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Delayed nerve injuries are rarely encountered in upper extremities. There are a few case reports in the literature. The reason is nearly always retained glass fragments. It can occur after motor vehicle accidents and trauma. In the other parts of body suchas central nerve system, some delayed neuropathies reported before by other type injuries such as bullets, shrapnel fragments, acupuncture needles and surgical screws. In this article we report a case that developed median nerve neuropathy and wrist flexion restriction after five years injury. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to determine the safety and symptomatic and functional efficacy of median nerve decompression with 3 cm limited incision in carpal tunnel syndrome surgery., Patients and Methods: Carpal tunnel release with a 3 cm limited palmar incision was performed on 91 hands in 83 patients. Patients were evaluated with Boston Carpal Tunnel Questionnaire, grip strength and pinch strength measurements, Semmes-Weinstein Monofilament test and two-point discrimination tests preoperatively, and at postoperative 3rd and 6th months. The pre- and postoperative mean values for these assessment criteria were statistically analyzed by paired samples t-test. The symptoms, physical findings, electroneuromyography carpal tunnel syndrome severity scores of the patients were evaluated using descriptive statistical analyses., Results: At postoperative evaluation, there was a statistically significant increase in Boston Carpal Tunnel Questionnaire scores, grip and pinch strengths, and sensory tests results of the patients when compared with preoperative values. No complications other than pillar pain were encountered., Conclusion: Carpal tunnel release with a 3 cm limited incision technique appears to be effective when compared with classical open, endoscopic and mini incision techniques. The rate of complications is lower than that of these techniques. In conclusion, a 3 cm limited incision is both effective and safe in carpal tunnel release.

Objectives: Nerve guidance channels are natural or synthetic tubular conduits used to bridge the gap between the nerve stumps. Creation of a biological membrane may be a simple and cheaper way to obtain a nerve guidance channel. The goal of this study was to examine the role of a biological membrane in expediting nerve regeneration., Methods: Twenty adult male Wistar albino rats weighing 200 to 250 g were divided into two groups equal in number. All the animals underwent median nerve dissection to create a 5-mm gap. In the first group, the defect was repaired with a graft obtained from the contralateral median nerve, while in the second group, a silicon implant was sutured and anastomosed between the stumps. After five weeks, the silicon implant was removed and a nerve graft taken from the contralateral median nerve was anastomosed inside the neoformed biological membrane. Recovery of muscular function indicating nerve regeneration was assessed by the prehension test proposed by Bertelli and Mira. In both groups, measurements were started after five weeks of grafting and continued for 12 weeks., Results: Rats in the second group exhibited an accelerated recovery and nerve regeneration compared to the first group. Nerve regeneration was completed at 10 weeks in the second group, whereas the recovery rate was 90.2% at 12 weeks in the first group (p<0.05)., Conclusion: The use of autogenous grafts is still the gold standard in nerve repair. This biological membrane not only expedites nerve regeneration, but also facilitates surgery and reduces operating time because it requires small incisions at the two ends. Considering these advantages, it may prove to be a good alternative to other techniques.

Objectives: In this study, we aimed to evaluate the functional results of nerve repair (median and/or ulnar) in patients with forearm clean-cut injuries and investigated the effect of injury level, associated injuries, the type of repair (primary or secondary), and age on the prognosis., Methods: The study included 42 patients (34 males, 8 females; mean age 31 years; range 9 to 62 years) who were treated for forearm clean-cut injuries. Involvement was in the proximal forearm in four, mid-forearm in 11, and distal forearm in 27 cases. There were 51 nerve injuries affecting the median nerve (n=30) and the ulnar nerve (n=21). Nerve injuries were isolated in 12 patients, associated with tendon injuries in nine patients, and with tendon and artery injuries in 21 patients. The patients were evaluated in four age groups including 0-15, 16-30, 31-45 years, and 46 years or above. Functional evaluations were made using the Seddon classification. The effect of injury level, associated injuries, the type of repair, and age on the prognosis was assessed. The mean follow-up was 39 months (range 11 to 57 months)., Results: Although the clinical and functional results of primary and late-primary repairs were less favorable than those of secondary repairs, the difference did not reach a significant level (p>0.05). The injury level, associated injuries, and age did not influence the Seddon scores significantly (p>0.05). In the age group of 0-15 years, the results were very good in all the patients (100%), but good and very good results accounted for only 20% in the age group of 46 years or above., Conclusion: In appropriate cases with clean-cut nerve injuries, primary repair must be the first choice. Taking the low regeneration capacity into consideration, priority should be given to reconstructive procedures in patients at older ages.

Background: We evaluated the clinical and functional results of nerve repair in patients with combined tendon-nerve injuries of the forearm., Methods: The study included 68 patients (58 males, 10 females; mean age 33.5 years; range 5 to 48 years) with combined tendon-nerve injuries of the forearm. A total of 96 nerves were repaired. Patients with nerve defects were excluded. Both median and ulnar nerves were injured in 17 patients; median and ulnar nerve injuries were detected in 17 patients and 34 patients, respectively. The mean time to operation was four hours (range 20 min to 24 h). Primary nerve repair was performed in 60 patients, and secondary repair was performed in eight patients. The interfascicular technique was employed in 18 patients, and epiperineural suture in 50 patients. Rehabilitation included early motion using the Washington regimen. A modified MRC (Medical Research Council) motor and sensory classification system was used for postoperative evaluation. The mean follow-up was at least two years., Results: The modified MRC results were as follows: of 17 patients with median nerve injuries, 10 had excellent, seven had good results. Of 34 patients with ulnar nerve injuries, the results were excellent in nine, very good in 10, good in 10, and fair in five patients. Of those with median and ulnar nerve injuries, four, seven, and six patients had excellent, very good, and good results, respectively. Overall, 61 patients (89.7%) had satisfactory results. A significant correlation was found between age and the MRC results (p=0.016)., Conclusion: Primary nerve repair followed by early motion results in substantial rates of excellent and satisfactory results in patients with combined nerve-tendon injuries.

Objectives: We evaluated surgery-related issues concerning the excision of volar wrist ganglia in the light of data obtained from our patients., Methods: The study included 40 patients (10 males, 30 females; mean age 32.5 years; range 18 to 65 years) who underwent surgery for volar ganglia. All the patients had unilateral involvement. All operations were performed under axillary brachial plexus regional anesthesia in the microsurgery operating room. The mean follow-up period was 2.5 years (range 1 to 5 years)., Results: The ganglia originated from the radioscaphoid joint capsule in 18 patients (45%), scaphotrapezial joint capsule in 16 patients (40%), and from the flexor carpi radialis tendon in two patients (5%). The ganglia were attached to the radial artery in 26 patients (65%), in two patients (5%) the radial artery completely merged into the lesion. The pedicles could not be dissected in four patients (10%), all of whom developed recurrences. Complications included recurrences in nine patients (22%), injury to the median palmar cutaneous nerve in four patients (10%), injury to the radial artery in two patients (5%) and wrist stiffness in five patients (12.5%). No significant correlation was found between complications and experience of the operating surgeons., Conclusion: Considering possible dissections and interventions for complication-associated repairs, and potential recurrences, surgical removal of volar ganglia should be performed under appropriate circumstances, especially in a formal operating room.

Median nerve hemangiomas causing carpal tunnel syndrome are very rare. The number of reported cases is less than ten, all of which resulted in recurrences. We present a 35-year-old woman who developed median nerve hemangioma in her left wrist. The mass was removed by epineural resection and the patient's complaints disappeared after a while. During a six-year follow-up no recurrences were detected.

Lipofibromatous hamartoma of the nerve is a very uncommon, congenital, benign, peripheral nerve tumor. It is mostly encountered in the extremities of young adults, involving the median nerve in the majority of cases. The nerve tissue is infiltrated by diffuse fibroadipose tissue which dissociates the fasciculi without invasion. Patients with lipofibromatous hamartoma of the median nerve usually present with symptoms of carpal tunnel syndrome, usually accompanied by marked macrodactyly. Lipofibromatous hamartoma of the median nerve was encountered in an 18-year-old female patient, involving the wrist, causing macrodactyly of the index finger, and resulting in symptoms of carpal tunnel syndrome. Median nerve release and partial excision of the adipose tissue along the mass were performed. Fourteen months postoperatively, the patient had no complaints and the mass decreased in size without any motor or sensory functional losses.