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The choice of a specific technique for surgical treatment of neuromas remains a problem. The purpose of this study is to determine the overall effectiveness of surgery as well as to find out whether certain surgical procedures are more effective than others. Twenty-nine patients operated between 1998 and 2018 and followed for at least 12 months were reviewed. Clinical assessment included the identification of a pre- and postoperative Tinel sign, pain visual analog score, two-point discrimination (2PD), and grip strength. Mechanisms of injury included clean lacerations (11), crush injuries (11), and other trauma or surgery (7). Mean time from presentation to surgery was 9 months. Seven surgical procedures involving excision in 10 patients and excision and nerve repair in 19 patients were performed. Pain score improved from an average of 7.1 ± 2.3 to 1.8 ± 1.7 with 27 patients (93%) reporting mild or no postoperative pain. Nine patients complained of residual scar hypersensitivity and six patients had residual positive Tinel. No patient required an additional surgical procedure. 2PD improved from an average of 9.6 ± 4.0 to 6.8 ± 1.0. The improvement of pain score and 2PD was statistically significant. Nerve repair resulted in marginally better outcomes, in terms of 2PD and grip strength recovery, than excision alone. The mechanism of injury, zone of involvement, time to intervention, or length of follow-up did not have an impact on the outcomes. Although patient numbers in this study are large in comparison to previous studies, larger patient numbers will allow for a multivariate analysis, which can be possible with a prospective multicenter trial.

Hidradenitis suppurativa, also known as acne inversa, is a chronic inflammatory skin disease which affects ~1% of the world population. Hidradenitis suppurativa significantly impacts patients’ quality of life due to its chronic nature and frequently occurring relapses. Therefore, Hidradenitis suppurativa patients need to get an early diagnosis. This study was designed to evaluate the efficiency of Endolift®, a novel minimally invasive outpatient laser procedure, for treating Hidradenitis suppurativa. Thirty patients in the range of 19 to 43 y-o, 20 women and 10 men, were enrolled on this study. Patients have undergone a single treatment under tumescent anaesthesia. Treatment was performed using the Endolift® procedure, consisting of the device Eufoton® LASEmaR® 1500. This device uses a 1470 nm wavelength laser lead by micro-optical fibres of different calibres directly inside the skin. This treatment aims to destroy problematic glands with a thermal effect and remove them with liposuction. The treatment has a strong anti-inflammatory effect and promotes neocollagenesis. Eighteen patients obtained optimal results, 5 had good results, and 7 reported moderate results. The treatment was repeated for 7 patients for small refractory areas. Patients with earlier onset of the disease generally had better results. No side effect was recorded. Endolift® treatment represents a big hope for the patient because it is a safe, effective, minimally invasive procedure and can be repeated.

Purpose: The current study was conducted to evaluate the therapeutic effect of resistive training in reducing the effect of cancer cachexia. Subjects and Methods: Thirty patients with gastrointestinal cancer cachexia participated in this study. Their ages ranged from 50-70 years. They were recruited from Al Kasr El-Ani hospital outpatient clinic to be treated in the outpatient clinic, Faculty of Physical Therapy, Cairo University and were divided randomly into two equal groups.Group (A) composed of 15 patients who received their ordinary medical treatment in addition to resistive training program 2 times per week for 8 weeks. Group (B) composed of 15 patients who received their ordinary medical treatment. Methods of assesment was measurements of Handgrip strength assessed by handgrip dynamometry, Lower body strength assessed using a 30-second sit to stand test, Lean body mass assessed by bioelectrical impedance analysis. Results: There was a significant increase in both muscle strength and lean body mass in patient who received resistive training. Conclusion: Resistive training can be considered as an effective method in decreasing severity of cancer cachexia in gastrointestinal cancer patient.

Recently, there is an increase application of chest ultrasound to evaluate and monitor pleuropulmonary diseases. Computed tomography (CT) is the gold standard for most different lung pathologies with limitations. This study aims to assess the effectiveness of Chest Ultrasound compared to Computed Tomography in diagnosis of different pleuropulmonary disorders and to define the rules of chest ultrasound in pulmonary medicine. This study was conducted upon randomly selected 110 patients with different pleuropulmonary disorders who were admitted to the respiratory ward and ICU, Zagazig University Hospitals, from April 2018 to April 2020. All patients with abnormal chest X. ray opacities were evaluated for complete history taking, full clinical examination, laboratory investigations, then Chest US was performed on the first day of admission then CT was done as a gold standard for the final diagnosis then results of both Chest US and CT were compared. Compared to CT, Chest US had sensitivity (95.8%) for free pleural effusion diagnosis, specificity (90.3%), and (92.7%) accuracy; for pneumonia, (90.9%), (96.1%), and (94.5%) respectively, while pneumothorax had (81.8%), (98%), and (96.3%) accuracy, respectively; for pulmonary edema, (89.5%), (97.8%), and (96.4%) accuracy, respectively. The US plays a valuable role in the diagnosis of different pleuropulmonary diseases and can be used as the first routine radiological modality in both ward & ICU.

Mitochondrial temperature is produced by various metabolic processes inside the mitochondria, particularly oxidative phosphorylation. It was recently reported that mitochondria could normally operate at high temperatures that can reach 50℃. The aim of this review is to identify mitochondrial temperature differences between normal cells and cancer cells. Herein, we discussed the different types of mitochondrial thermosensors and their advantages and disadvantages. We reviewed the studies assessing the mitochondrial temperature in cancer cells and normal cells. We shed the light on the factors involved in maintaining the mitochondrial temperature of normal cells compared to cancer cells.

To evaluate the efficacy of pulsed electromagnetic field therapy versus extracorporeal shock wave therapy in the treatment of iliohypogastric neuralgia post inguinal herniorraphy.Measurement of the serum cortisol level and the carbamazepin medicament intake. 40 male and female patients with iliohypogastric neuralgia post inguinal herniorraphy were divided into two groups. Group (A) received the thoracolumbar pulsed electromagnetic field therapy.Group (B) received the thoracolumbar extracorporeal shock wave therapy, duration of treatment was 20 minutes, every other day for the 3 months as a total period of treatment in addition to the traditional physical therapy and medical care for 3 months in group (A) and in group (B) the following parameters were used as following: 1,000 impulses; energy flux density (ED) varied from the lowest (0.08 mJ/mm2) to the highest energy level (0.44 mJ/mm2), depending on patient’s pain tolerance, on the trigger point area,over the thoracolumbar region paravertebrally once every two weeks for 12 weeks (3 months) on the affected side, the handpiece of the ESWT device was positioned perpendicular on the target area of treatment and moved circular over gel that was used over the target area of treatment in addition to the traditional physical therapy and medical care for 3 months.

Background: Surgical and medical care for patients with bone and soft tissue tumors of the extremities continues to improve with advancement of chemotherapeutic strategies, surgical techniques, and understanding of pathogenesis. Aim and Objective: To Analysis of the results of lower limb preservation after neoplastic resection to reproduce an advisory algorithm for surgical decision making to achieve optimal functional results.Methods: This retrospective study was performed in the microsurgery unit Assiut university hospital between 2013 and 2019, involved (40) patients with primary malignant bone tumors and benign aggressive bone tumors who had wide local resection and reconstruction by vascularized fibula (osteoseptocutaneous flap). Results: The highest mean time of union rate was 5.75±2.06 for GCT. The least mean time of union rate was 3.86±1.21 forChondrosarcoma. the least Mean±SD of function was 2.83±0.75 in chondrosarcoma while the highest Mean±SD of emotional acceptance was 4±0.82 in Ewing sarcoma. The Mean±SD of pain were equal in both Ewing sarcoma and GCT. Conclusions: Benign aggressive tumors & primary malignant bone tumors now become not a rare tumor. Free vascularized fibular graft is one of several methods of bone reconstruction after bone tumor resection. Using as a means of reconstruction.

Rare diseases (RDs) are a group of lifetime incapacitating or fatal diseases affecting nearly 3.5–5.9% of the global population, reaching 263–446 million individuals. RDs possess a genotypic-phenotypic pleiotropic nature so that the same disease can manifest with different outcomes. This renders definitive diagnosis challenging and thus hinders providing appropriate treatment, if available. Since 80% of rare diseases have a genetic origin, evolution in genetic diagnosis owing to the NGS has widely contributed to proper diagnosis and hence facilitating the future implementation of precision medicine. Currently, treatments covering less than 3% of rare diseases are US Food and Drug Administration (FDA) approved. Besides, RDs have a very high economic burden. This review sheds the light on Egyptian achievements and efforts in the field of rare diseases to prioritize the rare genomic diseases to be studied in Egypt. This will grab the attention towards conducting further studies that target Egyptians, to include the under-recognized populations potentially affected.

In this work, the binding mechanism between donepezil (DNP) and bovine serum albumin (BSA) was established using several techniques, including fluorimetry, UV- spectrophotometry, synchronous fluorimetry (SF), fourier transform infrared (FTIR), fluorescence resonance energy transfer (FRET) besides molecular docking study. The fluorescence quenching mechanism of DNP-BSA binding was a combined dynamic and static quenching. The thermodynamic parameters, binding forces, binding constant, and the number of binding sites were determined using a different range of temperature settings. Van't Hoff's equation was used to calculate the reaction parameters, including enthalpy change (ΔHο) and entropy change (ΔSο). The results pointed out that the DNP-BSA binding was endothermic. It was shown that the stability of the drug-protein system was predominantly due to the intermolecular hydrophobic forces. Additionally, the site probing method revealed that subdomain IIA (Site I) is where DNP and BSA's binding occurs. This was validated using a molecular docking study with the most stable DNP configuration. This study might help to understand DNP's pharmacokinetics profile and toxicity as well as provides crucial information for its safe use and avoiding its toxicity.

Background Traumatic brachial plexus injuries in children represent a definite spectrum of injuries between adult and neonatal brachial plexus injuries. Their characteristics have been scarcely reported in the literature. The priority of functional restoration is not clear. Methods In total, 52 children with surgically treated traumatic brachial plexus injuries, excluding Erb's palsy, were reviewed after a minimum follow-up of 2 years. All children except nine were males, with an average age at surgery of 8 years. Forty-five children had exclusive supraclavicular plexus injuries. Twenty-one of them (46%) had two or more root avulsions. Seven children (13.5%) had infraclavicular plexus injuries. Time from trauma to surgery varied from 1 to 15 months (mean = 4.7 months). Extraplexal neurotization was the most common surgical technique used. Results Shoulder abduction and external rotation were restored to an average of 83 and 26 degrees, respectively. Elbow flexion and extension were restored to grade ≥3 in 96 and 91.5% of cases, respectively. Finger flexion and extension were restored to grade ≥4 in 29 and 32% of cases, respectively. Wrist flexion and extension were restored to grade ≥4 in 21 and 27% of cases, respectively. Results of neurotization were superior to those of neurolysis and nerve grafting. Among the 24 children with insensate hands, 20 (83.3%) recovered S3 sensation, 3 recovered S2, and 1 recovered S1. No case complained of neuropathic pain. Functional recovery correlated negatively but insignificantly with the age at surgery and time from injury to surgery. Conclusion Brachial plexus injuries in children are associated with a high incidence root avulsions and no pain. Neurotization is frequently required and the outcome is not significantly affected by the delay in surgery. In total plexus injuries, some useful hand function can be restored, and management should follow that of obstetric palsy and be focused on innervating the medial cord.

Introduction: Autoimmune epilepsy was an under-recognized condition, and its true incidence was unknown in pediatrics. Serum antibodies suggesting a potential autoimmune etiology were detected in 34.8% of patients presented by epilepsy of unknown etiology. Diagnosis of autoimmune epilepsy would be of great value in the search for potential preventive treatments for disabling seizures and cognitive impairment. Autoimmune epilepsy was characterized by a depressed or altered level of consciousness, lasting more than 24 h, lethargy, or change in personality or behavior and at least one of the following features: neuropsychiatric symptoms, seizures, movement disorder, or cognitive dysfunction. Patients were excluded if an alternative diagnosis was made. The presence of neuronal antibodies and MRI changes supported the diagnosis. This study aimed to assess the possible role of immunity in the pathogenesis of pediatric drug resistant epilepsy through clinical electroencephalographic, neuroimaging and neuro-immunological testing. Subjects and Methods: This study was conducted on twenty-four drug resistant epileptic children with suspected autoimmune etiology over the period from 2016-2018. The control group comprised twenty four children with idiopathic controlled epilepsy matched to the drug-resistant epilepsy sample for age and gender. Both groups were subjected to clinical examination, neuronal antibodies in serum and CSF, Mini-Mental State Examination (MMSE), Chalfont seizure severity scale (CSSS), EEG, and brain MRI studies. Results: There was a large percentage of autoimmune epilepsy in pediatric cryptogenic drug-resistant epilepsy. 55% of DRE cases presented with mild pleocytosis and elevated CSF proteins. Serum and CSF neuronal antibodies were positive in about 66.63% and 65% of cases respectively. Serum neuronal antibodies to GAD were positive in 8.33%, NMDA Abs were positive in 33.3%, and VGKC Abs were in 25.0% of cases. In the CSF, GAD antibodies were positive in 10%, NMDA antibodies in 40%, and VGKC antibodies in 20% of cases. Seizures reduction was achieved with immunotherapy, also was prevalent in seropositive cases. Conclusion: Pediatric patients presented by drug-resistant epilepsy should receive immunotherapy for a definite diagnosis. MRI changes in the form of temporal hyperintensity, claustrum, cortical hyperintensities were a common finding in pediatric patients presented by drug-resistant epilepsy. CSF changes in the form of elevated proteins and /or mild pleocytosis signified inflammatory changes in the CNS and blood brain barrier (BBB) disruption. Steroid responsiveness played a major role in the diagnosis of autoimmune epilepsy, especially seronegative cases.

This research aimed to study the effect of addition carrot powder and pumpkin powder on some properties of flat bread. Carrot powder and pumpkin powder were added with the ratio of 10 % and 20% with bread flour in order to prepare flat bread. Chemical composition, caloric value, mineral content, dietary fiber, texture profile and staling rate of flat bread samples were studied. Obtained results indicated that addition of carrot powder and pumpkin powder increased the amount of protein, ash, crude fibers, minerals and dietary fiber in prepared flat bread samples. While, the carbohydrates and caloric value content decreased in compared with those of control samples. Texture properties also resulted that addition of carrot and pumpkin powder positively influence on some texture parameters. Staling rate results showed that there was gradual decrease in all fortified flat bread samples for freshness up to 72 hours of storage in compared with those of control sample, also, an observed decrease in staling rate after 72 hours of storage of all flat bread samples. Results of sensory evaluation showed that flat bread samples with 10% carrot and pumpkin powder were more acceptable than those of other sample with 20% carrot and pumpkin powder.

Methods: We performed a non-randomized comparative trial that recruited infertile men with varicocele who were scheduled to undergo MSV. Eligible patients were allocated by the investigators in a 1:1 ratio to receive intraoperative Doppler (group I) or intraoperative Doppler plus hydrodissection (group II). Results: Sixty men were included in each group. The two study groups showed a comparable number of ligated veins on the right (4.22 ±1.57 versus 4.42 ± 1.65; p = 0.49) and left side (6.77 ± 2.14 versus 6.98 ± 2.29; p = 0.59). On the contrary, group II showed a significantly higher number of preserved arteries on the right (2.42 ± 0.56 versus 1.47 ±0.5 in group I) and left side (2.6 ± 0.53 versus 1.63 ± 0.55 in group I), with p-value < 0.001. The sperm motility was significantly higher in group II than in group I (21.25 ± 13.73 versus 13.85 ± 12.25, respectively; p = 0.002). In both groups, the sperm motility increased significantly at the end of follow-up compared to the preoperative period. The postoperative sperm mortality remained significantly higher in group II than in group I(p = 0.008).Conclusions: Intraoperative Doppler plus hydrodissection (D+IH-MSV) has advantages in preserving more arteries and enhancing the motility of sperms. Based on these findings, we strongly recommend D+IH-MSV when treating infertile men with varicocele.

Neurodegenerative disorders (NDs) are rare multifactorial disorders characterized by dysfunction and degeneration of synapses, neurons, and glial cells which are essential for movement, coordination, muscle strength, sensation and cognition. It may also be associated with neuroinflammation and oxidative stress. Several genes have been identified underlying the different forms. Herein, we describe seven patients from 6 Egyptian families. The core clinical features of our patients included dysmorphic features, neurodevelopmental delay or regression, gait abnormalities, skeletal deformities, visual impairment, and seizures. Previously unreported clinical phenotypic findings were recorded. Whole-exome sequencing (WES) was performed followed by in silico analysis of the detected genetic variants effect on the protein structure. Three novel variants were identified in three genes “MFSD8 (CLN7), AGTPBP1, and APTX” and other previously reported three variants have been detected in “TPP1, AGTPBP1 and PCDHGC4” genes. In this cohort, we described the detailed unique phenotypic characteristics in view of the identified genetic profile in patients with ND disorders, hence expanding the mutational spectrum of such disorders.

During the Late Campanian, sea-level fluctuation occurred in the form of two chert bands and the topmost conglomeratic phosphate beds (CF8a zone). A great transgression event occurred associated with the global warming (CF8b zone) trend indicated by large double-keeled foraminifera as Globotruncana aegyptiaca Nakkady of oligotrophic conditions. Through the event of CF6/CF5 zones, a gradual increase in the relative abundance of Gublerina rajagopalani Govindan and Planoheterohelix planata (Cushman) and other heterohelicids have been shown to tolerate and thrive in a wide range of environmental conditions as in high-stress environments. Sea-level fall at the CF6 zone and the overlying CF5 boundary marked a warming climate for the Middle Maastrichtian Event. In the latest CF4 records, the beginning of the decrease in planktic/benthic ratio, globotruncanids, rugoglobigerinids, and heterohelicids indicating a fall in sea level coincided with the CF4/CF3 and the development of dark grey shales in a regressive regime. The observed low abundance of planktic specimens may be due to the presence of pyrite with black shale interval suggesting low oxygen condition. The latest zones CF3, CF2, and CF1 are generally characterized by heterohelicids blooms specially Planoheterohelix globulosa (Ehrenberg), and a gradual decrease in diversity associated with the warming phase before the K/Pg boundary event, implying high biotic stress to even absent of Guembelitria cretacea species through CF3–CF1 zones. Pseudotextularia elegans (Rzehak) occurs in the zones CF4 and CF2 warming of phases 1 and 2 of Deccan Trap Volcanic. The absence of P. elegans (Rzehak) in the zone (CF3) is postulated due to a tectonic cause (maximum cooling of Deccan Trap Volcanic) whereas its absence in the zone (CF1) was due to regression of phase 2.

Background Vascularized fibular grafting (VFG) is currently accepted as one of the best treatments for congenital tibial pseudoarthrosis (CPT). However, with longer follow-up, functional results deteriorate, and some problems become evident. Methods Thirty-nine patients with CPT were treated with VFG. Their age at surgery averaged 5.2 years. Twenty-one cases aged 3 years or less at the time of surgery. All cases were Crawford type IV affected by neurofibromatosis-1. Fourteen patients had 1 to 7 previous surgeries with an average of 4.2 procedures. The length of the fibula used averaged 9.9 cm, and the fibula was fixed by intramedullary wires in 26 cases, and transfixion screws in 11 cases. Results Follow-up averaged 8.1 years. Seventeen cases (43.6%) reached skeletal maturity before the final follow-up. Primary bone union was achieved in 37 cases (96%) after an average of 3.2 months. Stress fracture occurred in 21 cases (51.3%) and was recurrent in 11 cases. Twenty-one cases (53.8%) developed tibial shaft deformities with an average valgus angle of 13.8 degrees and procurvatum angle of 18.8 degrees. The overall final limb length discrepancy (LLD) averaged 2.2 cm. Ipsilateral ankle valgus deformity occurred in 21 cases (53.8%) and averaged 10 degrees. A total of 17 cases required an average of 2 secondary procedures. The tibial deformity did not appear to remodel with age, but the LLD and the angle of ipsilateral ankle valgus deformity continued to significantly increase until skeletal maturity. Conclusion This study reports the largest single center experience of CPT cases treated with VFG. Free VFG is an excellent treatment option for CPT. Best results are achieved when the procedure is performed at or before the age of 3 years, in the absence of previous surgeries, and with the use of intramedullary fixation. The resulting LLD and the degree of ipsilateral ankle valgus increase with age until skeletal maturity, however, tibial deformity does not remodel and should be corrected at any age if it is excessive. Donor side mild ankle valgus may occur despite sound tibiofibular synostosis. Level of evidence Level IV.

Introduction In brachial plexus injuries, useful recovery of arm function has been documented in most patients after phrenic nerve transfer after variable follow-up durations, but there is not much information about long-term functional outcomes. In addition, there is still some concern that respiratory complications might become manifest with aging. The aim of this study was to report the outcome of phrenic nerve transfer after a minimum follow-up of 5 years. Patients and methods Twenty-six patients were reviewed and evaluated clinically. Age at surgery averaged 25.2 years and follow-up averaged 9.15 years. Results Shoulder abduction and external rotation achieved by transfer of phrenic to axillary nerve (or posterior division of upper trunk), combined with spinal accessory to suprascapular nerve transfer, were better than that achieved by transfer of phrenic to suprascapular nerve, combined with grafting the posterior division of upper trunk from C5, 52.3 and 45.5 degrees versus 47.5 and 39.4 degrees, respectively. There was no difference in abduction when the phrenic nerve was transferred directly to the posterior division of upper trunk or to the axillary nerve using nerve graft. Elbow flexion (≥M3 MRC) was achieved in 5 (83.3%) of 6 cases. Elbow extension M4 MRC or greater was achieved in 4 (66.6%) of 6 cases. All patients, including those who exceeded the age of 45 years and those who had concomitant intercostal nerve transfer, continued to have no respiratory symptoms. Conclusions The long-term follow-up confirms the safety and effectiveness and of phrenic nerve transfer for functional restoration of shoulder and elbow functions in brachial plexus avulsion injuries.

Background The long-term results of soft tissue rebalancing procedures of the shoulder in obstetric brachial plexus palsy have been scarcely reported. The effect of this procedure on the evolution of secondary bone changes has been a subject of controversy. Methods Twenty-six children are included in this study. All initially had postganglionic C5-6 or C5-7 (Narakas types I and II) obstetric brachial plexus palsy, which spontaneously recovered. Children included are those who had persistent external rotation weakness with or without internal rotation contracture, nondysplastic glenohumeral joint, and functioning teres major. All had anterior shoulder release and teres major to infraspinatus transfer to correct internal rotation deformity and/or increase active shoulder external rotation. Patients were 18 males and 8 females. The right upper limb was affected in 16 patients, and the left in 10. Surgery was performed at an average age of 3.01 years (range, 1-10 years). Follow-up averaged 8.2 years (range, 5-16 years). Eight cases (30%) were followed up for 10 years or greater. Age at final follow-up averaged 10.5 years (range, 6-17.8 years). Results The results showed to be significant: 67 degrees (63%), 71.3 degrees (412%), and -32 degrees (-35%), respectively. There was no single recurrence of internal rotation deformity. Global Mallet score averaged 20 ± 2.7. Global abduction and external rotation averaged 3.5 ± 0.8 and 4 ± 0.3, respectively. Shoulder abduction range included an average of 45 degrees glenohumeral and 65 degrees scapulothoracic motion. Postoperative internal rotation in adduction was limited to 55.96 ± 25.65 degrees and was significantly lower that the preoperative value. Radiological measurements showed no significant differences between the operated and normal sides. Conclusions We conclude that the long-term results after soft tissue rebalancing, combined with open reduction when required, demonstrated significant improvement of abduction and external rotation and significant loss of internal rotation. The difference in glenoid version and humeral head subluxation continued to be insignificant compared with the normal side.

The role of primary surgery in delayed presenting cases of brachial plexus birth injury is still debated. The purpose of this study was to evaluate the results of brachial plexus reconstruction performed at the age of ≥12 months.Twenty-nine cases were included. Five cases had upper (C5-6) palsy, 4 had upper/middle (C5-7), and 20 had total (C5-8 and T1) palsy.The age at the time of primary surgery was an average of 15.6 months. The brachial plexus was formally explored and neurolysis, grafting, and neurotization were used in different combinations. Exploration revealed that 27% of the roots were avulsed and 32% were ruptured. The follow-up was an average of 7.9 years. Generally, the best functional recovery was elbow flexion followed by shoulder external rotation. Satisfactory shoulder abduction (≥6 on the Toronto Active Movement Scale [TAMS]) was achieved in 31% of cases. The abduction range was an average of 79° ± 35°; 50° in upper palsy, 103° in upper/middle palsy, and 82° in total palsy. Shoulder external rotation ≥6 on the TAMS was achieved in 62% of cases. External rotation range was an average of 58° ± 29°; 78° in upper palsy, 68° in upper/middle palsy, and 52° in total palsy. Elbow flexion and extension of ≥6 on the TAMS were achieved in 69% and 58% of cases, respectively. Wrist flexion and finger flexion of ≥6 on the TAMS were achieved in 35% and 12.5%, whereas wrist and finger extension of6 on the TAMS were achieved in 25% and 4% of cases, respectively.In the delayed presentation of brachial plexus birth injury, brachial plexus reconstruction results in good functional recovery of elbow flexion and shoulder external rotation but modest functional recovery of finger flexion and wrist extension. The rate of functional recovery of the elbow flexion was similar following nerve grafting and transfer. Nerve transfer for shoulder external rotation should be considered even in infants with available roots for grafting.Therapeutic IV.