Publications by authors named "Tim Hems"

This article reviews the pathology and management of peripheral nerve tumours, including a framework for investigation and decision-making. Most tumours are benign, including schwannomas and neurofibromas, but malignant peripheral nerve sheath tumours can occur. The risk of malignant change is remote for schwannomas but higher for neurofibromas, particularly in neurofibromatosis type 1.

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  • - A study involving 159 children with obstetric brachial plexus injuries examined elbow and forearm contractures and found varying degrees of fixed elbow flexion, worsening with injury severity.
  • - Severe contractures of 30° or more affected 31 children, with poor shoulder abduction identified as a key risk factor; onset of these contractures typically occurred before age 5 and stabilized after age 12.
  • - The research revealed a trend of decreasing active and passive wrist movement (pronation and supination) correlating with the severity of the injury, with a specific number of children developing significant restrictions in these movements over time.
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Current standard management of a cut digital nerve is end-to-end microsurgical nerve coaptation where possible. A recent systematic review of adult digital nerve injuries that were either repaired or left unrepaired showed that the evidence for good nerve recovery or improved function following nerve repair is poor. In the 30 studies included, only 24% of repaired nerves regained sensory recovery close to or equivalent to estimated pre-injury levels.

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We present a case of painful radial nerve palsy following application of a humeral lengthening frame. At re-operation, the radial nerve was found to be compressed against a distal pin. This was re-sited providing immediate pain relief and a gradual resolution of the radial nerve palsy.

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The effect of alcohol on surgical skills. 2012; : 90–93 doi: 10.1308/003588412X13171221501627

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In recent years nerve transfers have been increasingly used to broaden reconstructive options for brachial plexus reconstruction. Nerve transfer is a procedure where an expendable nerve is connected to a more important nerve in order to reinnervate that nerve. This article outlines the experience of the Scottish National Brachial Plexus Injury Service as our use of nerve transfers has increased.

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