Introduction: Palliative tendon transfer procedures for radial nerve palsy are continuing to evolve.There is a big history behind this procedure. Many studies are done and they have gradually led to describe two basic methods of transfer, using the FLEXOR CARPI Ulnaris (FCU) or the FLEXOR CARPI RADIALIS (FCR) for transfer. There are some differences in cosmetic and functional results of these surgical plans. This study was done to compare these two methods.Methods: This study was done in Alzahra (SA) and Kashani hospitals in Isfahan. 41 known cases of chronic radial nerve palsy that had the inclusion criteria were selected during 7 years. They had divided into 2 groups randomly. In one group, we used FCR and in the other one we used FCU to restore fingers (metacarpophalangeal joint) extension. Post operative plan was the same in both groups. A questionnaire was designed and each patient was evaluated by physical exam. The collected data was analyzed by SPSS software. The chi square, t, and Fischer tests were used for data analyzing.Results: There was significant difference between fingers active extension, Ulnar deviation and cosmetic results in two groups (P<0.05). The difference between wrist extension, infection and scar formation was not significant (P>0.05).Conclusion: The use of FCR method had better results in our study. We recommend this method if the patient does not have any contra indications.

Background: H-reflex is a valuable electrophysiological technique for assessing nerve conduction through entire length of afferent and efferent pathways, especially nerve roots and proximal segments of peripheral nerves. The aim of this study was to investigate the relation between normal values of FLEXOR CARPI RADIALIS (FCR) H-reflex latency, upper limb length and age in normal subjects, and to determine whether there is any regression equation between them. Methods: By considering the criteria of inclusion and exclusion, 120 upper limbs of 69 normal volunteers (68 hands of 39 men and 52 hands of 30 women) with the mean age of 39. 8 ± 11. 2 years participated in this study. FCR H-reflex was obtained by standard electrodiagnostic techniques, and its onset latency was recorded. Upper limb length and arm length were measured in defined position. The degree of association between these variables was determined with Pearson correlation and linear regression was used for obtaining the proposed relations. Results: Mean FCR H-reflex latency was found to be 15. 88 ± 1. 27 ms. There was a direct linear correlation between FCR H-reflex latency and upper limb length (r = 0. 647) and also arm length (r = 0. 574), but there was no significant correlation between age and FCR H-reflex latency (P = 0. 260). Finally, based on our findings, we tried to formulate these relations by statistical methods. Conclusion: We found that upper limb length and arm length are good predictive values for estimation of normal FCR H-reflex latency but age, in the range of 20-60 years old, has no correlation with its latency. This estimation could have practical indications in pathologic conditions.

Introduction: Avulsion of extensor CARPI RADIALIS brevis (ECRB) insertion from dorsal base of the third metacarpal with or withoutbony chips is rarely reported. Case Presentation: The current study reported the case of a young male that after falling down the stairs, referred to emergencyroomwith dorsal wrist painandweakness in wrist extension, andthe lateral X-rayshowedabonefragment of dorsal capitate, but thecomputed tomography (CT) scan proved that the fragment was detached from the third metacarpal base. Then, with the diagnosisof ECRB avulsion fracture of its metacarpal base, the patient was operated and the fragment and accompanying tendon were fixedwith 3 k-wires to its anatomic location and after 6 weeks of casting the pins were removed and at 6 months post-operation the rangeof motion and strength were the same as those of contralateral side. Conclusions: ECRB avulsion is a rare condition, and its diagnosis can be difficult, and it should be in differential diagnosis of wristtrauma with tenderness on the base of the third metacarpal bone.

Background: This randomized clinical trial was carried out to document the clinical presentation of isolated high radial nerve palsy (high RNP) and compare the outcome of triple tendon transfers. Methods: The study included patients of all genders and ages who presented with isolated high RNP. Half of them were randomly assigned to the FLEXOR CARPI RADIALIS set (FCR-set) of tendon transfers (group A) and a half to the FLEXOR CARPI ulnaris (FCU-set) of tendon transfers (group B). Results: Out of 44 patients, 38 were males, and 6 were females. The age ranged from 7 years to 55 years. 26(59. 09%) patients had primary RNP in association with fractures of the humerus. The postoperative mean disability of arm, shoulder, and hand score (Quick DASH-11 score) for the patients in the FCR-set of transfers was 34. 54%% versus 41. 81% for the FCU-set of transfers. 11 patients (25%) developed radial deviation deformity. Conclusion: RNP was predominantly found among males of the young age group, and the majority of the cases resulted from preventable causes. The triple tendon transfers among patients of the two groups robustly restored the lost extension of the wrist and digits in a matching way. The patients also subjectively reported remarkable improvement in terms of the favorable Quick-DASH-11 scores. Radial deviation deformity occurred among half of the patients who underwent the FCU set of tendon transfers.

Background: Enthesopathy of the extensor CARPI RADIALIS brevis origin [eECRB] is a common idiopathic, noninflammatory disease of middle age that is characterized by excess glycosaminoglycan production and frequently associated with radiographic calcification of its origin. The purpose of our study was to assess the relationship of calcification of the ECRB and advancing age. Methods: We included 28, 563 patients who received an elbow radiograph and assessed the relationship of calcifications of the ECRB identified on radiograph reports with patient age, sex, race, affected side, and ordering indication using multivariable logistic regression. Results: Calcifications of the ECRB were independently associated with age (OR: 1. 04; P<0. 001); radiographs ordered for atraumatic pain (OR2. 6; P<0. 001) or lateral epicondylitis (OR5. 5; P<0. 001); and Hispanic ethnicity (OR1. 5; P<0. 001) and less likely to be found at the left side (OR0. 68; P<0. 001). Similarly, incidental calcifications of the ECRB, those on radiographs not ordered for atraumatic pain or lateral epicondylitis, were independently associated with age (OR1. 03; P<0. 001) and Hispanic ethnicity (OR1. 5; P<0. 024) and less likely to be found on the left side (OR0. 71; P<0. 001). Conclusion: We observed that about nine percent of people have ECRB calcification by the time they are in their sixth decade of life and calcifications persist in the absence of symptoms which supports the idea that eECRB is a common, self-limited diagnosis of middle age.

Damage to the brachial plexus branches is one of themost important events during traumatic events, whichmay cause various disabilities. Electrodiagnostic testing is the preferred method to evaluate the extent of damage to the brachial plexus following trauma. The case presented in this paper, is a 26-year-old man who had near normal function of pronator teres and FLEXOR CARPI RADIALIS muscles on electrodiagnostic testing following a right upper limb severe blunt injury at the level of his arm. After surgical investigation, we found a rare variation in the proximal part of the median nerve. In this case, branches to the pronator teres muscle and FLEXOR CARPI RADIALIS had emerged from the proximal section of themedian nerve in the armregion. This new variation holds important clinical implications especially in trauma patients presenting with weakness in forearmflexion.

Background: The aim of this study was to assess the functional outcomes and time to improve after the modified arthroscopic technique (recession technique) by using a knife to sharply cut the extensor CARPI RADIALIS brevis (ECRB) tendon origin in patients with recalcitrant tennis elbow. Methods: In a prospective study, we included 11 consecutive patients. Following the routine elbow arthroscopy and after exposing the ECRB tendon, we used a knife (no. 11 blade) to cut the tendon at the level of radiocapitellar articulation while avoiding the lateral collateral ligament, which is considered a tendon recession as is done in spastic muscles. Patients were followed up for 1, 3, 6, and 12 month intervals and were asked to fill the Mayo Elbow Performance Index (MEPI), Quick Disabilities of the Arm Shoulder Hand (QuickDASH), and Patient-Rated Tennis Elbow Evaluation (PRTEE). Results: The mean PRTEE, QuickDASH, and MEPI scores showed significant improvement over time (P<0. 001). There were 5 excellent, 5 good and 1 fair results based on MEPI. The patient with fair result was the only patient with existing varus instability on examination under anesthesia although we could not elicit the test positive on clinical examination. Substantial functional and pain improvement was reported almost 6 months after surgery. We did not find any nerve injury or post-operative infection. Conclusion: Arthroscopic recession surgery by using a knife is a safe and effective way in managing recalcitrant tennis elbow although patients should be informed of the expected time to improve. A simple tendon recession by a sharp cut is a time-saving technique that works effectively and is comparable with the piecemeal shaving. Clinical Relevance: The modified muscle recession technique is a rapid and safe way to manage the recalcitrant tennis elbow arthroscopically while the outcomes are comparable to the routine piecemeal shaving of the pathologic tissue.

Objectives: This study presents a method of assessing muscle fatigue during endurance testing at 50% maximal voluntary contraction (MVC) using electromyography (EMG) information as indirect indices of fatigability in the forearm muscles, namely, FLEXOR digitorum superficialis (FDS); FLEXOR CARPI ulnaris (FCU); extensor CARPI ulnaris (ECU) and extensor CARPI RADIALIS brevis (ECRB). " This study presents a method of assessing muscle fatigue during endurance testing at 50% maximal voluntary contraction (MVC) using electromyography (EMG) information as indirect indices of fatigability in the forearm muscles, namely, FLEXOR digitorum superficialis (FDS); FLEXOR CARPI ulnaris (FCU); extensor CARPI ulnaris (ECU) and extensor CARPI RADIALIS brevis (ECRB). Methods: A randomized comparative experimental design was used during endurance test with 8 VT protocols; based on different combinations of vibration frequency (35 & 45 Hz), amplitude (3± 0. 5g & 9± 0. 5g), and exposure duration (30 & 60 seconds), i. e., were given to the study participants for 4 days. A random sampling of participants was conducted from two groups (n=56/group), as follows: individuals with a Sedentary Lifestyle (SL) and a group of Construction Workers (CW). Results: Multivariate Analysis of Variance (MANOVA) results indicated a significant increase in EMG rms, median frequency, waveform length, mean absolute value (P<0. 001), and the variance of EMG signal (P<0. 05) (except in ECU for the SL group and ECRB for the CW group on the variance of EMG signal) after VT in all muscles of both research groups. Therefore, an increase in the EMG parameter value after a grip endurance task revealing an elevation in EMG signal amplitude is indicative of muscle fiber fatigue. Furthermore, the strongest correlation was found between grip endurance and WL (r=0. 471, P<0. 001), and EMG rms (r=0. 401, P<0. 001) of the ECU muscle in the SL group only. Discussion: The patterns of EMG signal represented the amplitude and spectral parameters of the signal, enabling real-time fatigue analysis. Additionally, surface EMG information is useful for indirectly evaluating performance fatigue during the endurance test.

Background: The median nerve is one of the most important branches of the brachial plexus. Due to the role of the median nerve in sensory and motor innervation of the forearm and hand in the upper limbs, its blood supply is very important. Awareness of variations in the blood supply pattern to this nerve reduces the incidence of necrosis and ischemia of the nerve during surgical and diagnostic procedures. Case Presentation: During routine dissection of the cadaver of a 65-year-old man fixed in formalin (10%), in the Department of Anatomy and Reproductive Biology, Shahid Beheshti University of Medical Sciences, a rare variation was observed in the median nerve nutritional artery at the distal end of the left forearm. After dissection of the skin, superficial and deep fascia, anterior compartment forearm muscles, nerves and blood vessels were exposed from surrounding tissues. The median nerve passed through the two heads of the pronator teres muscle and left the cubital fossa in the depth of the FLEXOR digitorum superficialis and the surface of the FLEXOR digitorum profundus in the forearm. It was observed that at the distal end of the left forearm between the FLEXOR CARPI RADIALIS and the FLEXOR digitorum superficialis, a relatively thick branch originates from the radial artery and supplies blood to the median nerve. This branch was separated from the radial artery (before the artery enters the anatomical snuffbox) and crossed the surface of the FLEXOR CARPI RADIALIS muscle and inserted into the median nerve sheath. In the forearm, this branch was the only artery supplying blood to the median nerve. Conclusion: Due to the superficial position of the median nerve at the distal end of the forearm, physical damage to the nerve and its nutritional artery leads to necrosis and ischemia of the nerve, and ultimately disturbed the transmission of sensory and motor messages.