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.

Isolated radial nerve palsy is caused by pressing this nerve and it is usually caused by the excessive pressure either in the uterus or during the labor. Isolated radial nerve palsy should be considered different from brachial plexus damages. In brachial plexus damages depending on the damage degree and involved spinal roots, different disorders such as disability in brachial abduction, disability in elbow, wrist and digital flexion and extension may be observed, however, in isolated radial nerve palsy weakness is only reported in extension power. In isolated radial nerve palsy depending on the level of pressure and damage, different symptoms are suspected but the most common symptom is inability in extension of wrist and fingers, which is called wrist drop.This phenomenon is a rare condition and usually recuperates by itself. In the present case report, we have described a newborn case with isolated radial nerve palsy. This male newborn was born after a long labor during which his radial nerve was pressed, so he was born with wrist drop. By prescribing Physical therapy modalities including IR (Infrared), Gentle Massage, Electrical Stimulation (IDC), Gentle Rang of Motion, the patient was completely revealed from the disease.

Supracondylar humeral fractures can be associated with nerve injury, either at the time of fracture or as a result of treatment. Such nerve injuries often recover spontaneously. Late radial nerve problem from repeated traumatization by a protruding pin has not been previously reported. Exact pin length and removal of pin after fracture union could avoid the rare occurrence of nerve irritation by the sharp pin end.

Stroke has many different symptoms, isolated hand weakness is the rarest one. Even less common are concomitant radial nerve lesions and ischemic stroke that leads to isolated hand weakness. We report a patient with sudden onset of right wrist drop mimicking radial nerve palsy, found to be due to a acute cerebral infarct and radial nerve palsy in the same time. A well-taken history of the patient's illness and thorough clinical examination can differentiate stroke from peripheral neuropathy as the cause of hand weakness. Modern neuroradiological methods such as brain MSCT or MRI can quickly and reliably indicate the etiology of a neurological disease. In every patient who presents with isolated arm weakness, and for whom we are not sure whether it is a lesion of the central or peripheral nervous system, cerebral infarction must be included as a critical differential diagnosis because it can divert attention from sometimes harmful thrombolytic therapy.

Introduction: radial nerve palsy (RNP) is the most common nerve lesion complicating humeral shaft fractures in 2%-17% of cases. Exploration timing (early or delayed) and various nerve repair procedures are still matter of dispute. The objective of this study is to determine the functional treatment outcome of microsurgeric repair of RNP associated with humeral fractures.Materials and Methods: In this retrospective study of 20 patients (15 males and 5 females with a mean age of 35±12.5) with humeral fractures, 15 cases had primary RNP and the other 5 cases experienced nerve palsy after their orthopedic manipulations (secondary or Iatrogenic RNP). Of the first 15 patients, 7 cases had open humeral fractures which were treated using ORIF and early exploration procedures and 8 cases with closed humeral fractures treated conservatively with closed reduction-casting and delayed exploration after 3months because of no recovery. Iatrogenic RNP were observed for 3 months and explored after no sign of recovery. nerve repair procedures were performed based on nerve injury and patients were followed up for a mean of 24.4±2.5 months (19-20 months). Exploration findings, kind of nerve repair and functional recovery rate (based on Alnot criteria) were recorded and analyzed using SPSS-19 software.Results: Of the 7 cases who suffered from total radial nerve transection (repaired by interfasicular grafting) 3 cases had good outcome, 2 cases had fair outcome and 2 cases were failed. Exploration of 3 cases revealed partial nerve tearing (repaired by neurorrhaphy) with good results. Eight cases with perineural fibrosis and 2 cases of nerve entrapment in callus were treated by interfasicular neurolysis and the results were good. Overall recovery rate of these three procedures was 90%.Conclusion: In patients with RNP associated with humeral fractures, choosing proper microsurgeric nerve repair and determining proper exploration timing (early or delayed) could result in desirable functional outcomes.

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.

Dear Editor-in-Chief We read with interest the article by Toopchizadeh et al. (1) reporting outcomes in pediatric patients with Sciatic nerve Injection injury (SNII) following gluteal injection. Despite the commendable efforts of the authors in long-term monitoring of outcomes in these select cohort of patients with SNII using appropriate electro-diagnostic studies, supplemented use of advanced imaging techniques such as Magnetic Resonance (MR) Neurography to note for structural changes, and diffusion tensor tractography (DTT) for functional altercation, if at all, would have been worth exploring, especially in a setting where the utility of the former in pediatric patients may be limited by poor tolerance (2).

Purpose: To report the outcomes of surgical and non-surgical treatment for sixth nerve palsy and paresis in our center.Methods: Hospital records of 33 patients (35 eyes) with sixth nerve dysfunction who were referred to Labbafinejad Medical Center from September 1996 to September 2006 and underwent surgical procedures or botulinum toxin injection were reviewed.Results: Patients were divided into three groups: Group A had muscle surgery without transposition; group B had transposition procedures and group C had botulinum toxin injection. The deviation improved from 50.3±16.8 to 6±9.8 prism diopter (PD) after the first operation and to 2.5±5 PD after the second operation in group A; from 56.9±24.3 to 5.5±16 PD after the first operation and to almost zero following the second operation in group B; and from 44.3±10.5 to 15±20 PD 6 months following botulinum toxin injection. Head posture and limitations of motility also improved significantly in all three groups. The overall reoperation rate was 18.2%.Conclusion: Various procedures are effective for sixth nerve dysfunction; all improve ocular deviation, head turn and abductive capacity of the eye. The rate of reoperation is not High if treatment is selected appropriately according to the patient's condition.

One of the rare complications of brucellosis is neurobrucellosis. There havebeen numerous reports showing clinical forms of brucellosis affecting CNS, such as cranial nerve involvement, myelitis, vascular disease, radiculoneuritis, meningitis, meningoencephalitis, and demyelinating disease. In this casereport, we introduce a 2.5 yr old girl with unilateral abducens nerve palsyreferred to Baghiyatallah Hospital Outpatient Clinic, Tehran, Iran in June 2015.