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Peripheral neuropathy (PN) is a severe and frequent complication of obesity, prediabetes, and type 2 diabetes characterized by progressive distal-to-proximal peripheral nerve degeneration. However, a comprehensive understanding of the mechanisms underlying PN, and whether these mechanisms change during PN progression, is currently lacking. Here, gene expression data were obtained from distal (sciatic nerve; SCN) and proximal (dorsal root ganglia; DRG) injury sites of a high-fat diet (HFD)-induced mouse model of obesity/prediabetes at early and late disease stages. Self-organizing map and differentially expressed gene analyses followed by pathway enrichment analysis identified genes and pathways altered across disease stage and injury site. Pathways related to immune response, inflammation, and glucose and lipid metabolism were consistently dysregulated with HFD-induced PN, irrespective of injury site. However, regulation of oxidative stress was unique to the SCN while dysregulated Hippo and Notch signaling were only observed in the DRG. The role of the immune system and inflammation in disease progression was supported by an increase in the percentage of immune cells in the SCN with PN progression. Finally, when comparing these data to transcriptomic signatures from human patients with PN, we observed conserved pathways related to metabolic dysregulation across species, highlighting the translational relevance of our mouse data. Our findings demonstrate that PN is associated with distinct site-specific molecular re-programming in the peripheral nervous system, identifying novel, clinically relevant therapeutic targets. [ABSTRACT FROM AUTHOR]

The major peripheral nerves supplying motor and sensory function to the forearm and hand traverse the elbow joint. The complex anatomical relationships of these nerves to the joint and its surrounding musculotendinous structures creates a series of sites where these nerves are vulnerable to compression. Compression syndromes result in distressing constellations of pain, paraesthesia, weakness and loss of coordinated motor function. This article discusses the anatomy and pathophysiology of compressive neuropathies around the elbow joint, their presentation, how they are investigated and diagnosed, and the available management options. [ABSTRACT FROM AUTHOR]

This study was a scoping review. Continued advances in musculoskeletal sonography technology and access have increased the feasibility of point-of-care use to support day-to-day clinical care and decision-making. Sonography can help improve therapeutic outcomes in upper extremity (UE) rehabilitation by enabling clinicians to visualize underlying structures during treatment. This study aimed to (1) evaluate the growth, range, extent, and composition of sonography literature supporting UE rehabilitation; (2) identify trends, gaps, and opportunities with regard to anatomic areas and diagnoses examined and ultrasound techniques used; and (3) evaluate potential research and practice utility. Searches were completed in PubMed, CINAHL, SPORTDiscus, PsycINFO, and BIOSIS. We included data-driven articles using ultrasound imaging for upper extremity structures in rehabilitation-related conditions. Articles directly applicable to UE rehabilitation were labeled direct articles, while those requiring translation were labeled indirect articles. Articles were further categorized by ultrasound imaging purpose. Article content between the two groups was descriptively compared, and direct articles underwent an evaluation of evidence levels and narrative synthesis to explore potential clinical utility. Average publication rates for the final included articles (n = 337) steadily increased. Indirect articles (n = 288) used sonography to explore condition etiology, assess measurement properties, inform medical procedure choice, and grade condition severity. Direct articles (n = 49) used sonography to assess outcomes, inform clinical reasoning, and aid intervention delivery. Acute UE conditions and emerging sonography technology were rarely examined, while tendon, muscle, and soft tissue conditions and grayscale imaging were common. Rheumatic and peripheral nerve conditions and Doppler imaging were more prevalent in indirect than direct articles. Among reported sonography service providers, there was a high proportion of nonradiologist clinicians. Sonography literature for UE rehabilitation demonstrates potential utility in evaluating outcomes, informing clinical reasoning, and assisting intervention delivery. A large peripheral knowledge base provides opportunities for clinical applications; however, further research is needed to determine clinical efficacy and impact for specific applications. • Sonography is used to examine a range of UE conditions, structures, and etiologies. • Sonography demonstrates preliminary utility in UE rehabilitation and research. • A large body of knowledge is available to inform innovative clinical applications. • Further research is needed to determine specific clinical efficacy and impact. [ABSTRACT FROM AUTHOR]

Copyright of Zentralblatt fuer Arbeitsmedizin, Arbeitsschutz und Ergonomie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: Diabetic foot syndrome is becoming increasingly common in India with a prevalence ranging from 24.9% to 49%. Diabetic foot syndrome patients have an increased likelihood of developing ulcers in their feet. Accordingly, this study evaluates the influence of photobiomodulation on altered plantar pressure distribution and ankle biomechanics in individuals with diabetic foot syndrome. Methods: A total of 20 diabetic foot syndrome patients with an absence of 10 g monofilament in one out of six sites at the plantar surface of feet, a biothesiometer for vibration perception threshold of >20 V, and diminished or absent ankle reflexes were included. The evaluation of ankle biomechanics was performed by SIMI motion analysis. In addition, the plantar pressure distribution was measured by the WinTrack pressure platform at baseline and the end of 10 sessions. They were treated with scanning mode on the foot plantar surface and probe laser at the popliteal fossa region for three sessions per week, for ten sessions. Results: Plantar pressure parameters were significantly improved (P<0.01) and ankle biomechanics (P<0.01) after the intervention, respectively, except for no significant difference in the total contact area and ankle midstance kinematics. Discussion: Photobiomodulation therapy can be an effective treatment for improving foot plantar pressure redistribution and ankle biomechanics in individuals with diabetic foot syndrome [ABSTRACT FROM AUTHOR]

Background: Leprosy is an age-old chronic infectious disease with the majority of annual new case detections from South-East Asia. The disease manifestations coupled with the stigma attached to it often creates grave socioeconomic problems. Leprosy is curable and if detected and treated in the early stages can prevent disability. Ultrasonography provides information regarding location and degree of the nerve damage, nerve morphologic alterations, echo texture, fascicular pattern and vascularity. The aim of this study was to study the ultrasonographic features of neuropathy in leprosy with electrophysiologic correlation. Results: A total of 34 histopathological proven cases of leprosy were included in this study, which was conducted for 1 year. High-resolution ultrasound (HRUS) of a total of 204 peripheral nerves in these 34 patients, including bilateral ulnar, median and common peroneal nerves, was performed. Cross-sectional areas, nerve diameters, nerve morphology and vascularity were noted and correlated with electrophysiologic study of these nerves. The results showed that all the patients having reduced motor or sensory function [decreased compound muscle action potential (CMAP), decreased compound nerve action potential (SNAP) and increased latency] in ulnar and common peroneal nerves were thickened on HRUS (100% in ulnar and common peroneal nerves) while 92% right median and 89% left median nerves with reduced motor or sensory function showed thickening on HRUS. Also, 5.8% ulnar nerves and 11.7% common peroneal nerves showed thickening on HRUS; however, sensory or motor conduction of these nerves was unaffected on nerve conduction study (NCS). So, a positive correlation was observed for nerve involvement as detected by ultrasonographic findings of nerve hypertrophy and the electrophysiologic study. The most common finding was focal or diffuse nerve thickening. Ulnar nerve was the most commonly thickened nerve in leprosy patients with the most common location of nerve thickening at medial epicondyle. Conclusions: Ultrasound and electrophysiologic study of peripheral nerves in leprosy are complimentary to each other in diagnosing leprotic neuropathy. [ABSTRACT FROM AUTHOR]

Percutaneous Achilles tendon lengthening is an effective surgical procedure to treat and prevent forefoot and midfoot ulcerations in patients with diabetes. Patients with diabetes are prone to plantar ulcerations due to a combination of factors, such as peripheral neuropathy, decreased tendon elasticity, peripheral vascular disease, and hyperglycemia. Complications such as re-ulceration and transfer lesion to the heel, associated with a calcaneal gait secondary to over-lengthening, are possible with percutaneous Achilles tendon lengthening. Although percutaneous Achilles tendon lengthening is well accepted, the overall incidence of complication has not been well described. A systematic review of the reported data was performed to determine the incidence of complication for percutaneous tendo-Achilles lengthening when used for the treatment and prevention of diabetic plantar ulcerations. Nine studies involving 490 percutaneous lengthening procedures met the inclusion criteria. The overall complication rate was 27.8% (8% with transfer heel ulcerations). Given the high rate of complications associated with a percutaneous Achilles tendon lengthening, careful patient selection and consideration of these risks should be considered prior to proceeding with this procedure. Additional prospective comparative analyses with standardization of surgical technique, degrees of lengthening achieved, and post-operative weightbearing and immobilization modalities are needed to decrease incidence of complication and achieve higher healing rates. [ABSTRACT FROM AUTHOR]

Liver transplantation is the ideal treatment of choice for Familial amyloid polyneuropathy (FAP). It is known that during transplantation surgery, this explant liver which will be removed from amyloid patient can be used as a domino graft for another suitable recipient. Even after successful results of domino liver transplantation in deceased donation setting this procedure is always seen with a fear of putting both the recipients at risk due to technical challenge. With living donor as the liver donor for the amyloid patient, the challenges faced are even higher. Only few centres have done similar surgeries and there are no standard guidelines for the same. The anatomical prerequisites, technique, and indications of domino orthotopic liver transplant (D-OLT) in live donation settling are still evolving. We here report a case of live donor liver transplant from a 38 year old with a Right lobe graft for a 40 year old with FAP along with D-OLT for a 52 year old with HBV related decompensated chronic liver disease with HCC. We have described the technical challenges and learnings in our first case which is one of few cases done in the Indian Subcontinent. [ABSTRACT FROM AUTHOR]

Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Context: Chemotherapy Treatment-Induced Peripheral Neuropathy (CIPN), is a significant side effect of anti-neoplastic treatment faced by cancer patients. CIPN results in sensory-motor deficiencies, altered proprioceptive signals, and poor posture control, increasing the risk of fall. Modified trampoline training is a recent rehabilitation method that can stimulate proprioception. However, its effects in cancer patients with CIN remain unexplored. The study's objective was to examine and compare the effects of Modified Trampoline Training (MTT) and Conventional Proprioception Training (CPT) on balance in cancer patients with CIPN. Study Designs and Settings: This randomized controlled trial was conducted in the tertiary care center, Miraj. Methods: The study included male and female patients aged between 41-60 years, suffering from colorectal cancer who are receiving or have received chemotherapy and were experiencing the symptoms of CIPN. A total of 26 patients were divided into two equal groups. Group A received MTT and Group B received CPT for 3 days/week for 4 weeks. The outcome measure was balance which was assessed using the Berg Balance Scale (BBS) and Timed Upand-Go test (TUG). Statistical analysis: The data was analyzed using paired and independent t-tests for within and between groups respectively. Results: Within-group analysis showed statistically significant improvement in all the outcomes for both groups (p<0.01). Between groups, the analysis revealed that the MTT group showed better improvement for BSS (p<0.0) and TUG (p = 0.01) than the control group. Conclusion: The study concluded that MTT is more effective than CPT in improving balance in cancer patients with CIPN. [ABSTRACT FROM AUTHOR]

Importance: Handedness and motor asymmetry are important features of occupational performance. With an increased understanding of the basic neural mechanisms surrounding handedness, clinicians will be better able to implement targeted, evidence-based neurorehabilitation interventions to promote functional independence. Objective: To review the basic neural mechanisms behind handedness and their implications for central and peripheral nervous system injury. Data Sources: Relevant published literature obtained via MEDLINE. Findings: Handedness, along with performance asymmetries observed between the dominant and nondominant hands, may be due to hemispheric specializations for motor control. These specializations contribute to predictable motor control deficits that are dependent on which hemisphere or limb has been affected. Clinical practice recommendations for occupational therapists and other rehabilitation specialists are presented. Conclusions and Relevance: It is vital that occupational therapists and other rehabilitation specialists consider handedness and hemispheric lateralization during evaluation and treatment. With an increased understanding of the basic neural mechanisms surrounding handedness, clinicians will be better able to implement targeted, evidence-based neurorehabilitation interventions to promote functional independence. Plain-Language Summary: The goal of this narrative review is to increase clinicians' understanding of the basic neural mechanisms related to handedness (the tendency to select one hand over the other for specific tasks) and their implications for central and peripheral nervous system injury and rehabilitation. An enhanced understanding of these mechanisms may allow clinicians to better tailor neurorehabilitation interventions to address motor deficits and promote functional independence. This rapid review examines the basic neural mechanisms behind handedness and their implications for central and peripheral nervous system injury and rehabilitation. [ABSTRACT FROM AUTHOR]

To investigate the frequency, characteristics, and associated factors of systemic lupus erythematosus-related peripheral neuropathy (SLE-PN) using nerve conduction study (NCS). A retrospective chart review was conducted at the Rheumatology clinics of King Abdulaziz University Hospital, Jeddah, Saudi Arabia from 2016 to 2020. Eligibility included systemic lupus erythematosus (SLE) diagnosed patients with at least one NCS result in their clinical records. Demographic, clinical, and biological characteristics were collected. Among 101 female SLE patients, abnormal NCS findings were observed in 11 (10.9%) patients. Of those with abnormal NCS, 27.3% showed mixed axonal and demyelinated motor neuropathy, 18.2% had sensory-motor axonal neuropathy, another 18.2% presented with axonal left common peroneal neuropathy, and the same percentage was observed for axonal sensory neuropathy. Comparisons between abnormal and normal NCS groups in a study population revealed that the abnormal NCS group had significantly higher proportions of non-Saudi nationality, lupus nephritis, seizures, and high SLICC DI. Furthermore, this group was associated with higher ANA titers and exhibited a non-significant trend towards increased positive anti-DNA frequency. Multivariate analysis identified non-Saudi nationality and the presence of end-organ damage as two significant predictors of SLE-related PN. Peripheral neuropathy in SLE patients in Saudi Arabia is not uncommon, specifically those with heightened disease activity, organ damage, or disadvantaged socioeconomic backgrounds. Predominantly, the condition presents as axonopathy impacting sensory nerves, with possible motor involvement. The critical role of electrophysiological studies in early detection and improved patient management is high lightened. [ABSTRACT FROM AUTHOR]

A 30-year-old male patient presented to the eye department with complaints of blurring of vision of right eye at distance and near for a duration of 1.5 months. Ocular examination revealed Anisocoria with enlarged pupil in the right eye. On instillation of 0.1% pilocarpine, there was a pronounced miosis in the dilated pupil seen at 30 min associated with an improvement in distance and near vision. On slit lamp examination, vermiform movements were seen in the affected pupil on shining the slit from temporal aspect. Fundus examination was within normal limits. Systemic examination revealed absent deep tendon reflexes. Based on the clinical features, a diagnosis of Holmes-Adie syndrome was reached and the patient was started on 0.1% pilocarpine eye drops. This case highlights the importance of thorough systemic examination and investigations in all cases of anisocoria. [ABSTRACT FROM AUTHOR]

Dysesthesia is an abnormal sensation in the skin that occurs in the absence of any extraordinary stimulus or other primary cutaneous disorders, excluding any delusions or tactile hallucinations. Clinicians have characterized dysesthesias to include sensations such as burning, tingling, pruritus, allodynia, hyperesthesia, or anesthesia. The etiology and pathogenesis of various generalized dysesthesias is largely unknown, though many dysesthesias have been associated with systemic pathologies including malignancy, infection, autoimmune disorders, and neuropathies. Dermatologists are often the first-line clinicians for patients presenting with such cutaneous findings, thus it is crucial for these physicians to be able to methodically work-up generalized dysesthesias to build a working differential diagnosis, follow up with key labs and/or imaging, and offer patients evidence-based treatment to relieve their symptoms. This broad literature review is an attempt to centralize key studies, cases, and series to help guide dermatologists in their assessment and evaluation of complaints of abnormal cutaneous sensations. [ABSTRACT FROM AUTHOR]

Background: Myelin oligodendrocyte glycoprotein antibody-associated disease is usually associated with optic neuritis, acute disseminated encephalomyelitis or transverse myelitis. We are presenting a rare case report wherein myelin oligodendrocyte glycoprotein antibody seropositivity was associated with hemorrhagic longitudinally extensive transverse myelitis. To our knowledge, no such cases were found to be published. Case presentation: A 15-year-old female came with complaints of sudden onset paraparesis. MRI was performed within 48 h from the episode of paraparesis, which revealed a long-segment, intramedullary, expansile and heterogeneously enhancing spinal cord lesion extending from T1 vertebral level up to conus medullaris. Few foci of blooming were also noted within the spinal cord on gradient sequences. Laboratory evaluation of cerebrospinal fluid analysis revealed no significant abnormality. Neuromyelitis optica antibodies were negative, and myelin oligodendrocyte glycoprotein antibodies (MOG) showed seropositivity. The patient was started on methylprednisolone and plasmapheresis for the same after which the patient gradually improved and regained her ability to walk. Follow-up MRI was performed after 4 weeks, which revealed significant reduction in the extent of the intramedullary lesion described earlier. Conclusions: Hemorrhagic longitudinally extensive transverse myelitis without any involvement of optic nerves and brain may show MOG seropositivity, and it should be considered as one of the differential diagnosis in acute myelopathy. [ABSTRACT FROM AUTHOR]

Fractures of the humeral shaft are relatively common and can occur in any age group. The anatomy of the humeral shaft is vital to understand, in order to plan management of these fractures: the relationship of the radial nerve with the humeral shaft in particular, plays an important role in these fractures. Though non-operative measures are employed for humeral shaft fractures routinely, there are some indications for operative management. There remain a variety of operative interventions available to the surgeon, all with associated pros and cons. This review aims to look in detail at the fracture types, the evidence and surgical methods including a discussion about the complications, particularly a radial nerve palsy. [ABSTRACT FROM AUTHOR]

The evaluation of peripheral neuropathy in children receiving Vincristine treatment is challenging. This study examined the Turkish validity and reliability of the Total Neuropathy Score-Pediatric Vincristine (TNS-PV) measurement tool, which can measure Vincristine-induced peripheral neuropathy symptoms in children with cancer. A total of 53 children aged 5–17 years who received Vincristine treatment in two pediatric hematology-oncology centers participated in the study. Data was collected using the Total Neuropathy Score-Pediatric Vincristine (TNS-PV), the Common Terminology Criteria for Adverse Events (CTCAE), the Wong-Baker FACES Pain Scale, and the Adolescent Pediatric Pain Tool (APPT). The correlation between the TNS-PV total score and other scales and the inter-rater reliability coefficient was evaluated. Of the children, 81.1% were diagnosed with ALL and 13.2% with Ewing Sarcoma. Cronbach's alpha values of form A and B of the TNS-PV scale were 0.628 and 0.639, respectively. As the cumulative Vincristine dose increased, the children's scores on TNS-PV were higher. A moderate and significant positive correlation was found between the TNS-PV form A total score and the worst subjective symptoms a, b (A), strength, tendon reflexes, and autonomic / constipation (r = 0.441, r = 0.545, r = 0.472, r = 0.536, p < 0.01). The TNS-PV form B total score was found to have a moderate level, significant correlation with CTCAE sensory neuropathy score and Wong-Baker FACES Pain Scale, and a high level, significant positive correlation with CTCAE motor neuropathy score. The TNS-PV is valid and reliable for measuring Vincristine-induced peripheral neuropathy in practice in Turkish children 5 years and older. [ABSTRACT FROM AUTHOR]

Background: Peripheral neuropathy is a result of damage to the nerves located outside of the brain and spinal cord. Over all prevalence in India varies from 5 - 2400 per 10,000 populations. Diabetic neuropathy is the most common type. Kinesthesia is the ability to sense the motion of a joint or limb. It is primarily influenced by muscle spindles and secondarily influenced by skin receptors and joint receptors. Objectives: To determine the effectiveness of sensory integration on kinesthesia in peripheral neuropathy and to compare the effect of sensory integration with conventional therapy on kinesthesia in peripheral neuropathy. Materials And Methods: This was an experimental study conducted on 68 subjects in which Group A received conventional therapy (control) and another group received sensory integration along with conventional therapy (experimental). Simple Random Sampling technique was used. Pre intervention assessment was done and treatment was given for 6 weeks. Post intervention assessment was done with help of outcome measures. Statistical analysis was done using students t test. Results:Among the 68 subjects, Group B which received sensory integration along with conventional therapy showed extremely significant improvement in impaired kinesthesia. In the Weber two point discrimination test, the post intervention comparison (8.6 with group A and 5.98 with group B) showed that group was extremely significant in improving joint position sense. In joint position sense for plantar flexion and dorsiflexion, Group B showed extremely proximate results to range which was asked and the range which was performed by the subjects. Conclusion: Sensory integration therapy was found to be significantly effective on impaired kinesthesia in peripheral neuropathy. [ABSTRACT FROM AUTHOR]

In preclinical research, etodolac, a non-steroidal anti-inflammatory drug, affected transient receptor potential ankyrin 1 (TRPA1) activation. Yet, whether the in vitro interaction between etodolac and TRPA1 translates to altered TRPA1 functionality in vivo in human remains to be investigated. A randomized, double-blinded, celecoxib-controlled study was conducted to assess the effect of etodolac on TRPA1-mediated dermal blood flow (DBF) changes on the forearm of 15 healthy, male volunteers aged between 18 and 45 years. Over four study visits, separated by at least five days wash-out, a single or four-fold dose of etodolac 200 mg or celecoxib 200 mg was administered orally. Two hours post-dose, TRPA1 functionality was evaluated by assessing cinnamaldehyde-induced DBF changes. DBF changes were quantified and expressed in Perfusion Units (PUs) using laser Doppler imaging during 60 min post-cinnamaldehyde application. The corresponding area under the curve (AUC0–60min) was calculated as summary measure. Statistical analysis was performed using Linear mixed models with post-hoc Dunnett. Neither the single dose of etodolac nor celecoxib inhibited the cinnamaldehyde-induced DBF changes compared to no treatment (AUC0–60min ± SEM of 17,751 ± 1,514 PUs*min and 17,532 ± 1,706 PUs*min vs. 19,274 ± 1,031 PUs*min, respectively, both p=1.00). Similarly, also a four-fold dose of both compounds failed to inhibit the cinnamaldehyde-induced DBF changes (19,235 ± 1,260 PUs*min and 19,367 ± 1,085 PUs*min vs. 19,274 ± 1,031 PUs*min, respectively, both p=1.00). Etodolac did not affect the cinnamaldehyde-induced DBF changes, suggesting that it does not alter TRPA1 functionality in vivo in human. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the effects of Buddhist walking meditation on diabetic neuropathy and blood sugar and cortisol levels in middle-aged patients with type 2 diabetes. The subjects were patients with type 2 diabetes aged 35 to 55 years. They were randomly allocated into the Walking Meditation (WM), Traditional Walking (TW), and Control Groups, with 15 subjects in each Group. During the study, six subjects completed less than 80% of the exercise program due to coronavirus infections and quarantine. There were 11, 13, and 15 participants in the Walking Meditation Group, the Traditional Walking Group, and the Control Group, respectively. HbA1c levels decreased significantly in both the WM and TW Groups, but blood sugar levels decreased significantly only in the WM Group. The percentage of blood sugar and HbA1c levels showed the greatest improvement in the WM Group. Significant improvement in diabetic neuropathy was observed in the WM Group. Compared with the Control Group, the results suggest that Buddhist WM is a new treatment and prevention method with an easy and low-intensity form of exercise that is suitable for middle-aged patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]

The lumbosacral plexus originates from the anterior rami of the lumbar and sacral nerve roots forming a network of nerves which supply the lower half of the body. The lumbar plexus (L1–L4) is situated within the upper two-thirds of psoas major and gives rise to the iliohypogastric nerve, ilioinguinal nerve, genitofemoral nerve, lateral femoral cutaneous nerve, femoral nerve and obturator nerve. The sacral plexus (L4–S4) is located within the pelvis and gives rise to the superior gluteal nerve, inferior gluteal nerve, sciatic nerve, posterior cutaneous nerve, perforating cutaneous nerve and the pudendal nerve. Peripheral neuropathy of these nerves may occur from an autoimmune, inflammatory, endocrine, infective, congenital, traumatic, neoplastic, vascular, degenerative or metabolic cause. This article will give an overview of the relevant anatomy of the lumbosacral plexus and neuropathies which affect the peripheral nerves of the lower limb. [ABSTRACT FROM AUTHOR]

Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

• Data on Peripheral neuropathies (PN) in sub-Saharan African region are scarce. • Population-based study was performed to explore factors associated with PN. • The overall prevalence of PN was high (6.9%). • Polyneuropathy was the most common PN (4.8%). • Older age, diabetes, and hypertension were independently associated with PN. Peripheral neuropathies (PN) are a group of neurological conditions related to damage to the peripheral nervous system. Due to their wide diversity, few studies in sub-Saharan Africa have explored their epidemiology in general population. Our objective was to study the prevalence and associated factors with PN in general population in Adjohoun in Benin. A cross-sectional study has been conducted from February to March 2019 and included people aged ≥ 18 years old living in Adjohoun, Benin. Following a screening phase for PN (using World Health Organization questionnaire for major neurological diseases), a neurologist made a diagnosis after in-depth clinical examinations completed in some cases by electroneuromyography. The EFNS (European Federation of Neurological Societies) 2010 criteria was used for chronic inflammatory demyelinating polyneuropathy diagnosis. Data such as age, occupation, consanguinity, alcohol consumption, diabetes, hypertension were collected. Association between independent variables and PN were investigated using multivariable logistic regression models. In total, 1 655 participants were included, mean age 41.4 ± 16.7 years; 64.8 % are female. The overall prevalence of PN was 6.9 % (95 %CI: 5.7 %-8.2 %). The main types of PN were: polyneuropathies 4.8 % (95 %CI: 3.8 %-5.9 %); polyradiculoneuropathies 1.6 % (95 %CI: 1.0 %-2.2 %). Factors independently associated with PN were age ≥ 40 years (adjusted Odds Ratio aOR = 19.6; 95 %CI: 8.2–46.3), diabetes (aOR = 1.8; 95 %CI: 1.08–2.99) and hypertension (aOR = 1.6; 95 %CI: 1.02–2.5). The prevalence of PN was high in the rural commune of Adjohoun in Benin. Actions on its modifiable associated factors such as diabetes and hypertension could help reduce the proportion of PN and their potential harmful consequences. [ABSTRACT FROM AUTHOR]

Evaluation of chemotherapy-induced peripheral neuropathy has gained importance in symptom management of pediatric patients with cancer. This study aimed to perform the Turkish validity and reliability study of the Pediatric-Modified Total Neuropathy Score (Ped-mTNS). A methodological, descriptive, and cross-sectional design was used in the study. Forty children aged between 5 and 18 and were treated for cancer and 40 age- and gender-matched healthy children (control group) were included in the study. The mean scores of the items on the Ped-mTNS were compared, and item-total score correlations were evaluated. Cronbach's alpha coefficient of the Ped-mTNS was calculated for internal consistency. Cronbach's alpha value of the scale was found as 0.709. The item-total correlations of the scale items ranged from 0.260 to 0.658. The mean score of cancer patients on the Ped-mTNS was found as 4.4 ± 3.8. Ped-mTNS scores of children with cancer indicated more deficits than those of the control group. In the evaluation of children in the patient and control groups, a difference was found in terms of light touch sensation, which is one of the sensory symptoms in the items of the Ped-mTNS, and pin sensibility and strength, which are among the clinical symptoms. The Ped-mTNS was determined to be a valid and reliable measurement tool for children with cancer aged between 5 and 18 in the Turkish population. [ABSTRACT FROM AUTHOR]

Clostridium perfringens toxinotype E infections are rare in calves, and the development of intestinal lesions were commonly observed. In 2012, a 6-day-old calf in Japan exhibited swelling with emphysema on the right gluteal region, sudden paralysis of the hind limb and dysstasia. A pathological examination revealed myositis of the gluteal muscle and neuritis of the ischiatic nerve. C. perfringens type E strain CP118 was isolated from the affected muscle. However, the intestinal symptoms and lesions that commonly develop in type E infections in calves were not detected in the present case. Genome analyses revealed that CP118 possessed 16 virulence-related genes, including enterotoxin, and was closely related to other type E and F strains. Particularly, CP118 was more closely related to type E strains from humans, including a food poisoning case, than calf isolates, suggesting its potential to cause food poisoning in humans and, thus, its importance as a potential risk to public health. Since CP118 did not possess the reported toxin genes associated with neuropathy, pyogenic inflammation caused by CP118 and/or other bacteria may have damaged the ischiatic nerve, resulting in neuropathy. Alternatively, unidentified CP118 toxins may have caused the neuropathy. This is the first study to report C. perfringens type E infection with peripheral neuropathy. The distribution of all the reported virulence-related genes in the C. perfringens population as well as the details of this rare case will provide further insights into C. perfringens type E infections. [ABSTRACT FROM AUTHOR]

* SYNOPSIS: Neurological testing is essential for screening and diagnosing suspected peripheral neuropathies. Detecting changes in somatosensory and motor nerve function can also have direct implications for management decisions. Nevertheless, there is considerable variation in what is included in a bedside neurological examination and how it is performed. Neurological examinations are often used as screening tools to detect neurological deficits but not used to their full potential for monitoring progress or deterioration. Here, we advocate for better use of the neurological examination within a clinical reasoning framework. Constrained by the lack of research in this field, our Viewpoint is based on neuroscientific principles. We highlight 6 challenges for clinicians when conducting neurological examinations and propose ways to overcome these challenges in clinical practice. We challenge widely held ideas about how the results of neurological examinations for peripheral neuropathies are interpreted and how the examinations are performed in practice. [ABSTRACT FROM AUTHOR]

Background: Skin dimples at specific sites of the body at birth are a clue to underlying congenital malformation and intimate the need for extensive evaluation. A midline dimple in the spinal region may be a sign of occult spinal dysraphism in a neonate. Methods: A toddler presented with clinical symptoms and signs of acute paraparesis. The child also had thoracic dermal sinus on clinical examination. The child was evaluated with hematological and radiological investigations to diagnose the cause of acute paraparesis. Results: Hematological investigations were normal. Magnetic resonance imaging of the spine showed an intramedullary epidermoid cyst at the D1 vertebral level to D4 vertebral level with dorsal dermal sinus at the D3 vertebral level. Conclusion: We are reporting this case to insist on clinical examination of all neonates for skin dimples and detailed evaluation of neonates with suspicious skin dimples to prevent future neurological disability. A clinically significant skin dimple implies impending neurological problems in a patient. [ABSTRACT FROM AUTHOR]

Taxane-induced peripheral neuropathy (TIPN) is a debilitating adverse effect of cancer treatments with taxanes which may require a reduction or discontinuation chemotherapy and affect clinical and survival outcomes. A number of factors have contributed to the increasing prevalence of TIPN. Nonetheless, limited knowledge exists of potential prechemotherapy blood-based biochemical factors associated with TIPN development. We recruited breast cancer patients at seven cancer institutions in China. Participants aged 18 years or older with stage I to III breast cancer who scheduled to undergo primary neoadjuvant and adjuvant chemotherapy with taxanes were eligible. Eligible patients underwent patient-reported neuropathy assessments using the EORTC-CIPN20 questionnaire. Patients completed the questionnaire before commencing treatment and after every cycle. For every patient, we selected the highest TIPN toxicity score for analysis since the first cycle. The posttreatment TIPN severity was compared with blood-based biochemical factors within 30 days before commencing treatment. Independent samples t tests, Mann-Whitney U tests and linear regression were used to identify blood-based and clinical associations with TIPN development. The study included 873 breast cancer participants who received paclitaxel, docetaxel or nanoparticle albumin-bound (nab)-paclitaxel. In the whole cohort, factors associated with higher TIPN toxicity scores were higher cumulative chemotherapy dose (β = 0.005; 95% CI, 0.004 to 0.006; P <.001), lower sodium ions (β = −0.24; 95% CI, −0.39 to −0.09; P =.002) and higher chloride ions (β = 0.30; 95% CI, 0.16 to 0.44; P <.001). The findings suggest that breast cancer patients with a higher cumulative chemotherapy dose, lower pretreatment sodium ions, and higher pretreatment chloride ions receiving taxanes should receive closer monitoring to mitigate the development of short-term and long-term TIPN. • Taxane-induced peripheral neuropathy (TIPN) is a debilitating adverse effect of cancer treatments. • Limited knowledge exists of potential prechemotherapy blood-based biochemical factors associated with TIPN development. • Ion channels, including sodium, potassium, and chloride ion channels, are associated with TIPN. • Alterations in sodium ion channel type and activity may contribute to the development of TIPN. • The altered function of chloride ion cotransporters can cause the transmission of peripheral pain. [ABSTRACT FROM AUTHOR]

• Nerve biopsies have limited role if the clinical diagnosis is unclear. • Nerve biopsies are helpful in the diagnoses of vasculitis and amyloidosis. • Careful selection of cases for nerve biopsy is crucial to increase the diagnostic yield. With progress made in neurogenetics and neuroinflammation, the indications and value of nerve biopsies in the diagnostic evaluation of peripheral neuropathies are less clear. In this study, we aimed to evaluate the diagnostic yield of nerve biopsies in patients with peripheral neuropathies. We performed a retrospective review of nerve biopsy reports from April 1998 to June 2021 of patients with peripheral neuropathies presenting to the Department of Pathology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia. The diagnostic value of the biopsies was determined based on the criteria by Midroni and Bilbao as follows: contributive (essential and helpful), non-contributive and inadequate. A total of 107 nerve biopsies were analysed. Sixty-four (60 %) were males and the mean age was 52 years, ranging from 13 to 86 years. Ninety-four (88 %) were sural nerve biopsies; and only one patient (1 %) each had superficial peroneal and superficial radial nerve biopsy. The indications for the procedure were vasculitis (34 %), peripheral neuropathy of unknown aetiology (34 %), amyloidosis (14 %) and chronic inflammatory demyelinating polyneuropathy (10 %). In 68 (63 %) biopsies, the diagnostic value was contributive. Of these, 28 (26 %) were essential and 40 (37 %) were helpful. In contrast, 35 (33 %) biopsies were non-contributive and 4 (4 %) were inadequate. In 66 % (71/107) of cases, the nerve biopsy did not reveal a definite pathological diagnosis. However, in the remainder, a diagnosis of vasculitis (18 %, 19/107), followed by amyloidosis (10 %, 11/107) could be determined. For 32/71 biopsies with undetermined pathological diagnosis, neuropathy remained cryptogenic in 22 % (7/32) upon follow up. With the exception of vasculitis and amyloidosis, there is limited value in performing nerve biopsies in the evaluation of patients with peripheral neuropathy. However, this should be interpreted with caution as the number of patients with a clinical diagnosis of vasculitis and amyloidosis were relatively larger than patients with other diagnosis. Refinement and careful selection of cases are required to increase the diagnostic yield of nerve biopsy. [ABSTRACT FROM AUTHOR]

Mutation in human FAM134B gene has been implicated in hereditary sensory and autonomic neuropathy type IIB. We aimed to knock out Fam134b in mice and explored its phenotypes to determine whether the genetic impairments and behavioral changes can mirror manifestations noted in humans. We used CRISPR/Cas9 technology to knockout the Fam134b gene in the C57BL/6 J mouse. After confirming the knockout was successful by Sanger sequencing and Western blot, sensory function was measured using the hot plate test and the 50% paw withdrawal threshold test. In addition, standard microscopy and transmission electron microscopy were performed to observe the structural changes of the dorsal root ganglion sensory neuron and the sciatic nerve. DNA sequencing and Western blot analysis confirmed the mutation in the Fam134b mutation gene and the loss of expression of its products. Fam134b knockout mice exhibited heat pain insensitivity and mechanical hyperalgesia. Interestingly, limb damage was found in some homozygotes. Demyelination in the sciatic nerve was common. Golgi bodies were turgid in dorsal root ganglion neuron. These findings indicate that peripheral neuropathy is common in Fam134b KO mice. We believe this novel animal model is likely to have significant future potential as a reliable model for the evaluation of peripheral neuropathy and its complications. [ABSTRACT FROM AUTHOR]

Background: Breast cancer-related lymphedema (BCRL) is a common complication. Docetaxel (DOC) and paclitaxel (PTX) have been used in taxane-based chemotherapy for breast cancer and to induce fluid retention. The purpose of this study was to investigate the association between lymphatic functionality and the side effects of taxane-based chemotherapy using indocyanine green (ICG) lymphography. Methods and Results: One hundred and eighty breast cancer cases who underwent full-dose taxane-based chemotherapy (DOC or PTX) and complained of upper extremity edema were enrolled in this study. BCRL was diagnosed exclusively on the basis of ICG lymphography results. The characteristics (age, body mass index, laterality, surgery type, regional lymph node irradiation, hormone therapy, and chemotherapy type) of patients diagnosed with BCRL (+) and BCRL (−; fluid retention only) were compared. The side effects were compared in eight categories (neutropenia, skin toxicity, nail changes, myalgia/arthralgia, peripheral neuropathy, stomatitis, dysgeusia, and digestive disease). BCRL (+) consisted of 116 patients and BCRL (−) consisted of 64 patients. BCRL (+) had significantly higher rates of axillary lymph node dissection (98.3%), lymph node irradiation (68.1%), neoadjuvant chemotherapy (14.7%), and DOC (62.9%) than BCRL (−) patients (56.3%, 20.3%, 3.1%, and 34.4%, respectively; p = 0.002 for neoadjuvant rate, p < 0.001 for the other rates). BCRL (+) patients had significantly higher rates of peripheral neuropathy (60.3%) than BCRL (−) patients (40.6%; p = 0.01). Conclusions: The occurrence rate of BCRL increased for the patients with peripheral neuropathy induced by taxane-based chemotherapy. This implies that peripheral neuropathy can induce BCRL. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the effects of peripheral neuropathy symptoms, self-care ability, and disturbances to daily life on quality of life (QoL) among gynecological cancer patients undergoing chemotherapy. Methods: The participants included 144 patients with gynecological cancer undergoing anticancer chemotherapy at a tertiary hospital in Seoul, South Korea, from December 1, 2021 to January 28, 2022. Convenience sampling was used to recruit patients who had received 4 or more cycles of chemotherapy using a paclitaxel-platinum regimen, and a self-reported questionnaire was used to collect data. Descriptive statistics, the t-test, analysis of variance, Scheffé test, Pearson correlation coefficients, and multiple regression analysis were performed. Results: Most of the participants had ovarian cancer (70.1%) or endometrial cancer (14.6%), and the most common number of treatment cycles was 6 to 10 (29.2%). The mean QoL (60.83±19.89) was greater than the midpoint. The regression model analyzing the patients' QoL was statistically significant (F=15.38, p<.001) with an explanatory power of 56.7%. Self-care ability (β=.39, p<.001), disturbances to daily life (β=--.38, p<.001), the duration of peripheral neuropathy symptoms (β=2.14, p=.034), and regular exercise (β=--2.12, p=.036) were found to significantly affect QoL. Conclusion: Efforts to improve the self-care ability of gynecological cancer patients who have experienced peripheral neuropathy after receiving chemotherapy and mitigate disturbances to their daily life can improve their QoL. Healthcare professionals should identify peripheral neuropathy symptoms and examine the effects of the symptoms on patients' daily lives. Improving the self-care ability of patients and alleviating their limitations in daily life may improve QoL. [ABSTRACT FROM AUTHOR]

Peripheral neuropathy can affect balance and increase fall risk. Tai Chi is known to activate neuromuscular systems and may help improve balance and postural control. We conducted a scoping review of clinical studies that evaluated the impact of Tai Chi on balance and related neurobiological outcomes among individuals with peripheral neuropathy. We systematically searched three databases from inception to December 19, 2023 and identified 11 eligible clinical studies. We extracted trial information from each study and performed a qualitative study features analysis to summarize the clinical evidence and neurobiological mechanisms of Tai Chi in regulating balance among people with peripheral neuropathy. We found that among 508 participants with clinical peripheral neuropathy, Tai Chi significantly improved single leg stance, 6-min walk, timed up-and-go tests, and gait speed when measured pre- and post-exercise. However, the differences between Tai Chi and sham exercise control that involved active calisthenics and stretching exercises were not statistically significant. Studies that used quantitative sensory testing showed that Tai Chi was associated with significant increases in plantar vibration and tactile sensitivity. The effect of Tai Chi on postural control varied depending on plantar sensory loss status, and results on muscle strength remained mixed. Other neurobiological effects involve strengthening muscle performance and proprioception and consolidating cognitive awareness of walking strategy and practical behavioral techniques. The findings indicated that Tai Chi may enhance balance, postural control, and gait speed in patients with peripheral neuropathy, possibly through sensory restoration, although further research is needed to confirm this. Whether Tai Chi improves muscle strength or other gait health parameters is inconclusive. Rigorous randomized clinical trials should be conducted to determine the effect of Tai Chi on balance in this population by measuring functional balance and quantitative sensory outcomes. • This scoping review included 508 participants with a clinical diagnosis of peripheral neuropathy. • Among people with peripheral neuropathy, Tai Chi is associated with enhanced balance control. • Balance improvements from practicing Tai Chi may be attributed to sensory function recovery. [ABSTRACT FROM AUTHOR]

Palliative systemic therapy alternated with electrostatic precipitation oxaliplatin-based pressurized intraperitoneal aerosol chemotherapy (ePIPAC) has never been prospectively investigated in patients with unresectable colorectal peritoneal metastases (CPM). The CRC-PIPAC-II study aimed to assess safety, feasibility and efficacy of such bidirectional therapy. This two-center, single-arm, phase II trial enrolled chemotherapy-naïve patients to undergo three treatment cycles, consisting of systemic therapy (CAPOX, FOLFOX, FOLFIRI, or FOLFOXIRI, all with bevacizumab) and oxaliplatin-based ePIPAC (92 mg/m2) with intravenous leucovorin (20 mg/m2) and 5-fluorouracil (400 mg/m2). Primary outcome were major treatment-related adverse events. Secondary outcomes included minor events, tumor response, progression-free survival (PFS) and overall survival (OS). Twenty patients completed 52 treatment cycles. Fifteen major events occurred in 7 patients (35 %): 5 events (33 %) related to systemic therapy; 5 (33 %) related to ePIPAC; and 5 (33 %) were biochemical events. No treatment-related deaths occurred. All patients experienced minor events, mostly abdominal pain, nausea and peripheral sensory neuropathy. After treatment, radiological, pathological, cytological, and biochemical response was observed in 0 %, 88 %, 38 %, and 31 % of patients respectively. Curative surgery was achieved in one patient. Median PFS was 10.0 months (95 % confidence interval [CI] 8.0–13.0) and median OS was 17.5 months (95 % CI 13.0–not reached). Combining palliative systemic therapy with oxaliplatin-based ePIPAC in patients with unresectable CPM was feasible and showed an acceptable safety profile. Treatment-induced response and survival are promising, yet further research is required to determine the additional value of ePIPAC to systemic therapy. [ABSTRACT FROM AUTHOR]

Aim: The relationship between autophagy and diabetic peripheral neuropathy (DPN) has been highlighted in only few reports. Using an animal model, we investigated the relationship between autophagy and DPN, and focused particularly on changes in autophagy in Schwann cells. Method: The ultrastructural features of DPN mice were evaluated in vivo using transmission electron microscopy. Dysfunction of autophagy in DPN was evaluated using immunofluorescence microscopy and western blot analysis of autophagy-related proteins, including Beclin1, LC3, and p62. Reactive oxygen species (ROS) levels were measured in vitro in glucose-treated Schwann cells. Dysfunction of autophagy in glucose-treated Schwann cells was examined by immunofluorescence microscopy and western blot analysis. Results / Discussion: Reduced myelin thickness and axonal shrinkage were observed in the sciatic nerves of DPN mice (Fig 1-4). ROS levels were increased in high glucose-treated Schwann cells (p < 0.05) (Fig 5). The expression of Becline1 was increased in DPN mice and high glucose-treated Schwann cells (p < 0.05), whereas the expression of LC3-II/LC3-I ratio and p62 were decreased in DPN mice and high glucose-treated Schwann cells (p < 0.05) (Fig 6,7). Conclusion: Our results suggest that increased levels of ROS induced by high glucose may contribute to autophagy dysfunction in Schwann cells. Autophagy dysfunction especially in Schwann cells may be an underlying cause of DPN. This work was supported by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare, Republic of Korea (grant no.: HI20C2088). [ABSTRACT FROM AUTHOR]

Les neuropathies périphériques chez les hémodialysés sont fréquentes. Étudier les neuropathies périphériques au sein de la population des patients hémodialysés chroniques au Bénin. Il s'agissait d'une étude transversale descriptive et analytique, conduite du 1er avril au 31 juillet 2017 dans les unités d'hémodialyse des deux centres publics de dialyse du Bénin. Le recrutement était exhaustif, avec inclusion de tous les patients hémodialysés depuis plus de 3 mois, âgés d'au moins 18 ans et consentants. Le diagnostic de neuropathie périphérique a été retenu sur la présence de troubles sensitivomoteurs et/ou végétatifs associés à une amyotrophie, une abolition ou une diminution des réflexes ostéo-tendineux, et une absence de signes centraux. Au total, 189/233 hémodialysés ont été inclus dans les deux centres d'hémodialyses publics du Bénin, soit 180 au CNHU-HKM et 9 au CHUD/BA. L'âge moyen était de 50,23 ± 13,31 ans, avec des extrêmes de 20 à 85 ans et un sex-ratio de 1,59. La fréquence globale de la neuropathie périphérique était de 59,26 %, dont les polyneuropathies (72,32 %), les mononeuropathies unifocales (10,71 %), les polyradiculoneuropathies (9,82 %) et les mononeuropathies multiples (7,14 %). Le facteur associé en analyse multivariée était le niveau socio-économique (p = 0,001 ; OR 39,41 ; IC 95 % 4,81–322,64). La neuropathie périphérique est fréquente chez les hémodialysés chroniques au Bénin, imposant un dépistage et une prise en charge précoces. Peripheral neuropathies, in hemodialysis patients, are frequent. To study peripheral neuropathies in the population of chronic hemodialysis patients in Benin. This was a descriptive and analytical cross-sectional study conducted from April 1st to July 31st, 2017 in the hemodialysis units of the two public dialysis centers in Benin. Recruitment was exhaustive with inclusion of all patients with hemodialysis for more than 3 months, aged at least 18 years and consenting. The diagnosis of peripheral neuropathy was based on the presence of sensory-motor and/or vegetative disorders associated with amyotrophy, abolition or reduction of osteotendinous reflexes and absence of central signs. A total of 189 hemodialysis patients were included in the two public hemodialysis centers of Benin, 180 at the CNHU-HKM and 9 at the CHUD/BA. The mean age was 50.23 ± 13.31 years with extremes from 20 to 85 years and a sex ratio of 1.59. The overall frequency of peripheral neuropathy was 59.26%, including polyneuropathies (72.32%), unifocal mononeuropathies (10.71%), polyradiculoneuropathies (9.82%), and multiple mononeuropathies (7.14%). The associated factor in multivariate analysis was socioeconomic level (P = 0.001; OR 39.41; 95% CI 4.81–322.64). Peripheral neuropathy is frequent in chronic hemodialysis patients in Benin, requiring early detection and management. [ABSTRACT FROM AUTHOR]

Episodic weakness is typically associated with a group of disorders so called periodic paralyses. Their major causes are mutation of ion channels, and have rarely been linked to mitochondrial disorders. We report a 20-year-old man with episodic weakness and axonal sensorimotor neuropathy since the age of 10 years. Analysis of the next generation sequencing data of the entire mitochondrial genome extracted from the blood revealed a homoplasmic m.9185T > C variant in MT-ATP6. Acetazolamide may be responsive for episodic weakness, and supplements with l-carnitine with coenzyme-Q10 seem to be beneficial as well. To the best of our knowledge, this is the first report in Taiwan which reveals episodic weakness and sensorimotor polyneuropathy as a unique phenotype of MT-ATP6 mutations. [ABSTRACT FROM AUTHOR]

Abstract: This study analyzes the effectiveness of ultrasound-guided hydrodissection (HD) perineural as a treatment for radial tunnel syndrome (RTS). A literature search was performed along with retrospective analysis of local cases to assess outcomes and safety of this procedure. In the case series, surgical candidates, defined as cases with over 80% but temporary relief after diagnostic injection, were treated with ultrasound-guided HD. Of 22 patients who received ultrasound-guided diagnostic injections, 11 proceeded to HD. All HD patients experienced complete and lasting symptom resolution for a minimum of 2 years, and none required surgery. Thorough literature review provided seven studies, which fulfilled inclusion criteria. Sixty-one patients are represented in the literature. All studies reported significant benefit to pain symptoms with HD of radial nerve, with five specifying over 90% improvement. No adverse effects from HD were noted in any study. Ultrasound-guided HD of the radial tunnel has potential to be a surgery sparing treatment for RTS. [ABSTRACT FROM AUTHOR]

One of the most common complications associated with a diaphyseal humeral fracture is the development of a radial nerve injury. We conducted a study to analyze the degree of recovery and prognostic factors associated with radial nerve palsy in patients with diaphyseal humerus fractures. We retrospectively analyzed 28 patients who presented to the Hospital La Fe, Valencia, Spain, with a diaphyseal humerus fracture associated with radial nerve injury between 2010 and 2020. A total of 14.3% (n = 4) of the patients in our cohort had open fractures and 85.7% (n = 24) had closed fractures. There were no statistically significant differences between the type of treatment and the type of fracture (p = .13). There were also no significant differences between the type of treatment and recovery time (p = .42). There was a statistically significant difference (p = .04) in the mean recovery time for patients with preoperative radial nerve injuries (11.9 months) compared with patients who sustained a radial nerve injury secondary to surgical repair of the fracture (8.6 months). The difference in recovery time between patients with open and closed fractures was not statistically significant (p = .3). Results of the study showed that the type of fracture (i.e., open or closed) did not affect radial nerve palsy recovery time. Patients who sustain radial nerve injuries secondary to a surgical repair have a shorter recovery time than patients who sustain primary radial nerve injuries. [ABSTRACT FROM AUTHOR]

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