Low risk of postoperative ulnar nerve affection in surgically treated distal humeral fractures when the nerve is released in situ

BACKGROUND Adult distal humeral fractures(DHF)comprise 2%-5%of all fractures and 30%of all elbow fractures.Treatment of DHF may be technically demanding due to fracture complexity and proximity of neurovascular structures.Open reduction and internal fixation(ORIF)are often the treatment of choice,but arthroplasty is considered in case of severe comminution or in elderly patients with poor bone quality.Ulnar nerve affection following surgical treatment of distal humerus fractures is a well-recognized complication.AIM To report the risk of ulnar nerve affection after surgery for acute DHFs.METHODS We retrospectively identified 239 consecutive adult patients with acute DHFs who underwent surgery with ORIF,elbow hemiarthroplasty(EHA)or total elbow arthroplasty(TEA)between January 2011 and December 2019.In all cases,the ulnar nerve was released in situ without anterior transposition.We used our institutional database to review patients’medical records for demographics,fracture morphology,type of surgery and ulnar nerve affection immediately;records were reviewed after surgery and at 2 wk and 12 wk of routine clinical outpatient follow-up.Twenty-nine percent patients were excluded due to pre-or postoperative conditions.Final follow-up examination was a telephone interview in which ulnar nerve affection was reported according to the McGowen Classification Score.A total of 210 patients were eligible for interview,but 13 patients declined participation and 17 patients failed to respond.Thus,180 patients were included.RESULTS Mean age at surgery was 64 years(range 18-88 years);121(67.3%)patients were women;59(32.7%)were men.According to the AO/OTA classification system,we recorded 47 patients with type A3,55 patients with type B and 78 patients with type C fractures.According to the McGowen Classification Score,mild ulnar nerve affection was reported in nine patients;severe affection,in two.A total of 69 patients were treated with ORIF of whom three had mild temporary ulnar nerve affection and one had severe ulnar nerve affection.In all,111 patients were treated with arthroplasty(67 EHA,44 TEA)of whom seven had mild ulnar nerve affection and one had severe persistent ulnar nerve affection.No further treatment was provided.CONCLUSION The risk of ulnar nerve affection after surgical treatment for acute DHF is low when the ulnar nerve is released in situ without nerve transposition,independently of the treatment provided.

Promising application of a new ulnar nerve compound muscle action potential measurement montage in amyotrophic lateral sclerosis:a prospective cross-sectional study

Previous studies have shown that ulnar nerve compound muscle action potential recorded by the conventional“belly-tendon”montage does not accurately and completely reflect the action potential of the ulnar nerve dominating the abductor digiti minimi muscle due to the effects of far-field potentials of intrinsic hand muscles.A new method of ulnar nerve compound muscle action potential measurement was developed in 2020,which adjusts the E2 electrode from the distal tendon of the abductor digitorum to the middle of the back of the proximal wrist.This new method may reduce the influence of the reference electrode and better reflect the actual ulnar nerve compound muscle action potential.In this prospective cross-sectional study,we included 64 patients with amyotrophic lateral sclerosis and 64 age-and sex-matched controls who underwent conventional and novel ulnar nerve compound muscle action potential measurement between April 2020 and May 2021 in Peking University Third Hospital.The compound muscle action potential waveforms recorded by the new montage were unimodal and more uniform than those recorded by traditional montage.In the controls,no significant difference in the compound muscle action potential waveforms was found between the traditional montage and new montage recordings.In amyotrophic lateral sclerosis patients presenting with abductor digiti minimi spontaneous activity and muscular atrophy,the amplitude of compound muscle action potential-pE2 was significantly lower than that of compound muscle action potential-dE2(P<0.01).Using the new method,damaged axons were more likely to exhibit more severe amplitude decreases than those measured with the traditional method,in particular for patients in early stage amyotrophic lateral sclerosis.In addition,the decline in compound muscle action potential amplitude measured by the new method was correlated with a decrease in Revised Amyotrophic Lateral Sclerosis Functional Rating Scale scores.These findings suggest that the new ulnar nerve compound muscle action potential measurement montage reduces the effects of the reference electrode through altering the E2 electrode position,and that this method is more suitable for monitoring disease progression than the traditional montage.This method may be useful as a biomarker for longitudinal follow-up and clinical trials in amyotrophic lateral sclerosis.

Efficacy comparison between anterior subcutaneous and submuscular transposition of ulnar nerve in treating moderate-severe cubital tunnel syndrome

OBJECTIVE:To explore the optimal surgery in treating moderate-severe cubital tunnel(CuTS) syndrome by comparing the clinical efficiency of decompression and anterior subcutaneous transposition of ulnar nerve and decompression and anterior submuscular transposition of ulnar nerve,and to provide a theoretical basis for the appropriate surgical programs in treating moderate-severe Cu TS.METHODS:47 consecutive cases of moderate-severe Cu TS were surgically treated in our department from January 2014 to January 2017.All patients were divided into two groups by the doctor in our department.21 Cu TS cases were treated with decompression and anterior subcutaneous transposition of ulnar nerve,and other 26 cases were treated with decompression and anterior submuscular transposition of ulnar nerve.All the patients were followed 1 month,3 months and 6 months after operation to evaluate the recovery degree of ulnar nerve function and the clinical efficiency of the two methods was compared.RESULTS:Clinical symptoms of two groups were significant alleviated.There was no significant statistical difference between two groups in the clinical efficiency.CONCLUSION:Completely releasing of nerve truck is the most important step in treating mediate-severe Cu TS.Theclinical results of the two methods are similar,but the anterior subcutaneous transposition of ulnar nerve is more easy to operate and can be widely used.

Tissue-engineered rhesus monkey nerve grafts for the repair of long ulnar nerve defects:similar outcomes to autologous nerve grafts

Acellular nerve allografts can help preserve normal nerve structure and extracellular matrix composition. These allografts have low immunogenicity and are more readily available than autologous nerves for the repair of long-segment peripheral nerve defects. In this study, we repaired a 40-mm ulnar nerve defect in rhesus monkeys with tissue-engineered peripheral nerve, and compared the outcome with that of autograft. The graft was prepared using a chemical extract from adult rhesus monkeys and seeded with allogeneic Schwann cells. Pathomo- rphology, electromyogram and immunohistochemistry findings revealed the absence of palmar erosion or ulcers, and that the morphology and elasticity of the hypothenar eminence were normal 5 months postoperatively. There were no significant differences in the mean peak compound muscle action potential, the mean nerve conduction velocity, or the number of neurofilaments between the experimental and control groups. However, outcome was significantly better in the experimental group than in the blank group. These findings suggest that chemically extracted allogeneic nerve seeded with autologous Schwann cells can repair 40-mm ulnar nerve defects in the rhesus monkey. The outcomes are similar to those obtained with autologous nerve graft.

Sleeve bridging of the rhesus monkey ulnar nerve with muscular branches of the pronator teres: multiple amplification of axonal regeneration

Multiple-bud regeneration, i.e., multiple amplification, has been shown to exist in peripheral nerve regeneration. Multiple buds grow towards the distal nerve stump during proximal nerve fiber regeneration. Our previous studies have verified the limit and validity of multiple ampli- fication of peripheral nerve regeneration using small gap sleeve bridging of small donor nerves to repair large receptor nerves in rodents. The present study sought to observe multiple ampli- fication of myelinated nerve fiber regeneration in the primate peripheral nerve. Rhesus monkey models of distal ulnar nerve defects were established and repaired using muscular branches of the right forearm pronator teres. Proximal muscular branches of the pronator teres were su- tured into the distal ulnar nerve using the small gap sleeve bridging method. At 6 months after suture, two-finger flexion and mild wrist flexion were restored in the ulnar-sided injured limbs of rhesus monkey. Neurophysiological examination showed that motor nerve conduction veloc- ity reached 22.63 _＋ 6.34 m/s on the affected side of rhesus monkey. Osmium tetroxide staining demonstrated that the number of myelinated nerve fibers was 1,657 ＋ 652 in the branches of pronator teres of donor, and 2,661 ~ 843 in the repaired ulnar nerve. The rate of multiple amplification of regenerating myelinated nerve fibers was 1.61. These data showed that when muscular branches of the pronator teres were used to repair ulnar nerve in primates, effective regeneration was observed in regenerating nerve fibers, and functions of the injured ulnar nerve were restored to a certain extent. Moreover, multiple amplification was subsequently detected in ulnar nerve axons.

Applied anatomical study of the vascularized ulnar nerve and its blood supply for cubital tunnel syndrome at the elbow region

Cubital tunnel syndrome is often accompanied by paresthesia in ulnar nerve sites and hand muscle atrophy. When muscle weakness occurs, or after failure of more conservative treatments, anterior transposition is used. In the present study, the ulnar nerve and its blood vessels were examined in the elbows of 18 adult cadavers, and the external diameter of the nutrient vessels of the ulnar nerve at the point of origin, the distances between the origin of the vessels and the medial epicondyle of the humerus, and the length of the vessels accompanying the ulnar nerve in the superior ulnar collateral artery, the inferior ulnar collateral artery, and the posterior ulnar recurrent artery were measured. Anterior transposition of the vascularized ulnar nerve was per- formed to treat cubital tunnel syndrome. The most appropriate distance that the vascularized ulnar nerve can be moved to the subcutaneous tissue under tension-free conditions was 1.8 ± 0.6 cm （1.1-2.5 cm）, which can be used as a reference value during the treatment of cubital tunnel syndrome with anterior transposition of the vascularized ulnar nerve.

Axonal degeneration of the ulnar nerve secondary to carpal tunnel syndrome: fact or fiction?

The distribution of sensory symptoms in carpal tunnel syndrome is strongly dependent on the degree of electrophysiological dysfunction of the median nerve. The association between carpal tunnel syndrome and ulnar nerve entrapment is still unclear. In this study, we measured ulnar nerve function in 82 patients with carpal tunnel syndrome. The patients were divided into group I with minimal carpal tunnel syndrome （n = 35） and group II with mild to moderate carpal tunnel syndrome （n = 47） according to electrophysiological data. Sixty-one age- and sex-matched subjects without carpal tunnel syndrome were used as a control group. There were no significant differences in ulnar sensory nerve peak latencies or conduction velocities from the 4th and 5th fingers between patients with carpal tunnel syndrome and the control group. The ulnar sensory nerve action potential amplitudes from the 4th and 5th fingers were lower in patients with carpal tunnel syndrome than in the control group. The ratios of the ulnar sensory nerve action potential amplitudes from the 4th and 5th fingers were almost the same in patients with carpal tunnel syndrome as in the control group. These findings indicate that in patients with minimal to moderate carpal tunnel syndrome, there is some electrophysiological evidence of traction on the adjacent ulnar nerve fibers. The findings do not indicate axonal degeneration of the ulnar nerve.

Myeloid sarcoma with ulnar nerve entrapment:A case report

BACKGROUND Myeloid sarcoma(MS) is relatively rare,occurring mainly in the skin and lymph nodes,and MS invasion of the ulnar nerve is particularly unusual.The main aim of this article is to present a case of MS invading the brachial plexus,causing ulnar nerve entrapment syndrome,and to further clinical understanding of the possibility of MS invasion of peripheral nerves.CASE SUMMARY We present the case of a 46-year-old man with a 13-year history of well-treated acute nonlymphocytic leukaemia who was admitted to the hospital after presenting with numbness and pain in his left little finger.The initial diagnosis was considered a simple case of nerve entrapment disease,with magnetic resonance imaging showing slightly abnormal left brachial plexus nerve alignment with local thickening,entrapment,and high signal on compression lipid images.Due to the severity of the ulnar nerve compression,we surgically investigated and cleared the entrapment and nerve tissue hyperplasia;however,subsequent pathological biopsy results revealed evidence of MS.The patient had significant relief from his neurological symptoms,with no postoperative complications,and was referred to the haemato-oncology department for further consultation about the primary disease.This is the first report of safe treatment of ulnar nerve entrapment from MS.It is intended to inform hand surgeons that nerve entrapment may be associated with extramedullary MS,as a rare presenting feature of the disease.CONCLUSION MS invasion of the brachial plexus and surrounding tissues of the upper arm,resulting in ulnar nerve entrapment and degeneration with significant neurological pain and numbness in the little finger,is uncommon.Surgical treatment significantly relieved the patient’s nerve entrapment symptoms and prevented further neurological impairment.This case is reported to highlight the rare presenting features of MS.

Ulnar nerve injury associated with displaced distal radius fracture:Two case reports

BACKGROUND Ulnar nerve injury subsequent to a fracture of the distal radius is extremely rare compared to median nerve injury.Treatment of ulnar nerve injury after closed distal radial fracture is controversial.Reasonable surgical planning and careful postoperative management can improve the prognosis of patients.CASE SUMMARY We report two cases of ulnar nerve injury subsequent to fracture of the distal radius.Both patients were admitted to hospital.Both patients had persistent ulnar nerve compression syndromes.The first patient achieved rapid recovery by early nerve decompression surgery,while the second patient had no recovery at 2-3 mo after injury and had more severe symptoms.At 10 wk after injury,the second patient agreed to nerve decompression surgery.The second patient finally achieved a successful outcome after nerve decompression and neurolysis,although she still has residual symptoms.CONCLUSION For patients with ulnar nerve compression syndrome related to acute wrist fracture,if symptoms persist and signs of recovery are not observed,early release is necessary to prevent permanent neurological damage.

Anatomical peculiarities of sensory tracts of the wrist median nerve pedicled with nutrient vessels transferring to bridge wrist ulnar nerve defect

BACKGROUND： Translocation or transplantation of nerve stem has good effect; however, nervous function of donator is completely lost. If some nerve stem is damaged, sensory tracts are intercepted from the near nerve stem by nutrient vessels to regard as neural graft for transferring and bridging which may repair injured nerve and decrease neural functional loss of donator. OBJECTIVE： To observe anatomical peculiarities on sensory tracts of wrist median nerve pedicled with nutrient vessels transferring to bridge wrist ulnar nerve defect, and to investigate its feasibility. DESIGN：Duplicated and measured design.SETTING ： Anatomy Department of Medical College affiliated to Nanhua University.MATERIALS： A total of 14 samples of upper limbs were selected from adult unnamed corpse and volunteers.METHODS： The experiment was completed at the Clinical Application Anatomy Laboratory of Medical College affiliated to Nanhua University from September to November 2005. Samples were perfused with red emulsion through artery to observe length, fibrous bands and blood supply of median nerve and ulnar nerve at wrist. Boundary of median nerve at wrist ranged from superficial site between flexor carpi radialis and palmaris Iongus to branch of common palmar digital nerves. Ulnar nerve at wrist ranged from branch of back of the hand to site of common palmar digital nerves. Proximal boundary of the two nerves was crossed from 1/8 to 2/8 region of forearm. Samples of upper limbs from 1 case were selected to simulate operation on sensory tracts of wrist median nerve pedicled with nutrient vessels transferring to bridge wrist ulnar nerve. MAIN OUTCOME MEASURES： Anatomical peculiarities on sensory tracts of wrist median nerve pedicled with nutrient vessels transferring to bridge wrist ulnar nerve defect. RESULTS： ① The length of wrist median nerves was 7.8 （7.5-8.1） cm. There were 19 to 27 nerve tracts in it and the majority belonged to sensory tracts on the ulnar side, in which non-damaged separated length was about 10.0 cm to 14.0 cm. The third, second and first tracts of cutaneous branches at digital interspace and radialis of thumb arrayed from ulnaris to radialis by turns, and numbers of bands were 6.9, 7.4 and 7.2, respectively. The bands in total were 21.6. Cutaneous branches of palm entered from lateral margin of radialis and were completely separated at wrist. Two-thirds of ulnaris at nerve stem, i.e. the third, second and first tracts of cutaneous branches at digital interspace, were separated, which had little effect on sensation in distribution of median nerve. ② Its nutrient vessels originated from radial arteries about 6.2 （6.1-6.6） cm above radial styloid process were 1.2 （1.1-1.4） mm in outer diameter. The length was 5.7 （5.1-6.1） cm.③ The length of wrist ulnar nerve were 9.4 （8.9-9.7） cm and the number of nervous tract were 14 to 19, in which sensory tracts on the anterior external side were approximately equal to motor and mixed tracts on the posterior internal side in quantity. Sensory tracts were located at radialis of palm and motor tracts were located at ulnaris of back. CONCLUSION ：① Character and position of median nerve fibre bundle are clear, and length of non-damage separation of sensory tracts is coincidence with the request of transferring to bridge. ② Summation of the third, second and first tracts of cutaneous branches at digital interspace may be satisfactory to bridge of ulnar nerve at wrist （14-19 bands）. ③ This technique has little effect on sensation in distribution of median nerve. Nutrient artery of median nerve locates constantly; journey table is superficial and is easily to find out; caliber of arterial canal is thick; blood supply is plentiful; length of pedicel is suitable for translocation. The sensery tracts of wrist median nerve pedicled with nutrient vessels can be applied as nervous grafts to join injured gap in wrist ulnar nerve.

Transfer of the extensor indicis proprius branch of posterior interosseous nerve to reconstruct ulnar nerve and median nerve injured proximally:an anatomical study

Proximal or middle lesions of the ulnar or median nerves are responsible for extensive loss of hand motor function.This occurs even when the most meticulous microsurgical techniques or nerve grafts are used.Previous studies had proposed that nerve transfer was more effective than nerve grafting for nerve repair.Our hypothesis is that transfer of the posterior interosseous nerve,which contains mainly motor fibers,to the ulnar or median nerve can innervate the intrinsic muscles of hands.The present study sought to investigate the feasibility of reconstruction of the deep branch of the ulnar nerve and the thenar branch of median nerve by transferring the extensor indicis proprius branch of the posterior interosseous nerve obtained from adult cadavers.The results suggested that the extensor indicis proprius branch of the posterior interosseous nerve had approximately similar diameters and number of fascicles and myelinated nerve fibers to those of the deep branch of ulnar nerve and the thenar branch of the median nerve.These confirm the feasibility of extensor indicis proprius branch of posterior interosseous nerve transfer for reconstruction of the deep branch of the ulnar nerve and the thenar branch of median nerve.This procedure could be a novel and effective method for the functional recovery of the intrinsic muscles of hands after ulnar nerve or median nerve injury.

Anterior subcutaneous transposition of the ulnar nerve improves neurological function in patients with cubital tunnel syndrome

Although several surgical procedures exist for treating cubital tunnel syndrome, the best surgical option remains controversial. To evaluate the efficacy of anterior subcutaneous transposition of the ulnar nerve in patients with moderate to severe cubital tunnel syndrome and to analyze prognostic factors, we retrospectively reviewed 62 patients（65 elbows） diagnosed with cubital tunnel syndrome who underwent anterior subcutaneous transposition. Preoperatively, the initial severity of the disease was evaluated using the Mc Gowan scale as modified by Goldberg： 18 patients（28%） had grade IIA neuropathy, 20（31%） had grade IIB, and 27（42%） had grade III. Postoperatively, according to the Wilson ＆ Krout criteria, treatment outcomes were excellent in 38 patients（58%）, good in 16（25%）, fair in 7（11%）, and poor in 4（6%）, with an excellent and good rate of 83%. A negative correlation was found between the preoperative Mc Gowan grade and the postoperative Wilson ＆ Krout score. The patients having fair and poor treatment outcomes had more advanced age, lower nerve conduction velocity, and lower action potential amplitude compared with those having excellent and good treatment outcomes. These results suggest that anterior subcutaneous transposition of the ulnar nerve is effective and safe for the treatment of moderate to severe cubital tunnel syndrome, and initial severity, advancing age, and electrophysiological parameters can affect treatment outcome.

Anterior Subcutaneous Transposition of the Ulnar Nerve Affects Elbow Range of Motion： A Mean 13.5 Years of Follow-up

Background：Surgical decompression of the ulnar nerve is effective for cubital tunnel syndrome.However,deep approaches may result in iatrogenic elbow stiffness.This long-term study was to evaluate the range of motion （ROM） of the elbow and functional outcomes after anterior subcutaneous transposition.Methods：A total of 115 patients （78 male and 37 female;mean age：46.6 years） who underwent anterior subcutaneous transposition of the ulnar nerve between 2001 and 2005 were evaluated retrospectively;mean follow-up was 13.5 years.Elbow ROM was measured as flexion arc,flexion,and extension preoperatively and at the final follow-up,and compared via a mixed analysis of variance adjusting for age.Neuropathy was assessed preoperatively using a modified McGowan neuropathy grade and postoperatively using modified Wilson-Krout criteria.An ordinal logistic regression analysis used postoperative modified Wilson-Krout criteria as the outcome and preoperative factors as predictors.Results：Preoperative McGowan grades were Grade 1 in 14 patients （12.2%）,Grade 2A in 28 （24.3%）,Grade 2B in 53 （46.1%）,and Grade 3 in 20 （17.4%） patients.Postoperatively,66 patients （57.4%） had excellent results,26 （22.6%） had good results,16 （13.9%） had fair results,and 7 （6.1%） had poor results at the final follow-up,as per the Wilson-Krout criteria.There were no complications.Pre-and postoperative elbow ROM was significantly decreased in patients with previous trauma or surgery of the elbow compared with those without （P 〈 0.05）.Anterior subcutaneous transposition of the ulnar nerve did not significantly affect elbow ROM regardless of previous trauma or surgical history nor preoperative ROM （P 〉 0.05）,after adjusting for age.Patients with prolonged symptoms prior to surgery and worse neuropathy tended to have less satisfactory functional outcomes （P 〈 0.05）,after adjusting for covariates.Conclusions：Anterior subcutaneous transposition of the ulnar nerve is an effective and reliable treatment of cubital tunnel syndrome with satisfactory outcomes and minimal effect on elbow ROM.

Is it necessary to use the entire root as a donor when transferring contralateral C7 nerve to repair median nerve？

If a partial contralateral C7 nerve is transferred to a recipient injured nerve, results are not satisfactory. However, if an entire contralateral C7 nerve is used to repair two nerves, both recipient nerves show good recovery. These findings seem contradictory, as the above two methods use the same donor nerve, only the cutting method of the contralateral C7 nerve is different. To verify whether this can actually result in different repair effects, we divided rats with right total brachial plexus injury into three groups. In the entire root group, the entire contralateral C7 root was transected and transferred to the median nerve of the affected limb. In the posterior division group, only the posterior division of the contralateral C7 root was transected and transferred to the median nerve. In the entire root ＋ posterior division group, the entire contralateral C7 root was transected but only the posterior division was transferred to the median nerve. After neurectomy,the median nerve was repaired on the affected side in the three groups. At 8, 12, and 16 weeks postoperatively, electrophysiological examination showed that maximum amplitude, latency, muscle tetanic contraction force, and muscle fiber cross-sectional area of the flexor digitorum superficialis muscle were significantly better in the entire root and entire root ＋ posterior division groups than in the posterior division group. No significant difference was found between the entire root and entire root ＋ posterior division groups. Counts of myelinated axons in the median nerve were greater in the entire root group than in the entire root ＋ posterior division group, which were greater than the posterior division group. We conclude that for the same recipient nerve, harvesting of the entire contralateral C7 root achieved significantly better recovery than partial harvesting, even if only part of the entire root was used for transfer. This result indicates that the entire root should be used as a donor when transferring contralateral C7 nerve.

Three-dimensional visualization of the functional fascicular groups of a long-segment peripheral nerve

The three-dimensional（3D） visualization of the functional bundles in the peripheral nerve provides direct and detailed intraneural spatial information. It is useful for selecting suitable surgical methods to repair nerve defects and in optimizing the construction of tissue-engineered nerve grafts. However, there remain major technical hurdles in obtaining, registering and interpreting 2D images, as well as in establishing 3D models. Moreover, the 3D models are plagued by poor accuracy and lack of detail and cannot completely reflect the stereoscopic microstructure inside the nerve. To explore and help resolve these key technical problems of 3D reconstruction, in the present study, we designed a novel method based on re-imaging techniques and computer image layer processing technology. A 20-cm ulnar nerve segment from the upper arm of a fresh adult cadaver was used for acetylcholinesterase（ACh E） staining. Then, 2D panoramic images were obtained before and after ACh E staining under the stereomicroscope. Using layer processing techniques in Photoshop, a space transformation method was used to fulfill automatic registration. The contours were outlined, and the 3D rendering of functional fascicular groups in the long-segment ulnar nerve was performed with Amira 4.1 software. The re-imaging technique based on layer processing in Photoshop produced an image that was detailed and accurate. The merging of images was accurate, and the whole procedure was simple and fast. The least square support vector machine was accurate, with an error rate of only 8.25%. The 3D reconstruction directly revealed changes in the fusion of different nerve functional fascicular groups. In conclusion. The technique is fast with satisfactory visual reconstruction.

Investigation of the effectiveness of LI4, LI10, LR3 and ST36 acupoints electroacupuncture in radialis and ulnaris nervus injuries

Background:Radial and ulnar nervus injuries are among the most common peripheral nerve injuries in veterinary medicine.In this study,it was aimed to evaluate electroacupuncture applications in radialis and ulnaris nervus injuries.Methods:New Zealand rabbits were used in the study.Rabbits were divided into treatment groups and control groups.The treatment groups included the acute nerve injury group and the chronic nerve injury group.The control groups included the positive control group(damaged but no treatment),and the negative control group(no damage but with electroacupuncture).Hegu(LI4),Shousanli(LI10),Taichong(LR3)and Zusanli(ST36)acupoints were used for electroacupuncture applications.During the treatment period,clinical examinations of the rabbits were performed.Results:The deep pain sensation and resistance to the applied pulling force in the legs of the rabbits in the treatment groups(both acute nerve injury group and the chronic nerve injury group)were statistically significantly increased(P˂0.001 for all).Again,the rabbits in the treatment groups were found to be in a better condition than the positive control group in terms of using their legs while walking and using their claws,and there was a statistically significant difference(P˂0.001 for all).Electroacupuncture is an effective treatment for both acute and chronic nerve injuries,as well as being more effective in acute cases than in chronic cases.Conclusion:Electroacupuncture based on LI4,LI10,LR3 and ST36 acupoints is an effective treatment in rabbits’radial and ulnar nervus injuries.

End-to-side neurorrhaphy repairs peripheral nerve injury：sensory nerve induces motor nerve regeneration

End-to-side neurorrhaphy is an option in the treatment of the long segment defects of a nerve.It involves suturing the distal stump of the disconnected nerve（recipient nerve） to the side of the intimate adjacent nerve（donor nerve）.However,the motor-sensory specificity after end-to-side neurorrhaphy remains unclear.This study sought to evaluate whether cutaneous sensory nerve regeneration induces motor nerves after end-to-side neurorrhaphy.Thirty rats were randomized into three groups：（1） end-to-side neurorrhaphy using the ulnar nerve（mixed sensory and motor） as the donor nerve and the cutaneous antebrachii medialis nerve as the recipient nerve;（2） the sham group：ulnar nerve and cutaneous antebrachii medialis nerve were just exposed;and（3） the transected nerve group：cutaneous antebrachii medialis nerve was transected and the stumps were turned over and tied.At 5 months,acetylcholinesterase staining results showed that 34% ± 16% of the myelinated axons were stained in the end-to-side group,and none of the myelinated axons were stained in either the sham or transected nerve groups.Retrograde fluorescent tracing of spinal motor neurons and dorsal root ganglion showed the proportion of motor neurons from the cutaneous antebrachii medialis nerve of the end-to-side group was 21% ± 5%.In contrast,no motor neurons from the cutaneous antebrachii medialis nerve of the sham group and transected nerve group were found in the spinal cord segment.These results confirmed that motor neuron regeneration occurred after cutaneous nerve end-to-side neurorrhaphy.

Bilateral snapping triceps syndrome:A case report

BACKGROUND Snapping triceps syndrome(STS)is a rare disease,while occurrence of bilateral STS is extremely rare.It is usually accompanied by dislocation of the ulnar nerve and double snapping is a clinically important feature.However,to the best of our knowledge,there has been no report of bilateral STS in young active patient.CASE SUMMARY A 23-year-old male presented with a complaint of discomfort and snapping on the medial side of both elbows while performing push-ups.On physical examination,two distinct snaps that were both palpable and audible were detected on additional clinical examination.Dynamic ultrasonography showed that the ulnar nerve and the medial head of the triceps were dislocated anteriorly over the medial epicondyle of the elbow during flexion motion.Finally,he was diagnosed as dislocation of the ulnar nerve and STS.Staged anterior subcutaneous transposition of the ulnar nerve combined with partial resection of the snapping portion of the triceps was performed.The patient’s pain and snapping symptoms were resolved immediately after surgery.Three months later,the patient was completely asymptomatic and returned to normal activity.CONCLUSION STS should be included in the differential diagnosis for active young patients who present with painful snapping on the medial side of the elbow joint,particularly when dislocation of the ulnar nerve is detected.Dynamic sonography is used to assist in accurate diagnosis and differentiation between isolated dislocation of the ulnar nerve and STS.

Brachial arteries sympathetic innervation: A contribution to anatomical knowledge

BACKGROUND The sympathetic nervous system makes medium and large peripheral arteries smaller to slow the blood flowing through them.AIM To observe brachial artery sympathetic innervation.METHODS We developed a neurophysiological autonomous test that measured the effects of peripheral sympathetic fibres on peripheral arteries.Our specific objective was to find the sympathetic innervation of the brachial artery.To accomplish this purpose,the brachial artery baseline diameter and flow rate were measured in the right arm of the patients.Afterwards,electrical stimulus was applied to the medial nerve for 5 s.Through electrical sympathetic activation,the vessel diameter and overall flow rate will decrease.After 7 d,a similar experiment was repeated using the ulnar nerve.RESULTS The differences in diameter and flow rate of the brachial artery in response to median and ulnar nerve activation were compared.In the total group,no significant difference in diameter was seen between medial and ulnar nerve stimulation(P=0.648).The difference in absolute slowdown of flow rate between median nerve stimulation and ulnar nerve stimulation was not statistically significant for the entire group(P=0.733).CONCLUSION As a target organ,the brachial artery receives an equal amount of sympathetic innervation from the median and the ulnar nerves.

Berrettini Anastomosis Iatrogenic Injury Relating to Carpel Tunnel Syndrome Case Study

Some diseases require medical mitigation following the diagnosis, and sometimes the situation means that the patient has to undertake strong medication. However, this medicine is designed pharmacodynamically to interact with other organs before they reach the intended organ. Some mitigation imposes challenges on the involved organ. While the main organ will be healed, some drugs’ footprints will be left out to other organs. These are called iatrogenic injuries. In the case of anastomosis, it requires the alteration of surgical methods or the origin of iatrogenic injury in the arm;thus, the knowledge of anastomosis is very important to the field of medical practice. In addition, carpal tunnel release becomes vital in curing carpal tunnel syndrome. The paper focuses on a case of a 42-year-old woman found to have a complication to her middle finger. This case becomes important for studying Berrettini anastomosis iatrogenic injury, which relates to carpal tunnel syndrome. The Berrettini branch is a complication that facilitates communication between the superficial ulnar and median nerve. The analysis also provides the electro-diagnostic evidence of Berrettini anastomosis on how it can give a position three-finger and thus contribute to a force explanation of the median neuropraxia. Lastly, the paper provides information on the implication of the Berrettini branch for surgical use. The implication of pictures in the digital era can be used to analyze the varied connection and length between the median nerve and ulnar section. It’s easy to locate the position of high risk of iatrogenic injury in the palm due to the consistent location of Berrettini communication branches. The precaution is that operations have to be conducted moderately for a clear vision as the carefully mitigated practice ensures protection from the destruction and injury of the surrounding structures.