We present 7 children with obstetric brachial plexus palsy treated by transferring two motor fascicles out of the ulnar nerve to the biceps nerve. Three were male, and 4 were female. The left-side brachial plexus was affected in 4 patients, and the right side in 3 patients. All children had vaginal delivery; two of them presented with shoulder dystocia. The average birth weight was 4300 g (range, 3620-5500 g). Average age at time of operation was 16 months (range, 11-24 months). The indication for the operation was absent active elbow flexion with active shoulder abduction against gravity in 4 cases, and no biceps function and bad shoulder function in 3 cases. Oberlin's ulnar nerve transfer was done in 4 cases without brachial plexus exploration in those children with good shoulder function, and exploration of the brachial plexus was performed in the other 3 cases with bad shoulder function. The average follow-up was 19 months (range, 13-30 months). Five children had biceps muscle >or=M(3) with active elbow flexion against gravity, and 2 children had biceps muscle

We report the use of a hypothenar pedicled fat flap to cover the median nerve in recalcitrant carpal tunnel syndrome. Forty-five patients with recurrent symptoms after previous carpal tunnel surgery were included in this study. Patients with incomplete release of the transverse carpal ligament were not included. We performed an anatomical study on 30 cadavers. The original technique with the section of the deep branch of ulnar artery was modified. The flap could be transferred onto the median nerve without stretching. The median follow-up was 45 months (range, 12-80 months). Pain completely disappeared in 41 patients with normal nerve conduction. Based on clinical and electromyographic signs, the global results showed excellent results (49%), 19 good results (45%), two average results (4.5%) and two failures (2%). The use of a hypothenar pedicled fat flap to cover the median nerve in recalcitrant carpal tunnel syndrome is a simple and efficient technique which improves the trophic environment of the median nerve and relieves pain.

We present a series of 40 children who were operated on for supination contracture following severe obstetric brachial plexus palsy. Surgery was done at an average age of 7 years and the mean postoperative follow-up was 4 years. In the 23 cases treated by an open or closed radial osteotomy, the mean intraoperative derotation was 78 degrees, the immediate postoperative position was 29 degrees pronation and it stabilized at follow-up at 17 degrees pronation. Biceps rerouting was performed in 17 cases without any recurrence of supination deformity and the final position was 22 degrees pronation. Some active forearm rotation was obtained in a few cases. These surgical corrections are part of an overall treatment plan and allow the "begging hand" to be corrected to a more functional and less noticeable position.

Information about the structural and functional characteristics of the motor unit (MU) is highly relevant for the diagnosis of neuromuscular disorders. Electromyography (EMG) is a suitable method for obtaining the information needed. The problem is the separation of the activity of one MU from others which are simultaneously active. Such investigations of single MU activity have commonly used invasive methods, e.g. employing a needle or a wire. Conventional surface-EMG methods have limited resolution and detect, at high contraction levels, multiple MU superimposed one on the other. The separation of the activity of a single MU can be achieved in a non-invasive way when highly specialised acquisition techniques are used. One approach, called high spatial resolution EMG (HSR-EMG), is based on the use of multi-electrode arrays in combination with a two-dimensional Laplace filter. The HSR-EMG permits the completely non-invasive detection of single MU activity even during maximal voluntary contractions. First applications have shown that the method provides a deeper insight into the functional and structural characteristics of the MU. In this paper the application of HSR-EMG to the diagnosis of neuromuscular disorders will be presented, and the latest results will be given of its application in the evaluation of treatment of patients with plexus lesion.

The potential for scientific analysis is limited, due to the rarity and interindividual variability of the lesions and the varying effects on function and growth. Expectations and compliance are different in every patient. Surgical techniques are not yet standardized. Knowledge of the consequences for joint growth and congruence is inadequate. Today, functional improvement can be achieved by surgery in most clinical manifestations of obstetric brachial plexus palsy, within the framework of an interdisciplinary treatment concept.