Compressive Neuropathy of the Ulnar Nerve in the Hypothenar Region by Lipoma: Case Report

Lipomas are well-defined tumors of the adipose tissue that often occur in the torso or the extremities of adult patients. These tumors usually develop painlessly and insidiously, but theymay compress adjacent structures. The objective of the present study is to describe the case of a 68-year-old female patient with a giant lipoma located at the hypothenar region, with manifestation of compression of the common palmar digital nerves, the ulnar nerve, andthe abductormuscle of theVfinger. Regarding the symptoms, the patient feltmoderate pain in the hypothenar region, with no Tinel sign, and no changes in the motor function or sensibility of the digits innervated by the ulnar nerve. Lipomasmay present a varied range of histological characteristics, and malignant tumors may be a differential diagnosis. An imaging exammay aid in the diagnosis, which is confirmed by a histopathological study. For the present case, as recommended in the literature, a surgical procedure was performed for the resection of the tumor, which resulted in the control of the symptoms.

Modified simple decompression in the treatment of cubital tunnel syndrome: avoiding ulnar nerve subluxation / Descompressão simples modificada no tratamento da síndrome do túnel cubital: evitando subluxação do nervo ulnar

ABSTRACT Objective In this study, we propose a modification to the simple decompression technique that contains the ulnar nerve in the cubital fossa, thus preventing subluxation during forearm flexion movements. Methods Five consecutive patients with leprosy-associated cubital tunnel syndrome underwent surgery with the modified technique between July 2011 and October 2012. Results The most common symptoms were neuropathic pain and sensory changes (both 60%). On the McGowan scale, three patients maintained their preoperative score and two patients improved by two points, while on the Louisiana State University Health Sciences Center scale, two patients maintained the same scores, two improved by two points, and one improved by one point. Four patients were able to discontinue corticosteroid use. The mean follow-up time was 25.6 months (range 2-48 months). There were no recurrences or subluxations in the long-term. Conclusion This alternative technique resulted in excellent functional results, as well as successful withdrawal from corticosteroids. Furthermore, it resulted in no ulnar nerve subluxations.

RESUMO Objetivo Neste manuscrito apresentamos uma modificação da técnica de descompressão simples do nervo ulnar no túnel cubital que impede a subluxação do nervo em movimentos de flexão do antebraço. Métodos Foram incluídos cinco pacientes consecutivos acometidos por síndrome do túnel cubital (Hanseníase) submetidos à cirurgia entre 2011 e 2012. Resultados Os sintomas mais comuns foram dor neuropática e alterações sensitivas (60%). No pós-operatório, três pacientes mantiveram o mesmo escore e dois melhoraram dois pontos na escala de McGowan, enquanto na escala Louisiana State University Health Sciences Center, dois pacientes mantiveram o mesmo escore, dois melhoraram dois pontos e um melhorou um ponto. Os corticosteróides foram descontinuados em quatro pacientes. O tempo médio de seguimento foi 25,6 meses (variação 2-48 meses). Não foram observadas recorrência ou subluxação no longo prazo. Conclusões A técnica alternativa apresentou excelentes resultados funcionais e foi bem sucedida na retirada dos corticosteróides. Ademais, subluxações do nervo ulnar não foram observadas.

Desempenho funcional de pacientes com deformidades visíveis na hanseníase / Functional performance of patients with visible deformities in leprosy

Esse estudo tem por objetivo avaliar a capacidade funcional da mão das pessoas atingidas pela hanseníase na realização das atividades básicas e instrumentais da vida diária. A amostra foi constituída por 50 pacientes, maiores de 18 anos, que estavam sendo acompanhados no ambulatório do Instituto Lauro de Souza Lima. Para avaliação das características sociodemográficas e clínicas foi elaborado um questionário próprio. As dificuldades manuais para realizar atividades nas áreas de vestuário, alimentação, higiene pessoal, cuidados com a casa, escrita e outros foram avaliados por meio da Avaliação Funcional das Mãos em Hanseníase. Os resultados demonstram que em todas as atividades houve algum grau de dificuldade, porém, a maioria dos pacientes as realiza com independência. As atividades consideradas mais difíceis de serem executadas pelos pacientes com garra ulnar foram: pegar objetos pequenos em superfície plana, abrir/fechar fecho de corrente e cortar unhas. Na população de pacientes com garra ulnar/mediano foram: pegar objetos pequenos em superfície plana, abotoar/desabotoar, dar laço/ amarrar cadarço e abrir/fechar fecho de corrente. As atividades são realizadas com algum grau de dificuldade, porém, com independência pela maioria dos indivíduos que tem ou tiveram hanseníase e apresentam deformidades visíveis. Muitas dessas dificuldades podem ser minimizadas por meio de transferências tendinosas ou pela indicação, confecção e uso de tecnologia assistiva(AU).

This study aims to assess the functional capacity of the hand of people affected by leprosy in carrying out basic and instrumental activities of daily living. The sample consisted of 50 patients, aged over 18, who were being followed up at the outpatient clinic of the Instituto Lauro de Souza Lima. A questionnaire was developed to assess sociodemographic and clinical characteristics. Manual difficulties in carrying out activities in the areas of clothing, food, personal hygiene, home care, writing and others were assessed through the Functional Hand Assessment in Leprosy. The results show that in all activities there was some degree of difficulty, however, most patients perform them independently. The activities considered most difficult to be performed by patients with an ulnar claw were: picking up small objects on a flat surface, opening / closing the chain clasp and cutting nails. In the population of patients with an ulnar / median claw were: picking up small objects on a flat surface, buttoning / unbuttoning, looping / tying shoelaces and opening / closing chain fastening. The activities are performed with some degree of difficulty, however, independently by the majority of individuals who have or have had leprosy and have visible deformities. Many of these difficulties can be minimized by means of tendon transfers or by the indication, preparation and use of assistive technology(AU).

Luxación bilateral del vientre medial del tríceps (snapping triceps) asociada a luxación del nervio cubital. presentación de un caso / Bilateral dislocation of the medial fold of the triceps tendon (snapping triceps) with ulnar nerve dislocation. a case report

Snapping triceps es la luxación del vientre medial del tríceps por encima de la epitróclea, asociada o no a la luxación del nervio cubital. En algunos casos publicados, los pacientes eran intervenidos por luxación del nervio cubital y, durante la cirugía, se diagnosticaba la luxación del vientre medial del tríceps, incluso algunos pacientes eran operados en varias oportunidades. Presentamos un paciente de 16 años que refiere un resalto en la región medial de ambos codos. En el examen físico, es evidente un doble resalto tanto del nervio cubital, como del vientre medial del tríceps. Estos hallazgos se confirman por ecografía comparativa bilateral. El tratamiento quirúrgico consistió en la transposición cubital transmuscular y la resección del vientre medial del tríceps que se luxaba anterior a la epitróclea. Los dos codos fueron operados con diferencia de un mes. El paciente tuvo una excelente evolución sin complicaciones a los dos meses de las operaciones. Esta patología poco frecuente debe ser considerada con atención, ya que puede llevar a errores de diagnóstico y de tratamiento. Nivel de Evidencia: IV.

Snapping triceps is the dislocation of the medial triceps belly above the medial epicondyle, with or without the ulnar nerve. In some cases described in the literature, patients were operated on by ulnar nerve dislocation and dislocation of the medial triceps belly was diagnosed during surgery; some patients were even operated on several occasions. We report the case of a 16-year-old patient with a snap in the medial region of both elbows. Physical examination reveals a clear doublé click of the ulnar nerve and the medial triceps belly. These findings are confirmed by bilateral comparative ultrasound. Surgical treatment consisted of transmuscular ulnar transposition and resection of dislocated medial triceps belly. Both elbows were operated on one month apart. Two months after surgeries, the patient achieved an excellent outcome without complications. This rare condition must be carefully considered since it may lead to diagnostic and therapeutic errors. Level of Evidence: IV.

Una opción para restaurar la musculatura intrínseca cubital cuando el nervio interóseo anterior no se encuentra disponible / An option to restore ulnar intrinsic muscles when the anterior interosseus nerve is not available

Resumen: Antecedentes: Las lesiones de nervio periférico, principalmente las traumáticas, tienen efectos devastadores para la función. Tradicionalmente las opciones eran en forma temprana el injerto nervioso y en forma tardía la transferencia tendinosa. Durante los últimos años se han venido realizando transferencias nerviosas cuando la lesión es temprana y la placa motora aún es viable. Los resultados en su mayoría son superiores a los injertos nerviosos y a las transferencias tendinosas. Métodos y resultados: Se presenta el caso de una paciente que sufrió lesión de nervio mediano y cubital en el antebrazo y se utilizaron las ramas redundantes de los músculos extensor carpi ulnaris y extensor digiti quinti. Los resultados fueron buenos a los cuatro años. Conclusión: Cuando existe un déficit de la musculatura intrínseca cubital de la mano, el donador favorito es la rama terminal del nervio interóseo anterior. Cuando éste no se encuentra, debemos tener opciones para restaurar esta función.

Abstract: Background: The peripheral nerve injuries are devastating for the patient; the classic reconstructive options are the Nerve Graft and Tendon Transfers. Lately the Nerve Transfers are being used more and more broadly. They are an excellent option on early injuries and when the motor plate is still alive. The advantages are numerous, because the functional recovery is much better. Methods and results: We report the case of a patient who sustained and injury on the median and ulnar nerve, so the EDQ and ECU branches were used to restore the Ulnar Intrinsic Function. The 4-year follow-up showed good results. Conclusion: The ulnar intrinsic innervations provide dexterity; fine motor function and pinch, which is essential for a functioning hand. The most popular donor to restore the function of the motor branch of the ulnar nerve is the anterior interosseous nerve. When this is unavailable the use of the redundant branches of the EDQ and ECU must be considered.

Early sensory re-education of the hand after peripheral nerve repair based on mirror therapy: a randomized controlled trial

BACKGROUND: Mirror therapy has been used as an alternative stimulus to feed the somatosensory cortex in an attempt to preserve hand cortical representation with better functional results. OBJECTIVE: To analyze the short-term functional outcome of an early re-education program using mirror therapy compared to a late classic sensory program for hand nerve repair. METHOD: This is a randomized controlled trial. We assessed 20 patients with median and ulnar nerve and flexor tendon repair using the Rosen Score combined with the DASH questionnaire. The early phase group using mirror therapy began on the first postoperative week and lasted 5 months. The control group received classic sensory re-education when the protective sensation threshold was restored. All participants received a patient education booklet and were submitted to the modified Duran protocol for flexor tendon repair. The assessments were performed by the same investigator blinded to the allocated treatment. Mann-Whitney Test and Effect Size using Cohen's d score were used for inter-group comparisons at 3 and 6 months after intervention. RESULTS: The primary outcome (Rosen score) values for the Mirror Therapy group and classic therapy control group after 3 and 6 months were 1.68 (SD=0.5); 1.96 (SD=0.56) and 1.65 (SD=0.52); 1.51 (SD=0.62), respectively. No between-group differences were observed. CONCLUSION: Although some clinical improvement was observed, mirror therapy was not shown to be more effective than late sensory re-education in an intermediate phase of nerve repair in the hand. Replication is needed to confirm these findings.

Flexor zone 5 cut injuries: emergency management and outcome

To determine the outcome and devise a protocol for emergency management of cut injuries in Flexor Zone 5 of hands. Descriptive study. Department of Plastic Surgery and Burn Unit, Mayo Hospital, KEMU, Lahore, Pakistan, from January 2009 to March 2013. All patients above 12 years of age with single sharp cut injuries in Flexor Zone 5, with no skeletal injuries, presenting within 12 hours in emergency were included with follow-up of 6 months, with active range of motion evaluated by Strickland's adjusted formula. Power of opponens pollicis and adductor muscles was evaluated from P0-4. Nerve repair results were evaluated serially by advancing Tinnel's sign, electrophysiological studies and sensory perception scored from S0-4 compared to the normal opposite upper limb. The study group comprised of 31 patients [M: F = 2.4: 1]. Average age was 27 years ranging from 17 - 53 years. In 25 [80%] cases, injury was accidental, in 3 [10%] homicidal and in 3 [10%] injury was suicidal. Four most commonly involved structures included Flexor carpi ulnaris, ulnar artery, ulnar nerve and Flexor digitorum superficialis. Median nerve and radial artery were involved in 10 cases each, while ulnar artery and ulnar nerve were involved in 14 cases each. Longtendons were involved in most cases with greater involvement of medial tendons. None of the patients required re-exploration for ischaemia of distal limb while doppler showed 22 out of 24 vascular anastomosis remained patent. Recovery of long-tendons was good and recovery after nerve repair was comparable in both median and ulnar nerves. Early and technically proper evaluation, exploration and repair of Zone 5 Flexor tendon injuries results in good functional and technical outcome

Stability after close reduction and stabilization by two percutanious pinning technique in type-Ill supracondylar fracture of humerus

The objectives of this study were to compare the stability of fixation in Supracondylar fracture humerus in children between two techniques of pin fixation [cross K wires and two parallel wires] at four weeks and to compare Ulnar Nerve injury. Study design was Quasi experimental and done at Orthopaedic Complex, Bahawal Victoria Hospital Bahawalpur. The study period was one and half year. Two groups A and B of thirty patients each formed after convenience non-probability sampling technique. Group A was treated by medial lateral cross K wire fixation after close reduction. Group B was treated by lateral two pins placed parallel to each other. In-group A there was 23 male and 7 female children. In-group B there was 24 male and 6 female children. All treated patients were evaluated clinically on next day for distal neurovascular status especially for ulnar nerve in group A. Reduction checked on plane AP and Lat elbow X-rays. On AP Bauman's angle and on lateral X-ray shaft condyl angle measure and compare with normal side X -rays. After four weeks X-ray again done and compared with the first post-op X-rays. A difference of 5 degree noted as mild stability loss and change of 5-10 degree taken as major stability loss. Three patients treated by lateral k wires and one in patients treated with cross k wires had a mild loss of reduction. No patient in either group had a major loss of reduction. No ulnar nerve injury noted in both groups. Cross k wire fixation method is more stable than lateral paralle wires. Cross K- wire fixation method is also safe with no iatrogenic ulnar ner injury when medial wire pass after lateral wire and extending the elbc beyond the 90 degree with medial incision on epicondyle

Occupational therapy intervention in combination flexor tendon and peripheral nerve injury 10 patients with disabilities of arm, shoulder and hand

Measuring outcomes of intervention is one of the most important components of occupational therapy process. The Disabilities of Arm, Shoulder and hand [DASH] questionnaire is a valid and reliable instrument to measure outcomes of the occupational therapy services in the area of hand therapy. The study aims to measure outcomes from interventions of hand therapy in patients with the combined flexor tendon and peripheral nerve injuries in hand. In this cross sectional study, the Persian version of DASH questionnaire was filled by 20 patients with the combined flexor tendon and peripheral nerve injuries [17 males and 3 females with the age range of 18-58 years] referred to Asma Rehabilitation Center and it was reported that there was a relationship between variables of age, gender, literacy and accurate diagnosis [injured flexor tendon and peripheral nerve] with score calculated in DASH questionnaire. According to the variables of age, sex, education level and accurate diagnosis, patients showed that according to the DASH in calculating the mean score of questionnaire, the rate of individual's disability is reduced by increasing age, women show more disability in work performances, the individual's music and sport performances indicate more disability by increasing the educational level and finally, individuals with the combined finger flexor and ulnar nerve have the higher rate of disabilities. Patients with the combined flexor tendon and peripheral nerve injuries experience many disabilities even after surgery and rehabilitation

Effect of skilled and unskilled training on nerve regeneration and functional recovery

The most disabling aspect of human peripheral nerve injuries, the majority of which affect the upper limbs, is the loss of skilled hand movements. Activity-induced morphological and electrophysiological remodeling of the neuromuscular junction has been shown to influence nerve repair and functional recovery. In the current study, we determined the effects of two different treatments on the functional and morphological recovery after median and ulnar nerve injury. Adult Wistar male rats weighing 280 to 330 g at the time of surgery (N = 8-10 animals/group) were submitted to nerve crush and 1 week later began a 3-week course of motor rehabilitation involving either "skilled" (reaching for small food pellets) or "unskilled" (walking on a motorized treadmill) training. During this period, functional recovery was monitored weekly using staircase and cylinder tests. Histological and morphometric nerve analyses were used to assess nerve regeneration at the end of treatment. The functional evaluation demonstrated benefits of both tasks, but found no difference between them (P > 0.05). The unskilled training, however, induced a greater degree of nerve regeneration as evidenced by histological measurement (P < 0.05). These data provide evidence that both of the forelimb training tasks used in this study can accelerate functional recovery following brachial plexus injury.

Reabilitação virtual através do videogame: relato de caso no tratamento de um paciente com lesão alta dos nervos mediano e ulnar / Virtual rehabilitation using video games: a case report of the treatment of a patient with high median and high ulnar nerve lesions

O uso da reabilitação virtual através do video game visa simulação de situações reais; percebe-se que o uso desta, afasta o paciente do foco da dor ou do incomodo; melhora na funcionalidade dos membros acometidos e o leva a retomar as atividades nas áreas de desempenho ocupacional. Este estudo teve como objetivo verificar o uso da reabilitação virtual, como recurso terapêutico ocupacional, em um paciente com lesão alta dos nervos mediano e ulnar, bem como descrever e comparar os graus da amplitude de movimento das articulações do membro lesado. Trata- se de uma pesquisa do tipo longitudinal com um paciente de 09 anos de idade, sexo masculino, diagnosticado com lesão nervosa, na Clínica Escola de Terapia Ocupacional da Universidade Potiguar, no período de maio a setembro de 2010. Nos 13 encontros, foram utilizados televisão, o videogame Nintendo® Wii e quatro jogos e um goniômetro como instrumentos de intervenção e coleta de dados. Na reavaliação, observou-se a movimentação ativa e o aumento da amplitude de movimento em todas as articulações medidas: cotovelo em flexão e extensão; antebraço em pronação e supinação; punho em flexão, extensão, desvio ulnar e desvio radial; polegar em flexão de metacarpofalangiana, flexão interfalangiana, abdução e estágio III de oponência (Kapangji); II, III, IV e V quirodátilos. Os metacarpos apresentaram ganhos em flexão e extensão. Os resultados desse estudo evidenciaram a eficácia do videogame, comprovado através da avaliação goniométrica. O indivíduo estudado voltou a realizar as atividades de vida diária de forma independente e retornou as suas atividades esportivas de forma competitiva.

The use of virtual rehabilitation with video games aims to simulate real situations. It has been observed that the use of video games as a rehabilitation tool allows the patient to focus on something other than the pain or discomfort. It improves functionality of affected limbs, and helps the patient to resume activities involving occupational performance. The intent of this study was to verify the application of virtual rehabilitation as a resource for occupational therapy for a patient with high median and high ulnar nerve injuries, and to describe and compare the levels of range of motion of the injured limb joints. This was a longitudinal survey with a 9 years old patient, male, diagnosed with nerve damage at the Potiguar University School of Occupational Therapy Clinic. The survey was carried out from May to September of 2010. Throughout the 13 sessions, a television and a Nintendo ® Wii video game (with four games) were used as intervention tools, and a goniometer was used for collecting data. During reassessment, active movement and increased range of motion in all joints assessed were observed: elbow flexion and extension; forearm pronation and supination; wrist flexion, extension, radio and ulnar deviation; thumb metacarpophalangeal flexion, interphalangeal flexion, abduction and opponency at stage III (Kapandji); II, III, IV and V fingers. The metacarpals presented improvements in flexion and extension. The results showed the effectiveness of video games as evidenced by goniometric evaluation. The patient studied regained the ability to perform activities of daily living independently and to play sports competitively.

Distal anterior interosseous nerve transfer to the deep ulnar nerve and end-to-side suture of the superficial ulnar nerve to the third common palmar digital nerve for treatment of high ulnar nerve injuries: experience in five cases / Transferência do nervo interósseo anterior distal para o ramo profundo do nervo ulnar e sutura término-lateral do nervo ulnar superficial ao terceiro nervo digital comum para tratamento de lesões altas do nervo ulnar: experiência em cinco casos

OBJECTIVE: To demonstrate the results of a double nerve transfer at the level of the hand for recovery of the motor and sensory function of the hand in cases of high ulnar nerve injuries. METHOD: Five patients underwent a transfer of the distal branch of the anterior interosseous nerve to the deep ulnar nerve, and an end-to-side suture of the superficial ulnar nerve to the third common palmar digital nerve. RESULTS: Two patients recovered strength M3 and three cases were graded as M4; recovery of protective sensation (S3+ in three patients and S4 in two) was observed in the fourth and fifth fingers, and at the hypothenar region. The monofilament test showed values of 3.61 or less in all cases and the two-point discrimination test demonstrated values of 7 mm in three cases and 5 mm in two. CONCLUSION: This technique of double nerve transfer is effective for motor and sensory recovery of the distal ulnar-innervated side of the hand.

OBJETIVO: Demonstrar os resultados obtidos com uma dupla transferência nervosa ao nível da mão para tratamento de lesões do nervo ulnar localizadas acima do cotovelo. MÉTODO: Cinco pacientes foram submetidos à transferência do nervo interósseo anterior para o ramo profundo do nervo ulnar, associado à sutura término-lateral do nervo ulnar superficial ao terceiro nervo digital comum. RESULTADOS: Dois pacientes recuperaram força M3 e os outros três casos foram graduados como M4. Recuperação de sensibilidade protetora (S3+ em três pacientes e S4 em dois) foi observada nos quarto e quinto dedos, além da região hipotenar. O teste de monofilamentos demonstrou valores iguais ou menores do que 3,61 em todos os casos e o teste de discriminação de dois pontos apresentou valores de 7 mm em três casos e 5 mm em dois. CONCLUSÃO: A técnica de dupla transferência nervosa é eficaz como modalidade de tratamento para lesões altas do nervo ulnar.

Lesão aguda do ramo motor do nervo ulnar no punho após treinamento com cabo de guerra / Acute lesion of the motor branch of the ulnar nerve in the wrist after tug-of-war training

Artigos que correlacionam achados clínicos e eletrofisiológicos da lesão do nervo ulnar no punho são incomuns na literatura, se comparados com lesões no cotovelo. Apresentamos o caso de um paciente com atrofia da musculatura intrínseca da mão, secundária à lesão exclusiva do ramo motor do nervo ulnar, localizada no canal de Guyon, próxima ao gancho do hamato. Revisamos aspectos anatômicos, clínicos, neurofisiológicos da lesão do nervo ulnar, de localização distal e enfatizamos a importância da abordagem multidisciplinar. Especificamente relacionado ao mecanismo de lesão do paciente (cabo de guerra), não encontramos casos semelhantes na literatura e alertamos quanto aos riscos durante o treinamento físico militar.

Papers correlating clinical and electrophysiological findings relating to ulnar nerve lesions in the wrist are uncommon in the literature, if compared with elbow injuries. We present the case of a patient with atrophy of the intrinsic musculature of the hand, secondary to injury only of the motor branch of the ulnar nerve, which is located in Guyon's canal close to the hamate hook. We review the anatomical, clinical and neurophysiological aspects of distal ulnar nerve injuries and we emphasize the importance of multidisciplinary approaches. Specifically in relation to the mechanism of injury of this patient (tug-of-war), we did not find any similar cases in the literature. We issue an alert regarding the risks during military physical training.

Tratamiento de disociación radioulnar longitudinal ignorada: reporte de un caso / Delayed treatment of distal radial ulnar longitudinal dissociation: case report

La disociación radioulnar longitudinal o lesión de Essex-Lopresti es una entidad traumática rara definida como fractura de la cúpula radial, ruptura de la banda central de la membrana interósea del antebrazo y luxación de la articulación radioulnar distal ipsilateral. Las lesiones tipo III con migración irreductible de la diáfisis del radio sintomáticas tienen varias opciones de tratamiento. Presentamos el caso de un paciente joven con una lesión de Essex-Lopresti ignorada, manejada quirúrgicamente con una prótesis modular de cúpula radial cementada sin exploración de la articulación radioulnar distal.

Questionário para avaliação funcional da mão em lesão de nervos / Questionnaire to evaluate hand function in nerve lesions

OBJETIVO: elaborar um questionário de avaliação funcional para analisar as dificuldades manuais encontradas na realização de atividades cotidianas de indivíduos ocidentais adultos com lesão dos nervos ulnar, mediano ou radial.MÉTODO: foi realizada entrevista com 50 pessoas, idade entre 21 e 65 anos, portadoras de lesão nos nervos ulnar, mediano ou radial para identificar as dificuldades manuais ao realizar as tarefas cotidianas. Em seguida, seis cirurgiões de mão e nove terapeutas de mão, analisaram as tarefas listadas pelos entrevistados e as classificaram em níveis de importância para uma avaliação funcional das mãos. Posteriormente, o questionário foi elaborado baseado nessa classificação.RESULTADOS: o "Questionário de avaliação da mão com lesão de nervo" é constituído por 30 questões objetivas divididas em domínios de tarefas (vestuário, alimentação, higiene pessoal, tarefas domésticas, escrita, uso de computador e atividades diversas). As respostas são atribuídas de acordo com o grau de dificuldade na realização das tarefas listadas no instrumento. O questionário foi respondido por 32 pessoas com idade entre 18 e 65 anos apresentando sequela de hanseníase. O cálculo do alfa de Cronbach foi utilizado para avaliar a confiabilidade do instrumento. Após a remoção de duas questões relacionadas ao uso de computador, o resultado do alfa de Cronbach aumentou para 0,90.CONCLUSÃO: o "Questionário de avaliação da mão com lesão de nervo" apresenta alta consistência interna. Além disso, é conciso, de fácil preenchimento não necessitando a presença de profissional especializado para sua aplicação e permite a verificação do nível de independência do indivíduo com lesão de nervo periférico na mão na realização de suas tarefas habituais.

OBJECTIVE: to develop a functional evaluation questionnaire to limitations in hand function by western adults individuals with lesions of the ulnar, median or radial nerves in their routine tasks.DESIGN: an interview was conducted with 50 patients of 21-65 years of age with ulnar, median and radial nerve lesions to identify any manual difficulties in their performance of routine daily tasks. Six hand surgeons and nine hand therapists then analyzed the tasks listed by the patients and graded them in levels of importance for the evaluation of hand function, after which a questionnaire based on this classification was drawn up.RESULTS: the instrument Evaluation of Hand with Nerve Damage Questionnaire, consists of 30 objective questions divided into task domains (dressing, feeding, personal hygiene, housework, writing, use of computers and "others"), answers being classified according to degree of difficulty. The questionnaire was completed by 32 patients of 18-65 years of age with sequelae of Hansen's disease. Cronbach's coefficient alpha was used to assess the reliability of the instrument. Following removal of two questions regarding computer use, Cronbach's coefficient alpha increased to 0.90.CONCLUSION: the Evaluation of Hand with Nerve Damage Questionnaire shows a high internal consistency. In addition it is concise, easy to fill instrument not requiring specialized professional to apply and allows evaluation of the degree of independence of the individual with peripheral nerve lesion in the hand in performing routine daily tasks.

Experience with peripheral nerve injury in upper extremities

This study reports the results of 87 operations performed on nerves of the upper extremities of 87 patients during the period of 5 years from 2000-2005 in Mansoura University hospital and Emergency Hospital. Among them there were 84 males and 3 females, age ranged from 5 - 53 years. There were 27 patients with isolated median nerve injury, 33 with isolated ulnar nerve injury, 12 with isolated radial nerve injury and 15 patients with combined median and ulnar nerve injury. All patients were treated with nerve exploration within 1 hour, 7 months after combined injury and were followed-up for 3 months - 2 years. There were 77 nerve lesions not in continuity [74 needed suture repair and 3 needed sural nerve graft repair], while 25 nerve lesions where in continuity [9 partial lesions needed neurolysis and 16 complete lesions needed neuroma excision and suture repair]. Analysis of the outcome of surgical treatment was performed with respect to the following parameters: period between the injury and operation, patient age, type of injured nerve, level of injury and type of surgical intervention. Overall significant outcome [>/= 3 Lousiana State University Health Science [LSUHS] grade] was obtained in 67.5% [radial nerve 75%, ulnar nerve 64% and median nerve 71%]. Significant outcome according to the level of the injury were 51% arm, 69% forearm and elbow and 82% wrist. According to the type of intervention and lesion categories, lesions not in continuity had a significant outcome 61% [primary suture repair 75%, secondary suture repair 61%, while graft repair was 0%]. Lesions in continuity had a significant outcome 88% [partial lesions underwent neurolysis 100%, while complete lesions underwent surture repair 81%, cut injuries 79% and crushed injuries 59%]. The most favourable outcome was obtained with lesions that result in partial lesion in continuity

Forensic analysis on injuries involving main branches of brachial plexus in 66 cases / 法医学杂志

OBJECTIVE@#To study injuries involving brachial plexus and its branches.@*METHODS@#66 cases collected from 2003 to 2005 in our department were analyzed statistically.@*RESULTS@#94% of injuries involved young adult males; 94% were blunt force injuries; 34% involved both nerve and bone mainly involving ulnar nerve and ulnar bone (50%); 40% of the injured nerves received electromyogram and 15 nerves were diagnosed with injuries clinically.@*CONCLUSION@#Forensic determination on severity of brachial plexus injuries mainly depends on movement recovery of limb. The best time for forensic appraisal is 20 d post operation+L (length of nerve severed distally)/R (growth rate)+90 d.

Evaluación del tratamiento y complicaciones en fracturas supracondíleas de húmero distal en el Hospital Universitario del Valle (enero 2000 a diciembre 2001) / Evaluation of treatment and complications in supracondylar distal humerus fractures at the Hospital Universitario del Valle (January 2000 to December 2001)

Se realizó un estudio descriptivo de tipo corte transversal con el fin de evaluar el tratamiento y la incidencia de complicaciones neurovasculares en niños menores de 15 años de edad con fracturas supracondíleas del húmero que ingresaron al Hospital Universitario del Valle entre enero de 2000 y diciembre de 2001. Se encontraron 239 niños. El principal mecanismo de trauma fue caídas 96% y el 96% de ellas fueron cerradas. El 83% correspondieron a un Gartland tipo 3.Todos tuvieron reducción cerrada con clavos percutáneos, en 99.6% de los casos de usaron clavos cruzados. Se encontró después de cirugía compromiso del nervio ulnar en 3.2% y del nervio radial 0.4%. Hubo rigidez articular en 1.7% e infección en 1.3%. Solo 3 pacientes desarrollaron cúbito varo. Nos permitimos recomendar la reducción cerrada y la fijación percutánea con clavos cruzados, para las fracturas supracondíleas del húmero inestables.

Significado anátomo-funcional e importância cirúrgica da anastomose mediano-ulnar de Martin-Gruber / Martin-Gruber mediano-ulnar anastomosis: anatomic/functional meaning and surgical importance

Os objetivos foram: verificar a freqüência da anastomose de Martin-Gruber, topografar e classificar as mesmas e comparar a freqüência encontrada anatomicamente e a encontrada nos exames eletroneuromiográficos de rotina. Foram dissecados 50 antebraços de cadáveres, e foram estudados 75 antebraços por eletroneuromiografia. Foram encontradas 5 anastomoses entre o nervo mediano e o nervo ulnar e nenhuma nas eletroneuromiografias.A freqüência da anastomose de Martin-Gruber no nosso meio foi de 10 por cento / The objectives were: to verify the frequency of the anastomosis of Martin-Gruber, to topography and to classify the same ones and to compare the frequency found anatomicallyand found her/it in the exams routine electroneuromiographies.50 forearms of corpses were dissected, and they were studied 75 forearms by electroneuromiographies. They were found 5 anastomosis between the median nerve and the ulnar nerve and none in the electroneuromiographies.The frequency of the anastomosis of Martin-Gruber found was 10 per cent...