US-guided perineural injections are quick, cost effective, and safe for diagnostic evaluation and treatment of multiple upper extremity neuropathies. They are performed to confirm a specific neuropathy before nerve surgery or to relieve nerve pain. Nerves in the upper extremity can be damaged from trauma, entrapped by fibrous bands or scars, or damaged from surgery itself. Surgery is increasingly being performed on nerves to relieve neurogenic pain. The radiologist plays a key role in diagnosing and aiding in the treatment of neurogenic pain by injecting around the nerve in question and recording the immediately elicited a response to the injection. US allows for precise nerve localization and real-time needle guidance to ensure that the local anesthetic or steroid and local anesthetic mixture is injected precisely around a nerve. Accurate perineural injection requires detailed knowledge of nerve anatomy and location. The authors review the anatomy and course of select nerves in the upper extremity with MRI and US correlation, including the axillary, musculocutaneous, lateral antebrachial cutaneous, medial antebrachial cutaneous, radial, ulnar, and median nerves. For each nerve, the authors describe patient positioning, US transducer placement, and needle placement for performing these perineural injections and provide representative case examples. With detailed knowledge of nerve anatomy and US techniques, perineural injections of the upper extremity can be performed safely and effectively for diagnosis and therapy.

UltraMN: Advancing Real-Time Median Nerve Ultrasound Monitoring With a Multitask Deep Learning Framework.

Sleep is essentially contributing to human health and well-being through multiple biological functions, including restoration and biosynthesis, brain clearance, energy metabolism, immunological and endocrine processing, synaptic plasticity, memory consolidation, and regulation of cognitive and emotional processes. Sleep disturbances are highly prevalent and are both a symptom and a contributing risk factor for psychiatric, neurological, and somatic disorders. Given the limitations of pharmacological interventions, noninvasive neuromodulation techniques ranging from noninvasive transcranial [transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), transcranial random noise stimulation (tRNS), temporal interference stimulation (tTIS), and transcranial ultrasound stimulation (TUS)] to peripheral sensory (auditory, olfactory, visual, tactile, vestibular) and electrical nerve (galvanic vestibular, transcutaneous vagus nerve, and median nerve) stimulation have gained increasing attention as potential tools to modulate sleep physiology. These techniques offer promising avenues for both therapeutic applications and fundamental research into sleep-dependent neuroplasticity, interregional communication, and oscillatory activity. However, sleep is not a uniform state but a highly complex and dynamic phenomenon, with intricate macrostructural [e.g., non-rapid eye movement (NREM)-rapid eye movement (REM) sleep balance, sleep efficiency] and microstructural (e.g., hierarchically nested slow waves and spindles) characteristics that contribute to a variety of functions. This complexity necessitates precise targeting strategies, often employing real-time brain state-dependent stimulation, to modulate specific sleep-related processes effectively. In this review, we summarize the functions of sleep and the available noninvasive tools for its modulation, addressing key methodological challenges and providing recommendations for best practices in sleep neuromodulation.

Root of Helix Inter Tragus Notch Incision (RHITNI) for open temporomandibular joint surgery: A five-year retrospective cohort study on safety and complications.

To analyze the association between the growth of the central and peripheral nervous systems (PNS) in children aged 0 to 3 years.A total of 40 participants were included in this cross-sectional study to analyze the association between the growth and development of the peripheral and central nervous system (CNS). Using high-resolution ultrasound, the cross-sectional area (CSA) of the median nerve was measured at three locations (wrist, forearm, and upper arm) representing the development of the PNS and then compared with the head circumference (HC) as a proxy for the CNS development.There was a significant correlation between HC and the CSA of the median nerve at the three measured locations. When looking at adjusted linear regression models, HC appeared to be a stronger predictor of nerve CSA size than age.The observed association between nerve CSAs and HC growth indicates a parallel size increase. This association may have clinical relevance because both HC and nerve CSA could potentially serve as complementary markers for neurodevelopmental monitoring, that is, myelination, and may contribute to the early identification of atypical developmental patterns, though confirmatory longitudinal data are required.

Roc-based validation of palmar sensory latency in Carpal tunnel syndrome diagnosis.

Background: Carpal tunnel syndrome is a common occupational musculoskeletal disorder, particularly among computer-based workers. Prolonged repetitive hand movements, sustained wrist postures, and inadequate ergonomic practices increase the risk of median nerve compression, leading to pain, numbness, and functional impairment. Objective: To determine the prevalence of carpal tunnel syndrome among computer-based employees of government banks and the National Savings Centre in Abbottabad, and to examine its association with occupational and ergonomic factors. Methodology: This cross-sectional study included computer-based bank employees in selected government and semi-government banks, conducted under the FIMS College of Physiotherapy, Abbottabad. The study included 160 employees aged 23–63 years, with a calculated sample size of 114 selected through convenience sampling. Both male and female employees engaged in routine computer work were included, while individuals with medical conditions that could confound this syndrome were excluded. Data collection spanned six months following ethical approval and informed consent. Carpal tunnel syndrome assessment was carried out using the Boston Carpal Tunnel Questionnaire, along with the carpal compression test performed by a trained examiner. Data were analyzed using SPSS version 20, employing descriptive statistics. Results: The overall prevalence of carpal tunnel syndrome based on carpal compression test was 36.8% (42). Males exhibited higher positivity (30.7%) compared to females (6.1%). Symptom analysis revealed 43% reported wrist/hand pain at night, 46.5% during daytime, 34.2% numbness, and 35.1% tingling. Longer daily computer use and increased years of computer work were significantly associated with carpal tunnel syndrome (p<0.05). Conclusion: Carpal tunnel syndrome is moderately prevalent among computer-based bank employees in Abbottabad, with higher occurrence in individuals with prolonged occupational computer exposure. These findings underscore the importance of ergonomic interventions, regular breaks, and early symptom screening to reduce carpal tunnel syndrome risk and enhance occupational health.

Background: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome, often requiring carpal tunnel release surgery. Anatomical anomalies within the carpal tunnel, such as the palmaris profundus (PP) tendon, may contribute to symptomatology or complicate surgical management. The PP is a rare vestigial muscle, with a reported cadaveric incidence of 0.125 per cent. It may share a fascial sheath with the median nerve and increase local volume within the carpal tunnel, thereby contributing to CTS. This review provides the first systematic synthesis of published cases of CTS associated with the PP. Methods: A systematic literature search was conducted across MEDLINE, Embase, PubMed and Cochrane Library on March 22, 2025. Studies were included if the PP was associated with CTS and if they were published in English. Two independent reviewers screened titles, abstracts and full texts, with data extracted on patient demographics, diagnostic methods, surgical approach, intraoperative findings and outcomes. Results: Eighteen studies, reporting on 21 patients, met the inclusion criteria. The mean age was 59.0 years with 76.2 per cent of cases involving the right hand. The PP was most often found arising from the flexor digitorum superficialis fascia and inserting into the palmar aponeurosis. Open carpal tunnel release and PP resection was the predominant surgical intervention (95.2%), with symptom resolution in 85.7 per cent of cases. A bifid median nerve was observed in 33.3 per cent of patients. Preoperative imaging rarely identified the anomaly. Conclusion: The PP is a rare but clinically relevant anatomical variant that may cause or contribute to CTS. Surgical vigilance and resection when encountered are strongly recommended to improve outcomes and reduce recurrence.

Prospective interventional sham-controlled pilot study. To investigate the effect of motor-tract paired-associative stimulation consisting of high-intensity transcranial magnetic stimulation and high-frequency electric stimulation of peripheral nerves (high-PAS) on moderate-to-severe upper limb neuropathic pain in patients with incomplete spinal cord injury compared with sham treatment in the same patients. BioMag Laboratory, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. High-PAS was applied for 4 weeks to 5 patients with incomplete, non-traumatic SCI and chronic neuropathic pain in upper limb(s). Median, ulnar, and radial nerves of the more painful hand were stimulated. The same patients also received sham stimulation for 4 weeks. Pain was measured with Verbal Rating Scale weekly and with Brief Pain Inventory before and after both stimulation periods and after follow-up of 8 weeks. Clinically significant relief in pain was not achieved with high-PAS or sham treatment. In this pilot study, clinically significant pain relief was not observed with high-PAS compared with sham treatment. Larger studies are needed to confirm these findings. Nevertheless, pain is not a contraindication for high-PAS in rehabilitation. The previously reported positive effect on milder neuropathic pain may be due to improved muscle activity, different pain types, or placebo effect. High-PAS targeting sensory tracts instead of motor tracts merits further investigation for pain treatment. clinicaltrials.gov, ID NCT05362422.

Nerve ultrasound (n-US) supports the diagnosis of multifocal motor neuropathy (MMN), though most studies focus on nerve enlargement (NE) and its distribution. This study explored nerve echotexture using ultrahigh-frequency ultrasound (UH-FUS) in 13 MMN patients (mean age 61.9 years, disease duration 147 ± 105 months). NE was detected in 77%, preferentially involving median nerve, yet conduction blocks corresponded to NE in only 15%. Notably, 92% showed mixed/hyperechoic echotexture, including three patients with normal CSA, suggesting microstructural remodeling beyond swelling. No hypoechoic nerves were observed, consistent with limited acute inflammation. Combining echogenicity with NE assessment may improve n-US sensitivity, especially in atypical MMN.

This study investigated the attenuation of somatosensation in healthy subjects (n = 18) and subjects with carpal tunnel syndrome (CTS) (n = 6) via displacement-guided median nerve focused ultrasound (FUS). Somatosensory evoked potentials (SSEPs), pain, stiffness, and numbness were used as markers of sensation. Electroencephalography (EEG) was used to evaluate changes in electrically-induced SSEPs when paired with FUS. Subjects underwent 1000 (healthy population) or 500 (CTS population) surface electrical pulses at a maximum rate of 1 Hz to the median nerve to invoke a thumb twitch. Half of these pulses were paired with 5 ms of upstream median nerve sonication from a 1.1 MHz transducer at 1.8 or 2.9 MPa derated peak-positive pressure. On-nerve sonication reduced the amplitude of SSEPs at both pressures. Reductions in beta and low-gamma frequency power occurred in healthy subjects and increases in alpha power occurred in CTS subjects. CTS subjects who received on-nerve sonication reported an average pain reduction of 40.6%. Off-nerve sonication did not reduce SSEP amplitudes or CTS symptoms. Median nerve displacement was correlated with SSEP reductions. Sonication of the median nerve can attenuate SSEPs, potentially in a displacement dose-driven manner. Symptom reduction in CTS subjects lasted 1-3 days post-procedure. Nerve targeting is essential to ensure therapeutic efficacy. This study is the first to demonstrate that peripheral nerve FUS modulates somatosensory-evoked potentials in humans. FUS attenuated neuropathic pain and stiffness related to median nerve entrapment, illustrating the potential analgesic effects of the procedure.

BACKGROUND AND IMPORTANCE: Eustachian tube dysfunction due to medial pterygoid nerve impairment is a rare complication after trigeminal schwannoma surgery. Eustachian tube dysfunction leads to fluid inside the mastoid air cell, which requires differential diagnosis with cerebrospinal fluid leakage. CLINICAL PRESENTATION: We present a 49-year-old male patient of trigeminal schwannoma. The extradural middle fossa rhomboid approach was performed. The mastoid air cell was opened during the drilling of the middle skull base. After surgery, mastoid air cell fluid was observed. The fluid volume did not increase during hospitalization. However, at 3 months after surgery, the mastoid air cell fluid gradually increased. Otolaryngological examination revealed serous otitis media on the surgical side. Furthermore, opening dysfunction of pharyngeal orifice of eustachian tube due to the medial pterygoid nerve impairment after trigeminal schwannoma surgery was suspected. Tympanotomy was performed, after which the mastoid air cell fluid disappeared. CONCLUSION: Eustachian tube dysfunction due to the medial pterygoid nerve impairment is a rare postoperative complication of trigeminal schwannoma. This condition can lead to serous otitis media and increased mastoid air cell fluid.

To compare the length staining of the radial, ulnar, median, and musculocutaneous nerves (RUMM) in rat cadavers using one of two ultrasound-guided injection approaches: medial (MA) and lateral (LA). Prospective, experimental, randomized cadaveric study. A group of ten frozen-thawed adult Wistar rat cadavers. Ultrasound-guided proximal RUMM injections were performed using a volume of 0.1 mL of a bupivacaine-dye solution, divided between two injection sites: within the neurovascular sheath [radial, ulnar, and median (RUM) nerves] and near the musculocutaneous nerve. For LA (n = 10 rats, 10 limbs), a linear transducer was positioned over the triceps region at the proximal third of the brachium, oriented perpendicular to the humerus's longitudinal axis, with the needle advanced from caudal to cranial. For MA (n = 10 rats, 10 limbs), the transducer was aligned perpendicular to the proximal humeral head, with the needle introduced from caudal to cranial. Anatomical dissections were performed and length of nerve staining was measured. Data were analyzed using paired two-tailed t-tests for parametric data with significance set at p < 0.05. In both approaches, complete staining of RUM nerves within the neurovascular sheath was achieved. The MA resulted in significantly greater dye spread (10.4 ± 1.0 mm) than the LA (6.7 ± 1.7 mm, 95% confidence interval 2.1-5.3) (p < 0.001). All musculocutaneous nerves were stained in MA {5.0 mm [interquartile range (IQR): 4.8-6.0 mm]}, while one nerve was unstained in LA [5.5 mm (IQR: 5.0-6.0 mm)], with no observable differences between them. The MA achieved greater dye spread length along the RUM nerves and similar spread length of the musculocutaneous nerve compared with the LA. Further studies are necessary to assess the application in live rats.

Leprosy is a chronic granulomatous disease that commonly affects the peripheral nervous system, often leading to significant disability. High-resolution ultrasonography has emerged as a promising tool for the noninvasive assessment of nerve involvement in leprosy. To figure out the diagnostic value of HRUS in assessing peripheral nerve involvement in leprosy, with a focus on measuring the cross-sectional area (CSA) of major nerves. A systematic search of PubMed, Scopus, Web of Science, and Embase was conducted up to 2024. Seventeen studies were included, and quality assessment was performed using NIH and NOS tools. Meta-analyses compared CSA of the ulnar, median, posterior tibial, and common fibular nerves between patients with leprosy and healthy controls. Heterogeneity was evaluated using the I2 statistic and sensitivity analyses were performed. Patients with leprosy showed significantly increased CSA in all examined nerves compared with controls. Single-arm analysis of CSA in patients with leprosy showed consistent nerve enlargement, particularly in the ulnar nerve. Our review shows the usefulness of HRUS as a sensitive, noninvasive imaging modality for evaluating peripheral nerve involvement in leprosy.

Evaluation of wrist radiographic indices in people with idiopathic carpal tunnel syndrome: a prospective cross-sectional study.

An Institutional Study Of Cervical Compressive Myelopathy Patients: Surgical Outcomes Based On Clinical And Neurophysiological Parameters.

Surgical Management of Wrist Arthritis Is Linked to Increased Carpal Tunnel Syndrome/Carpal Tunnel Release Risk: Rethinking Preoperative Evaluation.

Variations in the terminal branches of the brachial plexus in humans. A cadaveric study.

Supracondylar humerus fracture is a common elbow injury sustained in the pediatric population. Percutaneous pinning, whether all lateral or medial-lateral, is the mainstay of operative management for these injuries. There has been much debate on the safety of medial-sided pinning, with the literature indicating that medial-sided pinning can lead to iatrogenic ulnar nerve injury. Thus, the goal of our study is to describe the rates of nerve injuries (radial, median, and ulnar), loss of reduction, and range of motion between all lateral and medial-lateral treatment groups. Patients aged 1 to 18 years presenting at a pediatric hospital for a single, isolated supracondylar humerus fracture and treated with percutaneous pinning between 2018 and 2023 were reviewed. Patients with concurrent surgical treatment at the time of pinning, who presented with multiple injuries, had an open reduction, had an open fracture, or were lost to follow-up, were excluded. Age, sex, Gartland fracture classification, pinning method, nerve injury, range of motion, loss of reduction, and duration of follow-up were collected. Descriptive statistics were analyzed for variables of interest. A total of 406 pediatric patients were included. The average (SD) age at presentation was 5.7 (2.3) years, with 179 (44.1%) patients presenting with Type II fracture and 227 (55.9%) with Type III or IV. There were 131 (32.3%) patients treated with a medial-lateral pinning approach and 275 (67.7%) patients treated with an all-lateral pinning approach. Patients treated with a medial-lateral pinning experienced no new ulnar, radial, or median nerve injuries postoperatively. There was 1 (0.8%) patient with a loss of reduction, and 68.4% of patients with a medial pin had a full range of motion at their last follow-up. Patients treated with an all-lateral pinning approach experienced a new median nerve injury (n=1) and a new ulnar nerve injury (n=1) postoperatively. No patients with an all-lateral pinning approach had a loss of reduction, and 70.7% had a full range of motion at the last follow-up. This study demonstrated no occurrence of an ulnar nerve injury while utilizing the medial entry pins in the treatment of supracondylar fractures. Strict adherence to surgical principles pertaining to medial entry pins is crucial to avoid ulnar nerve injury and should be included in orthopaedic surgeon's armamentarium when treating unstable supracondylar fractures.

Variant vascular pathways often present a challenge to a radiologist interpreting routine musculoskeletal imaging studies. In this article, the authors focus on the prevalence, anatomic landmarks for both normal and variant anatomy, clinical significance of the aberrant vasculature and anatomic associations, and potential risks of surgical complications. In the upper extremity, the persistent median artery and high division of the radial artery, known as the brachioradial artery, threaten median neuropathy or upper extremity ischemia. Pelvic trauma cases should be scrutinized for corona mortis, an anastomotic vessel draping around the superior pubic ramus, that threatens severe, even fatal, hemorrhage if lacerated from superior pubic rami fractures or during acetabular fixation. In the posterior thigh, the persistent sciatic artery can be the supplemental or dominant vascular supply to the leg, which when thrombosed risks limb-threatening arterial insufficiency. The relatively fixed course of the aberrant anterior tibial artery between the popliteus muscle and posterior tibial cortex places it at risk in several orthopedic procedures, predominately those involving anterior to posterior instrumentation, and can have severe clinical repercussions including compartment syndrome, limb ischemia necessitating amputation, and hemorrhage. The peroneal arteria magna, referring to a dominant peroneal artery providing the sole vascular supply to the foot, is at risk for traumatic or iatrogenic aneurysm or pseudoaneurysm formation or ischemia if lacerated. Both common and uncommon variants are important to recognize for potential immediate or remote surgical intervention and treatment. ©RSNA, 2026 Supplemental material is available for this article.