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11 pages, 3705 KiB  
Article
Triangular Fibrocartilage Characterization with Ultrashort Echo Time-T2* MRI: Insights from a Healthy Cohort
by Sana Boudabbous, Hicham Bouredoucen, David Ferreira Branco, Stefan Sommer, Tom Hilbert, Pierre-Alexandre Poletti, Rares Salomir and Bénédicte Marie Anne Delattre
Life 2025, 15(7), 1117; https://doi.org/10.3390/life15071117 - 17 Jul 2025
Viewed by 293
Abstract
The objective of this study is to measure T2* relaxation time in the triangular fibrocartilage (TFC) disc in asymptomatic volunteers and evaluate its variation with factors such as age, hand dominance, sex, and ulnar variance, using a dedicated MRI sequence. The MRI protocol [...] Read more.
The objective of this study is to measure T2* relaxation time in the triangular fibrocartilage (TFC) disc in asymptomatic volunteers and evaluate its variation with factors such as age, hand dominance, sex, and ulnar variance, using a dedicated MRI sequence. The MRI protocol included anatomical sequences as well as a 3D ultra-short echo time (UTE)-T2* mapping sequence. A linear regression model was used to assess the potential influence of age, sex, and hand dominance on T2* values measured in the TFC disc and to evaluate the correlation between T2* values and ulnar variance. T2* relaxation time was positively correlated with age. The higher T2* relaxation times may reflect early degeneration of the fibrocartilage microstructure, which is associated with both biomechanical factors and the aging process. However, T2* was not significantly influenced by sex or hand dominance, nor was it correlated with ulnar variance (this later being limited by the fact that none of our subject had positive ulnar variance). In conclusion, UTE-T2* is a promising MRI technique showing positive correlation with age in the TFC of healthy subjects. These findings are a first step to establish normative T2* values and will help interpreting deviations observed in patient with suspected pathology in future studies. Full article
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13 pages, 3483 KiB  
Article
The “Double-Row Shoelace” Capsulodesis: A Novel Technique for the Repair and Reconstruction of the Scapholunate Ligament of the Wrist
by Adriano Cannella, Rocco De Vitis, Arturo Militerno, Giuseppe Taccardo, Vitale Cilli, Lorenzo Rocchi, Giulia Maria Sassara and Marco Passiatore
Surgeries 2025, 6(3), 57; https://doi.org/10.3390/surgeries6030057 - 16 Jul 2025
Viewed by 168
Abstract
Introduction: The scapholunate interosseus ligament (SLIL) is critical for wrist stability, with injuries causing carpal instability and potential scapholunate advanced collapse (SLAC). This technical note presents a novel ligament-sparing surgical technique for treating SLIL tears ranging from grade 2 to 4 of the [...] Read more.
Introduction: The scapholunate interosseus ligament (SLIL) is critical for wrist stability, with injuries causing carpal instability and potential scapholunate advanced collapse (SLAC). This technical note presents a novel ligament-sparing surgical technique for treating SLIL tears ranging from grade 2 to 4 of the Garcia-Elias classification. Materials and Methods: A retrospective study was performed on ten patients treated with this novel technique. The technique involves a dorsal approach to the wrist through a 5–7 cm incision ulnar to Lister’s tubercle. After exposing the scapholunate joint, reduction is performed using Kirschner wires (K-wires) as joysticks, followed by stabilisation with three K-wires through the scapholunate, scapho-capitate, and radio-lunate joints. Two 2.3 mm suture anchors with double sutures are placed where the reduction K-wires were removed. One pair of sutures connects the anchors and any remaining SLIL tissue, while the second pair create a shoelace-like capsulodesis. Post-operative care includes staged K-wire removal at one and two months, with progressive rehabilitation before returning to weight-bearing activities at six months. Results: All patients improved in pain and function. The technique addresses SLIL injuries by restoring both coronal alignment through ligament repair and sagittal alignment via dorsal capsulodesis. The use of suture anchors and direct repair preserves the native tissue while reinforcing the dorsal capsule–scapholunate septum complex, avoiding the need for tendon grafts or extensive bone tunnelling. Conclusions: This ligament-sparing technique offers several advantages, including absence of donor site morbidity, minimal damage to carpal cartilage and vascularity, and preservation of surgical options should revision be necessary. The procedure effectively addresses both components of scapholunate instability while maintaining a relatively straightforward surgical approach. Full article
(This article belongs to the Section Hand Surgery and Research)
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16 pages, 321 KiB  
Article
The Association Between Vibrotactile and Thermotactile Perception Thresholds and Personal Risk Factors in Workers Exposed to Hand-Transmitted Vibration
by Fabiano Barbiero, Andrea Miani, Marcella Mauro, Flavia Marrone, Enrico Marchetti, Francesca Rui, Angelo Tirabasso, Carlotta Massotti, Marco Tarabini, Francesca Larese Filon and Federico Ronchese
Vibration 2025, 8(3), 36; https://doi.org/10.3390/vibration8030036 - 4 Jul 2025
Viewed by 295
Abstract
Background: Hand–arm vibration syndrome (HAVS) is a well-recognized occupational condition resulting from prolonged exposure to hand-transmitted vibration (HTV), characterized by vascular, neurological, and musculoskeletal impairments. While vibration exposure is a known risk factor for HAVS, less is understood about the role of personal [...] Read more.
Background: Hand–arm vibration syndrome (HAVS) is a well-recognized occupational condition resulting from prolonged exposure to hand-transmitted vibration (HTV), characterized by vascular, neurological, and musculoskeletal impairments. While vibration exposure is a known risk factor for HAVS, less is understood about the role of personal risk factors and, particularly regarding neurosensory dysfunction. This study aimed to examine the association between vibrotactile (VPT) and thermotactile perception thresholds (TPT) and individual risk factors and comorbidities in HTV-exposed workers. Methods: A total of 235 male HTV workers were evaluated between 1995 and 2005 at the University of Trieste’s Occupational Medicine Unit. Personal, occupational, and health-related data were collected, and sensory function was assessed in both hands. VPTs at 31.5 and 125 Hz and TPTs (for warm and cold) were measured on fingers innervated by the median and ulnar nerves. Results: Multivariable regression analysis revealed that impaired VPTs were significantly associated with age, higher daily vibration exposure (expressed as 8 h energy-equivalent A(8) values), BMI ≥ 25, smoking, vascular/metabolic disorders, and neurosensory symptoms. In contrast, TPTs showed weaker and less consistent associations, with some links to smoking and alcohol use. Conclusions: These findings suggest that, in addition to vibration exposure, individual factors such as aging, overweight, smoking, and underlying health conditions significantly contribute to neurosensory impairment and may exacerbate neurosensory dysfunction in a context of HAVS. The results underscore the importance of including personal health risk factors in both clinical assessment and preventive strategies for HAVS and may inform future research on its pathogenesis. Full article
12 pages, 3998 KiB  
Review
Bifocal Radial Fracture/Dislocation and Distal Ulnar Fracture—A Rare Case of Proximal Forearm Instability Not Yet Classified and Literature Review
by Michele Dario Gurzì, Giacomo Capece, Guido Bocchino, Alessandro El Motassime, Rocco Maria Comodo, Massimiliano Nannerini, Giulio Maccauro and Raffaele Vitiello
J. Clin. Med. 2025, 14(13), 4694; https://doi.org/10.3390/jcm14134694 - 2 Jul 2025
Viewed by 310
Abstract
Introduction: Monteggia fractures, first described by Giovanni Battista Monteggia, involve a fracture of the proximal ulna with anterior dislocation of the radial head. Bado’s 1967 classification divides these injuries into four types. Rare mixed patterns exist, overlapping with other forearm injuries such as [...] Read more.
Introduction: Monteggia fractures, first described by Giovanni Battista Monteggia, involve a fracture of the proximal ulna with anterior dislocation of the radial head. Bado’s 1967 classification divides these injuries into four types. Rare mixed patterns exist, overlapping with other forearm injuries such as Galeazzi and Essex–Lopresti lesions. These complex fractures/dislocations pose significant diagnostic and therapeutic challenges and are not adequately represented in current classification systems. Methods and Case Presentation: We report the case of a 56-year-old woman with a complex forearm injury sustained from a fall, presenting with radial head fracture/dislocation, mid-shaft radial fracture, distal ulna fracture, and ulnar collateral ligament rupture. Intraoperative imaging confirmed DRUJ stability and partial interosseous membrane disruption. Surgical management included radial head prosthesis implantation, radial shaft fixation with an anatomical locking plate, intramedullary nailing of the distal ulna, and ligament reconstruction. At two-year follow-up, the patient demonstrated full recovery of elbow flexion–extension and satisfactory forearm function. A narrative literature review was also conducted, focusing on hybrid injury variants. Results: Intraoperative examination under anesthesia revealed good elbow stability with 130° flexion, 15° extension lag, and forearm pronation/supination of 70°/60°. An initial Mayo Elbow Performance Score (MEPS) of 65 was recorded, limited by range of motion and stability. Pain during passive mobilization was mild, with a Visual Analogue Scale (VAS) score of 3/10. Postoperative recovery included 15 days of immobilization followed by structured rehabilitation. At two years, the patient regained full elbow flexion–extension but had residual deficits in pronation–supination, attributed to pre-existing conditions. Conclusions: This case illustrates a previously unreported hybrid Monteggia variant, combining features of Monteggia, Galeazzi, and Essex–Lopresti injuries. It highlights the limitations of current classification systems and supports the need for an expanded diagnostic framework. Successful management required a multidisciplinary surgical approach tailored to the injury’s complexity. Further studies are warranted to refine classification and treatment strategies for these rare combined injuries. Full article
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11 pages, 1713 KiB  
Article
Superficial Arterial Variants of the Upper Limb: Clinical Implications of High-Origin Ulnar and Radial Arteries Detected by Ultrasound and Anatomy Study
by Maribel Miguel-Pérez, Sara Ortiz-Miguel, Ana Martínez, Juan Carlos Ortiz-Sagristà, Ingrid Möller, Carlo Martinoli and Albert Pérez-Bellmunt
J. Funct. Morphol. Kinesiol. 2025, 10(3), 246; https://doi.org/10.3390/jfmk10030246 - 27 Jun 2025
Viewed by 234
Abstract
Background: Arterial variations in the upper limb, although infrequent, carry critical clinical implications. The presence of superficial ulnar and radial arteries, especially when originating from high levels, increases the risk of iatrogenic injury, misdiagnosis, and surgical complications. To confirm and describe, through ultrasound [...] Read more.
Background: Arterial variations in the upper limb, although infrequent, carry critical clinical implications. The presence of superficial ulnar and radial arteries, especially when originating from high levels, increases the risk of iatrogenic injury, misdiagnosis, and surgical complications. To confirm and describe, through ultrasound and anatomical dissection, the presence of a high-origin superficial ulnar artery and a superficial radial artery in a cadaver, highlighting their anatomical trajectory and clinical relevance. Methods: A cross-sectional ultrasound and anatomical study was conducted on 150 upper limbs from fresh-frozen cadavers. High-frequency ultrasound was used to scan the vasculature from the axilla to the wrist. Subsequently, dissection was performed to confirm sonographic findings. Results: One case (0.66%) of concurrent superficial ulnar artery and superficial radial artery was identified in the left arm of a 79-year-old male cadaver. The superficial ulnar artery originated from the axillary artery and coursed superficially along the forearm, anterior to the flexor muscles. The superficial radial artery emerged from the brachial artery and ran subcutaneously in the distal forearm. These arteries remained in close relation to key neural and venous structures, increasing their vulnerability to clinical error. Conclusions: The identification of high-origin superficial arteries is essential for clinical practice. Ultrasound serves as a reliable, non-invasive method for detecting such variations preoperatively. Awareness of these anomalies can prevent inadvertent vascular injuries, improve diagnostic accuracy, and inform safer surgical and anesthetic approaches in upper limb interventions. Full article
(This article belongs to the Section Functional Anatomy and Musculoskeletal System)
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11 pages, 744 KiB  
Article
Short-Term Outcomes of a Novel Fascio-Aponeurotic Flap Technique for Ulnar Nerve Instability at the Elbow
by Rocco De Vitis, Marco D’Orio, Adriano Cannella, Eve Michel Gabriel, Giuseppe Taccardo, Luciana Marzella, Vitale Cilli, Giulia Maria Sassara and Marco Passiatore
Surgeries 2025, 6(3), 49; https://doi.org/10.3390/surgeries6030049 - 24 Jun 2025
Viewed by 258
Abstract
Background: Cubital tunnel syndrome is the second most common compressive neuropathy of the upper limb, and it is characterized by ulnar nerve compression at the elbow. Traditional surgical options, including simple decompression and anterior transposition, have limitations in addressing ulnar nerve instability. This [...] Read more.
Background: Cubital tunnel syndrome is the second most common compressive neuropathy of the upper limb, and it is characterized by ulnar nerve compression at the elbow. Traditional surgical options, including simple decompression and anterior transposition, have limitations in addressing ulnar nerve instability. This study introduces and evaluates the short-term outcomes of a novel surgical technique, the fascio-aponeurotic epicondylar flap (FAEF), for stabilizing the ulnar nerve and managing its instability. Materials and methods: A retrospective study was conducted on ten patients with longstanding cubital tunnel syndrome and confirmed ulnar nerve dislocation or instability. All patients underwent surgical intervention using the FAEF technique, which involves creating a quadrangular fascial flap from the epicondylar fascia to stabilize the ulnar nerve within the retrocondylar groove. Outcomes were assessed using clinical follow-ups, the Michigan Hand Outcomes Questionnaire (MHQ), VAS, and qDASH scores over a 90-day postoperative period. Results: All ten patients experienced complete resolution of neurological symptoms, including paresthesia, pain, and nerve clicking, by the final follow-up. Postoperative recovery was uneventful, with no complications such as infections or hematomas. Grip strength and hand functionality were fully restored, with significant improvements in MHQ scores (mean: 94). Dynamic elbow mobilization initiated on the first postoperative day resulted in full recovery of elbow range of motion. No recurrence of ulnar nerve dislocation was observed. Discussion: The FAEF technique effectively stabilizes the ulnar nerve, alleviates symptoms, and restores function while minimizing risks associated with traditional procedures, such as nerve trauma and elbow instability. By preserving the anatomical integrity of the medial epicondyle and enhancing nerve mobility, this approach represents a less invasive alternative to anterior transposition and medial epicondylectomy. Conclusions: The FAEF technique is a viable and effective surgical option for managing ulnar nerve instability in cubital tunnel syndrome. It offers a less invasive solution with excellent short-term outcomes, making it a promising addition to the surgical armamentarium for this condition. Further studies are warranted to evaluate long-term efficacy and broader applicability. Full article
(This article belongs to the Section Hand Surgery and Research)
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18 pages, 12909 KiB  
Article
A Wearable Wrist Rehabilitation Device with Vacuum-Actuated Artificial Muscles
by Xinbo Chen, Kunming Zhu, Fengchun He, Weihua Gao and Jiantao Yao
Actuators 2025, 14(7), 304; https://doi.org/10.3390/act14070304 - 21 Jun 2025
Viewed by 438
Abstract
The complex structure of the wrist joint supports the hand to complete a variety of dexterous and accurate operations in daily living, which in turn makes it vulnerable to motor injury due to stroke, sports, occupational, or traffic accidents. As a supplement to [...] Read more.
The complex structure of the wrist joint supports the hand to complete a variety of dexterous and accurate operations in daily living, which in turn makes it vulnerable to motor injury due to stroke, sports, occupational, or traffic accidents. As a supplement to traditional medical treatment, timely and effective rehabilitation training can accelerate the recovery process of wrist motor function. The wearable rehabilitation device in this work exhibits excellent application prospects in the field of human rehabilitation training due to its inherent flexibility and safety. Inspired by the motion principle of tendons and muscles, a modular vacuum-actuated artificial muscle (VAM) is proposed, with the advantages of being lightweight and having a high contraction ratio. The VAMs are applied to the development of a wearable wrist rehabilitation device (WWRD) prototype, which can realize wrist rehabilitation training in the motion directions of extension, flexion, radial deviation, and ulnar deviation. The design concept, structural model, and motion analysis of a WWRD are introduced to provide a reference for the design and analysis of the WWRD prototype. To evaluate the performance of the WWRD, we establish the force and motion parameter models of the WWRD and carry out performance experiments. The process of wrist rehabilitation training is tested and evaluated, which indicates that the WWRD with VAMs will enhance flexibility, comfort, and safety in wrist rehabilitation training. This work is expected to promote the development of high-performance wearable wrist rehabilitation devices based on an understanding of the bionic vacuum-actuated artificial muscles. Full article
(This article belongs to the Section Actuators for Robotics)
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11 pages, 2307 KiB  
Article
A Retrospective Study of 10 Patients Exhibiting the “Pseudo Wartenberg Sign”
by Lisa B. E. Shields, Vasudeva G. Iyer, Yi Ping Zhang and Christopher B. Shields
Neurol. Int. 2025, 17(7), 97; https://doi.org/10.3390/neurolint17070097 - 20 Jun 2025
Viewed by 397
Abstract
Background/Objectives: The Wartenberg sign is a diagnostic feature of ulnar nerve neuropathy. It results from unbalanced activity of the abductor digiti minimi (ADM) and extensor digiti minimi (EDM) muscles secondary to weakness of the third palmar interosseous muscle. Rarely, this sign may occur [...] Read more.
Background/Objectives: The Wartenberg sign is a diagnostic feature of ulnar nerve neuropathy. It results from unbalanced activity of the abductor digiti minimi (ADM) and extensor digiti minimi (EDM) muscles secondary to weakness of the third palmar interosseous muscle. Rarely, this sign may occur in the absence of an underlying ulnar neuropathy, which we refer to as the “pseudo Wartenberg sign” (PWS). Methods: This is a retrospective review of 10 patients manifesting an inability to adduct the little finger towards the ring finger with no evidence of an ulnar neuropathy. We describe the clinical and electrodiagnostic (EDX) findings in these patients and discuss the pathophysiologic basis of PWS. Results: The most common cause was an injury in five (50.0%) patients: avulsion of the third volar interosseous muscle in two (20.0%), contracture of the ADM muscle in one (10.0%), and trauma-related dystonia in two (20.0%). The most frequent mechanism of PWS was focal dystonia of specific hand muscles in seven (70.0%) patients. Needle electromyography (EMG) demonstrated no denervation changes in ulnar nerve-innervated hand muscles; the motor and sensory conduction was normal in the ulnar nerve in all patients. Four (40.0%) patients underwent ultrasound studies, with a hyperechoic, avulsed third volar interosseous muscle in one, a hyperechoic and atrophic ADM muscle in one, normal hypothenar and extensor muscles in one, and a normal hypothenar muscle in one. Conclusions: Neurologists, neurosurgeons, and hand and orthopedic surgeons should be aware of the rare cases in which the inability to adduct the little finger may occur in the absence of ulnar neuropathy and look for other causes like avulsion of the third palmar interosseus muscle or focal hand dystonia. Full article
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16 pages, 2228 KiB  
Article
Potential Use of a New Energy Vision (NEV) Camera for Diagnostic Support of Carpal Tunnel Syndrome: Development of a Decision-Making Algorithm to Differentiate Carpal Tunnel-Affected Hands from Controls
by Dror Robinson, Mohammad Khatib, Mohammad Eissa and Mustafa Yassin
Diagnostics 2025, 15(11), 1417; https://doi.org/10.3390/diagnostics15111417 - 3 Jun 2025
Viewed by 474
Abstract
Introduction: Carpal Tunnel Syndrome (CTS) is a prevalent neuropathy requiring accurate, non-invasive diagnostics to minimize patient burden. This study evaluates the New Energy Vision (NEV) camera, an RGB-based multispectral imaging tool, to detect CTS through skin texture and color analysis, developing a machine [...] Read more.
Introduction: Carpal Tunnel Syndrome (CTS) is a prevalent neuropathy requiring accurate, non-invasive diagnostics to minimize patient burden. This study evaluates the New Energy Vision (NEV) camera, an RGB-based multispectral imaging tool, to detect CTS through skin texture and color analysis, developing a machine learning algorithm to distinguish CTS-affected hands from controls. Methods: A two-part observational study included 103 participants (50 controls, 53 CTS patients) in Part 1, using NEV camera images to train a Support Vector Machine (SVM) classifier. Part 2 compared median nerve-damaged (MED) and ulnar nerve-normal (ULN) palm areas in 32 CTS patients. Validations included nerve conduction tests (NCT), Semmes–Weinstein monofilament testing (SWMT), and Boston Carpal Tunnel Questionnaire (BCTQ). Results: The SVM classifier achieved 93.33% accuracy (confusion matrix: [[14, 1], [1, 14]]), with 81.79% cross-validation accuracy. Part 2 identified significant differences (p < 0.05) in color proportions (e.g., red_proportion) and Haralick texture features between MED and ULN areas, corroborated by BCTQ and SWMT. Conclusions: The NEV camera, leveraging multispectral imaging, offers a promising non-invasive CTS diagnostic tool using detection of nerve-related skin changes. Further validation is needed for clinical adoption. Full article
(This article belongs to the Special Issue New Trends in Musculoskeletal Imaging)
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20 pages, 2808 KiB  
Systematic Review
Sonographic Evaluation of Peripheral Nerves and Cervical Nerve Roots in Amyotrophic Lateral Sclerosis: A Systematic Review and Meta-Analysis
by Anas Elgenidy, Ibrahim A. Hassan, Yasser Hamed, Hassan Ahmed Hashem, Osama Abuel-naga, Hazem I. Abdel-Rahman, Kawashty R. Mohamed, Belal Mohamed Hamed, Mennatullah A. Shehab, Mohamed Zeyada, Somaia Kassab, Shaimaa Sabri Abdelkarim Abdelgawad, Abdelbaki Idriss Ibrahim, Ekram Hassan Hasanin, Amira A. Elhoufey, Khalid Hashim Mahmoud and Khaled Saad
Med. Sci. 2025, 13(2), 67; https://doi.org/10.3390/medsci13020067 - 1 Jun 2025
Viewed by 1436
Abstract
Background: Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease that leads to nerve atrophy. Ultrasonography has a significant role in the diagnosis of ALS. Aim: We aimed to sonographically assess the size of all peripheral nerves and cervical nerve roots in ALS compared [...] Read more.
Background: Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease that leads to nerve atrophy. Ultrasonography has a significant role in the diagnosis of ALS. Aim: We aimed to sonographically assess the size of all peripheral nerves and cervical nerve roots in ALS compared to controls. Methods: We searched MEDLINE (PubMed), Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Scopus using comprehensive MeSH terms for the keywords nerve, ultrasound, and ALS. We extracted data regarding cross-sectional area (CSA) or diameter for the following nerves: vagus, phrenic, tibial, fibular, sural, radial, ulnar, and median nerves, and the roots of C5, C6, C7, and C8 in both ALS patients and controls. Results: Our study included 2683 participants, of which 1631 were ALS patients (mean age = 60.36), 792 were healthy controls (mean age = 57.79), and 260 were patients with other neurological disorders. ALS patients had significantly smaller nerve size compared to controls. Nerve size differences were observed in the vagus nerve [MD = −0.23], phrenic nerve [MD = −0.25], C5 nerve root [SMD = −0.94], C6 nerve root [SMD = −1.56], C7 nerve root [SMD = −1.18], C8 nerve root [MD = −1.9], accessory nerve [MD = −0.32], sciatic nerve [MD = −11], tibial nerve [MD = −0.68], sural nerve [MD = −0.32,], ulnar nerve [MD = −0.80], and median nerve [MD = −1.21]. Conclusions: Our findings showed that ALS patients have a sonographically smaller nerve size than healthy controls. Therefore, this is a potential marker for neuronal diseases. Full article
(This article belongs to the Section Neurosciences)
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12 pages, 3820 KiB  
Article
Analysis of the Correlation Between Postoperative MRI Findings, Patient-Reported Outcome Measures, and Residual Pain After Arthroscopic TFCC Repair—A Pilot Study
by Francesca von Matthey, Franziska Hampel, Georg Feuerriegel, Klaus Woertler, Alexandra Gersing and Helen Abel
J. Clin. Med. 2025, 14(11), 3729; https://doi.org/10.3390/jcm14113729 - 26 May 2025
Viewed by 478
Abstract
Background: Triangular fibrocartilage complex (TFCC) tears are a common source of ulnar-sided wrist pain. Surgery has to be performed in case of instability, pain, or if non-operative treatment fails. Overall, the results are very good. However, some patients still suffer from pain after [...] Read more.
Background: Triangular fibrocartilage complex (TFCC) tears are a common source of ulnar-sided wrist pain. Surgery has to be performed in case of instability, pain, or if non-operative treatment fails. Overall, the results are very good. However, some patients still suffer from pain after surgery. Post-operative MR imaging can reveal potential pathologies but it needs to be assessed whether depicted changes are normal or whether these findings have a clinical significance. Therefore, the purpose of this study was to evaluate postoperative MR imaging and the function of the patients’ wrists in order to assess which postoperative changes are correlated with pain. Patients and Methods: All patients with a TFCC lesion who were treated arthroscopically at our hospital between January 2012 and December 2016 were retrospectively enrolled. Seventeen patients with complete data sets were enrolled. Post-operative MRI examinations needed to be performed within 24 months after arthroscopy. The mean magnet resonance imaging (MRI) follow-up was 22 months. The average clinical follow-up was 27.3 months. Age, gender, pain level, PROM scores (Munich Wrist Questionnaire, MWQ), follow-up interval, and TFCC classification (Palmer) were documented. The patients underwent a clinical examination and MR imaging. Results: Ten patients (59%) had scar tissue at the triangular fibrocartilaginous complex (TFCC) and nine (53%) had an effusion in the ulnar recess. These findings were not necessarily associated with pain, as six patients without pain and four with pain had scar tissue at the TFCC and six patients without pain and three with pain showed an effusion in the ulnar recessus. Bone marrow edema could be found in the lunate of five patients (29%) (three with pain, two without pain) and in the distal radial ulnar joint (DRUJ) of one patient (6%) with pain. However, typical degenerative changes were not necessarily associated with pain. Conclusions: This present study is the first study correlating postoperative MRI findings after arthroscopic assisted TFCC surgery with both pain and function. Bone edema seems to be associated with pain, whereas scarring at the TFCC is visible on MRI but is not necessarily associated with pain. Full article
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12 pages, 5179 KiB  
Article
TRPC6 in Human Peripheral Nerves—An Investigation Using Immunohistochemistry
by Cedric Raming, Carola Meier and Thomas Tschernig
NeuroSci 2025, 6(2), 44; https://doi.org/10.3390/neurosci6020044 - 19 May 2025
Viewed by 882
Abstract
Since its discovery, TRPC6 has been associated with a variety of physiological and pathophysiological processes in different tissues. It functions as a non-selective cation channel and belongs to the group of TRP channels. Its importance in the development of pain hypersensitivity is becoming [...] Read more.
Since its discovery, TRPC6 has been associated with a variety of physiological and pathophysiological processes in different tissues. It functions as a non-selective cation channel and belongs to the group of TRP channels. Its importance in the development of pain hypersensitivity is becoming increasingly apparent. This condition has already been associated with increased expression of TRPC6 in dorsal root ganglia. Apart from the fact that most of the evidence has been obtained from samples of animal origin, it remains unclear whether the channel is also expressed in peripheral nerves outside the dorsal root ganglia. The aim of this work was therefore to examine peripheral nerves from human samples for TRPC6. For this purpose, samples of both the sciatic and ulnar nerves were taken from a total of eight body donors and analyzed by immunohistochemistry. Both longitudinal and transverse sections were obtained from the samples and stained. In total, 43 of 48 histological sections showed a positive immunosignal. There were no major differences between the sciatic and ulnar nerves with regard to staining. There was a slight difference in the staining intensity of transverse and longitudinal sections. The longitudinal sections of both nerves were consistently colored slightly more intensely. However, the inter-individual differences between the donors were more pronounced. Interestingly, the samples of a donor who suffered from chronic pain syndrome during his lifetime were particularly strongly stained. This is consistent with the knowledge gained to date, largely from animal experiments, that the channel shows increased expression in pain conditions in dorsal root ganglia. In the future, TRPC6 could therefore be a target in pain therapy. Full article
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9 pages, 3329 KiB  
Case Report
Brachial Plexus Abnormalities with Delayed Median Nerve Root Convergence: A Cadaveric Case Report
by Austin Lawrence, Nathaniel B. Dusseau, Alina Torres Marquez, Cecilia Tompkins, Eunice Obi and Adel Maklad
Anatomia 2025, 4(2), 7; https://doi.org/10.3390/anatomia4020007 - 12 May 2025
Viewed by 551
Abstract
Background: The brachial plexus is a network of nerves responsible for the motor and sensory innervation of the upper limb. Variations in the formation and course of the brachial plexus are well documented, though combinations of multiple unilateral abnormalities are rare. The complex [...] Read more.
Background: The brachial plexus is a network of nerves responsible for the motor and sensory innervation of the upper limb. Variations in the formation and course of the brachial plexus are well documented, though combinations of multiple unilateral abnormalities are rare. The complex pathology of this structure nerve may result in clinical consequences. We present a unique set of brachial plexus abnormalities involving the C4–C6 nerve roots, superior and middle trunks, additional communicating branches, and delayed median nerve union. Case Presentation: During the routine dissection of a 70-year-old female cadaver, several unique variations in the brachial plexus anatomy were identified. The C4 root contributed to C5 before the superior trunk formed, resulting in a superior trunk composed of C4–C6. The C5 root was located anterior to the anterior scalene muscle, whereas C6 maintained its usual posterior position. Additionally, an anterior communicating branch from the middle trunk to the posterior cord was observed. A communicating branch between the lateral and medial cords split into two terminal branches: one merged with the ulnar nerve, and the other joined the medial contribution of the median nerve. The median nerve contributions from the lateral and medial cords merged approximately two inches above the elbow. Conclusions: This rare combination of brachial plexus anomalies has not been previously described in the literature and is of significant clinical relevance. The additional anterior communicating branch from the middle trunk may suggest potential flexor muscle innervation by the posterior cord, which typically innervates extensor muscles. Additionally, the delayed convergence of the median nerve may provide a protective mechanism in cases of midshaft humeral fracture. Awareness of these peripheral nerve abnormalities is important for diagnostic imaging, surgery, or peripheral nerve blocks. Knowledge of such variations is critical for clinicians managing upper limb pathologies. Full article
(This article belongs to the Special Issue From Anatomy to Clinical Neurosciences)
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16 pages, 10161 KiB  
Article
Optimizing Wound Healing in Radial Forearm Donor Sites: A Comparative Study of Ulnar-Based Flap and Split-Thickness Skin Grafting
by Adam Galazka, Katarzyna Stawarz, Karolina Bienkowska-Pluta, Monika Paszkowska and Magdalena Misiak-Galazka
Biomedicines 2025, 13(5), 1131; https://doi.org/10.3390/biomedicines13051131 - 7 May 2025
Viewed by 795
Abstract
Background: The radial forearm free flap (RFFF) is a common technique in head and neck reconstructive surgery. This study aimed to compare the clinical and biochemical outcomes of wound healing following ulnar-based transposition flap (UBTF) versus split-thickness skin grafting (STSG) for donor site [...] Read more.
Background: The radial forearm free flap (RFFF) is a common technique in head and neck reconstructive surgery. This study aimed to compare the clinical and biochemical outcomes of wound healing following ulnar-based transposition flap (UBTF) versus split-thickness skin grafting (STSG) for donor site closure, with a particular emphasis on tissue regeneration. Materials and Methods: A total of 24 patients (6 women, 18 men), underwent RFFF reconstruction. The donor site was closed using the UBTF technique in 10 cases, while STSG was performed in 14 cases. Postoperative complications—including necrosis, edema, hematoma, infection, and wound dehiscence—along with healing times were assessed daily during the first seven postoperative days and at monthly follow-ups over six months. Pre- and postoperative biochemical analyses included hemoglobin (HB), white blood cell count (WBC), platelets (PLT), albumin, and C-reactive protein (CRP) levels. An aesthetic evaluation of the flap was also performed. Results: The two groups were homogeneous. Postoperative complications occurred more frequently in the STSG group, which also demonstrated significantly longer healing times (p = 0.0004). In contrast, the UBTF group showed significantly better aesthetic outcomes in terms of skin color (p = 0.000021), skin texture (p = 0.000018), and flap stability (p = 0.0398). Additionally, pre- and postoperative PLT counts were significantly higher in the UBTF group (p = 0.001 and p = 0.043, respectively). Conclusions: While STSG remains a well-established method for forearm donor site closure following RFFF harvest, this study demonstrates that UBTF is a viable alternative associated with better clinical and aesthetic outcomes. Full article
(This article belongs to the Special Issue Wound Healing: From Basic to Clinical Research)
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14 pages, 1598 KiB  
Review
Modern Treatment of Supracondylar Humeral Fractures in Children
by Adrian Surd, Rodica Muresan, Carmen Iulia Ciongradi, Lucia Maria Sur, Lucia Raluca Ardelean, Lia Oxana Usatiuc, Kriszta Snakovszki, Camelia Munteanu and Ioan Sârbu
Children 2025, 12(5), 556; https://doi.org/10.3390/children12050556 - 25 Apr 2025
Cited by 1 | Viewed by 1151
Abstract
Supracondylar humeral fractures are the most common type of elbow fractures in children. The treatment methods vary depending on the type of fracture (Gartland classification), which can be conservative or surgical. There is no clear consensus or guidelines to dictate the treatment of [...] Read more.
Supracondylar humeral fractures are the most common type of elbow fractures in children. The treatment methods vary depending on the type of fracture (Gartland classification), which can be conservative or surgical. There is no clear consensus or guidelines to dictate the treatment of complicated supracondylar humeral fractures (Gartland types II and III). Gartland type II and III fractures are most frequently treated with closed reduction and percutaneous Kirchner-wire pinning or open reduction with K-wire pinning, depending on the degree of displacement and the orthopedic surgeon’s preference. Most studies recommend avoiding open reduction because of prolonged hospitalization and higher rates of complications. Orthopedic surgeons have different opinions regarding the Kirschner pin placement technique. Studies suggest that only lateral pinning is safe and effective, but medial and lateral pinning is proven to give more stability; there is always a risk of iatrogenic ulnar nerve damage during surgery. Modern treatment of supracondylar humeral fracture in children should focus on minimally invasive techniques and avoid open reduction, when possible, to ensure the best outcome for the patients. This scoping review’s purpose is to gather the available information on the topic in one place and to underline the lack of clear protocols. Full article
(This article belongs to the Special Issue Pediatric Orthopedic Injuries: Diagnosis and Treatment)
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