Spaghetti wrist: management and outcome

To determine the outcome of emergency management of the spaghetti wrist. Design: Descriptive study. Place and Duration of Study: Department of General Surgery, Sir Ganga Ram Hospital Lahore, Pakistan, from January 2000 to December 2003. Patients and During this period, all patients of more than 12 years, with sharp clean cut volar forearm lacerations [spaghetti wrist] of <6 hours were included, with a follow-up of one year, clinically and with nerve conduction studies, where appropriate. Sensory and motor recovery was evaluated according to S0-S4 and MRC [medical research council] scale respectively. The power of first dorsal interosseous and adductor pollicis was used to monitor the recovery of ulnar nerve; and abductor pollicis brevis and opponens pollicis for the median nerve. The tendon recovery was evaluated by Strickland Adjusted System Score. This study comprised of 10 patients [M:F, 4:1], of 14 to 38 years [mean 22.9 years]. Injury was accidental in 70%; due to broken glass in 50% and kite string in 40%; involving right hand in 70%. 8.2 [4-12] structures per patient were involved. The injury involved median nerve in 70%, ulnar nerve in 60%, [30% had both nerves involved], flexor carpi ulnaris in 70%. There was predilection of injury for medial structures. In 80%, wrist flexors were involved, and all wrist joints recovered to the full range of movements and power. The ulnar nerve showed less total motor and sensory recovery than median nerve. However, sensory and motor recovery was good. Overall functional results were good and did not correlate with neurophysiological studies. Immediate primary repair is safe and has good outcome, which also depends upon good physiotherapy, close follow-up and patients compliance. Overall clinical and functional assessment is more appropriate than series of individual observations and neurophysiological studies

Normative data of nerve conduction studies in the upper limb in Kuwait: are they different from the western data?

To establish the normal electrophysiological data for the median, ulnar and radial nerves and to compare our results with the Western data published in the literature. Nerve conduction studies were performed prospectively in the upper limbs of 50 carefully screened healthy individuals between the ages of 16 and 56 years using standardized technique. The median motor distal latency [DL] was 3.1 [0.3] ms, amplitude 11.01 [2.8] mV, conduction velocity [CV] 56.5 [3.5] m/s. The ulnar motor studies gave DL of 2.4 [0.3] ms, amplitude 9.2 [2.2] mV, CV 60.4 [5.0] m/s. Sensory studies for the median nerve were: DL of 2.3 [0.3] ms, amplitude 63.3 [18.9] micro V for men and 79.3 [28.8] micro V for women and CV 56.6 [7.6] m/s. For the ulnar nerve [DL] 2.0 [0.23] ms, amplitude 54.5 [18.4] micro V for men and 63.9 [16.8] micro V for women and CV 51.7 [5.3] m/s. The radial sensory studies were DL 1.95 [0.3] ms, amplitude 18.7 [5.5] micro V and CV 52.3 ms. Only gender showed a statistically significant effect on the sensory nerve action potential for the median [p = 0.04] and ulnar nerves [p = 0.07]. Normative conduction parameters of commonly tested nerves in the upper limb were established in our EMG lab in Kuwait. The mean motor nerve conduction parameters for the median and ulnar nerves compare favourably with the existing literature data. However, for the sensory nerves, higher value for the nerve action potential amplitude was demonstrated in the study. Gender was shown to have a significant effect on the sensory amplitude of the median and ulnar nerves

Padräo de normalidade em nervos distais dos membros superiores para aparelhos Polimed série 1002 / Normality levels in distal nerves of superior members for Polimed 1002 system

Os autores estudaram os diversos itens que se constituem no estudo eletroneuromiográfico de nervos distais dos membros superiores, com aparelho Polimed, série 1002, e mostraram os índices de normalidade das latências, amplitudes e duraçöes das ondas M distal e proximal, latência, amplitude e duraçäo da onda F e velocidade de conduçäo motora da parte motora dos nervos cubital e mediano. Apresentaram , ainda, os índices de mortalidade de latência, amplitude e duraçäo do potencial evocado da estimulaçäo da parte sensitiva dos nervos cubital, mediano e radial e respectivas velocidades de conduçöes sensitivas