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Radial nerve injury results in loss of wrist, finger, and thumb extension. Traditionally, radial nerve palsies that fail to recover spontaneously have been reconstructed with tendon transfers or nerve grafts. Nerve transfers are a novel approach to the surgical management of Sunderland grade IV and V radial nerve injuries. This nerve transfer specifically involves the transferring of two sets of nerves from the median (FCR/FDS) to the radial nerves (PIN/ECRB).

We describe our technique for the median to radial nerve transfers. In this procedure, the flexor digitorum superficialis nerve was transferred to the extensor carpi radialis brevis nerve for wrist extension, and the flexor carpi radialis nerve was transferred to the posterior interosseous nerve for finger and thumb extension. In conjunction to this nerve transfer in this case, the Pronator teres to ECRB tendon transfer was also performed to reinforce and provide function to wrist extension through ECRB using Pronator teres.

The procedure is quite feasible and can be beneficial to patients of radial nerve palsy presenting early to give benefit of individual finger movements.

This approach is technically feasible and is a reconstructive option for patients with this nerve deficit. Unlike tendon transfers, median to radial nerve transfers have the potential to restore normal radial nerve function, including independent finger motion. Tension-free nerve coaptation and postoperative motor re-education are critical factors to achieving these successful outcomes.

To synthesise patient-reported outcomes, complications and durability after revision surgery for recurrent carpal tunnel syndrome (CTS), and to explore whether outcomes differ between techniques and whether proximal compression prevalence predicts complications or re-revision.

A PRISMA‑guided systematic review and meta‑analysis searched PubMed, EMBASE, Scopus, Web of Science and CENTRAL (PROSPERO CRD420261323775). Studies of adults undergoing revision surgery for recurrent CTS were included. As no comparative studies were identified, outcomes were pooled primarily by technique. Techniques included vascularised flap coverage (e.g. hypothenar fat pad, synovial, regional fascial flaps), neurolysis/re-release without vascularised coverage, and interposition/barrier techniques (e.g. fat grafting, vein/tendon wraps, synthetic nerve protectors). Pooled mean pre-post change was calculated for VAS and QuickDASH where available. Pooled proportions were calculated for complications and re-revision. Exploratory meta-regression evaluated study-level moderators including reported proximal compression prevalence.

Thirty-six studies (1,025 patients, 1,095 hands) were included, involving 231 flap and 598 non-flap revisions. Both approaches demonstrated symptomatic and functional improvement, although heterogeneity was high for PROMs (I² typically >85%). Pooled VAS improvement was 5.60 (95% CI 4.78-6.41) in flap cohorts versus 4.08 (3.02-5.14) in non-flap cohorts while pooled QuickDASH improvement was 40.54 (24.67-56.40) versus 31.49 (14.89-48.09) respectively. Complication rates were low and similar (flap: 0.03 [0.00-0.09], non-flap: 0.03 [0.00-0.07]). Re‑revision was uncommon (1/231 flap, 25/598 non‑flap, pooled 0.02 [0.00-0.05]). Meta-regression suggested higher study-level prevalence of proximal compression was associated with increased complications and re-revision.

Revision surgery for recurrent CTS improves pain and function with low complication rates. Reported re-revision rates are low, though estimates are limited by sparse events, heterogeneous follow-up and non-comparative study designs. Technique-class subgroup findings are hypothesis-generating rather than comparative evidence of outcomes. Proximal compression appears to be an important contributor to poorer outcomes and should be systematically assessed in recurrent CTS revision.

This network meta-analysis of randomised controlled trials (RCTs) compared the efficacy of various interventions for managing carpal tunnel syndrome (CTS).

As part of a broader umbrella review, we included all systematic reviews of RCTs focused on CTS management. The primary outcome was the Boston Carpal Tunnel Questionnaire (BCTQ), analysed through its two subscales: Symptom Severity Scale (SSS) and Functional Severity Scale (FSS). Interventions supported by at least two RCTs were included. Analyses were performed separately for short-term (≤12 weeks) and mid-term (13–52 weeks) outcomes. Surface under the cumulative ranking (SUCRA) curves ranked treatments, while treatment class tables summarised comparisons. The GRADE tool assessed the certainty of evidence, and both clinical and statistical significance were considered when comparing interventions.

Of 113 eligible RCTs covering 66 interventions, 92 RCTs representing 16 interventions were included in the network meta-analyses. For CTS of any severity, corticosteroid injection with splinting ranked highest for short-term FSS, and endoscopic surgery for short-term SSS. At mid-term, extracorporeal shock wave therapy (ESWT) ranked highest for both SSS and FSS. In cases of mild-moderate CTS, platelet-rich plasma (PRP) injections ranked highest in the short term, while ESWT was most effective mid-term for both BCTQ subscales. Placebo or no treatment consistently ranked last. All interventions except splinting alone were superior to placebo at mid-term for CTS of any severity.

Non-surgical treatments, especially PRP and ESWT, show strong potential in managing CTS, particularly in mild to moderate cases. These findings support prioritising non-invasive approaches before considering surgery.

Osteoarthritis of the thumb carpometacarpal joint, also known as rhizarthrosis, represents a common degenerative hand disorder with associated pain and functional limitations. Treatment in advanced stages requires trapeziectomy with ligament reconstruction and tendon interposition (LRTI), or total joint arthroplasty. While LRTI remains the traditional gold standard, arthroplasty has become more popular in recent years due to its potential for faster recovery and increased postoperative strength. However, long-term comparative evidence between both techniques remains limited. Hence, the aim of this review was to evaluate the clinical outcomes following these two procedures at a minimum follow-up of 5 years.

This narrative review was conducted according to the PRISMA 2020 guidelines. A systematic literature search was performed in PubMed/Medline, Ovid/Medline, Embase and Cochrane Library Central for studies published between 2006 and 2026. Eligible studies included either LRTI or arthroplasty for primary rhizarthrosis in at least 10 patients and provided clinical outcome measures with a minimum follow-up of 5 years.

25 studies met the inclusion criteria. 16 arthroplasty studies evaluated 1,634 prostheses in 1,513 patients, while 12 LRTI studies analyzed 631 thumbs in 596 patients, including three direct comparative studies. While the arthroplasty group showed favorable DASH scores, grip strength and Kapandji scores in several studies, implant-related complications, such as dislocation and cup loosening, resulted in higher revision rates compared to LRTI (9.7% vs <1%). LRTI studies demonstrated durable long-term outcomes but were associated with postoperative weakness and persistent pain in rare instances.

Both techniques serve as effective long-term treatment options for advanced rhizarthrosis. While LRTI remains a reliable procedure with low revision rates, modern arthroplasty may provide improved functional outcomes in selected patients at the cost of increased complications. Further studies with standardized outcome measures and long-term follow-up are necessary to clarify the optimal surgical intervention in thumb carpometacarpal osteoarthritis.

Soleal sling syndrome (SSS) is an underrecognized cause of tibial nerve (TN) entrapment at the popliteal fossa, leading to exertional calf pain, paresthesias, and functional impairment. Surgical decompression typically improves symptoms, but outcomes may be limited by perineural fibrosis and recurrent tethering. Autologous fat grafting (AFG) has emerged as a biological adjunct in peripheral nerve surgery, offering mechanical cushioning and regenerative potential. However, its application following TN decompression in SSS has not been systematically studied. This study describes the initial clinical experience with AFG following soleal sling decompression.

A single-center retrospective review was performed of all patients who underwent soleal sling release with intraoperative AFG between January 2019 and September 2023 by a single surgeon. Demographic, surgical, and clinical outcome data were extracted from the electronic record. PROMIS Physical Function and Pain Interference scores were collected when available. AFG was harvested from various donor sites and applied circumferentially around the TN at the site of decompression.

Five patients (7 limbs) with SSS and concomitant popliteal artery entrapment syndrome (PAES) underwent soleal sling release with AFG. Median age was 19.0 years (range 16-27), and median symptom duration 12 months. AFG volumes ranged from 10-30 mL, with donor sites including abdomen, flanks, trunk, and thigh. All patients reported improvement in calf pain and sensory symptoms within 1-3 months postoperatively. Three patients resumed full activity within 3 months. One patient experienced symptom recurrence at 10 months, which improved with nerve hydrodissection. PROMIS scores showed variable improvement in physical function (range +11 to -1) and pain interference (range -3 to +4). No intraoperative or graft-related complications were observed. Fat grafting was well tolerated and integrated successfully in all cases.

This case series demonstrates the feasibility and safety of autologous fat grafting as an adjunct to soleal sling decompression for tibial nerve entrapment. Most patients experienced early symptom relief and functional recovery, with durable outcomes in the majority. While further prospective studies are needed, AFG may offer benefits by reducing postoperative fibrosis and enhancing nerve recovery in select patients with SSS.