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Background:Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy. Limited incision techniques for carpal tunnel release are gaining popularity. The main advantages of these techniques are less scar load, less pillar pain, shorter recovery, and return-to-work time. However, the completeness of release, and risk of neurovascular injury are always a concern. We devised a method of limited incision release with two mini-incisions and use of nasal speculum and a probe. We aimed to evaluate the clinical and neurological outcome of this technique.Materials and Methods:Twenty seven cases (9 male and 18 female, age 28–56 years) of isolated CTS cases were enrolled in the study. A total of 33 hands (six bilateral) underwent limited incision carpal tunnel release. In this study, two mini-incisions were used and release was done with the help of nasal speculum. Evaluation preoperatively and in 6 months and at 1-year postoperatively was done, namely, (a) clinical status examination, (b) motor testing using grip and pinch dynamometer, and (c) neurological outcome measure using nerve conduction study.Results:All the patients had good clinical and neurological outcome with no recurrence during followup. The first symptom to get relieved was night pains, with a mean of 4.5 days (range 2–14 days). Compared to pain, improvement of sensory symptoms was delayed; the mean duration was 42.8 days (range 30–90 days). Scar tenderness was present only for a mean duration of 9 days (range 7–21 days). The mean duration for patients to resume their daily activities was12 days (range 7–28 days) and to work was 32 days (range 21–90 days). The hand grip showed mean values of 45.12 ± 16.16 g/mm2 preoperatively, 62.45 ± 18.86 g/mm2 at 6 months postoperatively, and 74.87 ± 20.35 g/mm2 at 1-year postoperatively. The key pinch showed mean values of 11.27 ± 3.51 g/mm2 preoperatively, 20.181 ± 3.94 g/mm2 at 6 months postoperatively, and 27.96 ± 94.42 g/mm2 at 1-year postoperatively. The tip pinch showed mean values of 8.88 ± 2.39 g/mm2 preoperatively, 15.393 ± 3.25 g/mm2 at 6 months postoperatively, and 19.27 ± 4.81 g/mm2 at 1-year postoperatively. The palmar pinch showed mean values of 14.42 ± 2.92 g/mm2 preoperatively, 19.303 ± 3.62 g/mm2 at 6 months postoperatively, and 22.97 ± 4.08 g/mm2 at 1-year postoperatively.Conclusion:Limited incision carpal tunnel release can be considered a feasible alternative to traditional open release and endoscopic release.

Background: Traumatic amputations are very prevalent in today's world. Successful rehabilitation of an amputee largely depends on how well he/she adapt to prosthesis. However, because of poor scar characteristics, these patients often complain of pain while using prosthesis. Autologous fat graft is being vastly used all over the world to improve the scar of various etiologies. However, it has been associated with unpredictable resorption rate. Objectives: We report the results of the study which was done to assess the consequences of fat grafting over scars and to see its effects on pain management in amputated stump and compare the autologous fat graft with stromal vascular filtrate (SVF)-enriched fat graft for scar remodeling and pain modulation on amputation stumps. Materials and Methods: A prospective randomized trial was conducted from July 2014 to December 2015. A group of ten patients, who were unable to wear prosthesis due to painful amputation stump, incorporated in the study and randomly distributed in two groups. Group A of five patients (case group) was treated with autologous fat graft enriched with SVF while Group B (control group) of remaining five patients was treated with fat graft alone. The results were assessed at baseline, at 1 month, and at 6 months postoperatively using patient and observer scar assessment scale (POSAS) score. Magnetic resonance imaging (MRI) was done to compare fat content preoperatively and 6 months postoperatively. Results: All ten patients reported improvement in scar characteristics, most notably in pain in both scales of POSAS score. The improvement was comparable in both groups. However, the fat content in case group was significantly more in comparison to control group when assessed 6 months postoperatively using MRI scan. Conclusion: Autologous fat grafting is a viable and minimally invasive solution for painful amputation stump. Enrichment of fat graft with SVF can enhance its viability over long term. This study was done as a pilot project. Hence, further long term studies with large sample size are needed to ascertain the benefits observed in this study.

Introduction This study evaluates the clinical presentation, tumor characteristics, and clinical outcomes of surgically treated benign and malignant brachial plexus tumors (BPTs). Methods A prospective study of patients with BPTs from June 2015 to August 2020 was conducted. All patients underwent surgical resection with microneurolysis and intraoperative electrical stimulation to preserve the functioning nerve fascicles. Results Fourteen patients with 15 BPTs underwent surgical resection. Mean age was 37.8 ± 12.3 years; with male to female ratio 4:10. The clinical presentations were swelling (100%), pain (84.6%), and paresthesia (76.9%). The lesions involved roots (5/15), trunk (5/15), division (1/15), and cords (4/15). Thirteen patients had benign pathology (8 schwannomas, 3 neurofibromas, 2 lipomas) and two had malignant neurofibrosarcoma. Gross total resection was achieved in all cases except a dumbbell tumor. The mean follow-up period was 24 ± 5 months. Postoperatively, all patients reported improvement in pain and paresthesia with no new sensory deficit. All patients had developed initial motor weakness (Grades 2–4); however, full power (Grade 5) was recovered by 3 to 5 months. Conclusion Total resection can be achieved by appropriate microneural dissection and electrophysiologic monitoring and is potentially curative with preserving function.