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OBJECTIVE: Peripheral nerves remain a challenging target for medical imaging, given their size, anatomical complexity, and structural heterogeneity. Quantitative ultrasound (QUS) applies a set of techniques to estimate tissue acoustic parameters independent of the imaging platform. Many useful medical and laboratory applications for QUS have been reported, but challenges remain for deployment in vivo, especially for heterogeneous tissues. Several phenomena introduce variability in attenuation estimates, which may influence the estimation of other QUS parameters. For example, estimating the backscatter coefficient (BSC) requires compensation for the attenuation of overlying tissues between the transducer and the underlying tissue of interest. The purpose of this study is to extend prior studies by investigating the efficacy of several analytical methods of estimating attenuation compensation on QUS outcomes in the human median nerve. METHODS: Median nerves were imaged at the volar wrist in vivo and beam-formed radiofrequency (RF) data were acquired. Six analytical approaches for attenuation compensation were compared: 1-2) attenuation estimated by applying spectral difference method (SDM) and spectral log difference method (SLDM) independently to regions of interest (ROIs) overlying the nerve and to the nerve ROI itself; 3-4) attenuation estimation by applying SDM and SLDM to ROIs overlying the nerve, and transferring these properties to the nerve ROI; and 5-6) methods that apply previously published values of tissue attenuation to the measured thickness of each overlying tissue. Mean between-subject estimates of BSC-related outcomes as well as within-subject variability of these outcomes were compared among the 6 methods. RESULTS: Compensating for attenuation using SLDM and values from the literature reduced variability in BSC-based outcomes, compared to SDM. Variability in attenuation coefficients contributes substantially to variability in backscatter measurements. CONCLUSION: This work has implications for the application of QUS to in vivo diagnostic assessments in peripheral nerves and possibly other heterogeneous tissues.

Introduction: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition that affects cognitive, academic, behavioral, emotional, and social functioning, primarily in children. Despite its high prevalence, current pharmacological treatments are not effective in 30% of cases and show poor long-term adherence. Non-pharmacological interventions can complement medication-based treatments to improve results. Among these therapies, neurofeedback (NFB) and respiratory biofeedback (R-BFB) have shown promise in treating ADHD symptoms. Moreover, median nerve stimulation (MNS) can help to enhance the efficacy of these treatments, but it has never been explored in this context. This study aimed to: (1) investigate the effectiveness of a combined R-BFB and NFB intervention to treat ADHD, and (2) explore the potential benefits of MNS in enhancing the proposed intervention. Methods: Sixty children with ADHD participated in the study, divided into two experimental groups. The active group received verum MNS, and the sham group received sham MNS. Both groups performed the NFB/R-BFB treatment. Clinical assessments (i.e., Conner's parent rating scale) and electroencephalography (EEG) measurements were taken before the intervention, immediately after treatment, and one month later. Results: The results showed that the combined therapy significantly improved behavioral problems, anxiety, hyperactivity, and impulsivity-hyperactivity. Moreover, MNS enhanced the positive effects of the intervention, as the active group achieved higher improvement compared to the sham group. EEG analysis revealed significant changes in spontaneous brain activity, with an increase in frontal theta power (p = 0.0125) associated with reduced anxiety, which might explain the clinical outcomes. These changes were maintained 1 month after the intervention (p = 0.0325). Correlations between EEG changes and clinical outcomes were observed, suggesting a potential relationship between neurophysiological markers and ADHD symptoms measured by standardized scales. Discussion: The study findings suggest that the proposed R-BFB/NFB intervention may be an effective non-pharmacological therapy for ADHD, with the additional application of MNS potentially enhancing its effects. [ABSTRACT FROM AUTHOR]

Aim: This study aims to investigate the role of activated partial thrombin time (APTT) as a potential mediator in the relationship between suboptimal glycemic control and diabetic peripheral neuropathy (DPN) in individuals with type 2 diabetes mellitus (T2DM). Methods: A total of 183 T2DM patients were enrolled in this study. Comprehensive clinical data, including coagulation parameters and nerve conduction velocity, were collected and compared between patients with and without DPN. Subsequent correlation and regression analyses were conducted to explore the associations among APTT, HbA1c levels, and nerve conduction velocities. Moreover, mediation analyses were performed to evaluate the total, direct, and indirect effects of HbA1c on specific nerve conduction velocities, with APTT serving as a mediator. Results: In comparison to 101 patients without DPN, 82 patients with DPN exhibited significantly elevated levels of HbA1c and decreased levels of APTT. Notably, levels of APTT and HbA1c were correlated with conduction velocities of Tibial nerve motor fibers, as well as sensory fibers of the Ulnar nerve, Median nerve, and Sural nerve. Furthermore, both elevated HbA1c and decreased APTT were identified as risk factors for DPN in T2DM individuals. Mediation analysis showed that APTT mediated the indirect effect of HbA1c on the conduction velocities of sensory fibers in both the ulnar nerve and sural nerve (95% CI: -0.3448, -0.0135; -0.3523, -0.0180). APTT mediated the relationship between HbA1c and the conduction velocities of sensory fibers in the ulnar nerve or sural nerve by 34.66% or 22.03%, respectively. Conclusions: In patients with T2DM, uncontrolled HbA1c and shorter APTT emerges as risk factors for DPN. Additionally, the effect of increased HbA1c upon DPN, especially for influenced conduction velocities of sensory fibers in both the ulnar nerve and sural nerve may partly medicated by decreased APTT. [ABSTRACT FROM AUTHOR]

Background: Carpal tunnel syndrome (CTS) can be treated surgically. Although the minimally invasive open surgical method is widely used, it is not possible to directly visualise the entire length of the carpal tunnel, especially the proximal end, which is on the side away from the skin incision. In this study, we performed a mini-open carpal tunnel release with endoscopic assistance to release the entire length of the carpal tunnel under direct vision and investigated the treatment outcomes. Methods: The surgical method included an incision of ≤2 cm in the palm, cutting of the transverse carpal ligament under direct vision and cutting of the forearm fascia under endoscopic vision. A uniquely designed sheath was used for the endoscopic resection. We investigated the sex, age, medical history, symptoms, examination findings, anaesthesia method, operation time, thenar motor branch variation, postoperative complications, presence or absence of pillar pain and final examination findings of the target patients. Results: A total of 100 hands (85 patients) were included. Anatomical variations of the thenar motor branches were observed in 19 hands. At the final follow-up, hand numbness improved in all patients, while mild numbness was observed in 25 hands. The abductor pollicis brevis muscle improved in all patients with paresis, but 8 of the 27 hands remained completely paralysed. Pillar pain was observed in 36 hands at 8 weeks postoperative, but the condition improved in all patients. The clinical outcomes of this study were good with no cases of major complications or reoperation. Conclusions: The minimally invasive open surgical method described here can be reliably used to release the forearm fascia proximal to the carpal tunnel. The thenar motor branch can also be confirmed under direct visualisation, making it a relatively safe and useful approach. Level of Evidence: Level Ⅳ (Therapeutic) [ABSTRACT FROM AUTHOR]

Before clinical approval of chitosan nerve conduits (CNCs) less than 10 years ago, substantial material degradation was not reported from pre-clinical research. The current study investigated the biodegradation of two different CNC variants in the median nerve model. In adult rats, 10 mm long CNCs were secured covering end-to-end repair sites. After 2, 6, 12, and 18 months, the implantation sites were inspected, and samples harvested. Histology was performed in order to analyze local immune response or foreign body tissue reaction around the devices or within nerve samples. Further, the number of myelinated nerve fibers and the condition of the chitosan material was evaluated. Data confirmed that different CNC variants did not induce tissue reaction or negatively impact the condition of the regenerated nerve. At late time points, some specific variants were demonstrated to have resulted in encapsulated material debris in the vicinity of the original implantation side. The reported degradation behavior resembles recent clinical reports and indicates that implantation sites for CNCs need to be chosen carefully. Nerve regeneration itself is undisturbed, but narrow implantation sites should be avoided for eliminating the risk of foreign body sensation with immunologically inert material degradation. [ABSTRACT FROM AUTHOR]

This study aimed to develop, validate and test the clinical feasibility of ultrasound (US) speckle tracking method based on gradient optical flow for quantifying small longitudinal displacements, shear and strain in peripheral nerves. The speckle tracking method was validated using seven thawed, fresh-frozen isolated cadaveric forearms. Longitudinal motion of the median nerve was captured using a high-frequency 22 MHz linear probe. An air bubble marker was inserted as a reference point for manual measurement comparison. The precision and accuracy of the method were assessed by comparing manual and automatic measurements. Clinical feasibility was tested on eight healthy subjects, measuring the longitudinal displacement of the median nerve during elbow extension and shoulder anteflexion. The method demonstrated linearity, high precision and accuracy, particularly with a backtrace of five frames, reducing the displacement underestimation to 4%. In cadaveric models, the highest shear strain was observed at the nerve-tissue interfaces. In healthy subjects, the mean displacement of the median nerve was 3.3 ± 1.0 mm, with good inter-rater reliability (intraclass correlation coefficient = 0.87). The US speckle tracking method based on gradient optical flow effectively quantifies small longitudinal displacements and shear strain in peripheral nerves, with high precision and accuracy. However, the method could not detect longitudinal strain in nerves within the range of tested displacements. Future studies should investigate its applicability to smaller and deeper nerves and its usefulness in different pathological conditions. [ABSTRACT FROM AUTHOR]

Background: Trials demonstrated an increased risk of distal median nerve dysfunction (DMND) and carpal tunnel syndrome (CTS) associated with teriflunomide in people with multiple (pwMS). Objective: To estimate the real-world prevalence of clinical CTS and electrodiagnostic DMND in teriflunomide-treated pwMS. Methods: Cross-sectional study on selected teriflunomide (WHOATC code: L04AK02)-treated, risk factor-free pwMS at the Isfahan MS clinic in 2022. CTS was diagnosed through history and physical examination, and DMND was diagnosed by nerve conduction studies (NCS). Outcome consisted of an ordinal scale of DMND as follows: no DMND, all values within normal limits; mild, sensory conduction velocity < 40 m/s with motor onset latency < 4.5ms; moderate, motor onset latency between 4.5–6.5ms; severe, motor onset latency > 6.5ms with amplitude > 0.2mV; and very severe, motor amplitude < 0.2mV. Results: 52 participants were included (median [range] duration of teriflunomide treatment: 3 [18] years); 5.8% were diagnosed with CTS, yet, 51.9% showed at least some evidence of DMND; of the 104 hands, 25% showed mild, 11.5% moderate, 2.9% severe, and none showed very severe DMND. Right hand side (aβ [SE]: 0.67 [0.26]; p = 0.01), duration of MS (aβ [SE]: -0.14 [0.05]; p = 0.01) and age (aβ [SE]: 0.06 [0.03]; p = 0.05) were associated with a worse grade of DMND, while the association of DMND grade with sex, EDSS score, duration of teriflunomide treatment, and prior DMT, were not confirmed (all p values > 0.05). Conclusion: A considerable proportion of teriflunomide-treated pwMS had DMND in at least one hand. The etiology, along its optimal management strategy, remains to be explored. [ABSTRACT FROM AUTHOR]

Background: Lacertus syndrome, a condition characterized by median nerve compression at the elbow due to anatomical variations, is often misdiagnosed. This case report describes a 53-year-old female patient who presented with severe lateral elbow and shoulder pain, previously diagnosed with cervicalgia and tennis elbow. Methods: Upon admission, she reported significant pain (NRS—Numerical Rating Scale 8/10) and occasional radiating paresthesia in the first three digits of her left hand. Clinical examination revealed weakness in the wrist and finger flexion, which was exacerbated by a positive Cutaneous Scratch Test (CST), while Magnetic Resonance Imaging (MRI) of the cervical spine showed no definitive abnormalities. Electroneurography (ENG) indicated reduced amplitude in the left anterior interosseous nerve. Ultrasound excluded carpal tunnel syndrome but identified nerve flattening beneath the pronator teres muscle. A surgical decompression of the median nerve was performed, resulting in immediate improvement in muscle strength and significant pain reduction (NRS 1/10) postoperatively. Follow-up evaluations confirmed substantial recovery in nerve function and morphology. Conclusions: This case illustrates the atypical presentation of Lacertus syndrome, emphasizing the need for comprehensive diagnostic approaches that include clinical, imaging, and neurophysiological assessments. Awareness of this syndrome is crucial for differential diagnosis in patients exhibiting uncharacteristic symptoms, such as shoulder or elbow pain, to ensure timely and effective treatment. [ABSTRACT FROM AUTHOR]

Simple Summary: After dogs and cats, rabbits are the third most common pet kept in the UK, and they are often presented to veterinarians for a variety of surgical procedures. Many anaesthetic and pain-relieving drugs—in particular, opioids—can have adverse effects in this species, leading to prolonged recovery from general anaesthesia and gastrointestinal status, which may contribute to subsequent patient death; this is affirmed by the markedly increased anaesthetic mortality in rabbits compared to dogs and cats. Consequently, achieving a reduction in anaesthetic or opioid requirements is likely to lessen morbidity and mortality in this species. Locoregional analgesia techniques ("nerve blocks") involve the injection of local anaesthetic drugs to prevent the transmission of pain sensation to the brain, effectively "numbing" the affected area. By doing this as part of an anaesthetic procedure, it allows a marked reduction in both anaesthetic and opioid requirements. This study was undertaken to assess the feasibility of one specific locoregional technique (RUMM block) of the front leg in rabbit cadavers and demonstrated that this could be successfully performed; therefore, it may be of value in reducing complications in rabbits undergoing procedures on their forelimbs. This prospective, experimental, randomised, assessor-blinded cadaveric study was undertaken to describe the sono-anatomical features of the radial, ulnar, median and musculocutaneous (RUMM) nerves in rabbits and to develop and evaluate an ultrasound (US)-guided proximal RUMM block technique comparing a medial versus a lateral approach. A total of 13 adult rabbit cadavers were used. In Phase I of the study, four cadavers were used for anatomical dissection and to design and test a lateral and medial single injection point US-guided proximal RUMM block technique, while in Phase II, the medial and lateral approaches were randomly performed on nine cadavers administering 0.1 mL kg−1 injectate. After dissection, nerve staining was categorised as adequate (all nerves stained ≥4 mm) or inadequate (at least one nerve not stained or stained <4 mm). Staining spread was compared with Fisher's exact test, with p < 0.05 considered statistically significant. From Phase I, the axillary fascia containing all RUMM nerves was identified. The radial nerve exited the fascia right after the humeral head. In the lateral approach, the transducer was angled at 80° to the humerus longitudinal axis. In the medial approach, the transducer was placed perpendicularly to the humerus longitudinal axis. In both approaches, the brachial artery appeared as a rounded and anechoic structure, the musculocutaneous nerve as hypoechoic and oval and the radial nerve as a honeycomb, and the ulnar and median nerves were identified adjacent to each other. The radial nerve was selected as the injection point for both approaches using an in-plane technique. In Phase II, the injectate was found outside the axillary fascia in zero out of nine and five out of nine thoracic limbs, with an adequate staining in nine of nine and two of nine injections (p < 0.01) using the medial and lateral approach, respectively. Thus, a US-guided proximal RUMM block technique is feasible in rabbits, and the medial approach demonstrated evidence of a more consistent stain of the RUMM nerves. [ABSTRACT FROM AUTHOR]

• Nerve enlargement was common in SLE patients, in the forms of mild to moderate and focal thickening in upper limbs. • Nerve enlargement might be a potential indicator of high disease activity and poor functional status in SLE. • A combined examination using NCS and nerve ultrasound might be more effective in detecting SLE-related peripheral neuropathy. To explore the ultrasonographic characteristics of SLE-related peripheral neuropathy (PN) using nerve ultrasound. Patients with SLE were recruited consecutively between December 2022 and June 2023. Detailed clinical assessment and nerve ultrasound were conducted on each SLE patient and healthy control (HC) at predetermined sites of peripheral nerves. The upper limit of the CSA for each nerve location was defined as 95th percentile in healthy controls for the identification of nerve enlargement. Nerve conduction studies (NCS) and relevant ancillary examinations were conducted on all SLE patients for comparisons. A total of 32 SLE female patients and age- and gender-marched 52 HC were finally recruited. At M6 (P = 0.041) point of median nerve, U1 (P < 0.001) and U6-10 (P < 0.001, =0.008, <0.001, <0.001, <0.001, respectively) points of ulnar nerve, the CSA in SLE patients were remarkably higher than that in HC. Mild and moderate nerve enlargement were detected in 12 and 20 SLE patients, respectively. Only 12 tested nerves showed both axonal damage in electrophysiological studies and nerve enlargement under ultrasound. Nerve enlargement was extremely common in SLE patients, mainly in the forms of mild to moderate and focal thickening in upper limbs. There was significant inconsistency between NCS and ultrasound in detecting peripheral nerve involvement and a combined examination using NCS and nerve ultrasound might be more effective in detecting SLE-related PN. [ABSTRACT FROM AUTHOR]

• Avoiding neuromuscular blockade increases risk of unexpected movement in craniotomy with motor evoked potential (MEP) monitoring. • Post-tetanic MEP is an innovative technique to augment MEP amplitude. • Partial neuromuscular blockade with post-tetanic MEP improved baseline recordings and ensured patient safety during craniotomy. In craniotomies requiring motor evoked potential (MEP) monitoring, avoiding neuromuscular blockade (NMB) is preferable, but its complete avoidance poses risks of unexpected movement. This retrospective study investigates the application of a post-tetanic MEP augmentation technique to enhance baseline recording of transcranial stimulation MEP (Tc-MEP) under partial NMB during craniotomy. Twenty-six patients were included. The level of partial NMB was maintained at a train-of-four ratio of approximately 40 %. Monophasic constant-current stimulation was applied on the craniotomy side with + 20 % of the threshold intensity. Post-tetanic Tc-MEP, involving tetanic stimulation of the median nerve 1 s before transcranial stimulation, was performed on patients who failed to record using conventional baseline recording. The post-tetanic Tc-MEP technique successfully improved the success rate of baseline recording from 61.5 % to 100 %. Application of post-tetanic Tc-MEP significantly increased amplitudes in both the upper (p = 0.04) and lower limbs (p < 0.01) compared to before post-tetanic Tc-MEP. No patients had unexpected movements. This study indicates that post-tetanic Tc-MEP enhanced the success rate of baseline recording during craniotomy under partial NMB. The combination of partial NMB and post-tetanic Tc-MEP could be a useful regimen for craniotomy with MEP monitoring, addressing both safety concerns and successful baseline recording. [ABSTRACT FROM AUTHOR]

Purpose: Ultrasound-guided nerve hydrodissection has emerged as a potential non-surgical treatment for carpal tunnel syndrome (CTS). The objective of this research was to offer suggestions for optimizing injectables utilized in hydrodissection for the treatment of CTS through a systematic review and network meta-analysis. Materials and Methods: PubMed, MEDLINE, EMBASE, Cochrane, Scopus, and Web of Science were searched through April 25, 2024. Effect sizes were quantified using standard mean differences within a random-effects model. Effectiveness ranking for each treatment was expressed as the surface under the cumulative ranking curve (SUCRA). Results: Nine studies with 458 patients with CTS were included. According to SUCRA, 5% dextrose (DW) was the most effective option for the Boston Carpal Tunnel Questionnaire (BCTQ) function at 99.9, 89.8, and 88.8 at 4, 12, and 24 weeks, respectively; for BCTQ symptoms, 5% DW was the most effective option at 99.9 at 4 weeks and platelet-rich plasma at 95.7 and 93.9 at 12 and 24 weeks, respectively. In terms of both BCTQ symptoms and BCTQ function, the 5 cc injection was the most effective, with SUCRA values of 99.5 for both categories. However, the effectiveness of the electrodiagnostic assessment and ultrasound variables was dependent on the type and dose of medication. Conclusion: Administration of 5% DW showed better results in terms of initial symptom relief and long-term functional recovery compared to other agents, while platelet-rich plasma showed greater long-term symptom improvement; an injection dose of 5 cc showed the greatest benefit. However, additional research is required to establish precise protocols based on disease severity. [ABSTRACT FROM AUTHOR]

The feasibility of a pedicled flexor digitorum superficialis muscle flap was studied in 10 fresh cadavers. The number, length and distance from the flexion wrist crease of muscular branches from the ulnar artery in the distal 10 cm of the forearm were recorded. The mean number of muscular branches was 2.7 (range 1–4). The mean distance of the most distal branch was 35 mm (range 26–40) from the proximal wrist flexion crease. Its mean length was 20 mm (range 16–26). A partial muscle flap was raised on the most distal branch and transposed over the median nerve in the distal forearm. Dissection and transposition of this flap were feasible in all specimens. The reliable pattern of muscular branches to the flexor digitorum superficialis allows the elevation of a pedicled partial muscle flap that can cover the median nerve in the distal forearm. Level of evidence: V [ABSTRACT FROM AUTHOR]

Nerve terminals are the final point of regulation before neurosecretion. As such, neuromodulators acting on nerve terminals can exert significant influence on neural signaling. Hypothalamic corticotropin-releasing hormone (CRH) neurons send axonal projections to the median eminence where CRH is secreted to stimulate the hypothalamic-pituitary-adrenal (HPA) axis. Noradrenaline and corticosterone are two of the most important neuromodulators of HPA axis function; noradrenaline excites CRH neurons and corticosterone inhibits CRH neurons by negative feedback. Here, we used GCaMP6f Ca2+ imaging and measurement of nerve terminal CRH secretion using sniffer cells to determine whether these neuromodulators act directly on CRH nerve terminals in male mice. Contrary to expectations, noradrenaline inhibited action potential-dependent Ca2+ elevations in CRH nerve terminals and suppressed evoked CRHsecretion. This inhibitory effect was blocked by a2-adrenoreceptor antagonism. Corticosterone also suppressed evoked CRH peptide secretion from nerve terminals, independent of action potential-dependent Ca2+ levels. This inhibition was prevented by the glucocorticoid receptor antagonist, RU486, and indicates that CRH nerve terminals may be a site of fast glucocorticoid negative feedback. Together these findings establish median eminence nerve terminals as a key site for regulation of the HPA axis. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Methods Results Discussion Extrapolated reference values (E‐Ref) procedure is a new method for determining the cutoff value without collecting the control data. We tried to apply this method to determine the cutoff value for the distal motor latency of the median nerve (median DML). During this process, we found two pitfalls of the E‐Ref method. First, the E‐Ref procedure did not correctly work when the DML values measured with 0.1 ms accuracy frequently took on tie values. Second, the result was influenced by the proportion of abnormal values. This study investigated these issues.Data of the median DML were extracted from our laboratory database. To solve the problem of tie values, we tried a wider post‐smoothing window in the original E‐Ref method. We also devised a modified method conducting pre‐smoothing. To see the effect of the proportion of abnormal data, we simulated many datasets having different proportion of abnormal data.In total, 1016 DML values were identified. False deflections due to tie values were often identified as the E‐Ref point using the original methods even using a wider window, resulting in unrealistically low values. Modified method was free from this drawback. For all methods, the E‐Ref value increased as the proportion of abnormal values increased.The problem of tie values, a pitfall of the E‐Ref method, might be solved by pre‐smoothing the data. The E‐Ref value is influenced by the proportion of the normal data, and datasets containing less than 20% abnormal data may achieve appropriate results. [ABSTRACT FROM AUTHOR]

Background: In this study we investigate the selective compensation of paired peripheral nerves in healthy humans, focusing on distinct axonal conduction velocities in different fibre types. Using paired associative stimulation (PAS) with adjustable parameters, we aimed to modulate and compensate for neuronal activity along the median nerve. Methods: Six healthy volunteers (3 male, 3 female, aged: 22–49) participated in the current study. We conducted 30 experiments with the following protocol. A pair of pulses with the following parameters were applied to each volunteer: amplitude, pulse width and inter-pulse delay was generated by the dual-core programmed microcontroller STM32H745xI/G while values were set by one-board computer Jetson Nano. The microcontroller provided a pair of pulses to the DAC that applied it to nerve stimulation sites via a stimulator. During experiments, we used the following ranges: (a) current amplitudes [0–20mA], (b) pulse width [250–500 μs] and (c) delays [50–250 μs]. As the measurement of the stimulation effectiveness, we used the finger's contraction angles. Results: Our findings reveal a significant selective compensation (inhibitory) effect over the motor responses, demonstrated through variations in finger displacement angles. By optimizing individual parameters-pulse width, inter-pulse delay, and compensatory currents—we successfully induced motor response compensation effects. Notably, consistent compensatory effects were observed across all volunteers using a pulse width of (250 μs) and an inter-pulse delay of (50 μs). Discussion: These results highlight PAS's potential for developing non-invasive neuromodulation devices. However, further research is required to evaluate its efficacy in individuals with spasticity and upper motor neuron deficits. [ABSTRACT FROM AUTHOR]

Significance: The precise identification and preservation of functional brain areas during neurosurgery are crucial for optimizing surgical outcomes and minimizing postoperative deficits. Intraoperative imaging plays a vital role in this context, offering insights that guide surgeons in protecting critical cortical regions. Aim: We aim to evaluate and compare the efficacy of intraoperative thermal imaging (ITI) and intraoperative optical imaging (IOI) in detecting the primary somatosensory cortex, providing a detailed assessment of their potential integration into surgical practice. Approach: Data from nine patients undergoing tumor resection in the region of the somatosensory cortex were analyzed. Both IOI and ITI were employed simultaneously, with a specific focus on the areas identified as the primary somatosensory cortex (S1 region). The methodologies included a combination of imaging techniques during distinct phases of rest and stimulation, confirmed by electrophysiological monitoring of somatosensory evoked potentials to verify the functional areas identified by both imaging methods. The data were analyzed using a Fourier-based analytical framework to distinguish physiological signals from background noise. Results: Both ITI and IOI successfully generated reliable activity maps following median nerve stimulation. IOI showed greater consistency across various clinical scenarios, including those involving cortical tumors. Quantitative analysis revealed that IOI could more effectively differentiate genuine neuronal activity from artifacts compared with ITI, which was occasionally prone to false positives in the presence of cortical abnormalities. Conclusions: ITI and IOI produce comparable functional maps with moderate agreement in Cohen's kappa values. Their distinct physiological mechanisms suggest complementary use in specific clinical scenarios, such as cortical tumors or impaired neurovascular coupling. IOI excels in spatial resolution and mapping reliability, whereas ITI provides additional insights into metabolic changes and tissue properties, especially in pathological areas. Combined, these modalities could enhance the understanding and analysis of functional and pathological processes in complex neurosurgical cases. [ABSTRACT FROM AUTHOR]

Background: Carpal tunnel syndrome (CTS) is a common peripheral neuropathy, often assessed using the Boston Carpal Tunnel Questionnaire (BCTQ). The BCTQ evaluates symptom severity (SSS) and functional status (FSS) but has limitations in stratifying CTS severity, particularly in severe cases. Objective: This study aimed to evaluate the utility of the BCTQ in a homogeneous cohort of female workers engaged in repetitive manual tasks, exploring its correlation with objective clinical measures and its performance in detecting CTS severity. Methods: A cross-sectional study was conducted on 24 right-hand-dominant female workers with repetitive occupational tasks. CTS diagnosis was confirmed via clinical and electrodiagnostic criteria. Subjects completed the BCTQ, and correlations between BCTQ scores and objective measures such as median nerve cross-sectional area and nerve conduction studies were analyzed. Statistical analyses included comparisons across CTS severity groups and subgroup evaluations based on age and tenure. Results: The BCTQ demonstrated moderate correlations with objective measures, with a strong correlation between SSS and FSS scores (r = 0.86, p < 0.001). However, the sensitivity of the SSS and FSS was limited, particularly for severe CTS cases. Paradoxically lower scores in severe cases may reflect questionnaire limitations or adaptive responses. Targeted questions addressing pain and sensory symptoms showed better sensitivity (>80%) and may guide clinicians in identifying slight CTS cases. Conclusions: While the BCTQ remains a valuable tool for assessing CTS, its limitations necessitate complementary use of objective diagnostic tools, particularly for severe cases. Future refinements, such as tailored scoring systems and integration with clinical measures, could enhance its diagnostic utility and ensure comprehensive assessment of CTS severity. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the diagnostic and evaluative significance of combining median nerve (MN) morphological measurements with diffusion tensor imaging (DTI) and T2 mapping metrics for carpal tunnel syndrome (CTS). Morphological and multiparametric magnetic resonance neurography (MRN), along with clinical evaluation, were conducted on 33 CTS patients and 32 healthy controls. The MRN metrics included fractional anisotropy (FA), apparent diffusion coefficient (ADC), axial diffusivity (AD), radial diffusivity (RD), T2 value, cross-sectional area (CSA) and MN flattening ratio (MNFR) at both the pisiform bone and hamate bone levels. Differences in MRN metrics between the above two levels (Delta FA, Delta ADC, Delta AD, Delta RD and Delta T2) were calculated. T-tests, multivariable regression, and receiver operating characteristic (ROC) curve analyses were used to compare and classify patients with CTS and controls. The correlations between MRN metrics and clinical characteristics were analyzed. Comparisons were also made between MRN metrics in patients with and without significant symptom improvement after treatment. FA, AD, T2 value, and CSA at the pisiform bone level were identified as independent predictors of CTS. The combination of these metrics improved diagnostic performance (AUC 0.922, sensitivity 84.85% and specificity 90.62%). Delta ADC, Delta AD, and Delta T2 correlated with function Boston scores. The T2 value at hamate bone level, along with Delta AD and FA, correlated with visual analogue score (VAS). CSA and Delta T2 had higher AUCs for classifying patients with and without significant symptom improvement after treatment. These findings suggest that combining MN morphological and multiparametric MRN metrics can enhance the diagnostic performance of CTS and has the potential to provide an objective and quantitative basis for further study of the degree of entrapment and prognosis. [ABSTRACT FROM AUTHOR]

Introduction: Widespread pain may be related to psychosocial aspects in several musculoskeletal conditions, but the literature on carpal tunnel syndrome (CTS) is scarce. Objective: To determine the relationship between pain extent and psychological factors (catastrophizing, kinesiophobia, anxiety symptoms, and depression) in people with CTS. Methods: A cross-sectional study was conducted. The independent variables were: pain intensity, disability (QuickDASH), duration of symptoms, anxiety and depressive symptoms, catastrophizing, and kinesiophobia. The main outcome was: pain extent (% of total area and categories "pain within the median nerve-innervated territory" versus "extra-median nerve pain"). Correlation analysis was performed using Spearman's correlation coefficient. A linear regression model and binary logistic regression (both with forward selection) were performed to determine the main predictors of pain extent. Results: Forty-eight participants were included. A moderate positive correlation was found between catastrophizing (r = 0.455; p = 0.024) and disability (r = 0.448; p = 0.024) with total pain extent area. Regression models indicated that catastrophizing explained 22% of the variance in the pain extent (β = 0.003; 95% CI: 0.002–0.005), while kinesiophobia was the variable that best explained the distribution of pain in the extra-median territory (R2 Nagelkerke = 0.182). Null or weak correlations were found for the rest of the associations. Conclusion: Catastrophizing and kinesiophobia were the main indicators of pain extent in people with CTS. Clinicians are advised to use specific questionnaires to check for the presence of catastrophizing or kinesiophobia in people with CTS and wider pain extension. [ABSTRACT FROM AUTHOR]

This study aimed to demonstrate the effectiveness of our new diagnostic chart using point of care ultrasound combined with CTS-6 for diagnosing idiopathic carpal tunnel syndrome. We conducted a retrospective analysis of the data of patients who visited our department and received point of care ultrasound combined with CTS-6 from 2020 to 2023. Data regarding age, sex, initial and final diagnosis, cross-sectional area of the median nerve, CTS-6 score, and electrodiagnostic severity were obtained and statistically analyzed. Of the 177 wrists included in our study, 138 (78 %) were diagnosed with carpal tunnel syndrome, while 39 (22 %) were not (non-carpal tunnel syndrome). With our diagnostic method, 127 wrists (72 %) were diagnosed initially with carpal tunnel syndrome, 23 wrists (13 %) with non-carpal tunnel syndrome, and the rest 27 wrists (15 %) as borderline. Our initial diagnoses of carpal tunnel syndrome and non-carpal tunnel syndrome were maintained in all cases except for two. Cross-sectional area, CTS-6 score, and electrodiagnostic severity showed a positive correlation. A post hoc analysis showed that the new scoring system (CTS-6 score + 2 × cross-sectional area) with a cutoff value of 31.25 points showed a sensitivity as high as 95 % and a specificity of 100 %. Our findings suggest that most suspected idiopathic carpal tunnel syndrome cases can be diagnosed correctly using the diagnostic chart. Although additional tools, including electrodiagnostic studies, may be needed for borderline cases, the use of point of care ultrasound combined with CTS-6 may be a recommendable first-line confirmatory test because point of care ultrasound and CTS-6 could be complementary tools, and this chart may be especially beneficial for atypical or outlier cases. Diagnostic III. [ABSTRACT FROM AUTHOR]

Introduction: The epidermal growth factor receptor (EGFR; ErbB1), a membrane bound receptor tyrosine kinase, is hypothesized to have an inhibitory influence on peripheral nerve regeneration. This study examines the impact of EGFR inhibition on nerve regeneration using the commercially available small molecule inhibitor gefitinib. Method: In vitro assays included neurite outgrowth of cultured dorsal root ganglion (DRG) neurons from adult C57Bl/6 wildtype mice on immobilized chondroitin sulfate proteoglycans (CSPG). Following forelimb median nerve injury, EGFR expression, number of regenerated neurons (using retrograde labeling) and myelination of motor and sensory neurons were compared between mice that received either gefitinib or vehicle. Functional recovery was assessed using grip strength. Results: EGFR expression on DRG and spinal motor neurons was confirmed. Gefitinib significantly increased neurite outgrowth in medium sized (30–50 μm) DRG neurons, resulting in longer neurites (183 ± 36 μm) compared with CSPG alone (49 ± 9 μm). After median nerve injury, significantly greater numbers of sensory neurons (638 ± 112 vs. 301 ± 81), but not motor neurons (31 ± 12 vs. 42 ± 13) regenerated in animals treated with gefitinib compared with controls. Regenerated axons in gefitinib treated animals displayed significantly greater diameter and increased g‐ratio compared with controls. Grip strength recovered more quickly in animals receiving gefitinib compared with controls (27.6 vs. 19.1 g 18 days post‐injury). Discussion: This study provides data supporting the role of EGFR as a negative regulator of sensory but not motor neuron regeneration. Further, it demonstrates versatile potential uses of existing pharmaceuticals. [ABSTRACT FROM AUTHOR]

Objective: To investigate and compare the median nerve-cross sectional area at the wrist region of the dominant and non-dominant hands of high- and low- smartphone users. Method: This descriptive cross-sectional study was based on 128 human subjects conducted at Bahria University Health Sciences Karachi Campus from January to June 2022. The sample size was calculated using the method of sample size for frequency in a population www.openepi.com which is an open-source calculator, version 3-SSPropor using the following equation: Sample size n = [DEFF*Np(1-p)]/[(d²/Z²1-α/2*(N-1)+p*(1-P)]. The subjects were from MBBS, BDS, DPT, and Dental House Officers. They were grouped into two categories: high-smartphone users and lowsmartphone users, based on the smartphone addiction scale (SAS). Ultrasound was carried out on each subject’s wrist regions at the carpal tunnel level. The readings were compared between the dominant and non-dominant hands of each individual. Results: In this descriptive cross-sectional study on 128 subjects, the difference between the median nerve crosssectional areas (MN-CSAs) of the dominant and non-dominant hand of the high-smartphone group was highly significant (p=0.007). The difference between the MN-CSAs of the dominant and non-dominant hand of the low-smartphone group was significant too (p=0.0103). Conclusion: Smartphone overuse resulted in an enlarged median nerve, especially in the dominant hand. [ABSTRACT FROM AUTHOR]

Objectives: Lateral sagittal infraclavicular approach is frequently used because it has less risk of complications and provides rapid and adequate regional anesthesia. Due to the fact that the brachial plexus is deeper in the infraclavicular region and the approach angle is sharper, it can be technically challenging. In this study, we aimed to compare the costoclavicular approach, which is a newly defined approach, with the lateral sagittal infraclavicular brachial plexus block. Methods: This prospective, randomized, single-blind study was conducted with a total of 43 patients. There were 21 patients in the lateral sagittal infraclavicular approach group (Group L) and 22 patients in the costoclavicular approach group (Group C). A mixture of 10 ml 1% lidocaine with 10 ml 0.25% bupivacaine was given to both groups under the guidance of ultrasonography. Sensory and motor examinations were performed every five minutes for 30 minutes, and the results were recorded. Results: Sufficient block formation time was 10 (5–30) minutes in Group C and 15 (5–30) minutes in Group L (p=0.010). Sensory and motor block formation times of each nerve (median nerve, radial nerve, ulnar nerve, and musculocutaneous nerve) were found to be shorter in Group C than in Group L (p<0.05). Conclusion: The costoclavicular approach provides faster regional anesthesia formation than the lateral sagittal infraclavicular approach. [ABSTRACT FROM AUTHOR]

Background: In the era of the computer revolution, ubiquitous electronic devices comprise more than 80% of the work done using desktops and laptops. The wrist joint's reduced movement due to longer working hours on a computer is more closely associated with neurological symptoms like entrapment neuropathy at the wrist. With varying sensitivity and specificity, certain provocative tests such as Phalen's test are used to make diagnoses and have been employed as outcome measures in clinical investigations in the study. Aim: To evaluate and compare the role of provocative tests in the diagnosis of nerve compression among computer operators. Methods: This observational study was conducted in the Neurology OPD and Physiology Department. Sample size: the study included 120 participants with an average age of 18-50 (34 ± 6.4) years. Group I-60 long duration (>6 hrs/day for more than two years) and Group II-60 short duration (<2 hrs/week for more than two years) computer operators were included in the study. Phalen's test for median nerve compression was performed on participants. Results: The study showed Phalen's test with positive results with 15% in long-duration computer operators and 1.7% in short-duration computer operators. There was a statistically significant association between the duration of computer use and Phalen's test for diagnosing median nerve compression. Conclusion: Computer use for a long time causes median nerve compression, and Phalen's test is sensitive to tingling, numbness, and paraesthesia. Phalen's test as a provocative diagnostic test can be used for screening and early detection of CTS in computer operators. Further confirmation by nerve conduction studies is required. [ABSTRACT FROM AUTHOR]

When all four fingers are engaged together during a grip strength contraction, the force produced by an individual finger is less than the force produced when it acts in isolation. The purpose of this study was to evaluate whether the reduced force output of a digit during an all-finger grip contraction is due to a decline in voluntary activation. Fifteen young adults (n = 7 females) completed voluntary contractions of the index finger in isolation and all fingers together in a dynamometer capable of separately recording forces from each finger during voluntary and electrically evoked contractions. The median and ulnar nerves were electrically stimulated simultaneously at the elbow to record individual finger flexion forces from doublet (100 Hz) pulses. Doublet stimulations were applied during and immediately following contractions at 50, 65, 85, and 100% maximal voluntary contraction (MVC) forces. Two-way ANOVAs were used to compare the effects of sex and finger (single vs. all) on flexion forces and voluntary activation. The index finger produced ∼25% more force when engaged in isolation compared with the all-finger contraction; however, there were no differences in voluntary activation between the single and all-finger MVCs (P = 0.344). The index finger force deficit was larger in females compared with males (34 vs. 18%, P = 0.030), but this was not explained by sex-related differences in voluntary activation. These data indicate that the additional force produced during single-finger contractions is not due to an alteration in voluntary activation, as all-finger contractions display near-maximal activation of each digit. NEW & NOTEWORTHY: The deficit in finger flexion force when multiple digits are engaged is well characterized and often attributed to reduced motor unit activation. Using a custom-built, multifinger dynamometer, we report that the index-finger force deficit may not be related to a deficit in voluntary activation. Furthermore, the index-finger force deficit was greater in females compared with males, but this was also not related to sex-related differences in voluntary activation. [ABSTRACT FROM AUTHOR]

Objective: To systematically evaluate the clinical efficacy of acupuncture in the treatment of diabetic peripheral neuropathy (DPN). Methods: Randomized controlled trial (RCT) of acupuncture for diabetic peripheral neuropathy in Chinese Knowledge Network (CNKI), Wanfang database, VIP database (VIP), PubMed, web of science, cochrane library, AMED and CINAHL were searched by computer since the establishment of the database. All publications in English and Chinese as of 30 December 2023 will be searched, without country or article type restrictions. Study selection, data extraction and evaluation were performed independently by two researchers. Risk of bias was assessed using the Cochrane risk assessment tool, and Meta-analysis was performed using RevMan5.3 software. Results: DPN has good effective rate in acupuncture than conventional western medicine alone. However, the above conclusions need to be verified by larger samples and higher quality randomized controlled trials. ① Acupuncture treated DPN more effective than drug (RR = 1.38, 95%CI = 1.26 ~ 1.51, Z = 6.93, p < 0.00001), DPN of patients with acupuncture plus drug (RR = 1.38, 95%CI = 1.05 ~ 1.82, Z = 2.28, p = 0.02), There was no significant difference between acupuncture and usual care (RR = 2.41, 95%CI = 0.70 ~ 8.29, Z = 1.39, p = 0.16); ② Acupuncture treatment is superior to drug group in improving the SNCV of the median nerve (MD = 1.65, 95%CI = 0.74 ~ 2.57,Z = 3.55, p = 0.0004), sham needle treatment (MD = 0.50, 95%CI = 0.17 ~ 0.83, Z = 2.95, p = 0.003), Acupuncture plus drug was superior to drug in improving the SNCV of the median nerve (MD = 3.29, 95%CI = 2.55 ~ 4.03, Z = 8.70, p < 0.00001); ③ Acupuncture treatment is superior to drug group in improving the MNCV of the median nerve (MD = 2.24, 95%CI = 0.50 ~ 3.98, Z = 2.52, p = 0.01), and sham needle treatment (MD = 0.20, 95%CI = −0.03 ~ 0.43, Z = 1.69, p = 0.09), Acupuncture plus drug was superior to drug group in improving the MNCV of the median nerve (MD = 2.63, 95%CI = 1.83 ~ 3.42, Z = 6.46, p < 0.00001); ④ Acupuncture is better to drug group in improving SNCV of common peroneal nerve (MD = 1.67, 95%CI = 0.21 ~ 3.13, Z = 2.24, p = 0.02); ⑤ Acupuncture treatment is superior to drug group in improving the MNCV of the common peroneal nerve (MD = 2.03, 95%CI = 1.37 ~ 0.69, Z = 6.04, p < 0.00001), Acupuncture plus drug outperformed MNCV in improving the common peroneal nerve (MD = 4.23, 95%CI = −0.16 ~ 8.62, Z = 1, 89, p = 0.06); ⑥ Acupuncture treatment is superior to drug group in improving the SNCV of the tibial nerve (MD = 1.58, 95%CI = 0.85 ~ 2.30, Z = 4.26, p < 0.0001); ⑦ There was no significant difference between acupuncture treatment and drug group in improving the MNCV of the tibial nerve (MD =1.55, 95%CI = −0.59 ~ 3.68, Z = 1.42, p = 0.16); ⑧ Acupuncture plus drug is better than medication in reducing VAS (MD = −2.35, 95%CI = -3.78 ~ −0.93, Z = 3.23, p = 0.001), Acupuncture plus usual care is superior to usual caret (MD = −28.70, 95%CI = -39.50 ~ 17.90, Z = 5.21, p < 0.00001), There was no significant difference between acupuncture and sham needle treatment (MD = −4.00, 95%CI = -18.32 ~ 10.32, Z = 0.55, p = 0.58). Conclusion: Compared with drug, usual care, and sham AT, AT has a better response rate and more favorable effect in improving nerve conduction velocity. The combination of AT and drug demonstrates a more significant improvement compared to drug alone. The combination of AT and usual care improves DPN symptoms more effectively than usual care. However, the above conclusions need to be verified by larger samples and higher quality randomized controlled trials. Systematic review registration: [https://www.crd.york.ac.uk/], identifier [CRD42023451575]. [ABSTRACT FROM AUTHOR]

Carpal Tunnel Syndrome (CTS) is a prevalent neuropathic disorder caused by chronic compression of the median nerve, leading to sensory and motor impairments. Conventional treatments, such as corticosteroid injections, wrist splinting, and surgical decompression, often fail to provide adequate outcomes for chronic or recurrent cases, emphasizing the need for innovative therapies. Hydrogels, highly biocompatible three-dimensional biomaterials with customizable properties, hold significant potential for CTS management. Their ability to mimic the extracellular matrix facilitates localized drug delivery, anti-adhesion barrier formation, and tissue regeneration. Advances in hydrogel engineering have introduced stimuli-responsive systems tailored to the biomechanical environment of the carpal tunnel, enabling sustained therapeutic release and improved tissue integration. Despite these promising developments, hydrogel applications for CTS remain underexplored. Key challenges include the absence of CTS-specific preclinical models and the need for rigorous clinical validation. Addressing these gaps could unlock the full potential of hydrogel-based interventions, which offer minimally invasive, customizable solutions that could improve long-term outcomes and reduce recurrence rates. This review highlights hydrogels as a transformative approach to CTS therapy, advocating for continued research to address translational barriers. These innovations have the potential to redefine the treatment landscape, significantly enhancing patient care and quality of life. [ABSTRACT FROM AUTHOR]

Intraosseous median nerve entrapment at the level of the elbow can occur after a traumatic event such as fracture and/or dislocation of the elbow. It is considered a rare and severe entity. We present a rare case of nontraumatic median nerve entrapment inside the distal humerus. No article about atraumatic intraosseous entrapment was encountered in literature. [ABSTRACT FROM AUTHOR]

Background: Steroid injections are a common treatment option in the management of carpal tunnel syndrome (CTS). This study assesses various prognostic factors for progression to carpal tunnel release (CTR) after a first-time steroid injection for CTS with specific focus on concomitant ulnar nerve compression (UNC). Methods: This is a retrospective study of 426 hands with CTS treated with a first-time steroid injection in the Long Island region of New York. The main predictor variable was UNC measured in two analytical models of positive UNC and location of UNC (wrist or elbow). Multivariate logistic regression analyses adjusted for demographic, medical, and CTS-related variables for 2 study outcomes occurring within 1 year: (1) CTR; and (2) steroid reinjection. Results: Overall progression to CTR within 1 year of steroid injection was 23.0%. Ulnar nerve compression was present in 16.7% of patients and was significantly associated with increased odds for CTR but not with steroid reinjection. These results were further localized to be specific for UNC at the elbow. A moderate or severe result on electrodiagnostic studies was associated with increased odds for CTR. Increased age was associated with slightly increased odds of steroid reinjection while a history of distal radius fracture was associated with decreased odds of steroid reinjection. Conclusions: Carpal tunnel syndrome patients with UNC may benefit from earlier definitive treatment with CTR rather than attempting steroid injections, as they are more likely to seek reintervention within 1 year of their initial injection. [ABSTRACT FROM AUTHOR]

A 7-year-old golden retriever was evaluated for a 6-month history of progressive right thoracic limb lameness. A lameness (grade 3 out of 5 on visual gait analysis) and pain with palpation of the medial aspect of the brachium proximal to the elbow were identified on exam. Magnetic resonance imaging of the right thoracic limb revealed a well-delineated, ovoid mass arising from the median nerve just proximal to the elbow. Compartmental resection of the mass with limb preservation was performed. Microscopically, the mass was a malignant nerve sheath neoplasm. One week postoperatively, the lameness was mild (grade 1). Three months postoperatively, the lameness had resolved (grade 0). One year postoperatively, the dog’s gait remains normal. Malignant nerve sheath neoplasms commonly arise in the brachial plexus or cervical spinal nerves, often affecting the innervation provided by the radial nerve. Given its role in providing weight support, dysfunction of the radial nerve significantly impacts the gait. Conversely, dysfunction of the median nerve should not impair the gait. In the present case, compartmental resection of the neoplasm affecting the median nerve resolved the dog’s lameness. The return of normal limb function supports the contention that the lameness was consequent to general somatic afferent dysfunction, neuropathic pain, rather than general somatic efferent function (paresis).

The letter discusses the distinction between primary and secondary lacertus fibrosus syndrome (LS) and the need for cautious surgical treatment based on scientific evidence. Professor Tang emphasizes the rarity of primary LS in younger patients and warns against unnecessary surgeries. Another surgeon, Dr. Vastamäki, shares his experience with LS, highlighting the importance of clear diagnostic criteria and the need for further research to differentiate between primary and secondary LS. Both surgeons advocate for strict diagnostic criteria and the importance of randomized controlled trials in nerve entrapment surgery. [Extracted from the article]

In the present case, two Lateral Pectoral Nerves (LPN) were in the right axilla. The upper branch, superior LPN arose from the proximal part of the axilla deep to the clavicle from the anterior division of the upper trunk. This branch descends medially and enters the deep surface of the pectoralis major muscle. A larger LPN is seen originating from the distal part of the right lateral root of the median nerve at the lower part of the axilla, medial to the third part of the right axillary artery. This inferior LPN is 2 cm long, descends medially, and joins with the Medial Pectoral Nerve (MPN) forming ansa pectoralis. The branches from the ansa pierce the pectoralis minor muscle and enter the pectoralis major muscle. It supplies both the pectoral muscles. LPN fibers passing from the Lateral Cord (LC) through the lateral root of median have not been reported yet. The LPN is the main nerve of pectoralis major muscle. A thorough understanding of Pectoral Nerve (PN) anatomy is a must for surgeons practicing mastectomies, breast augmentation surgery, axillary dissection, harvesting pectoralis major muscle island flap, and dealing with trauma and fracture of the shoulder. [ABSTRACT FROM AUTHOR]

The article discusses a case of a symptomatic schwannoma originating from the median nerve in a 38-year-old male patient. The patient presented with burning pain in the hand radiating from the left arm, and after failed nonsteroidal anti-inflammatory drug and neuropathic pain agent treatments, an ultrasound-guided interventional pain management approach was taken. The schwannoma was diagnosed through ultrasound imaging, and surgical excision led to symptom relief. Schwannomas are benign tumors originating from Schwann cells, with surgical excision being the definitive treatment. Ultrasound imaging of peripheral nerves is increasingly used for diagnostic purposes in cases of nerve injuries. [Extracted from the article]

As a biarticular muscle, the biceps brachii both supinates the forearm and flexes the elbow and shoulder, thus allowing the upper limb to perform a variety of activities of daily living (ADL). The biceps brachii originates on the coracoid apex as well as the supraglenoid tubercle and inserts on the radial tuberosity. At the distal end, the bicipital aponeurosis (BA) provides a transition of the biceps tendon into the antebrachial fascia. Previous work has reported the importance of the bicipital aponeurosis in stabilizing distal tendons. Other studies have reported the supination effect that the BA has on the forearm at the radioulnar joint, where it also protects the brachial artery and median nerve (neurovascular bundle). In addition, it has been speculated to have a proprioceptive function. However, despite the important functions fulfilled by this structure, the mechanical properties of the BA are yet to be quantified. Mechanical properties for eight fresh frozen BA specimens (82 ± 12 years, 5 females, 5 right) were quantified using a Cellscale Biaxial (Waterloo, ON) testing machine. Three samples (approximately 7 × 7mm each) were harvested from the proximal, middle and distal regions along the length of the BA. Samples were tested on a biaxial testing machine while maintaining the alignment of the longitudinal collagen fiber orientation with the X-axis of the tester. The testing protocol included 10 preconditioning sinusoidal cycles at 9% strain, at a strain rate of 1%/s, followed by biaxial testing to a maximum strain of 12% at a strain rate of 1%/s. Young's modulus was quantified for all biaxial tests from the linear portion of the resulting stress-strain relation. Results showed that elastic modulus values were significantly greater in the longitudinal direction aligned with the collagen fibers. The outcomes of this study will provide input values for future models of distal biceps repair, thus aiding surgical planning by providing insight into the potential load sharing contributions of the BA. [ABSTRACT FROM AUTHOR]