Posterior Interosseous Nerve Injury After a Fracture of Ulna and Radius: A Case Report.

The aim of this study is present a case of isolated injury to the branch of posterior interosseous nerve. A 27-year-old gentleman was presented with an inability to extend the ulnar three fingers of his left hand after sustaining closed fractures of the left ulna and radius after a motorbicycle accident. The patient recovered partially over the course of 3 months but continues to be functionally compromised by the persistent radial deviation of his left wrist and incomplete mobility of the ulnar 3 fingers upon extension. On second exploration, we found the denervated muscles supplied by the recurrent branch of posterior interosseous nerve. Tendon transfer was performed with good clinical outcome at 12 months. This is a rare case of isolated injury to branch of posterior interosseous nerve. This generates the suspicion of possibility of PIN or its branch injury even in closed fractures of the forearm. In addition, this highlights the importance of interval generation during the fracture fixation to prevent the possibility of iatrogenic injury to branches of PIN.

Sensorimotor circuitry involved in the higher brain control of coughing.

There is an overwhelming body of evidence to support the existence of higher brain circuitries involved in the sensory detection of airways irritation and the motor control of coughing. The concept that cough is purely a reflex response to airways irritation is now superseded by the recognition that perception of an urge-to-cough and altered behavioral modification of coughing are key elements of cough disorders associated with airways disease. Understanding the pathways by which airway sensory nerves ascend into the brain and the patterns of neural activation associated with airways irritation will undoubtedly provide new insights into disordered coughing. This brief review aims to explore our current understanding of higher order cough networks by summarizing data from recent neuroanatomical and functional studies in animals and humans. We provide evidence for the existence of distinct higher order network components involved in the discrimination of signals arising from the airways and the motor control of coughing. The identification of these network components provides a blueprint for future research and the development of targeted managements for cough and the urge-to-cough.

Neuronal modulation of airway and vascular tone and their influence on nonspecific airways responsiveness in asthma.

The autonomic nervous system provides both cholinergic and noncholinergic neural inputs to end organs within the airways, which includes the airway and vascular smooth muscle. Heightened responsiveness of the airways to bronchoconstrictive agents is a hallmark feature of reactive airways diseases. The mechanisms underpinning airways hyperreactivity still largely remain unresolved. In this paper we summarize the substantial body of evidence that implicates dysfunction of the autonomic nerves that innervate smooth muscle in the airways and associated vasculature as a prominent cause of airways hyperresponsiveness in asthma.