The Journal of hand surgery, European volume
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J Hand Surg Eur Vol · Aug 2004
Treatment of end-neuromas, neuromas-in-continuity and scarred nerves of the digits by proximal relocation.
This paper reports the results of treatment by proximal relocation of 104 painful nerves in 57 digits in 48 patients. These included 86 digital nerves and 18 terminal branches of the superficial radial nerve and the dorsal branch of the ulnar nerve. Eighty-three were end-neuromas and 14 were neuromas-in-continuity, of which nine followed nerve repair and five occurred following a closed crush injury. ⋯ One patient had mild pain on pressure at the primary site after relocation of two nerves from this site. Over 90% of the nerves had no spontaneous pain, pain on movement or hypersensitivity of the overlying skin at the final site of relocation. However, the incidence of mild or no pain on direct pressure at the site of nerve relocation was lower at 83% as relocated nerves, although traumatized less often at the sites chosen for relocation, can still be painful on direct pressure.
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J Hand Surg Eur Vol · Aug 2004
Randomized Controlled Trial Clinical TrialReducing the pain associated with local anaesthetic infiltration for open carpal tunnel decompression.
This prospective, randomized study assessed the effectiveness of buffering lidocaine with sodium bicarbonate for reducing the pain associated with local anaesthetic infiltration for open carpal tunnel decompression. Twenty-one patients undergoing bilateral open carpal tunnel decompression received, in a randomized manner, lidocaine 1% with adrenaline (1:200,000) in one hand and the same local anaesthetic buffered with 8.4% NaHCO3 at a 5:1 ratio in the other hand. ⋯ The buffering was effective for all patients and no adverse effects were noted. This is a safe, easy and quick method for making open carpal tunnel surgery less uncomfortable to patients.
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J Hand Surg Eur Vol · Aug 2004
Shoulder function following late neurolysis and bypass grafting for upper brachial plexus birth injuries.
Eleven children ranging in age from 9 to 21 months underwent late nerve reconstruction for persistent shoulder paralysis following an upper brachial plexus birth injury. Only neurolysis was performed in three patients. ⋯ Two patients underwent a secondary procedure before their final follow-up evaluation. All infants demonstrated significant improvement when assessed by a modified Gilbert shoulder motion scale.