Tendon transfers can be tied too tight or too loose. Both impede good function after surgery. Performing tendon transfers without sedation and pain during the surgery and then watching the patient move the transfer have helped us adjust the tension more accurately. This method can be applied to complex transfers such as radial nerve palsy triple tendon transfers. We describe the technique and results of a triple tendon transfer using wide-awake local anesthesia no tourniquet in a patient with a high radial nerve palsy. This was a complex case of reconstruction after five operations at the level of the humerus. This left him with a pseudoarthrosis of the humerus and a complete radial nerve palsy. We performed tendon transfers of pronator teres to extensor carpi radialis brevis, flexor carpi ulnaris to extensor digitorum communis, and palmaris longus to extensor pollicis longus tendons. Eighteen months after the triple tendon transfer surgery for the radial nerve palsy, the patient has good extension of the fingers, wrist, and thumb. He can open and close the hand properly. He has excellent function and mobility allowing him to perform most activities in a manner that is practically normal. Wide-awake local anesthesia no tourniquet can be used safely and successfully in complex cases requiring triple radial nerve tendon transfers of pronator teres to extensor carpi radialis brevis, flexor carpi ulnaris to extensor digitorum communis, and palmaris longus to extensor pollicis longus tendons.
The brain is highly innervated by sympathetic nerve fibres; however, their physiological purpose is poorly understood. We hypothesized that unilateral cerebral norepinephrine (NE) spillover, an index of cerebral sympathetic nerve activity (SNA), would be elevated when engaging the baroreflex [via lower-body negative pressure (LBNP; -20 and -40 Torr)] and respiratory chemoreflexes [via carbon dioxide (CO) administration (+8 Torr)], independently, and in combination. Twelve young and healthy participants (5 females) underwent simultaneous blood sampling from the right radial artery and internal jugular vein.
Introduction: Dynamic modulation of grip occurs mainly within the major structures of the brain stem, in parallel with cortical control. This basic, but fundamental level of the brain, is robust to ill-formed feedback and to be useful, it may not require all the perceptual information of feedback we are consciously aware. This makes it viable candidate for using peripheral nerve stimulation (PNS), a form of tactile feedback that conveys intensity and location information of touch well but does not currently reproduce other qualities of natural touch.
Background: Understanding peripheral ulnar nerve anatomy is necessary to refine surgical treatment of ulnar nerve injuries. This study topographically mapped the ulnar nerve and its distal branch points from a well-defined surgical landmark and assessed for variations in interfascicular motor arrangement and branch size.
Methods: Fifty-four cadaveric upper extremities were dissected to expose the distal ulnar nerve and its branches (dorsal cutaneous (DCB), volar sensory (VSB), and motor branches).
The human upper limb has undergone various evolutionary myologic changes, accompanied by corresponding modifications in the anatomical course of neurovascular structures. In this study, we aimed to elucidate the emergence of the accessory head of the flexor pollicis longus (AHFPL) muscle as a beneficial biomechanical evolutionary development and its topographical relationship with adjacent neurovascular structures. In this pursuit to understand this phenomenon, dissections were conducted on sixty-two upper limbs from thirty-one cadavers.
