Upper extremity nerve lesions (diagnosis, indications, surgical techniques).

OBJECTIVE: Revision and questioning of orthodox principles regarding the conduction of nerve impulse. DESIGN: Retrospective study with clinical analysis of results. SITE: Hospital das Clinicas (HCFMSP), public university institution with research programs and tertiary attention to health. GROUP MEMBERS: Author and a team of residents and trainees. OPERATION: Direct suture of nervous stumps utilizing auxiliary technical procedures:- joint-flexion, nerve transposition, tendon transplants, bone shortening. MEASUREMENT: Clinical evaluation and objective tests for tactile and stereognostic function recovery (Weber Test). RESULTS: Variable, depending on preoperative conditions:- type of lesion, time elapsed since injury. CONCLUSIONS: Neurorrhaphy should be the procedure of choice even for long term lesions, although the expected results may be less favourable. Periodical evaluation from 24 hs. postoperative, checking for early undefined signals of nervous function recovery. Association of specific drugs for chemical biophysics of the nerve.

[Accident prevention and emergency treatment of traumatic hand injuries in the metropolitan area of São Paulo]. / Prevenção de acidentes e atendimento de emergência de lesões traumáticas da mão na área metropolitana de São Paulo.

The workman's hand is a "tool"; it is his most valuable asset. Worker selection and training, associated with a preventional approach, by employee and employer, humanises work and makes it more effective. The rate of hand injuries in the city of São Paulo is very high (of the order of 500 cases per day) and its aggregate cost is extremely high. The primary care of lesions is so poor that it well deserves the label of "second accident". The CIPAM-SUDS/SP system will provide a simpler and proper treatment by trained surgeons in full time duty in first-aid decentralized stations, located inside the industrial areas.

Early restoration of pinch grip after ulnar nerve repair and tendon transfer.

Restoration of pinch in ulnar nerve lesions may be achieved within three or four weeks by a one-stage operation combining nerve repair and tendon transfer. We have been using this approach for nerve injuries of the upper limb since 1961, to meet the socio-economic needs of patients who would otherwise need splints and long-term physiotherapy. In our experience, the procedure of choice is transfer of E.I.P. to adductor pollicis and E.P.B. to the first dorsal interosseous. The operative technique and its results in 18 patients followed up for 37-515 days are discussed.

Clinical aspects of muscle imbalance in the hand due to ulnar nerve lesions and a proposed thumb-index finger grip classification.

This study deals with the anatomical and clinical bases of the thumb-index finger grip, emphasizing not only its general importance, but also its ergonomic role. A classification according to the different functions of two muscular groups (extrinsic and intrinsic), with special reference to muscular imbalance due to ulnar nerve lesions is proposed. After some general considerations on the function of the hand practical conclusions are drawn.