Outcomes of complete neurotomy and immediate repair of the musculocutaneous nerve for treatment of elbow spasticity.

Neurotomy interrupts the stretch reflex and can be used for the treatment of spasticity. We hypothesized that neurotomy with nerve repair reduces spasticity while preserving motor function due to the preferential recovery of efferent over afferent fibres. This study reports the 1-year outcomes of neurotomy and immediate repair of the musculocutaneous nerve in the proximal arm for treatment of elbow flexor spasticity, comparing these to outcomes in the literature for neurectomy without nerve repair. A total of 10 adult patients with spasticity of the elbow flexors from stroke or traumatic brain injury who had undergone neurotomy and immediate repair of the musculocutaneous nerve were prospectively studied. The results suggest that this procedure effectively reduces elbow flexor spasticity, improves elbow resting position, active elbow extension and is useful for achieving patient goals with effects lasting at least 12 months.Level of evidence: IV (therapeutic).

Teleducation: medical education in the pandemic and beyond.

Medical education in the pandemic has been challenging owing to various physical and technological constraints in the current education landscape. This has resulted in reduced patient contact and opportunities for clinical exposure. In utilizing various platforms to supplement teaching, we adopted the use of Telegram, a cloud-based messaging application as an education aid for 3 cohorts of medical students in 1 medical school in Singapore. Herein, we share our experience with Telegram as a novel platform to augment medical education and to supplement clinical training amidst the various constraints. We believe that the circumstances have allowed us to find a method that may serve as an effective adjunct in education. Qualitative feedback has been positive and generally in line with our goals. We believe that further work could involve utilizing other features of the application, or by developing specialized applications to serve the same purpose. More needs to be done to consider applicability in different cultural and socioeconomic contexts.