Transfer of the Distal Anterior Interosseous Nerve for Thumb Motion Reconstruction in Radial Nerve Paralysis.

Purpose: With nerve or tendon surgery, the results of thumb reconstruction to treat radial nerve paralysis are suboptimal. The goals of this study were to describe the anatomy of the deep branch of the posterior interosseous nerve (PIN) to the thumb extensor muscles (DBPIN), and to report the clinical results of transferring the distal anterior interosseous nerve (DAIN) to the DBPIN.

Methods: The PIN was dissected in 12 fresh upper limbs.

Distal pronator teres motor branch transfer for wrist extension restoration in radial nerve paralysis.

Objective: The authors describe the anatomy of the motor branches of the pronator teres (PT) as it relates to transferring the nerve of the extensor carpi radialis brevis (ECRB) to restore wrist extension in patients with radial nerve paralysis. They describe their anatomical cadaveric findings and report the results of their nerve transfer technique in several patients followed for at least 24 months postoperatively.

Methods: The authors dissected both upper limbs of 16 fresh cadavers.

Transferring the Motor Branch of the Opponens Pollicis to the Terminal Division of the Deep Branch of the Ulnar Nerve for Pinch Reconstruction.

Purpose: With ulnar nerve injuries, paralysis of the first dorsal interosseous (FDI) and the adductor pollicis (ADP) muscles weakens pinch. The likelihood that these muscles will be reinnervated following ulnar nerve repair around the elbow is very low. To overcome this obstacle, we propose a more distal repair: transferring the opponens pollicis motor branch (OPB) to the terminal division of the deep branch of the ulnar nerve (TDDBUN).

Transfer of the Motor Branch of the Abductor Digiti Quinti for Thenar Muscle Reinnervation in High Median Nerve Injuries.

Purpose: In high median nerve repairs, thenar muscle reinnervation is impossible because of the long distances over which axons must regenerate. To overcome this obstacle, we propose transferring the abductor digiti quinti motor branch (ADQMB) to the thenar branch of the median nerve (TBMN).

Methods: We used 10 embalmed hands for anatomical and histological studies.

Sensory deficits after a radial nerve injury.

Background: The aim of our study was to objectively test sensibility on the dorsal side of the hand in patients with radial nerve injury, to document deficits and to detect if surgery for sensory reconstruction is needed.

Methods: Nineteen patients of mean age 31 ± 10 years were examined at a mean of 26.4 ± 27.

Nerve and Free Gracilis Muscle Transfers for Thumb and Finger Extension Reconstruction in Long-standing Tetraplegia.

Purpose: With spinal cord injuries, muscles below the level of the lesion remain innervated despite the absence of volitional control. This persistent innervation protects against denervation atrophy and may allow for nerve transfers to treat long-standing lesions within the spinal cord. We tested the hypothesis that in chronic spinal cord lesions, muscles remained viable for reinnervation.

Results of spinal accessory to suprascapular nerve transfer in 110 patients with complete palsy of the brachial plexus.

OBJECTIVE Transfer of the spinal accessory nerve to the suprascapular nerve is a common procedure, performed to reestablish shoulder motion in patients with total brachial plexus palsy. However, the results of this procedure remain largely unknown. METHODS Over an 11-year period (2002-2012), 257 patients with total brachial plexus palsy were operated upon in the authors' department by a single surgeon and had the spinal accessory nerve transferred to the suprascapular nerve.

Results of nerve grafting in radial nerve injuries occurring proximal to the humerus, including those within the posterior cord.

OBJECTIVE Results of radial nerve grafting are largely unknown for lesions of the radial nerve that occur proximal to the humerus, including those within the posterior cord. METHODS The authors describe 13 patients with proximal radial nerve injuries who were surgically treated and then followed for at least 24 months. The patients' average age was 26 years and the average time between accident and surgery was 6 months.

Results of wrist extension reconstruction in C5-8 brachial plexus palsy by transferring the pronator quadratus motor branch to the extensor carpi radialis brevis muscle.

OBJECT The objective of this study was to report the results of pronator quadratus (PQ) motor branch transfers to the extensor carpi radialis brevis (ECRB) motor branch to reconstruct wrist extension in C5-8 root lesions of the brachial plexus. METHODS Twenty-eight patients, averaging 24 years of age, with C5-8 root injuries underwent operations an average of 7 months after their accident. In 19 patients, wrist extension was impossible at baseline, whereas in 9 patients wrist extension was managed by activating thumb and wrist extensors.

Results of nerve grafting in radial nerve injuries occurring proximal to the humerus, including those within the posterior cord.

OBJECT Results of radial nerve grafting are largely unknown for lesions of the radial nerve that occur proximal to the humerus, including those within the posterior cord. METHODS The authors describe 13 patients with proximal radial nerve injuries who were surgically treated and then followed for at least 24 months. The patients' average age was 26 years and the average time between accident and surgery was 6 months.

Nerve transfers for elbow and finger extension reconstruction in midcervical spinal cord injuries.

Object: The objective of this study was to report the results of elbow, thumb, and finger extension reconstruction via nerve transfer in midcervical spinal cord injuries.

Methods: Thirteen upper limbs from 7 patients with tetraplegia, with an average age of 26 years, were operated on an average of 7 months after a spinal cord injury. The posterior division of the axillary nerve was used to reinnervate the triceps long and upper medial head motor branches in 9 upper limbs.

The median nerve consistently drives flexion of the distal phalanx of the ring and little fingers: Interest in finger flexion reconstruction by nerve transfers.

Surgeons believe that in high ulnar nerve lesion distal interphalangeal joint (DIP) flexion of the ring and little finger is abolished. In this article, we present the results of a study on innervation of the flexor digitorum profundus of the ring and little fingers in five patients with high ulnar nerve injury and in 19 patients with a brachial plexus, posterior cord, or radial nerve injury. Patients with ulnar nerve lesion were assessed clinically and during surgery for ulnar nerve repair we confirmed complete lesion of the ulnar nerve in all cases.

The C5 root dermatome enlarges and modulates hand pain in total brachial plexus palsy.

Hand pain is a major complaint in 80% of the patients with complete brachial plexus palsy; and, in 80% of these patients, the C5 root is ruptured and the C6-T1 roots avulsed from the spinal cord. It has been suggested that pain in brachial plexus injuries may not arise from avulsed roots, but rather from ruptured roots. Traditionally the C5 root dermatome does not extend to the hand.

Nerve transfer from triceps medial head and anconeus to deltoid for axillary nerve palsy.

Purpose: To report our results with reconstruction of the axillary nerve by transferring the branch to the triceps lower medial head and anconeus to the anterior division of the axillary nerve.

Methods: This study included 9 patients with isolated injury of the axillary nerve. Their average age ± SD was 35 ± 9 years, and the mean interval ± SD between injury and surgery was 6.

Single-stage surgery combining nerve and tendon transfers for bilateral upper limb reconstruction in a tetraplegic patient: case report.

A 39-year-old tetraplegic patient had paralysis of elbow, thumb, and finger extension and thumb and finger flexion. We transferred axillary nerve branches to the triceps long and upper medial head motor branches, supinator motor branches to the posterior interosseous nerve, and brachioradialis tendon to the flexor pollicis longus and flexor superficialis of the index finger. Surgery was performed bilaterally 18 months after spinal cord injury.

The anabolic steroid nandrolone enhances motor and sensory functional recovery in rat median nerve repair with long interpositional nerve grafts.

Background: Recovery from peripheral nerve repair is frequently incomplete. Hence drugs that enhance nerve regeneration are needed clinically.

Objectives: To study the effects of nandrolone decanoate in a model of deficient reinnervation in the rat.

Transfer of nerve branch to the brachialis to reconstruct elbow extension in incomplete tetraplegia: case report.

We undertook a brachialis to triceps nerve transfer to restore elbow extension in a 53-year-old man 5 months after he sustained a spine injury that resulted in a central cord syndrome. Within 3 months of surgery, the patient had recovered active elbow extension and had M3 level strength, which increased to M4 and 5 kg of strength by 12 months postoperatively. Despite transferring an antagonist nerve for triceps reinnervation, the patient had no problems controlling active elbow flexion-extension.

Transfer of a flexor digitorum superficialis motor branch for wrist extension reconstruction in C5-C8 root injuries of the brachial plexus: a case series.

In brachial plexus injuries, though nerve transfers and root grafts have improved the results for shoulder and elbow reconstruction, wrist extension has received little attention. We operated on three young patients with C5-C8 root injuries of the left brachial plexus, each operated upon within 6 months of trauma. For wrist extension reconstruction, we transferred a proximal branch of the flexor digitorum superficialis to the motor branch of the extensor carpi radialis brevis.

Grafting the C5 root to the musculocutaneous nerve partially restores hand sensation in complete palsies of the brachial plexus.

Background: In complete brachial plexus palsy, we have hypothesized that grafting to the musculocutaneous nerve should restore some hand sensation because the musculocutaneous nerve can drive hand sensation directly or via communication with the radial and median nerves.

Objective: To investigate sensory recovery in the hand and forearm after C5 root grafting to the musculocutaneous nerve in patients with a total brachial plexus injury.

Methods: Eleven patients who had recovered elbow flexion after musculocutaneous nerve grafting from a preserved C5 root and who had been followed for a minimum of 3 years were screened for sensory recovery in the hand and forearm.

Increased levels of Porphyromonas gingivalis are associated with ischemic and hemorrhagic cerebrovascular disease in humans: an in vivo study.

Objective: This study investigated the role of periodontal disease in the development of stroke or cerebral infarction in patients by evaluating the clinical periodontal conditions and the subgingival levels of periodontopathogens.

Material And Methods: Twenty patients with ischemic (I-CVA) or hemorrhagic (H-CVA) cerebrovascular episodes (test group) and 60 systemically healthy patients (control group) were evaluated for: probing depth, clinical attachment level, bleeding on probing and plaque index. Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans were both identified and quantified in subgingival plaque samples by conventional and real-time PCR, respectively.

Transfer of the distal terminal motor branch of the extensor carpi radialis brevis to the nerve of the flexor pollicis longus: an anatomic study and clinical application in a tetraplegic patient.

Background: In tetraplegics, thumb and finger motion traditionally has been reconstructed via orthopedic procedures. Although rarely used, nerve transfers are a viable method for reconstruction in tetraplegia.

Objective: To investigate the anatomic feasibility of transferring the distal branch of the extensor carpi radialis brevis (ECRB) to the flexor pollicis longus (FPL) nerve and to report our first clinical case.

Abduction in internal rotation: a test for the diagnosis of axillary nerve palsy.

Purpose: To describe and validate the use of a test of abduction in internal rotation for the assessment of axillary nerve injury.

Methods: A total of 14 male patients with a mean age of 29 years (SD ± 6 y), with axillary nerve lesions lasting an average of 6 months, participated. We measured their shoulder range of motion.

C5-8 brachial plexus root injury: the "T-1 hand".

Object: Classically, C5-7 root injuries of the brachial plexus have been associated with palsies of shoulder abduction/external rotation, elbow flexion/extension, and wrist, thumb, and finger extension. However, current myotome maps generally indicate that C-8 participates in the innervation of thumb and finger extensors. Therefore, the authors have hypothesized that, for palsies of the thumb and finger extensors, the injury should affect the C-5 through C-8 roots.