Results of Tendon Transfers in Radial Nerve Palsies: A New Evaluation Protocol.

Radial nerve palsies present a challenging clinical scenario, often leading to substantial functional impairment. This study focuses on evaluating the outcomes of tendon transfer surgeries in patients with post-traumatic radial nerve injuries. The radial nerve, vital for upper limb movements, faces various etiologies, such as trauma, compression, or idiopathy. Patients with radial nerve palsy encounter difficulties in daily activities, emphasizing the need for effective management strategies. The research introduces a novel evaluation protocol, aiming to comprehensively assess tendon transfer outcomes. This protocol incorporates functional movements of wrist and finger joints, encompassing both objective and subjective parameters. The retrospective study includes eleven patients treated between 2010 and 2022, with a minimum follow-up of one year post-surgery. Tendon transfers demonstrated positive results. The evaluation protocol covers a wide range of parameters, including wrist and finger mobility, thumb function, grip strength, and patient satisfaction. The results indicate successful restoration of motor function, with an average grip strength of 70% compared to the healthy arm. The proposed evaluation protocol facilitates standardized and reproducible assessment, minimizing subjective errors in clinical evaluations. Despite the study's limitations, such as a relatively small sample size, the findings underscore the effectiveness of tendon transfers in treating radial nerve palsies. The introduced evaluation scheme provides a comprehensive and reproducible approach to assess outcomes, contributing to the global standardization of tendon transfer assessments in radial nerve injuries.

Scapulohumeral rhythm in shoulders with reverse shoulder arthroplasty measured with a new portable three-dimensional scapular kinematics assessment system.

BACKGROUND: Reverse shoulder arthroplasty (RSA) is a valid and increasingly popular treatment option in eccentric arthrosis and cuff arthropathy. We know that the deltoid is the motor of RSA. However, the role of scapular motion has been poorly documented in the literature. The aim of our study is to analyze and quantify the role of the scapular contribution in the functional outcome of patients undergoing RSA. MATERIALS AND METHODS: Fourteen patients who underwent primary RSA were included in the study. In all cases, a reverse prosthesis with lateralizing stem was implanted. All patients underwent clinical examination, video recording, and motion analysis. X-ray and postoperative CT examinations were collected to evaluate positioning and any loosening. ShowMotion (NCS Lab srl, Modena, Italy) 3D kinematic tracking system was used to evaluate and measure the scapular motion in 3 planes. RESULTS: All patients show substantial amount of posterior tilting and lateral rotation starting at 30° in forward elevation. A further difference is the anticipation of the retraction during the range of motion in the RSA side. The contribution of scapular motion in the RSA shoulder was greater than in the healthy shoulder. In patients with bilateral RSA, the contribution of scapular motion was higher in tilting and lateral rotation in the worse shoulder side in terms of range of motion. This means that to compensate for the loss of glenohumeral motion in RSA, more scapula-thoracic motion is needed to obtain the same thoraco-humeral elevation angle. CONCLUSIONS: In the light of what has been measured, the post-RSA scapular kinematics has typical characteristics that must be achieved in order to obtain a good functional outcome. We can conclude that on the RSA side, the patients anticipate upward rotation both in flexion and abduction. The contribution of the upward rotation to elevation in the RSA group is therefore more significant. In addition to this, to facilitate elevation movements, there is an anticipation of the scapular retraction and a more prominent tilt resulting in different scapular kinematics. The analysis of scapular motion could be useful in the postoperative follow-up of patients undergoing RSA surgery and improve adaptative physiotherapy protocols. It potentially can even be included in future arthroplasty planning systems.

Prefilled devices for parenteral applications.

Current parenteral administration of drugs suffers from several drawbacks including the requirement of healthcare personnel to administer the drug, the risk of needle stick injuries that may result in the transmission of blood borne pathogens, and patient discomfort. Prefilled devices have emerged as powerful tools to improve parenteral administration of drugs. There are a number of clinical conditions including treatment of endocrine diseases, neurological disorders, autoimmune diseases and emergency medicine where prefilled devices have made major improvements to patient care. Prefilled devices have become an important set of tools for the medical practitioner due to their ease of use and safety, cost effectiveness and patient convenience. This review provides a comprehensive summary of existing prefilled devices, their current clinical uses and corresponding regulatory processes.