Radial nerve palsy (RNP) is classified as traumatic, non-traumatic, or iatrogenic. The most frequent etiologic agent is the fracture of the humerus of the shaftand distal. We experienced a case of RNP caused by desmoid-type fibromatosis around the radial nerve. The RNP caused by desmoid-type fibromatosis has not been reported in the literature. We present this case here with a review of the RNP literature. The patient is a 16-year-old female, right-hand dominant, who became aware of the difficulty in extending her right little finger without any triggers five months ago. She was also aware of the difficulty in extending the ring finger, and her symptoms gradually worsened. She was referred to our hospital after consulting a home doctor. MRI of the elbow showed a high-intensity occupying lesion on T2-weighted images (T2WI) slightly proximal to the elbow joint. Ultrasonography (US) showed a partial nerve constriction and radial nerve enlargement on the distal side of the constriction. The approach was made from the posterior lateral side of the distal upper arm, and the radial nerve was exposed. There was a 1 cm white tissue strongly adherent on the radial nerve, which was compressing the radial nerve, and it was resected piece by piece. After the resection, the radial nerve was indented. The pathological diagnosis of the resected tissue was fibromatosis. Gradually, she was able to extend her fingers after the surgery and recovered completely in six months.

OBJECTIVE: To investigate the prevalence of upper limb peripheral nerve injuries (PNI) in adult patients admitted to the intensive care unit (ICU) with acute respiratory distress syndrome (ARDS) undergoing prone positioning.
METHODS: This systematic review with meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Four electronic databases including PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), The Cochrane Library, and EMBASE were searched from inception to January 2024. The quality of the included studies was evaluated according to the Joanna Briggs Institute Critical Appraisal Tools. A proportion meta-analysis was conducted to examine the combined prevalence of upper limb PNI among patients requiring prone positioning.
RESULTS: A total of 8 studies (511 patients) were pooled in the quantitative analysis. All studies had a low or moderate risk of bias in methodological quality. The overall proportion of patients with upper limb PNI was 13% (95%CI: 5% to 29%), with large between-study heterogeneity (I2 = 84.6%, P<0.001). Both ulnar neuropathy and brachial plexopathy were described in 4 studies.
CONCLUSIONS: During the COVID-19 pandemic, prone positioning has been used extensively. Different approaches among ICU teams and selective reporting by untrained staff may be a factor in interpreting the large variability between studies and the 13% proportion of patients with upper limb PNI found in the present meta-analysis. Therefore, it is paramount to stress the importance of patient assessment both after discharge from the ICU and during subsequent follow-up evaluations.
CONCLUSIONS: Specialized training is essential to ensure safe prone positioning, with careful consideration given to arms and head placement to mitigate potential nerve injuries. Therefore, healthcare protocols should incorporate preventive strategies, with patient assessments conducted by expert multidisciplinary teams.

UNASSIGNED: The infraclavicular brachial plexus block (ICB) provides analgesia and anaesthesia of the upper limb. It is given using the classical or the more recently described costoclavicular (CC) approach at the level of cords. This systematic review aimed to assess which approach is better for the ICB in terms of onset, performance, and safety.
UNASSIGNED: This PROSPERO (vide registration number CRD42022361636) registered meta-analysis included randomised trials of patients undergoing upper limb surgery in ultrasound-guided ICB from MEDLINE, EMBASE, SCOPUS, and IRCTP from inception to March 2023. The quality of evidence was assessed using GradePro software. The primary outcomes were sensory and motor block onset time and the number of patients having complete block at 30 minutes. Secondary outcomes included block performance time (BPT), number of attempts, duration of the block, and any incidence of complications.
UNASSIGNED: Five trials with 374 adult patients (classic = 185, CC = 189) were included. No significant difference was found in the sensory (Mean difference (MD): 1.44 minutes [95% confidence interval (CI): 3.06, 5.95]; I2 = 95%; very low level of evidence (LOE); P = 0.53) and motor block onset times (MD: 0.83 minutes [95% CI: 0.96, 2.62]; I2 = 84%; very low LOE P = 0.36) and BPT (MD: 5.06 seconds [95% CI: 38.50, 48.63]; I2 = 98%; very low LOE; P = 0.82) in classic and CC approach of ICB. Trial sequential analysis revealed our sample size to be 0.65% of the required sample size to achieve 80% power, deeming our study underpowered.
UNASSIGNED: Costoclavicular approach was not superior or inferior to the classical technique for infraclavicular brachial plexus block. However, the quality of evidence is low and further studies are needed to corroborate the findings.

OBJECTIVE: Sensory nerve transfers may be performed to restore protective sensation and tactile perception after peripheral nerve injury in the upper extremity. There is a paucity of literature on the available donor-recipient configurations for sensory nerve transfers. This article presents a systematic review of reported sensory nerve transfers in the upper extremity.
METHODS: Original articles published between 1982 and 2022 were searched in MEDLINE and EMBASE. Articles describing a sensory nerve transfer were included if patient sensory outcomes were reported. Outcomes were categorized according to the modified British Medical Research Council scale, with an outcome of S3 or better defined as satisfactory.
RESULTS: Of 1,049 articles, 39 met inclusion and quality criteria. Twenty-seven articles were primary research studies reporting on 197 patients who underwent 11 unique nondigital sensory donor nerve transfers and 24 unique digital donor nerve transfer procedures. The most reliable recipient nerve for restoring sensation to the ulnar border of the small finger was proper ulnar digital nerve of the small finger (38 patients, 89% satisfactory sensory outcome). The best available donors for transfer into the proper ulnar digital nerve of the small finger were proper ulnar digital nerve of the long finger (16 patients, 87.5% good sensory outcome) and palmar cutaneous branch of the median nerve (15 patients, 100% good sensory outcome). To restore sensation along the ulnar border of the thumb and radial aspect of the index finger, the best available donor was the superficial branch of the radial nerve, regardless of transfer into common digital nerve 1 (38 patients, success rate 63%) or directly to proper ulnar digital nerve of the thumb or proper radial digital nerve of the index finger (nine patients, success rates 67%).
CONCLUSIONS: Outcomes after sensory nerve transfers are generally good. Surgeons should transfer into a digital nerve recipient when attempting to reconstruct sensation.
METHODS: Therapeutic IV.

(1) Background: Restoring arm and hand function is one of the priorities of people with cervical spinal cord injury (cSCI). Noninvasive electromagnetic neuromodulation is a current approach that aims to improve upper-limb function in individuals with SCI. The aim of this study is to review updated information on the different applications of noninvasive electromagnetic neuromodulation techniques that focus on restoring upper-limb functionality and motor function in people with cSCI. (2) Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used to structure the search protocol. A systematic review of the literature was performed in three databases: the Cochrane Library, PubMed, and Physiotherapy Evidence Database (PEDro). (3) Results: Twenty-five studies were included: four were on transcranial magnetic stimulation (TMS), four on transcranial direct current stimulation (tDCS), two on transcutaneous spinal cord stimulation (tSCS), ten on functional electrical stimulation (FES), four on transcutaneous electrical nerve stimulation (TENS), and one on neuromuscular stimulation (NMS). The meta-analysis could not be completed due to a lack of common motor or functional evaluations. Finally, we realized a narrative review of the results, which reported that noninvasive electromagnetic neuromodulation combined with rehabilitation at the cerebral or spinal cord level significantly improved upper-limb functionality and motor function in cSCI subjects. Results were significant compared with the control group when tSCS, FES, TENS, and NMS was applied. (4) Conclusions: To perform a meta-analysis and contribute to more evidence, randomized controlled trials with standardized outcome measures for the upper extremities in cSCI are needed, even though significant improvement was reported in each non-invasive electromagnetic neuromodulation study.

BACKGROUND: The majority of scapula fractures have historically been treated non-operatively. The current literature describing patient outcomes following scapula fractures is limited. Our objective was to determine differences in outcomes between operatively and non-operatively treated scapular fractures. The goal of our study was to provide an updated and comprehensive systematic review for scapula body, neck, and glenoid fractures focusing on several outcomes including union rate, return to work, pain, shoulder active range of motion, strength, functional scores, and any recorded complications.
METHODS: The PRISMA methodology was followed for this systematic review. Articles were obtained from the PubMed/Medline database using the following search terms: scapula body OR scapula neck OR intra-articular glenoid AND fracture. Additional articles were obtained by searching the bibliographies of included references. Studies were included if they contained clinical data on one or more of our study objectives and contained participants with a scapular body, neck, and/or glenoid fracture who were at least 16 years old. A total of 35 papers, with 822 total cases were included. Studies chosen were assessed for level of evidence and reviewed for data pertaining to the current study objectives. All cases of scapula fractures found throughout the literature were analyzed for outcome data. Outcomes studied included union rate, return to work, pain, shoulder active range of motion, strength, functional scores, and recorded complications.
RESULTS: The overwhelming majority of scapula fractures go on to union. The majority of patients will eventually return to work. Persistent post-injury pain is unfortunately common. Shoulder range of motion and strength are decreased when compared to the contralateral shoulder. Non-operative glenoid fractures have the lowest reported functional scores. Malunion, need for additional surgeries, and post-traumatic arthritis were the most common complications.
CONCLUSIONS: When treating scapula fractures, orthopedic surgeons must consider the specific fracture pattern, as well as patient specific goals. Risks and benefits of both operative and non-operative management should be discussed with the patient including the exceptionally low non-union rate regardless of treatment option and that persistent pain following injury is unfortunately common.

BACKGROUND: This systematic review describes the effectiveness of virtual reality (VR)-supported exercise therapy on upper limb motor function and activities of daily living after stroke.
METHODS: Studies published through January 24, 2022, were identified using CINAHL, Cochrane Library, Embase, Medline, and Web of Science. Randomized control trials comparing VR treatment with conventional therapy (CT) for upper extremity rehabilitation after stroke were included. Methodological quality was assessed using the Cochrane risk-of-bias tool.
RESULTS: Of 9 included studies, 5 concluded that the VR group outperformed control participants, 1 indicated the superiority of VR-supported exercises alone over CT, and 3 found VR comparable to CT in promoting upper limb motor function. Five studies analyzed independence in daily living, with 4 reporting no significant difference between VR and CT groups. No strong evidence indicated long-term benefits of VR-assisted exercise. All included studies demonstrated low risk of bias concerning random sequence generation, allocation concealment, outcome assessment blinding, incomplete outcome data, and selective reporting bias. However, a high risk of bias was observed regarding participant blinding due to the nature of the intervention.
CONCLUSIONS: Most studies suggested that VR, used alongside CT, can improve motor function following stroke. However, the evidence was insufficient to conclude that VR outperforms conventional approaches.

BACKGROUND: The increase in the number of people with upper limb spasticity as a sequela of cerebrovascular disease, which negatively impacts their autonomy, functional independence and participation, and affects their quality of life, calls for the application of precise and objective instruments for its measurement and evaluation.
OBJECTIVE: To assess the validity and reliability of the Tardieu scale in the evaluation of upper extremity spasticity in adults with cerebrovascular disease.
METHODS: The search strategy was implemented in eight databases; the systematic review protocol was registered beforehand in INPLASY (with registration no. 2023110076). The evidence was synthesised in three phases: a tabular presentation of results, an evaluation of the quality of the articles, and a narrative synthesis of the findings.
RESULTS: Only three of the 33 articles identified fulfilled the variables that enable the validity and reliability of the Tardieu scale to be established. The measurements of angles and velocities R1, R2 and R2-R1 were analysed. Student\'s t-test to assess the reliability between the measurements of R1 and R2; and angles R2 and R2-R1 showed statistical significance, which confirmed the reliability of the scale.
CONCLUSIONS: The Tardieu scale proved robust. It is important to note that the sample size, the time of evolution of the disease and the age of the patients may influence the results of the scale.
BACKGROUND: Validez y fiabilidad de la escala de Tardieu para evaluar la espasticidad en miembro superior en adultos con enfermedad cerebrovascular. Revisión sistemática.
Introducción. El incremento en el número de personas con espasticidad en los miembros superiores como secuela de una enfermedad cerebrovascular, que impacta negativamente en la autonomía, la independencia funcional y la participación, y afecta a la calidad de vida de las personas, demanda la aplicación de herramientas clínicas precisas y objetivas para su medición y evaluación. Objetivo. Evaluar la validez y la fiabilidad de la escala de Tardieu en la evaluación de la espasticidad en las extremidades superiores de adultos con enfermedad cerebrovascular. Materiales y métodos. La estrategia de búsqueda se implementó en ocho bases de datos; el protocolo de revisión sistemática se registró previamente en INPLASY (registro n.o 2023110076). La síntesis de la evidencia se llevó a cabo en tres fases: presentación tabular de resultados, evaluación de la calidad de los artículos y síntesis narrativa de los hallazgos. Resultados. De los 33 artículos identificados, sólo tres cumplieron con las variables que permiten establecer la validez y la fiabilidad de la escala de Tardieu. Se analizaron las medidas de los ángulos y velocidades R1, R2 y R2-R1. La prueba de la t de Student para evaluar la fiabilidad entre las medidas de R1 y R2; los ángulos R2 y R2-R1 mostraron significancia estadística, lo que confirmó la confiabilidad de la escala. Conclusiones. La escala de Tardieu demostró robustez. Es importante considerar que el tamaño de la muestra, el tiempo de evolución de la enfermedad y la edad de los pacientes pueden influir en los resultados de la escala.

OBJECTIVE: Survival rates for children diagnosed with acute lymphoblastic leukemia (ALL) have increased significantly over recent decades, and thus attention shifted toward understanding the adverse effects of cancer treatment. Chemotherapy has side effects that could affect muscle state and diminish motor performance. This scoping review was conducted to map the breadth of evidence for different tools used in fine motor skills assessment, the extent of upper extremity strength, and fine motor performance, highlighting the potential risk factors that may influence these skills.
METHODS: In March 2023, full-text studies that examined fine motor performance and/or upper extremity strength were identified via searches in PubMed, Science Direct, Scopus, Web of Science, and PEDro databases. The titles and abstracts of selected studies were screened according to the inclusion and exclusion criteria.
RESULTS: The search yielded initial 418 citations and 26 peer-reviewed articles were finally included in the review. Considerable heterogeneity was observed regarding the methods of evaluating fine motor skills. The results of this review indicate that children and adolescents with ALL experienced fine motor limitations and upper extremity weakness either during or after cessation of treatment.
CONCLUSIONS: This scoping review presents a broad overview of the literature addressing fine motor difficulties in the pediatric population with ALL. Results accentuate the need to incorporate strengthening and occupational therapy training to preserve muscle strength and minimize future fine motor problems along the course of chemotherapeutic treatment. Little evidence was reported regarding the risk factors that may impair muscle strength and motor performance.

Stroke is the second most common cause of death worldwide, and it greatly impacts the quality of life for survivors by causing impairments in their upper limbs. Due to the difficulties in accessing rehabilitation services, immersive virtual reality (IVR) is an interesting approach to improve the availability of rehabilitation services. This systematic review evaluates the technological characteristics of IVR systems used in the rehabilitation of upper limb stroke patients. Twenty-five publications were included. Various technical aspects such as game engines, programming languages, headsets, platforms, game genres, and technical evaluation were extracted from these papers. Unity 3D and C# are the primary tools for creating IVR apps, while the Oculus Quest (Meta Platforms Technologies, Menlo Park, CA, USA) is the most often used headset. The majority of systems are created specifically for rehabilitation purposes rather than being readily available for purchase (i.e., commercial games). The analysis also highlights key areas for future research, such as game assessment, the combination of hardware and software, and the potential integration incorporation of biofeedback sensors. The study highlights the significance of technological progress in improving the effectiveness and user-friendliness of IVR. It calls for additional research to fully exploit IVR\'s potential in enhancing stroke rehabilitation results.