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Background and Purpose Supracondylar humerus fractures (SCHFs) are the most common elbow fractures in children. Traumatic median nerve injury and isolated lesions of its pure forearm motor branch, anterior interosseus nerve (AIN), have both been independently reported as complications of displaced SCHFs. Our main objectives were to characterize the neurological syndrome to distinguish median nerve from AIN lesions and to determine the prognosis of median nerve lesions after displaced SCHFs. Methods Ten children were prospectively followed for an average of 11.6 months. Patients received a standardized clinical examination and high‐resolution ultrasound of the median nerve every 1–3 months starting 1–2 months after trauma. Electrodiagnostic studies were performed within the first 4 months and after complete clinical recovery. Results All children shared a clinical syndrome with predominant but not exclusive affection of AIN innervated muscles. High‐resolution ultrasound uniformly excluded persistent nerve entrapment and neurotmesis requiring revision surgery but visualized post‐traumatic median nerve neuroma at the fracture site in all patients. Electrodiagnostic studies showed axonal motor and sensory median nerve neuropathy. All children achieved complete functional recovery under conservative management. Motor recovery required up to 11 months and differed between involved muscles. Conclusions It was shown that neurological deficits of the median nerve in displaced SCHFs exceeded an isolated AIN lesion. Notably, detailed neurological follow‐up examinations and sonographic exclusion of persistent nerve compression were able to guide conservative therapy in affected children. Under these conditions the prognosis of median nerve lesions was excellent despite severe initial deficits, development of neuroma and axonal injury.

Some behavioral researchers occasionally wish to conduct a median split on a continuous variable and use the result in subsequent modeling to facilitate analytic ease and communication clarity. Traditionally, this practice of dichotomization has been criticized for the resulting loss of information and reduction in power. More recently, this practice has been criticized for sometimes producing Type I errors for effects regarding other terms in a model, resulting in a recommendation of the unconditional avoidance of median splits. In this paper, we use simulation studies to demonstrate more thoroughly than has been shown in the literature to date when median splits should not be used, and conversely, to provide nuance and balance to the extant literature regarding when median splits may be used with complete analytical integrity. For the scenario we explicate, the use of a median split is as good as a continuous variable. Accordingly, there is no reason to outright reject median splits, and oftentimes the median split may be preferred as more parsimonious.

In this rebuttal, we discuss the comments of Rucker, McShane, and Preacher (2015) and McClelland, Lynch, Irwin, Spiller, and Fitzsimons (2015). Both commentaries raise interesting points, and although both teams clearly put a lot of work into their papers, the bottom line is this: our research sets the record straight that median splits are perfectly acceptable to use when independent variables are uncorrelated. The commentaries do a good job of furthering the discussion to help readers better develop their own preferences, which was the purpose of our paper. In the final analysis, neither of the commentaries pose any threat to our findings of the statistical robustness and valid use of median splits, and accordingly we can reassure researchers (and reviewers and journal editors) that they can be confident that when independent variables are uncorrelated, it is totally acceptable to conduct median split analyses.

Prospective controlled study. Previous studies evaluated the effectiveness of sensory reeducation (SR) after peripheral nerve injury and repair. However, evidence for long-term clinical usefulness of SR is inconclusive. The purpose of this study is to compare the sensory results of patients with low-median nerve complete transection and microsurgical repair, with and without SR at long term. We prospectively studied 52 consecutive patients (mean age, 36 years; range, 20-47 years) with low-median nerve complete transection and microsurgical repair. When reinnervation was considered complete with perception of vibration with a 256-cycles per second tuning fork (mean, 3.5 months after nerve injury and repair), the patients were sequentially allocated (into 2 groups [group SR, 26 patients, SR; group R, 26 patients, reassured on recovery without SR). SR was conducted in a standardized fashion, in 2 stages, as an independent home-based program: the first stage was initiated when reinnervation was considered complete, and included instruction in home exercises to identify familiar objects and papers of different roughness, and localization of light touch (eyes open and closed); the second stage was initiated when the patients experienced normal static and moving 2-point discrimination (2PD) at the index fingertip of injured hand, and included instruction in home exercises for stereognosia, supplementary exercises for localization of light touch, and identification of small objects (eyes open and closed). Exercises were prescribed for 5-10 minutes, 4 times per day. At 1.5, 3, and 6 years after nerve injury and repair, we evaluated the static and moving 2PD, stereognosia with the Moberg's pick-up test, and locognosia with the modified Marsh test. Comparison between groups and time points was done with the nonparametric analysis of variance (Kruskal-Wallis analysis of variance). Static and moving 2PD and stereognosia were not significantly different between groups at any study period. Locognosia was significantly better at 1.5 and 3 years in group SR; locognosia was excellent in 17 patients of group SR vs 5 patients of group R at 1.5-year follow-up and in 14 patients of group SR vs 5 patients of group R at 3-year follow-up. Locognosia was not different between the study groups at 6-year follow-up. A 2-stage home program of SR improved locognosia at 1.5 and 3 years after low-median nerve complete transection and repair without significant differences in other modalities or the 6-year follow-up of a small subsample.

The effect of conservative treatments on sleep quality in carpal tunnel syndrome is unclear. Comparing the effect of splinting and kinesiotaping in carpal tunnel syndrome on functional status, pain, grip strength, nerve cross-sectional area and sleep quality. Randomized controlled study. The participants were divided into three groups. One group was given night splint and nerve tendon gliding exercises, one group was given kinesiotaping and nerve tendon gliding exercises and one group was given only nerve tendon gliding exercises. The participants was evaluated with Visual Analog Scale (VAS), Boston Carpal Tunnel Syndrome Questionnaire, Pittsburgh Sleep Quality Index (PSQI), Jamar hand dynamometer, ultrasonography by a blind investigator in the treatment group at baseline and at 3 months. A total of 90 participants, 53 women and 37 men, with a mean age of 47.6±10.5, participated in the study. The decrease in Boston symptom severity and functional status scores was higher in the kinesiotaping group than in the splint group (Cohen's d=−0.78). A statistically significant decrease was found in PSQI scores in all groups (p<0.05). A statistically significant decrease was found in the PSQI total and sleep duration component score in the kinesiotaping group compared to the splint group and the exercise group (Cohen's d=0.69). Both splinting and kinesiotaping are effective on pain, functional status, hand grip strength and median nerve cross-sectional area. This effect is greater in kinesiotaping. Splinting, kinesiotaping and nerve tendon gliding exercises treatments are effective in improving sleep quality, but this effect is greater in kinesiotaping. ClinicalTrials.gov ID: NCT06514625. •Splinting and kinesiotaping are effective in carpal tunnel syndrome.•Kinesiotaping is more effective on pain, hand grip strength and sleep quality.•Kinesiotaping may be the first choice for those with sleep disorders.

Background High-level complete transection of the median nerve will impair the flexion function and sensation of the thumb and index finger, and will also result in weakened wrist flexion strength. In rare cases, atypical clinical manifestations may arise, potentially due to ulnar-to-median nerve anomalies, such as Marinacci communication (MC), or the function of muscles directly innervated by ulnar nerve branches. Case presentation A 52-year-old male sustained a chainsaw injury to his left elbow and forearm, resulting in complete transection of the median nerve. Despite this, he retained partial finger flexion, with muscle strength reaching grade IV in the 3rd-5th fingers on postoperative day one. Marinacci communication, a rare anatomical variant, may explain the preserved motor function in the absence of direct nerve continuity. Electrophysiological studies are key to diagnosing MC, which can influence recovery after nerve injuries. In this case, preserved flexion function suggests the presence of MC. Greater awareness and understanding of this communication are essential for accurate diagnosis and treatment planning. Conclusion There exists a low-probability anatomical variation in the forearm concerning the ulnar and median nerves. This case contributes further to our understanding of the clinical presentation of hand function following high median nerve transection. It also provides valuable evidence for further exploration of the physiological aspects of never communication.

The objective of this paper is to design an II phase algorithm employing median filters for enlightening the performance in removing impulse noise during the processing of the image. The cascaded filter section employs an Adaptive median filter in the first phase followed by a Recursive weighted median filter (RWM) in the second phase. The RWM filter weight is selected with the Median Controlled Algorithm. As a design parameter, the exponential weights of RWM filters are used in the feedback path. The projected algorithm can achieve suggestively improved quality of image when compared to fixed weight or the Center Weighted Median filters.

Purpose This study aims to assess the clinical presentation and surgical outcomes of lacertus syndrome (LS) and concomitant median nerve entrapments. Methods A retrospective study of prospectively collected data was conducted on patients undergoing lacertus release (LR) from June 2012 to June 2021. Available DASH (Disability of the Arm Shoulder Hand questionnaire) scores and post-operative Visual Analogue Scale (VAS) of pain, numbness, subjective satisfaction with surgical outcome, and intra-operative return of strength were analyzed. Results Two-hundred-seventy-five surgical cases were identified of which 205 cases (74.5%) underwent isolated LR, and 69 cases (25.1%) concomitant lacertus and carpal tunnel release. The three most common presenting symptoms in LS patients were loss of hand strength (95.6%), loss of hand endurance/fatigue (73.3%), and forearm pain (35.4%). Numbness in the median nerve territory of the hand was found in all patients with combined LS and carpal tunnel syndrome. Quick-DASH significantly improved (pre-operative 34.4 (range 2.3–84.1) to post-operative 12.4 (range 0–62.5), p < 0.0001) as did work and activity DASH ( p < 0.0001). The postoperative VAS scores were pain VAS 1.9 and numbness VAS 1.8. Eighty-eight percent of patients reported good/excellent satisfaction with the surgical outcome. Intra-operative return of strength was verified in 99.2% of cases. Conclusion LS is a common median nerve compression syndrome typically presenting with loss of hand strength and hand endurance/fatigue. Minimally invasive LR immediately restores hand strength, significantly improves DASH scores, and yields positive outcomes regarding VAS pain, numbness, and subjective satisfaction with surgery in patients with proximal median nerve entrapment at a minimum six month follow-up.

Purpose The prevalence of carpal tunnel syndrome (CTS) as the foremost upper extremity entrapment neuropathy is well-documented. The present study aimed to evaluate the prevalence of anatomical variations in the carpal tunnel and their potential role as risk factors for CTS. Methods Data from 447 CTS patients who underwent median nerve decompression between 2018 and 2019 were retrospectively analyzed. As a control group, 200 hands from 103 age- and sex-matched asymptomatic volunteers were further investigated. Results Anatomical variations identified through ultrasound in 19.7% of CTS hands and 16.0% of controls. Specifically, 10.3% of CTS hands had persistent median arteries, while 14.3% had bifid median nerves. Both variations occurred in 4.9% of CTS patients. In the control group, 13.0% had persistent median arteries and 11.0% had bifid median nerves, with both found in 8.0%. Conclusions Anatomical variations were found in both, CTS patients and controls, but their prevalence did not differ significantly between groups, suggesting they are not independent risk factors for CTS.

Objectives. Carpal tunnel syndrome (CTS) is one of the most common nerve entrapment syndromes, which has a serious impact on patients’ work and life. The most effective conservative treatment is steroid injection but its long-term efficacy is still not satisfactory. The aim of this study was to evaluate the effectiveness of steroid injection combined with miniscalpel-needle (MSN) release for treatment of CTS under ultrasound guidance versus steroid injection alone. We hypothesized that combined therapy could be more beneficial. Methods. Fifty-one patients with CTS were randomly allocated into two groups, namely, steroid injection combined with MSN release group and steroid injection group. The therapeutic effectiveness was evaluated using Boston Carpal Tunnel Questionnaire (BCTQ), cross-sectional area (CSA) of the median nerve, and four electrophysiological parameters, including distal motor latency (DML), compound muscle action potential (CMAP), sensory nerve action potential (SNAP), and sensory nerve conduction velocity (SNCV) at baseline, 4 and 12 weeks after treatment. Results. Compared with baseline, all the parameters in both groups showed statistically significant improvement at week 4 and week 12 follow-up, respectively (P<0.05). When compared with steroid injection group, the outcomes including BCTQ, DML, CMAP, SNCV, and CSA of the median nerve were significantly better in steroid injection combined with MSN release group at week 12 after treatment (P<0.05). Conclusions. The effectiveness of steroid injection combined with MSN release for CTS is superior to that of steroid injection alone, which may have important implications for future clinical practice. This Chinese clinical trial is registered with ChiCTR1800014530.