Nerve Neurolysis Research Articles

Outcomes of sciatic neurolysis in chronic hamstring tears: a retrospective case series.

Proximal hamstring tears may present with neurological dysfunction due to compression or stretching of the sciatic nerve. The purpose of this study was to evaluate the effectiveness of hamstring repair with concurrent sciatic nerve neurolysis for clinical outcomes and patient symptoms. A retrospective chart review of patients who were diagnosed with hamstring injury at a large tertiary care institution was conducted. Patients with chronic tears (> 6weeks from injury to surgery) who underwent hamstring repair were reviewed for demographics, clinical variables including symptoms of sciatic neuritis, sciatic nerve abnormalities on MRI, and postoperative outcomes. Chi-square tests were used for categorical variables, t test for continuous variables. Pairwise t tests were used to compare average pre- and postoperative strength for patients with and without symptoms of sciatic neuritis. Thirty-two patients with chronic hamstring tears were included in the analysis. Patients were 59.4% female with an average age of 51.4years (SD 13.1). Preoperatively, 27 patients (84.4%) were noted to have symptoms of sciatic neuritis. These patients did not differ in age (p = .677) or sex (p = .374) from patients without preoperative symptoms. Sciatic nerve abnormalities were noted on MRI report in 7 patients who had sciatic nerve symptoms and 0 patients who did not have sciatic nerve symptoms. Symptomatic improvement was seen in 21/26 (81%) of patients who had preoperative neurological symptoms, and in 6/7 (86%) of patients with MRI findings. All patients had equivalent or improved strength postoperatively. A sciatic nerve neurolysis is a safe and effective procedure to perform on patients with preoperative sciatic nerve symptoms and chronic hamstring tears that leads to improvement in neurological symptoms and strength. In neurologically asymptomatic patients with chronic hamstring injuries and MRI findings indicating possible nerve damage, a discussion should be held about the risks and benefits of performing a sciatic nerve neurolysis.

Supracondylar ostectomy and shortening (S.O.S.) for distal humerus nonunions

Many distal humerus nonunions are associated with bone loss, and rigid internal fixation is difficult to obtain, especially for low transcondylar nonunions and those with severe intra-articular comminution. The purpose of this study was to analyze the results of a strategy to address this challenge utilizing internal fixation using the Supracondylar Ostectomy+Shortening (S.O.S.) procedure for distal humerus nonunions. The goals of this procedure are to (1) optimize bony contact and compression through re-shaping the nonunited fragments at the supracondylar level with selective humeral metaphyseal shortening, (2) maximize fixation using parallel-plating, and (3) provide biologic and structural augmentation with bone graft. Between 1995 and 2019, 28 distal humerus nonunions underwent internal fixation using the S.O.S. procedure at a single Institution. There were 14 males and 14 females with mean age of 47 (range 14-78) years at the time of the S.O.S procedure and an average of 1.7 prior surgeries. Medical records and radiographs were reviewed to determine rates of union, reoperations, complications, and Mayo Elbow Performance Scores (MEPS). Patients were also prospectively contacted to update their MEPS and gather additional information on complications and reoperations. Mean clinical exam follow-up was 17months, mean clinical contact follow-up was 19months, and mean radiographic follow-up was 32months. Four patients did not have adequate follow-up to determine union. Of the remaining 24 elbows, 22 achieved union. Two elbows developed collapse of the articular surface and were converted to a total elbow arthroplasty. There were complications in 10 elbows: contracture (5), superficial infection (2), ulnar neuropathy (1), deep infection (1), and hematoma (1). Twelve elbows underwent reoperation: 4 for contracture release, 3 for hardware removal, 2 for total elbow arthroplasty, 1 for bone grafting, 1 for hematoma evacuation, and 1 for ulnar nerve neurolysis. Compared to preoperative data, there was a significant improvement in postoperative flexion, extension and pronation (P<.01). The mean range of motion was 21° of extension, 119° of flexion, 79° of pronation, and 77° of supination. The mean MEPS was 80 points (range, 25-100 points) and 19 elbows (76%) rated as excellent or good. Stable fixation and high union rates are possible in distal humerus nonunions with bone loss using a technique that combines supracondylar humeral shortening, parallel plating, and bone grafting. Secondary procedures are commonly needed to restore function in this challenging patient population.

Pudendal Nerve Neurolysis in Patients Afflicted With Pudendal Nerve Entrapment: A Systematic Review of Surgical Techniques and Their Efficacy.

To assess the effectiveness and safety of various techniques of pudendal nerve neurolysis (PNN) in patients with pudendal nerve entrapment (PNE). A comprehensive literature search was conducted on May 20th, 2023, using Scopus, PubMed, and Embase databases. Only studies in English involving adults were accepted, while meeting abstracts and preclinical studies were excluded. A total of 34 papers were included. Transperineal PNN emerged as a promising technique, demonstrating significant potential in alleviating pain, restoring erectile function in males, and improving the resolution of urinary stress incontinence in females. Furthermore, the bilateral approach consistently yielded positive outcomes in addressing urinary symptoms. The transgluteal technique appeared particularly suitable for cases of posterior PNE, situated between the sacrospinous ligament and the lesser sciatic foramen. A progressive amelioration of painful symptoms was observed during follow-up. Minimally invasive PNN is evolving and enables decompression along the entire proximal tract up to the Alcock canal, minimizing the risk of comorbidities. In addition to reducing pudendal neuralgia, robot-assisted and laparoscopic approaches determined a reduction in lower urinary tract symptoms and an improvement in erectile function, though further studies are required to corroborate these findings. PNN emerges as an effective treatment for PNE with minimal morbidity. Therefore, PNN should be tailored according to the site of PNE to enhance functional outcomes and improve patient quality of life.

Anatomic Popliteus Tendon and Tibiofibular Joint Reconstructions

Background: The popliteus tendon is a primary stabilizer of external knee rotation and has been described as the “fifth ligament of the knee.” Injuries involving the posterolateral corner of the knee commonly involve the popliteus tendon; isolated injury to the popliteus tendon is relatively rare and usually involves a rotatory injury mechanism and symptoms of instability and pain. In this patient, there was a concomitant injury to the proximal tibiofibular joint. Indications: Popliteus tendon reconstruction is indicated for patients with abnormal external rotation on examination and symptoms of pain and instability. Proximal tibiofibular joint reconstruction is indicated for patients with instability of the tibiofibular joint. Technique Description: Preoperative examination under anesthesia is essential to determine the extent of external rotation and assess for additional posterolateral pathology. The popliteus tendon procedure begins with a meticulous common peroneal nerve neurolysis to minimize nerve irritation and decrease the risk of a postoperative foot drop. Semitendinosus and gracilis graft harvest is performed with at least 16 cm of graft length followed by tunnel reaming of the popliteus tendon femoral attachment and tibia tunnel identification and reaming. The femoral attachment of the popliteus tendon is secured, and the semitendinosus graft is anatomically oriented along the native path and passed from posterior to anterior through the femoral tunnel. The gracilis graft for anatomic proximal tibiofibular joint reconstruction requires an anterior to posterior tunnel through the fibular head. Finally, both grafts are secured in the tibial tunnel with the application of an anterior traction force. Results: A cadaveric study by LaPrade et al reported that an anatomic popliteus tendon reconstruction with a semitendinosus autograft significantly reduced external rotation laxity compared with the sectioned state. In addition, popliteus tendon reconstruction resulted in significantly decreased varus laxity, anterior tibial translation, and internal rotation. Discussion: This is a technique that effectively restores external rotation knee stability utilizing an anatomically oriented reconstruction of the popliteus tendon and tibiofibular joint. The popliteus tendon serves as a primary stabilizer to external rotation and facilitates static function of the knee. The proximal tibiofibular joint reconstruction restores the function of the posterior proximal tibiofibular joint ligaments. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Dexmedetomidine in Fluoroscopic Guided Splanchnic Nerve Neurolysis for Pain Control: A Randomized, Controlled Trial

BACKGROUND: Splanchnic nerve neurolysis (SNN) shows beneficial effects in reducing malignancy-associated refractory abdominal pain. Using adjuvants, such as dexmedetomidine to improve the pain was studied. OBJECTIVE: To detect any role of dexmedetomidine as an additive to local anesthetics with an alcohol injection in the chemical SNN process to improve pain in patients having upper-abdominal cancer. STUDY DESIGN: Double-blinded, prospective randomized study. SETTING: Department of Anesthesia and Intensive Care, faculty of medicine, Minia University, Egypt. METHODS: Forty patients with upper-abdominal malignancy-associated refractory abdominal pain underwent fluoroscopic guided SNN were divided into 2 groups. The SNN was performed by using 1.5 mL lidocaine 1%, dexmedetomidine 2 mu-g/kg, and then an injection of 4.5 mL of ethanol 96% on each side in group D and without dexmedetomidine in group C is done. Patients gave the score of abdominal pain expressed by the Visual Analog Scale (VAS), which measures the pain intensity. Scors were recorded prior to injection, during injection, after injection by 5 min, and after 2, 6, 12, 24, 72 hours, one week (W), 2 W, one month (M), and 2 M. Also, we recorded the amount of morphine required to relieve the residual pain after injection, the effect of procedure on quality of life (QOL), and any complication after injection. RESULTS: VAS scores showed a significant increase in group C in comparison to group D during injection, after injection by 5 min, 2, 6, 12, 24 hours, one and 2 months (P &lt; 0.0001, 0.0001, 0.029, 0.031, 0.025, 0.040, 0.020, 0.015), respectively. The morphine requirement was significantly increased at one W, one M, and 2 M in group C in comparison to Group D (P &lt; 0.044, 0.017, 0.033) with no significant change in the QOL observed between groups. LIMITATIONS: The limitations of this study were a relatively small sample size and short period of follow-up. CONCLUSIONS: This study revealed that using dexmedetomidine in the chemical SNN process improves the pain results from injection of alcohol and refractory cancer related pain with reduction in the consumption of morphine in patients with upper-abdominal malignancy. KEY WORDS: Splanchnic nerve neurolysis, dexmedetomidine, alcohol, chronic cancer pain

Efficacy and Safety of Celiac Plexus Neurolysis Versus Splanchnic Nerve Neurolysis in the Management of Abdominal Cancer Pain: A Meta-analysis of 359 Patients

BACKGROUND: Splanchnic nerve neurolysis (SNN) is commonly used as an alternative pain control technique to celiac plexus neurolysis (CPN) in patients with distortion of anatomy, but the analgesic effect and relative risks of the 2 procedures remain controversial in general condition. OBJECTIVES: The aim of this study was to evaluate the pain condition, safety, and symptom burden of SNN compared with CPN. STUDY DESIGN: A systematic review and meta-analysis of neurolysis therapy for intractable cancer-related abdominal pain. METHODS: A systematic search was performed for randomized controlled trials comparing SNN and CPN using the PubMed, Medline, Cochrane Library, Web of Science, Google Scholar, and China National Knowledge Infrastructure databases. Meta-analysis was performed using Stata Version 15.0. Outcomes included pain condition, opioid consumption, adverse effects, quality of life (QOL), and survival rate. Standardized mean difference (SMD) was calculated for continuous outcomes with its corresponding 95% CI. LIMITATIONS: Study limitations include challenges to make subgroup analysis by intervention measures and addressing inevitable heterogeneity. Larger studies are needed for survival rates and further insights. RESULTS: Seven studies involving 359 patients were included. No significant difference was found in pain condition at 2 weeks [SMD = 0.75, 95% CI (-0.25, 1.74), P &gt; 0.05], 2 months [SMD = 1.10, 95% CI (-0.21, 2.40), P &gt; 0.05] and 6 months [SMD = 0.53, 95% CI (-0.02, 1.08), P &gt; 0.05] between SNN and CPN. Opioid consumption was comparable at 2 weeks [SMD = 0.57, 95% CI (-1.21, 2.34), P &gt; 0.05] and one month [SMD = 0.37, 95% CI (-1.33, 2.07), P &gt; 0.05]. However, SNN was associated with a statistically significant reduction in the opioid consumption at 2 months postoperatively [SMD = 0.99, 95% CI (0.68, 1.30), P &lt; 0.05]. A systematic review was performed for adverse effects and QOL. CONCLUSIONS: Our evidence supports that the analgesic effect of SNN is equivalent to that of CPN, independent of changes in the anatomical structure of the abdominal nerve plexus. SNN requires less use of opioids at 2 months and does not show greater improvement in pain burden compared to CPN. KEY WORDS: Cancer pain, celiac plexus, meta-analysis, neurolysis, splanchnic nerve

Combined genicular artery embolization and genicular nerve block to treat chronic pain following total knee arthroplasty

BackgroundChronic knee pain after total knee arthroplasty (TKA) is a common complication that is difficult to treat. This report aims to highlight the benefit of combining embolotherapy and neurolysis intervention for symptomatic relief of post-TKA pain in a patient with long-standing pain refractory to conservative management.Case presentationA 77-year-old man who had previously undergone left knee arthroplasty has been grappling with worsening knee effusion and debilitating pain, resulting in limited mobility and progressive musculature deconditioning over a 20-year period. Diagnostic arteriography showed marked diffuse periarticular hyperemia around the medial and lateral joint spaces of the left knee, along with capsular distention. The patient initially underwent microsphere embolization to selectively target multiple branches of the genicular arteries, achieving a 50% reduction in pain at the one-month follow-up. Subsequently, the patient underwent image-guided genicular nerve neurolysis, targeting multiple branches of the genicular nerves, which led to further pain reduction (80% compared to the initial presentation or 60% compared to post-embolization) at the one-month follow-up. This improvement facilitated weight-bearing and enabled participation in physical therapy, with sustained pain relief over the 10-month follow-up period.ConclusionThe combination of genicular artery embolization and genicular nerve block may be a technically safe and effective option for alleviating chronic pain after total knee arthroplasty.

The Triple Varus Knee: A Case Presentation

Background: Knee instability due to posterior cruciate ligament (PCL) and posterolateral corner (PLC) deficiency is a devastating condition that negatively affects patient quality of life. This video presents the surgical management of a triple varus knee, including combined high tibial osteotomy (HTO), revision PCL and PLC reconstruction, and meniscus root repair. Indications: Combined HTO and revision PCL and PLC reconstruction is indicated for patients with previously failed PCL and PLC reconstruction in the setting of varus malalignment. Technique Description: The procedure begins with a medial opening-wedge biplanar HTO, which is fixed with a patient-specific locking plate. The PCL femoral tunnel is drilled via a low anterolateral portal, and the tibial insertion is debrided via a posteromedial portal. The medial meniscus is carefully freed from the posterior capsule, and 2 luggage tag sutures are placed through the posterior root. The PCL tibial tunnel and meniscus root tunnels are drilled via their respective guides. The meniscal sutures are passed through the tunnel but not fixed. An Achilles bone-block allograft is passed through the PCL tibial tunnel and fixed with suspensory fixation and an interference screw on the femoral side, while the tibial side is left free. A peroneal nerve neurolysis is performed. A fibular tunnel is drilled, and a semitendinosus allograft is whip-stitched on both sides and passed through the tunnel. A Beath pin is inserted into the femur, and the tunnel is over drilled. Both limbs of the graft are passed deep to the iliotibial band and into the tunnel. The tibial side of the PCL is fixed with an interference screw at 90° of knee flexion. The PLC grafts are fixed with an interference screw at 30° of knee flexion with slight valgus. The medial meniscus root sutures are tied over a button, with 60° of knee flexion. Screws from osteotomy fixation are replaced as needed. Results: Although outcomes following the combined procedure are lacking, good to excellent clinical outcomes have been reported in isolation following each procedure. Conclusion: A combination of HTO and revision PCL and PLC reconstruction should be considered for patients with persistent instability and/or pain in the setting of triple varus knee. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Efficacy of splanchnic nerve neurolysis in the management of upper abdominal cancer pain: A systematic review and meta-analysis.

Neurolytic splanchnic nerve block (NSNB) is practised in intractable abdominal pain secondary to intra-abdominal malignancies. This review evaluated the efficacy of NSNB. PubMed, Embase, Scopus, and Cochrane databases were searched for articles published from January 2001 to October 2023. Two independent reviewers extracted the data from the included studies. The quality of randomised controlled trials (RCTs) was assessed using the revised Cochrane risk-of-bias tool (RoB 2), and the Newcastle-Ottawa scale was used for cohort studies. Fourteen articles (4 RCTs, 3 non-randomised prospective, and 7 retrospectives) were included. Ten articles were quantitatively assessed and demonstrated significant pain relief at 1 week (standardised mean difference (SMD): 3.46 [2.09, 4.83], P < 0.001, I2 = 95%), 2 weeks (SMD: 4.45 [2.61, 6.29], P < 0.001, I2 = 95%), 4 weeks (SMD: 3.35 [2.23, 4.47], P < 0.001, I2 = 97%), 8 weeks (SMD: 3.7 [2.71, 4.7], P < 0.001, I2 = 86%), 12 weeks (SMD: 4.01 [2.66, 5.36], P < 0.001, I2 = 95%), and 24 weeks (SMD: 2.54 [1.71,3.37], P < 0.001, I2 = 84%). Daily narcotic consumption and quality of life (QOL) significantly improved post neurolysis, but survival rates showed controversial results. Significant heterogeneity was reported, and sub-group analysis revealed a moderate level of variability [I2 = 47.3%] pertaining to study design as a source of heterogeneity. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Pro GDT recommendation for the primary objective was 'high' for the analysis of RCTs and 'very low' evidence quality for observational studies. Only transient minor complications were reported. NSNB appears to be an efficacious technique that provides substantial pain relief, reduces opioid consumption, and ameliorates QOL.

The distance between the fibular collateral ligament tunnel and the common peroneal nerve allows a posterolateral corner reconstruction without neurolysis.

The most popular knee posterolateral corner (PLC) reconstruction techniques describe that a common peroneal nerve (CPN) neurolysis must be done to safely address the posterolateral aspect of the knee. The purpose of this study was to measure the distance between the CPN and the fibular insertion of the FCL in different degrees of knee flexion in cadaveric specimens, to identify if tunnel drilling could be done anatomically and safely without a CPN neurolysis. Ex vivo experimental analytical study. Ten fresh frozen human knees were dissected leaving FCL and CPN in situ. Shortest distance from the centreof the FCL distal tunnel and CPN was measured (antero-posterior and proximal-distal wire-nerve distances) at 90°, 60°, 30°, and 0° of knee flexion. Measurements between different flexion angles were compared and correlation between knee flexion angle and distance was identified. The mean distance between the FCL tunnel and the CPN at 90° were 21.15 ± 6.74 mm posteriorly (95% CI: 16.33-25.97) and 13.01 ± 3.55 mm distally (95% CI: 10.47-15.55). The minimum values were 9.8 mm posteriorly and 8.9 mm, respectively. These distances were smaller at 0° (p ≤ 0.017). At 90° of knee flexion, the mean distance from the fibular tip to the CPN distally was 23.46 ± 4.13 mm (20.51-26.41). Anatomic localization and orientation of fibular tunnels can be done safely while avoiding nerve neurolysis. Further studies should aim to in vivo measurements and results.

Reverse end-to-side technique (RETS) – supercharge and babysitting effect in median and ulnar nerve injuries. Case studies and surgical technique

High nerve damage at the shoulder or elbow is associated with a long regeneration period for effectorsmuscles located within the hand, leading to their irreversible atrophy and permanent dysfunction. Advanced microsurgical reconstructive techniques, such as end-to-side (ETS ) sutures, reverse end-to-side (RETS ) reconstruction (so-called supercharge/babysitting procedure), or nerve transfers within the hand, shorten the interval and thus the recovery time or provide continuous stimulation of the effector before the regeneration of the native axons of the nerve. The paper aims to present the authors’ results after treatment of a high injury of the ulnar and median nerves with additional RETS performed based on the results of three clinical cases. Two patients No 1 and 2 had a high ulnar nerve injury at the elbow level due to a distal humerus fracture. Nerve neurolysis was performed at the level of the primary lesion, followed by a reverse end-to-side transfer of the anterior interosseous nerve to the deep motor branch of the ulnar nerve. The patient No 3 with damage to the median nerve due to a fracture of the shaft of the radius. Neurolysis of the preserved part of the nerve, resection of the neuroma, and direct suture of the damaged part of the nerve were performed, as well as a simultaneous RETS transfer of the anterior interosseous nerve to the thenar motor branch of the median nerve. All presented patients had significant signs of improvement, with full to partial motor recovery of the nerves supported by supercharge/babysitting RETS technique. It is valuable, especially in borderline cases when the decision is between neurolysis/repair alone or nerve transfer is difficult to take and not clearly defined.

Letter to the Editor. Before surgical sural nerve neurolysis, study neighboring sensory nerves.

Letter to the Editor. Before surgical sural nerve neurolysis, study neighboring sensory nerves.

Ulnar Nerve Compression at the Elbow Secondary to Intramuscular Lipoma of the Flexor Carpi Ulnaris: A Case Report.

A 62-year-old right-hand-dominant woman presented with 1 year of persistent radiating pain, weakness, and paresthesias in her left forearm and hand. Electromyography findings were significant for ulnar neuropathy distal to the branch innervating the flexor carpi ulnaris (FCU), without superimposed cervical radiculopathy or other focal entrapment neuropathy. During open ulnar nerve neurolysis, an intramuscular lipoma was encountered within the FCU. Lipoma excision and cubital tunnel release with ulnar nerve transposition were performed with complete relief of neuropraxia. We demonstrate full neurologic recovery after intramuscular lipoma excision and cubital tunnel release. Although rare, anomalous anatomy and tissue overgrowth should remain on the differential for patients presenting with atypical neuropraxia.

Paper 20: Similar Clinical Outcomes Between Double Cortical Button and Docking Techniques for Ulnar Collateral Ligament Reconstruction in Baseball Players

Objectives: A double button technique using a cortical button on both the humeral and ulnar sides of the UCLR for fixation has recently been proposed, with advantages including greater control over graft tensioning and decreased risk of bone tunnel fracture. This double cortical button technique was recently evaluated biomechanically and found to be non-inferior to the traditional docking technique regarding strength, joint stiffness, and graft strain. However, clinical outcomes have not been compared between the double cortical button technique and standard UCLR techniques such as the docking technique. Therefore, the purpose of this study was to determine whether baseball players who underwent UCLR with a double cortical button (double button) technique have similar return to sport (RTS) rates, time to RTS, and subjective outcomes compared to baseball players who underwent UCLR with the traditional docking (Docking) technique. Methods: Competitive baseball players that underwent primary UCLR from 2011-2020 at across two institutions were identified using the CPT code 24346. Patients were excluded if they were not baseball players or if they did not undergo UCLR with the double button or docking technique. Included patients were contacted via RedCap to complete a follow-up survey evaluating reoperations, RTS, functional outcome scores, and patient satisfaction. Functional outcome surveys include the Kerlan-Jobe Orthopaedic Clinic (KJOC) score, Conway-Jobe score, Andrews-Timmerman (AT) elbow score, and the Single Assessment Numeric Evaluation (SANE) score. Results: Overall, 78 male baseball players (age: 18.9 ± 2.4 years) with an average follow-up of 3.1±2.4 years were evaluated, with 73 of the players being baseball pitchers and 55 (71%) of players completing the functional outcome surveys. Players in the double button group more frequently received palmaris longus autografts (78% vs. 30%) and less frequently received both gracilis autografts (22% vs. 58%) and allografts (0% vs. 13%) compared to players in the docking group (p=0.001); however, all other demographic factors were similar between groups (Table 1). All post-operative and patient-reported outcomes were also similar between groups. All players in the double button group (100%) were able to RTS in 11.1±2.6 months, while 96% of players in the docking group were able to RTS in 13.5±3.4 months (p&gt;0.05). All other post-operative outcomes and patient-reported outcomes were statistically similar between groups, and remained similar after isolating pitchers only and after separating partial-thickness from full-thickness UCL tears (all p&gt;0.05) (Tables 1-3). Two complications were observed in the docking group, with one player experiencing pain at elbow extension due to nerve neurolysis and another player developing an elbow stress fracture during rehabilitation, while no double button players experienced a complication. Conclusions: Post-operative outcomes were similar between baseball players who underwent UCLR with the double button technique and the docking technique. These findings provide the first clinical outcomes in support of a recent cadaveric study which showed the double button technique to provide similar elbow strength, joint stiffness, and graft strain compared to the docking technique. Larger comparative studies are necessary before a clear clinical recommendation can be made regarding the utilization of double button UCLR for baseball players. [Table: see text][Table: see text][Table: see text][Table: see text]

Median nerve entrapment in surgical scar: a rare complication in volar plating of fractures of distal end radius

A 25-year-old male presented to our OPD with pain and swelling of right wrist following trauma by RTA. X ray showed comminuted intraarticular fracture distal end radius (R) and confirmed with 3D CT. Patient was operated 15 days later with plate osteosynthesis using a 3-hole Elli’s T plate. The patient presented with complaints of numbness and tingling sensations over lateral 3 and half fingers about 2 months after surgery. Previous scar tissue excision was done which exposed the median nerve adhesions in its distal course with the scar tissue followed by median nerve neurolysis with carpal tunnel release was done.

Эндоскопическая хирургия при патологии седалищного нерва: первые результаты, возможности, осложнения: серия клинических наблюдений

IIntroduction Sciatic nerve neuropathy is common pathology. Development of endoscopic method of decompression and neurolysis is extremely prospective. Objective Analyze the results of endoscopic decompression of sciatic nerve at a 1-year follow-up. Material and methods 15 patients (11 females – 79 %, 4 males – 21 %) were included into the study and were treated in the period from 2018 to 2022. Endoscopic sciatic nerve neurolysis and decompression were performed. Mean age of the patients was 47 ± 16 years. The severity of pain according to VAS was 8 ± 1. Motor dysfunction according to the BMRC scale was 2.6 ± 1.7 points. Degree of sensitive dysfunction according to Seddon scale was 2.9 ± 0.9 points. Functional activity of the lower limb according to LEFS scale was 49 ± 7 points. Results The severity of pain one year after surgery according to VAS scale decreased to 2.8 ± 2.6 cm. Degree of motor dysfunction according to BMRC scale became 4.4 ± 0.8 points. Degree of sensitive dysfunction according to Seddon scale became 3.7 ± 0.4 points. Functional activity of the lower limb according to LEFS scale increased to 68 ± 8.7 points. Efficacy of surgery in our study was 80 % (12 patients), there was one complication after surgery (6.7 %). Discussion Our study obtained clinical results that are comparable with the data of domestic and world literature. Conclusion Endoscopic decompression of sciatic nerve is an effective and low-traumatic method with a low rate of complications, which allows for pain relief, promotes restoration of function of the sciatic nerve and lower extremity.

Percutaneous splanchnic nerve neurolysis analgesic efficacy and safety for cancer-related pain: a systematic review and meta-analysis.

To perform a systematic review and meta-analysis of publications to evaluate the analgesic efficacy and safety of percutaneous splanchnic nerve neurolysis (SNN) for cancer-related pain. We searched PubMed, Cochrane Library, and Ichushi-Web for English or Japanese articles published up to July 2022 and reporting patients who underwent percutaneous SNN for cancer-related pain. The outcome measures assessed in the systematic review and meta-analysis were the pain measurement scales and morphine equivalents daily dose (MEDD) before and after the intervention and the rate of complications. Pooled pain measurement scores at pre-intervention, 1-2weeks, and at 1, 2, 3, and 6months post-intervention were 6.65 (95% confidence interval [CI], 5.77-7.67, I2 = 97%), 2.79 (95% CI, 2.00-3.88, I2 = 88%), 2.82 (95% CI, 2.49-3.20, I2 = 55%), 2.86 (95% CI, 2.64-3.10, I2 = 0%), 2.99 (95% CI, 2.56-3.46, I2 = 82%), and 3.09 (95% CI, 1.44-6.65, I2 = 70%), respectively. Mean MEDD was described in 8 of the 11 included articles. In all 8 articles, MEDD decreased up to 3months post-intervention. The pooled minor complication rates for diarrhea and hypotension were 28% (95% CI, 13-49%, I2 = 85%) and 31% (95% CI, 16-51%, I2 = 80%), respectively. The pooled major complication rate was 2% (95% CI, 1-2%, I2 = 0%). Analysis indicates that percutaneous SNN for cancer-related pain can be performed safely with sustained reduction of pain measurement scales while reducing the administration of opioids.

Anatomic Fibular Collateral Ligament and Anterior Cruciate Ligament Reconstruction With Concomitant Biceps Femoris Avulsion Repair

Background: Injuries to the fibular collateral ligament (FCL) seldom occur in isolation and may present with a concomitant injury to the biceps femoris tendon and anterior cruciate ligament (ACL). Injuries to structures of the posterolateral corner (PLC) lead to varus and rotational instability of the knee, subjecting the cruciate ligaments to increased forces that may result in graft failure. Therefore, reconstruction of these structures should be performed concurrently with the ACL. Indications: Grade III FCL injuries heal poorly without operative treatment and often result in residual varus instability of the knee that increases medial knee compartment forces, and forces on both the native ACL and the graft status post ACL reconstruction. Therefore, preservation of biomechanical stability and long-term health of the knee are reliant on addressing injuries to the PLC surgically. Technique Description: A key concept of this surgical technique is a meticulous peroneal nerve neurolysis in the setting of altered biceps femoris anatomy, and the proper order of the surgical steps for tunnel creation, graft passage, and fixation and suture anchor insertion to achieve optimal patient outcomes. The described technique involves a lateral surgical approach, peroneal neurolysis, and preparation of fibular and femoral FCL tunnels, followed by a Bone-patellar tendon-bone graft (BTB) graft harvest. Attention is then turned to intra-articular work including the diagnostic arthroscopy, femoral and tibial tunnel preparation, passage of the ACL graft, and fixation of the grafts in femoral tunnels. Last, fixation is achieved in the following order: FCL graft on fibula, ACL graft on tibia, and biceps femoris tendon to fibular head. Results: Compared with the preoperative state, Moulton et al reported significant improvements in the average Lysholm and Western Ontario scores at 2.7 years postoperatively following anatomic FCL reconstrution. Furthermore, Thompson et al reported on primary suture anchor repair of distal biceps femoris in 22 elite athletes and reported that all patients had returned to their preinjury level of sporting activity at 2-year follow-up. Discussion: Anatomic reconstructions of the FCL and ACL, such as the one described in our technique, effectively restore near native knee biomechanics and offer superior clinical outcomes compared with nonanatomic-based FCL reconstructions. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

A Clinical Outcome of Median Nerve Neurolysis For the Treatment of Carpal Tunnel Syndrome: Conventional S-Shaped Versus Transwrist Mini-Incision Techniques

A Clinical Outcome of Median Nerve Neurolysis For the Treatment of Carpal Tunnel Syndrome: Conventional S-Shaped Versus Transwrist Mini-Incision Techniques

Amyloidosis and Carpal Tunnel Syndrome: Surgical Technique for Extended Carpal Tunnel Release with Tenosynovium and Transverse Carpal Ligament Biopsies.

We describe a retrospective, single-center experience performing an extended CTR technique including unilateral and bilateral cases for 13 consecutive patients (18 wrists) with ATTR and symptomatic median neuropathy at the wrist. The mean patient age was 83 (range 67-90) years and 11 (85%) were men. Notable intraoperative findings in all cases included thickened tenosynovium and median nerve epineurium, and adherence of the median nerve to the deep surface of transverse carpal ligament. Pathology findings were positive for amyloidosis from both the transverse carpal ligament and the tenosynovium biopsies in all patients. Extended CTR with simultaneous wrist tissue biopsy can be safely performed for ATTR patients with CTS. Characteristic intraoperative findings should increase clinical suspicion for undiagnosed ATTR and prompt performance of biopsy for diagnostic confirmation. Volar wrist tenosynovial biopsy is our preferred tissue for confirmation of ATTR, for patients with and without CTS, given its safety profile and 100% pathological yield in our series.