Re-innervation of M. biceps by end-to-side nerve suture.

End-to-side nerve suture (ETSNS) is a viable option to re-innervate a paralysed biceps muscle. The host or donor nerve could be any of the adjacent large nerves including the brachial plexus. It is important to adhere to certain principles when performing ETSNS, e.g. epineural window only, suture line without tension, the recipient nerve should not "kink" in any way and complete immobilisation for at least three weeks. The earlier this ETSNS is done after injury the better the outcome. Patient co-operation and motivation is of the utmost importance. The post-operative rehabilitation programme is essential to "awaken" and strengthen the dormant muscle. Our results are based on five patients. Good elbow flexion, i.e. biceps contraction can be regained after ETSNS of, for example, the musculo-cutaneous nerve into an appropriate viable host nerve.

The evaluation of function of the flail upper limb classification system: its application to unilateral brachial plexus injuries.

The evaluation of function of the flail upper limb (EFFUL) classification system measures in numerical terms the improvement achieved through hand surgery and hand therapy in patients with peripheral nerve injuries. To research the effectiveness of the EFFUL system a study was conducted that included 103 adult traumatic brachial plexus palsies. The measurement of upper limb function has 2 distinct phases: function without adaptation and function with adaptation. Patients will naturally adapt in order to cope whether we encourage them or not. This jump in gain of function by adaptation is a bonus that cannot be measured for comparison with other patients because each patient is different. Differences include factors such as each individual's personal pattern of adaptation with or without assistive devices, intelligence, dominant hand, and, in particular, motivation. Measurement of preoperative and postoperative function (with its associated hand therapy) therefore may not include adaptation. The EFFUL system is a method developed to measure unadapted function; it measures residual function of the flail upper arm using practical, everyday tasks performed by the shoulder, elbow, forearm, wrist, and hand, ie, all upper limb regions. It is a ranking system with a hierarchy of increasingly higher demands placed on function until normal function has been achieved. The execution of the tasks focuses on 2-handed coordination and hand dominance. The score is divided into no function, minimal nondominant arm function, supportive arm (nondominant side) function, minimal dominant arm function, useful arm function as done by the dominant arm, and normal arm function. These descriptive scores are subdivided into scores ranging from 0 to 10. Thus, the EFFUL classification system is an objective method of measuring residual function before and after treatment. The clinical examination and functional evaluation ought to have equal significance in the final report on outcome. This approach to upper limb function is holistic but does not generalize in broad terms. An EFFUL-o-gram (patient profile) is used to record the progress and outcome of each individual patient.

The EFFUL (Evaluation of Function in the Flail Upper Limb) system. A ranking score system to measure improvement achieved by surgical reconstruction and rehabilitation.

The EFFUL (Evaluation of Function of the Flail Upper Limb) system measures in numerical terms the improvement, achieved through reconstructive surgery and hand therapy, in patients with brachial plexus injuries. The EFFUL system measures practical, everyday activities performed with the shoulder, elbow, forearm, wrist and hand. The ranking system is based upon a classification of function, with a hierarchy of increasing functional demands until normal function has been achieved. These activities focus on two-handed coordination and hand dominance. The score is plotted on a star histogram known as the patient's profile, and shows the preoperative score achieved in the first evaluation, and the postoperative score achieved in the second evaluation. The shaded area between the two plotted points clearly demonstrates any improvement in function obtained by surgery and rehabilitation. It also demonstrates the interrelationship between the various regions: improvement in function in one region often results in improvement in other regions.

Elbow flexorplasty: a comparison between latissimus dorsi transfer and Steindler flexorplasty.

The latissimus dorsi transfer and the Steindler flexorplasty were compared to restore elbow flexion in seven cases. All patients had sustained upper trunk brachial plexus injuries and were adults of productive age. Both operations were successful. The results showed that the latissimus dorsi transfer provides more powerful elbow flexion and a greater range of movement one year post-operatively. The criteria for selection of candidates for both operations are set out.

Application of a quadriceps endurance programme to patients with femur fractures immobilised by skeletal traction.

Disuse atrophy of the quadriceps muscle and knee joint stiffness at the end of a 3-month period of immobilisation in patients with a fracture of the shaft of the femur is a common problem. A new approach to it was recently researched by applying a quadriceps endurance programme to a sample of this target population. Endurance capacity of matched experimental and control groups, consisting of 11 patients each, was tested at the end of the immobilisation period. Only the experimental group received the treatment intervention. Quadriceps endurance capacity in the experimental group at the end of the test period was at a 97% level compared with normal, uninjured subjects, while the control group's performance level was 57%. The difference is highly significant (P less than 0.0001). The problem of disuse atrophy had been successfully overcome in the experimental group. The unaffected leg of 10 patients from the same target population was also tested at the end of the immobilisation period. The mean value achieved was similar to the norm, i.e. there was no significant difference when compared with normal quadriceps endurance capacity.