4-Aminopyridine treatment for nerve injury resulting from radical retro-pubic prostatectomy: a single-center double-blind, randomized, placebo-controlled study.

BACKGROUND: Prostate cancer (PCa) is the most common non-cutaneous malignancy in men and leads to the second most common cause of cancer related mortality in men. Early detection of PCa allows for a potentially curative intervention. Most men will live over a decade from the time of their PCa diagnosis. Thus, treatments must balance curative interventions with their impact on quality of life. Radical prostatectomy (RP) is one such potentially curative intervention but often leads to erectile dysfunction (ED) and urinary incontinence (UI). Approximately 90,000 RPs are performed each year in the USA. Post-operative ED and UI is thought to occur in part from traumatic peripheral nerve injury (TPNI) to the neurovascular bundles that surround the prostate. Thus, patients undergoing RP may be a population that would benefit from clinical studies that look at TPNI. METHODS: The study is a single-institution, double-blinded placebo-controlled, randomized clinical trial in which patients immediately post-RP receive either 4-aminopyrdine (4AP) or placebo in a 1:1 fashion. The primary outcome is evaluation of the efficacy of 4AP in accelerating the early return of baseline erectile and urinary function post-radical prostatectomy. DISCUSSION: This study is critical as it could reduce the morbidity associated with RP, a commonly performed operation, and identify a patient population that may greatly benefit into further TPNI research. TRIAL REGISTRATION: ClinicalTrials.gov NCT03701581. Prospectively registered on October 10, 2018.

Subscapularis function after total shoulder arthroplasty: electromyography, ultrasound, and clinical correlation.

BACKGROUND: The literature lacks electromyographic (EMG) examination of subscapularis function in the postoperative period after total shoulder arthroplasty (TSA). The primary purpose of this study was to document EMG activity of the subscapularis after TSA and to correlate it with clinical and ultrasound findings. METHODS: The study included 30 patients who were at least 1 year (average, 2.1 years) from surgery, status post TSA approached through a standard subscapularis tenotomy. Patients returned for a physical examination, ultrasound evaluation, and EMG evaluation. Patients also completed postoperative surveys: the American Shoulder and Elbow Surgeons questionnaire, the Simple Shoulder Test, and the 12-Item Short Form Health Survey. RESULTS: The American Shoulder and Elbow Surgeons, Simple Shoulder Test, and physical 12-Item Short Form Health Survey scores improved from preoperatively to postoperatively, respectively, 45.3 to 76.8 (P = .0002), 3.9 to 9.0 (P < .0001), and 33.9 to 42.8 (P = .017). Six patients had a positive lift-off test result, and the belly-press test result was negative in all patients. Two patients had a subscapularis rupture on ultrasound. The postoperative EMG finding was normal in 15 patients; in the other 15 patients, there was evidence of chronic denervation with reinnervation changes: 30% subscapularis, 27% infraspinatus, 20% supraspinatus, 20% teres minor, and 13% rhomboids. CONCLUSIONS: This is the first study using a comparison EMG evaluation to document subscapularis function after TSA. EMG evaluation showed that active denervation of the subscapularis was not evident in any patient at least 1 year after TSA. However, in half of the patients, there was evidence of chronicdenervation and reinnervation changes across 5 muscle groups. We theorize that surgical exposure, traction, and the use of interscalene regional anesthesia may contribute to these unexpected EMG results.

Entire flexor carpi radialis tendon harvest for thumb carpometacarpal arthroplasty alters wrist kinetics.

PURPOSE: To investigate the clinical outcome of thumb carpometacarpal arthroplasty with entire-thickness flexor carpi radialis (FCR) ligament reconstruction and tendon interposition and to investigate the isokinetic wrist flexion/extension torque and flexion fatigue strength of the surgically treated wrist compared with the nonsurgically treated wrist. METHODS: Thirty-nine patients with osteoarthritis who had unilateral thumb carpometacarpal arthroplasty with the entire FCR tendon were studied prospectively with a minimum follow-up period of 24 months. Preoperative Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score, grip, pinch, and postoperative DASH score, grip, pinch, and Biodex (Shirley, NY) isokinetic wrist flexion/extension torques were recorded. The nonsurgically treated extremity served as the control for each patient with unilateral ligament reconstruction and tendon interposition. Peak torque ratios and fatigue were measured for the control and surgically treated extremities with the Biodex. RESULTS: Postoperative DASH scores were 12 +/- 4 and were improved significantly from preoperative scores of 43 +/- 4. The surgically treated extremity showed a significantly lower wrist flexion-to-extension peak torque ratio than the control extremity. The control extremity had 2.5 times greater wrist flexion fatigue resistance than the surgically treated side. After surgery the surgically treated extremity had significantly improved grip strength and thumb-index tip pinch compared with the preoperative status. CONCLUSIONS: Our data show conclusively that wrist flexion extension torque ratio decreases and wrist flexion fatigue resistance decreases when the entire FCR tendon is harvested even though the final outcome is favorable and uniformly based on traditional DASH, grip, and pinch scores.