) was positioned between the radius and ulna, on the posterior aspect of the forelimb and 3 Bone-cun proximal to the distal dorsal forepaw crease. When needled, the penetrated tissues are skin, superficial fascia, deep fascia, and the extensor digitorum, respectively. "Tianjing" (TE10) was located at the junction of the body of humerus and the lateral condyle of humerus, on the posterior aspect of the elbow and proximal to the prominence of the olecranon. When needled, the penetrated tissues are skin, superficial fascia, deep fascia, and triceps brachii muscle, respectively. The Five-shu points and Source-point of the TE Meridian on the forelimb in rabbits are innervated by the cutaneous branches of the ulnar radial nerve and the medial brachial cutaneous nerve at the superficial layer, and by the branches of the ulnar nerve and radial nerve in the deep layer, accompanied with cephalic vein and forearm blood vessels and their branches.

Henry Head’s lifelong studies of cutaneous sensation

In 1900 research on cutaneous sensation was defined by histological techniques defining sensory receptors in skin, leading to undetermined conceptual problems when considered in relation to Brown-Séquard's startling finding that there were two qualitatively different afferent pathways in the spinal cord. Four modalities were considered to function as the determinants of sensory input. In 1903 Rivers and Head carried out the first interventional study of human cutaneous sensation, and analysed the return of sensation following section and immediate suture of the dorsal cutaneous branch of Head's left radial nerve. This resulted in the revolutionary idea summarised in his description of protopathic and epicritic sensory systems in peripheral sensory nerve. Although this concept was at best seen as controversial and even ridiculed by some of his many contemporaneous critics, more recently this concept has proven a fundamentally important stimulus to understanding the physiology of cutaneous sensation. His writings show him to have been capable of deeply instructive thought, based on his clinical experience and his admiration of Hughlings Jackson's teaching concerning the hierarchical organisation of brain function. First and foremost a clinician neuroscientist, his ideas were ahead of their time and not understood.

Nerve transfers for acute flaccid myelitis: a case series.

Acute flaccid myelitis (AFM) syndrome consists of loss of lower motor neurons following a viral infection, with preserved sensory function. It usually affects the upper limbs asymmetrically, with proximal more than distal muscle involvement. Five cases were surgically treated with nerve transfers: spinal accessory to suprascapular nerve transfer (4 patients), branch of radial nerve to axillary nerve transfer (Somsak's procedure) (2 patients), and transfer of a fascicle of the ulnar nerve to the motor branch to the biceps (Oberlin's procedure) (1 patient). Motor improvement was seen in three cases. Widespread motor involvement was associated with poor outcome. This small series of cases reinforces that nerve transfers are a reliable option for treatment of selected children with AFM.

Delayed Transfer of the Extensor Carpi Radialis Brevis Branch of the Radial Nerve to the Anterior Interosseous Nerve for Restoration of Thumb and Index Finger Flexion: Case Report.

High median nerve injuries (HMNIs) are rare lesions involving the upper extremities and affect the median nerve from its origin to the emergence of the anterior interosseous nerve (AIN). Proximal reconstruction has long been considered the gold standard in treating HMNI, but thumb and index flexion and pinch and grip weakness are consistently not recovered. We report the surgical results of a patient affected by an HMNI with partial spontaneous recovery after a gunshot wound. AIN function was successfully restored in a delayed fashion by transferring the radial nerve branch to the extensor carpi radialis brevis to the AIN.

Application of the first dorsal metacarpal reverse fasciocutaneous flap with the superficial branch of radial nerve for repair of thumb defect

Objective To investigate the clinical efficacy of the first dorsal metacarpal reverse fasciocutaneous flap with the superficial branch of radial nerve for repair of thumb defect. Methods From January 2013 to June 2017, 14 patients with thumb defect were treated using the first dorsal metacarpal reverse fasciocutaneous flap with the superficial branch of radial nerve. The flap area was 2.0 cm×1.5 cm to 4.5 cm×3.5 cm. The donor area was sutured directly in 11 cases and covered with full thickness skin graft in 3 cases. Results All the 14 flaps were survived uneventfully without vascular crisis, necrosis and infection. The patients were follow-up for 6 to 15 months. The appearance of the fingers was aesthetic, the texture was soft, the skin color was close to the surrounding tissue, and the skin flap had good wear resistance. After the operation, the sensation of the flap recovered to S3+ with the two-point discrimination being 6 to 9 mm. The sensation of pain and temperature were recovered. Patients can use their thumbs for daily work and life. Conclusion The first dorsal metacarpal reverse fasciocutaneous flap with the superficial branch of radial nerve has the advantages of reasonable flap design, reliable blood supply, convenient cutting and simple operation. It is an ideal operation for repairing thumb defect. Key words: Surgical flaps; Treatment outcome; Thumb defect; Superficial branch of radial nerve

Schwannoma of the deep branch of radial nerve: a case report.

Schwannomas are the most common tumour of the peripheral nerve sheath. They are usually benign tumours. The aim of the study is the presentation of a case report with schwannoma of the deep branch of the radial nerve. This paper will present a case with schwannoma of the deep branch of the radial nerve, in which tumour was removed entirely. Surgical removal is a common treatment for schwannomas. It has satisfactory results, but sometimes surgical operation can be difficult and can be complicated.

The Course and Branching Patterns of the Superficial Branch of Radial Nerve in Foetuses and Clinical Significance

The Course and Branching Patterns of the Superficial Branch of Radial Nerve in Foetuses and Clinical Significance

Restoration of shoulder external rotation by means of the infraspinatus muscle reinnervation with a radial nerve branch transfer

Background: Although reinnervation of the suprascapular nerve is frequently obtained through brachial plexus surgery, reestablishment of infraspinatus muscle function is rarely achieved.Methods: The viability of transfer of the radial nerve to the nerve branch to the infraspinatus muscle was determined anatomically, including histomorphometrical analysis on 30 adult cadavers. Eleven adult patients were then treated using the proposed nerve transfer.Results: The branch to the medial head was more suitable for the nerve transfer. In one cadaver, nerve transfer was impossible because there was no donor of sufficient length. According to axon counts, the branches to the lateral and medial heads had sufficient numbers of axons (means = 994.2 ± 447.6 and 1030.8 ± 258.5, respectively) for reinnervation of the branch to the infraspinatus (means = 830.2 ± 241.2 axons). In the surgical series, one patient was lost in the follow-up and only two patients achieved a good result from the transfer. Recovery of external shoulder rotation started 14 months after surgery in one patient and 8 months in the other. The first patient reached 90° of external rotation 6 months later and the second, achieved 120°of shoulder external rotation 6 months after surgery . Four other patients recovered small amounts of movement: 20, 35, 40 and 45°.Conclusions: Although anatomically feasible, the proposed nerve transfer resulted in a small number of good clinical outcomes.