Introduction. Latissimus dorsi transfer is a procedure used in massive irreparable posterosuperior rotator cuff tears, in young patient with severe pain and significant functional impairment. The purpose of this retrospective study was to evaluate its clinical, radiological and electromyographic results. Methods. Forteen massive irreparable posterosuperior rotator cuff tears were performed with latissimus dorsi transfer between 2000 and 2008, and were reviewed at an average follow-up of 56 months and minimum of 19 months. Five transfers were primary reconstructions, and nine were revision surgeries. Patients’ mean age was 52.7 years. Clinical outcomes were measured by the Constant score, pain level, active range of motion, and strength. Osteoarthritis and acromiohumeral distance were measured on standardized radiographs. Ultrasound examination evaluate the integrity of the tendon. Axial images in CT-scan looked for muscle atrophy of latissimus dorsi in comparison with the controlateral. Electromyographic activity was measured during active flexion, abduction, adduction and rotations. Results. Twelve patients were satisfied. At the last follow-up, the average pain level according to a 100 mm visual analog scale was 31. The mean age and gender-matched Constant and Murley score improved from 34 to 60 % (p=0.003), forward elevation from 89° to 132° (p=0.006), abduction from 92° to 104°, external rotation from 12° to 24° (p=0.015). Mean abduction and external rotation strength were measured at 2.5 kg. Osteoarthritis progressed, and mean acromio-humeral distance has a significant decrease from 7.5 mm to 4.4 mm (p=0.003). Ultrasound examination showed twelve transferred tendons healed to the greater tuberosity. CT-scan showed a small atrophy of the transferred muscle, with a measurement of the cross-sectional area of the muscle belly at the inferior angle of the scapula at 1405 mm2, versus 1644 mm2 for the controlateral (p=0.06). Electromyographic analysis demonstrated a significant higher electric activity on the operative side during abduction and external rotation, and significant lower activity during adduction and internal rotation in comparison with the nonoperative side. Conclusions. Latissimus dorsi transfer allows for significant pain relief and function improvement in irreparable posterosuperior rotator cuff tears at young patients. Its electric activity increase in abduction and external rotation shows that the transferred muscle can integrate a new function and act like an active muscle transfer, in addition to an interposition or tenodesis effect. However we didn't find any depression of the humeral head or strength improvement

The median nerve compression in the carpal tunnel is the most common compression syndrome of the upper limb. In most cases it is idiopathic but may also occur from anatomical, traumatic, endocrine, rheumatic or tumoral causes. Chow's endoscopic technique was initially used to treat this disease and then modified to a mini-open approach through a single palmar incision. This incision is similar to the one used in endoscopic release by Agee. After exposing the proximal part of the transverse carpal ligament a meniscus knife is advanced until there is a complete section of the ligament, without endoscopic equipment. Between 2004 and 2006, 200 hands in 179 patients with a diagnosis based on clinical and electromyographic criteria were operated by this mini-open technique. The mean follow-up was 49 months (minimum of 34 months and a maximum of 70 months). 50 randomly selected patients were submitted to the self-administered Boston questionnaire. 50 patients treated by the minimal-incision decompression during the same period were also given the questionnaire. The aesthetic satisfaction was registered as well as if they would have surgery on the other hand or would recommend the procedure. This mini-open technique is another technique available to the surgeon that allows very similar functional results to endoscopic surgery, without use of specific material and with a shorter surgical time

We investigated the response of chronic neck and shoulder pain to decompression of the carpal tunnel in 38 patients with whiplash injury. We also determined the plasma levels of substance P (SP) and calcitonin gene-related peptide (CGRP), which are inflammatory peptides that sensitise nociceptors. Compared with normal control subjects, the mean concentrations of SP (220 v 28 ng/l; p < 0.0001) and CGRP (400 v 85 ng/l; p < 0.0005) were high in patients with chronic shoulder and neck pain before surgery. After operation their levels fell to normal. There was resolution of neurological symptoms with improvement of pain in 90% of patients. Only two of the 30 with chronic neck and shoulder pain who had been treated conservatively showed improvement when followed up at two years. In spite of having neuropathic pain arising from the median nerve, all these patients had normal electromyographic and nerve-conduction studies. Chronic pain in whiplash injury may be caused by ‘atypical’ carpal tunnel syndrome and responds favourably to surgery which is indicated in patients with neck, shoulder and arm pain but not in those with mild symptoms in the hand. Previously, the presence of persistent neurological symptoms has been accepted as a sign of a poor outcome after a whiplash injury, but our study suggests that it may be possible to treat chronic pain by carpal tunnel decompression

Between 1998 and 2002, 37 neuropathies in 32 patients with a displaced supracondylar fracture of the humerus who were referred to a nerve injury unit were identified. There were 19 boys and 13 girls with a mean age of 7.9 years (3.6 to 11.3). A retrospective review of these injuries was performed. The ulnar nerve was injured in 19, the median nerve in ten and the radial nerve in eight cases. Fourteen neuropathies were noted at the initial presentation and 23 were diagnosed after treatment of the fracture. After referral, exploration of the nerve was planned for 13 patients. Surgery was later cancelled in three because of clinical recovery. Six patients underwent neurolysis alone. Excision of neuroma and nerve grafting were performed in four. At follow-up, 26 patients had an excellent, five a good and one a fair outcome.