Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. Minimal invasive laparoscopic cholecystectomy is the typical surgical treatment for cholelithiasis (gallstones), where patients present with a history of upper abdominal pain and episodes of biliary colic. The classic technique for minimal invasive laparoscopic […]
The superficial radial sensory nerve can be entrapped between the brachioradialis and extensor carpi radialis longus tendons as the radial sensory nerve courses superficially from its deep origin. Compression of the radial sensory nerve presents with numbness and/or pain on the dorsal radial aspect of the hand. Pronation of the hand exacerbates these symptoms as […]
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Entrapment of the common peroneal nerve (CPN) at the fibular head is an under-recognized lower extremity neuropathy that contributes to weakness of the musculature within the anterior and lateral compartments of the leg and progress to foot drop. As well, there can be numbness/pain within the territory of the superficial and deep peroneal nerve. Compression […]
Compression of the superficial peroneal nerve (SPN) is due to the superficial fascial layer that encapsulates the SPN and its distal entrapment point called the transverse crural ligament. These structures are typically the cause for numbness and pain in the territory of the SPN. Release of the SPN involves the longitudinal release of the superficial […]
Failed surgical management of cubital tunnel syndrome may warrant a revision ulnar nerve transposition. Revision surgery is associated with increased technical difficulty depending on the primary procedure. The senior author’s preferred technique for management of cubital tunnel syndrome is a transmuscular ulnar nerve transposition. The technique for revision surgery incorporates methods towards a transmuscular transposition. […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation discusses carpal tunnel syndrome (CTS) and median neuropathy in the context of compression neuropathies. In particular, this presentation details the specific nuances for (1) an open carpal tunnel release, (2) revision carpal […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation discusses cubital tunnel syndrome (CTS) and ulnar neuropathy in the context of compression neuropathies. In particular, this presentation details several topics that includes (1) controversy of management for CTS, (2) patient evaluation, […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation discusses thoracic outlet syndrome (TOS) in the context of compression neuropathies. In particular, this presentation details conservation management of TOS and the pathogenesis of cumulative trauma disorder. Additionally, a case presentation for […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation is an introduction to compression neuropathies and examines the histological premise for nerve compression with methodology for evaluating these patients. Knowledge of compression neuropathy is key for treating patients with nerve injuries […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation is one of our principle lectures that discusses strategies for managing nerve injuries with gaps. These strategies include nerve repair, grafting, allografts, conduits, acellularized allografts, and nerve transfers. An understanding of these […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. While not as popular as motor nerve transfers, sensory nerve transfers are an important component of the reconstructive algorithm for restoring sensation and/or managing pain. The type of sensory nerve transfer performed depends on […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. In this presentation, we discuss nerve transfers and reconstructive strategies for managing ulnar nerve injuries. The anterior interosseous to ulnar motor nerve transfer is the procedure, where we utilize end-to-end repair for complete nerve […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation details reconstructive options for median nerve injuries, specifically nerve transfers to reinnervate the pronator teres and anterior interosseous nerve. These two recipient nerves are critical for median nerve function and strategies for […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation details reconstructive options for radial nerve injuries, specifically median to radial nerve transfers. Indications and discussion surrounding the advantages and disadvantages for nerve transfers versus tendon transfers are presented, however the goals […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation is an introduction to nerve transfers and details the indications for performing these procedures. Experimental studies are discussed in respect to nerve injury and recovery and the window for reinnervation. The classification […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation is a comprehensive review of our strategies for restoring function to the shoulder and elbow through nerve transfers. In particular, these transfers are discussed in reference to brachial plexus injuries with an […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation describes our approach to management of brachial plexus injuries. This includes a description of the nerve injury classification and the appropriate electrodiagnostic tools used for assessing these challenging cases. Additionally, case examples […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation was given at the 2016 American Society for Peripheral Nerve as part of a panel describing the experiences and cases that the panelists learned the most from. In this presentation, the primary […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. Tracheotomy and endotracheal intubation continues to be most common cause for tracheal stenosis and management involves tracheal resection and reapproximation. In this case, the patient presented with a history of multiple cardiac surgical procedures. […]
Entrapment of the saphenous nerve is probably under-recognized and presents with numbness/pain in the infrapatellar region and the medial aspect of the lower leg. The vastoadductor intermuscular septum is responsible for entrapment symptoms as it forms the anterior fascia of the adductor canal, deep to the sartorius muscle. The femoral vessels and saphenous nerve have […]
The axillary nerve has several distal branches that provide shoulder function through the innervation of the anterior, middle, and posterior deltoid and teres minor, as well as sensation to the lateral arm. Injury to the axillary nerve has been traditionally viewed as either a complete non-favorable injury where recovery does not occur or a favorable […]
Injury to the axillary nerve results in the loss of shoulder function, specifically deltoid and teres minor deficits. This injury can either be isolated or more commonly associated with an upper brachial plexus injury that includes the C5,6 roots. The medial triceps is an available donor for nerve transfer into the axillary nerve and is […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation describes the premise for the supercharge end-to-side nerve transfer and its clinical utility for incomplete injuries involving the ulnar nerve. Specifically, this presentation discuss the indications for this procedures, the research involved […]
Loss of flexor pollicis longus and radial profundus function results in a deficit of pinch and reduced grip strength in the hand. This palsy can be isolated or commonly included in a lower brachial plexus injury. The brachialis nerve is an available, synergistic, and powerful donor for transfer in these scenarios, especially in C7,8,T1 injuries […]
Radial nerve palsy is a debilitating nerve injury that results in lost of wrist and finger extension, which classically presents as wrist drop. The two reconstructive options for managing this injury are tendon transfers and nerve transfers, each with their advantages and disadvantages. Nerve transfers are able to provide independent finger extension, however there is […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation is a description on the median to radial nerve transfers for management of radial nerve palsies. It was presented at the 2014 ASSH Post-Course on distal nerve transfers for brachial plexus injuries. […]
Facial paralysis causes significant morbidity and dynamic reconstruction aims to address functional, aesthetic, and psychological aspects of the impairment. Cross-facial nerve grafting is a reconstructive strategy used to restore smile function and eye closure in both acute and chronic unilateral injury. In an acute injury, nerve grafting provides regenerating fibers from the donor nerve on […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. Facial paralysis causes significant morbidity and dynamic reconstruction aims to address functional, aesthetic, and psychological aspects of the impairment. Segmental gracilis muscle transfer is a reconstructive strategy used to restore smile function in a […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation is part of the upcoming second edition surgical book called Flaps and Reconstructive Surgery by Wei and Mardini. Specifically, this presentation discusses current methods for reconstructing a nerve gap with either a […]
Reconstructing shoulder function following a nerve injury is a challenge due to its dynamic movement originating from several muscles. The supra/infraspinatus muscles are critical for shoulder function in that they initiate abduction of the arm, external rotation, and stabilization of the shoulder joint. In upper brachial plexus injuries, it is common to find a deficit […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation is part of the 2014 Comprehensive Review of Neurosurgery video lectures and the second part of the Acute Nerve Injury and Repair lecture. Specifically, this presentation discusses nerve transfers for the hand. […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation is part of the 2014 Comprehensive Review of Neurosurgery video lectures and the first part of the Acute Nerve Injury and Repair lecture. Specifically, this presentation discusses reconstructive options for nerve injury, […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation is part of the 2014 Comprehensive Review of Neurosurgery video lectures and the second part of the Brachial Plexus Lesion lecture. Specifically, this presentation discusses nerve transfers for the shoulder and elbow. […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation is part of the 2014 Comprehensive Review of Neurosurgery video lectures and the first part of the Brachial Plexus Lesion lecture. Specifically, this presentation discusses the topic of treatment for brachial plexus […]
Radial nerve compression at the level of the humerus is uncommon and occurs at the spiral groove. The radial nerve has an anatomical course proximal below the lateral intermuscular septum and continues distal between the brachialis and brachioradialis muscles. The entrapment point involves the tendinous lateral intermuscular septum and provocative tests will be positive at […]
Pain resulting from nerve injury can originate from the site of injury (local neuroma pain) and from the collateral sprouting of adjacent sensory territories into the deinnervated territory (hyperalgesic pain). Surgical management of neuropathic pain is controversial and typical management of neuroma pain includes excision and transposition. In our institution, management includes a proximal crush […]
Injury to the ulnar nerve results in clawing of the hand due to lost of ulnar intrinsic hand muscles, lost of ulnar-innervated wrist/finger flexion, and numbness/pain within the ulnar nerve territory of the hand. To prevent clawing and reconstruct the ulnar intrinsic hand muscles, the anterior interosseous to ulnar motor nerve transfer is an available […]
Failure to resolve symptoms of carpal tunnel syndrome following a release of the flexor retinaculum can occur for a number of reasons. Failed carpal tunnel can be classified into three categories and include (1) persistent symptoms, (2) recurrent symptoms, and (3) new symptoms. Persistent symptoms of median nerve dysfunction can imply an incomplete release and/or […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. Complications following carpal tunnel release are uncommon with patients experiencing persistent, recurrent, or new symptoms in the post-operative period. There are multiple etiologies for recurrent carpal tunnel syndrome, which can include traction neuropathy. This […]
Compression of the posterior interosseous nerve can exhibit clinical weakness or functional loss of finger / thumb extension and lack of ulnar wrist extension. Provocative tests can confirm whether the radial tunnel in the region of the posterior interosseous nerve is the area of compression. Multiple anatomical structures can be involved in compressing the nerve […]
Sensory nerve transfers are an available option for restoring sensation to critical deinnervated territories. Multiple strategies exist for restoring sensation, which include end-to-end nerve transfers for critical territories and end-to-side nerve transfers for non-critical territories. For sensory deficits in the ulnar nerve, the 3rd webspace fascicle from the median nerve can be utilized as a […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation was given as a compliment to the CME article on nerve entrapment submitted to the Plastic and Reconstructive Surgery journal. Specifically, this presentation overviews the etiology, evaluation, and management of common compression […]
Compression neuropathy of the median nerve in the forearm, also known as pronator syndrome, typically presents with pain in the forearm +/- paresthesia/pain in the median nerve territory. The anterior interosseous nerve can be involved with a mononeuritis. While this usually resolves without surgery, occasionally will require this approach for reconstruction or release. Related anatomical […]
Carpal tunnel syndrome is a compression neuropathy of the median nerve as it travels through the carpal tunnel deep to the transverse carpal ligament. This causes paresthesia and pain in the territory of the median nerve and weakness of the thenar muscles depending on the severity of the neuropathy. Paresthesia is most typically in the […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation is part of the 2014 Comprehensive Review of Neurosurgery video lectures. Specifically, this presentation discusses compression neuropathies and includes topics of patient evaluation, thoracic outlet syndrome, ulnar nerve compression at the cubital […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation was given for the 2012 Comprehensive Review of Neurosurgery video lectures. Specifically, this presentation discusses the topic of treatment for brachial plexus injuries, which includes presentation of common injury patterns, management algorithms […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation is the first part of the topic on Acute Nerve Injury and Repair given for the 2012 Comprehensive Review of Neurosurgery video lectures. Specifically, this presentation discusses reconstructive strategies for general topics […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. Transmuscular ulnar nerve transposition is our method for surgical management of cubital tunnel syndrome. Previously known as ”submuscular”, we have transitioned to ”transmuscular” as this term accurately describes this transposition as through the flexor […]
The supercharge nerve transfer is a procedure that coapts the distal end of a donor nerve to the side of the recipient nerve. Nerve regeneration is facilitated from donor to recipient through a perineurial window to enhance regeneration from the proximal regenerating nerve. This procedure can be used in cases of 2nd/3rd degree nerve injuries […]