Scientific Abstract Presentations: Hand Session 4 Saturday, October 17 Sat, Oct 17 8:00-9:30 a.m. CDT

Introduction:  Studies have demonstrated that PEG may enhance functional recovery following repair of traumatic peripheral nerve injuries by attenuating the progression of Wallerian degeneration.  Compared to standard tension-free primary repair, nerve repairs using autografts are associated with inferior functional outcomes due to axon regeneration that requires traversing two coaptation sites. However, the role of PEG in autograft repairs of human peripheral nerves has been largely unexplored. This study investigates the differences in sensory recovery between PEG-mediated primary and PEG-mediated autograft neurorrhaphy,  addressing the current gap in the literature. 

Methods:  We analyzed prospectively  collected data from an ongoing randomized, double-blind trial comparing PEG-mediated versus standard neurorrhaphy for completely transected digital nerves and mixed motor-sensory forearm nerves. Complete follow-up data were available  up to  100 days  post-operation.  At each follow-up interval, sensory recovery was assessed using the Medical Research Council Classification (MRCC) grading system.  The number of Sensory MRCC grades ≥ 3  was compared between primary-PEG repairs and anterograde autograft-PEG repairs using the Kruskal-Wallis test, followed by Dunn's post hoc test with Bonferroni correction. 

Results:  A total of 48 PEG-mediated nerve repairs (42 primary, 6 autograft) were  analyzed, comprising 66  digital and 17 mixed motor-sensory nerves (Table 1). Primary and autograft  PEG repair groups were similar demographically and clinically, except for shorter operative time in the primary group (172.6  ±  124.4 vs. 262.0  ±  80.8 minutes,  p = 0.047). PEG-mediated primary repairs showed significantly lower numbers of MRCC sensory grade ≥ 3 compared to PEG-mediated autograft repairs (Z = -2.18,  p = 0.029) (Figure 1).

Conclusions:  PEG-mediated autograft repairs may enhance outcomes following peripheral nerve autograft repairs, and PEG may improve the inferior postoperative recovery typically observed with autograft nerve repairs.

Introduction: Lymphedema remains a morbid and costly complication of oncologic lymph node surgery. Immediate lymphatic reconstruction (ILR) has emerged as a preventive strategy, yet its perioperative risk profile and the influence of demographic, comorbidity, and procedural factors on outcomes remain incompletely characterized. Using a large national surgical cohort, we evaluated postoperative complications following lymphatic reconstruction, with particular attention to racial, ethnic, and clinical disparities.

Methods: We performed a retrospective analysis of 500,603 patients undergoing sentinel lymph node biopsy or lymphadenectomy between 2005 and 2023 using national surgical quality data. Patients undergoing lymphatic reconstruction were stratified by reconstruction type-ILR versus lymphovenous anastomosis (LVA)-and by race and Hispanic ethnicity. Primary outcomes included overall, wound-related, and medical complications within 30 days. Secondary outcomes included length of stay, readmission, and return to the operating room. Multivariable logistic regression identified independent predictors of complications.

Results: Among 8,115 patients undergoing lymphatic reconstruction, ILR was performed in 5,881 (72.5%) and LVA in 2,234 (27.5%). ILR was more frequently performed in White (35.8%) and Black (36.6%) patients compared with Asian (30.4%) and Other race groups (23.4%) (p=0.018), and in Hispanic compared with non-Hispanic patients (38.9% vs 33.9%; p=0.035). Compared with LVA, ILR was associated with significantly higher overall complications (35.4% vs 12.5%), wound complications (13.6% vs 5.0%), and medical complications (23.5% vs 5.6%) (all p<0.001). Specific adverse events were consistently more common following ILR, including bleeding requiring transfusion (16.2% vs 3.2%), pneumonia (4.5% vs 0.7%), sepsis (2.6% vs 0.7%), myocardial infarction (1.0% vs 0.0%), and pulmonary embolism (0.5% vs 0.1%) (all p≤0.01). ILR was also associated with longer hospital stays (5.87±14.51 vs 1.55±3.58 days), higher reoperation rates (14.1% vs 4.7%), and higher readmission rates (9.4% vs 3.6%) (all p<0.001). Overall complications differed by race, occurring in 36.2% of Black patients compared with 27.9% of White, 26.1% of Asian, and 37.2% of Other race patients (p<0.001), but did not differ by Hispanic ethnicity (p=0.813). Bleeding requiring transfusion was highest among Black patients (20.0% vs 11.5% White; p<0.001). On multivariable analysis, independent predictors of overall complications included age >65 (OR 1.18), African American race (OR 1.33), higher ASA class (OR 1.46 per unit), dependent functional status (OR 2.01), disseminated cancer (OR 1.46), bleeding disorders (OR 1.57), non-axillary reconstruction sites, and longer operative time (all p≤0.01). Hispanic ethnicity was not independently associated with complications.

Conclusion: ILR is associated with substantially higher perioperative morbidity compared with LVA, despite its potential preventive benefit against lymphedema. Complication risk varies by race, with Black patients experiencing higher overall and bleeding-related complications. These findings underscore the need for careful patient selection, targeted perioperative optimization, and equity-focused strategies when offering lymphatic reconstruction.

Introduction

Carpal Tunnel Syndrome (CTS) has widespread clinical significance, yet there is a lack of normative data on transverse carpal ligament (TCL) dimensions or comparisons between patients with and without CTS. Prior studies have assessed TCL anatomy, but primarily focus on thickness (1,2). This study aimed to establish normative data for TCL dimensions and compare them with CTS patients.

Methods

A retrospective study examining upper extremity MRIs in patients ≥18 years was performed. Two reviewers measured TCL thickness at inlet, center, and outlet; TCL length and width; carpus length and width; and median nerve thickness. Demographics were collected. Comparisons were made using two-sample t-tests (p<0.05).

Results

There were 261 patients included (68.2% female; 54.8% African American; mean age 48.9±14.9 years; mean BMI 31.2±8.5 kg/m²). CTS was present in 41%. TCL thickness was 1.2±0.3 mm in CTS vs. 1.3±0.3 mm non-CTS at the inlet (p=0.01), 1.5±0.4 mm in CTS vs. 1.5±0.4 mm in non-CTS at the center (p=1.0), and 1.5±0.4 mm in CTS vs. 1.4±0.3 mm at the outlet in non-CTS (p=0.04). TCL length was 29.1±4.3 mm in CTS vs. 29.9±4.3 mm in non-CTS (p=0.14) and width 22.3±2.6 mm in CTS vs. 22.2±2.8 mm in non-CTS (p=0.76). Median nerve thickness was 3.1±0.6 mm in CTS vs. 2.8±0.6 mm in non-CTS (p=0.0001).

Discussion CTS patients demonstrated thicker TCL at the outlet of the carpal tunnel suggesting this may be a compression point. CTS patients demonstrated thicker median nerves and smaller carpus. This study may serve to enhance early radiologic detection of CTS, which is especially important in a setting where clinical diagnosis is challenging (3).

References 1. Marquardt TL, Gabra JN, Evans PJ, Seitz WH Jr, Li ZM. Thickness and Stiffness Adaptations of the Transverse Carpal Ligament Associated with Carpal Tunnel Syndrome. J Musculoskelet Res. 2016;19(4):1650019.

2. Wu H, Yang K, Chang X, Liu Z, Ding Z, Liang W, Xu J, Dong F. Evaluation of the Transverse Carpal Ligament in Carpal Tunnel Syndrome by Shear Wave Elastography: A Non-Invasive Approach of Diagnosis and Management. Front Neurol. 2022;13:901104.

3. Roghani AS, Farooq J, Ullah W, Roghani FS, Ahmad B, Jan AA, Siddique N, Shahzad F. Diagnostic Accuracy of Clinical Examination for Carpal Tunnel Syndrome: Validation Using Nerve Conduction Studies. Cureus. 2025;17(7):e87563.

Background Tourniquet-associated ischemia may impair intraoperative nerve stimulation during upper-extremity nerve surgery; however, the duration of reliable stimulation and factors associated with stimulation loss remain incompletely defined. This study evaluates the duration of effective intraoperative nerve stimulation during upper-extremity procedures and identifies patient- and nerve-specific factors associated with earlier loss of stimulation.

Methods A prospective cohort study was performed including twenty-six patients undergoing upper-extremity surgery with tourniquet application and intraoperative nerve stimulation. The primary outcome was stimulation duration, defined as the time from tourniquet inflation to loss of an evoked motor response. Stimulation was performed on the affected nerves (ulnar, median, or radial) using a handheld biphasic nerve stimulator at two current intensities (0.5 mA and 2.0 mA). Measurements were obtained at 5-minute intervals following baseline stimulation after tourniquet inflation. Demographic variables and stimulation characteristics were recorded. Descriptive statistics were calculated, and subgroup analyses evaluated associations with comorbidities, tourniquet pressure, mechanism of injury, and preoperative neurologic examination findings. Minimal surgical time included for stimulation not impacted by tourniquet time was 40 minutes.

Results Twenty-two patients were analyzed, contributing 22 upper-extremity nerves evaluated intraoperatively. Mean age was 49.6 ± 18.3 years, and 69% of patients were male. Common comorbidities included hypertension (46%), peripheral arterial disease (35%), diabetes mellitus (27%), hyperlipidemia (31%), and smoking history (31%). The most common indication for surgery was compressive or degenerative neuropathy of the upper extremity (46%), followed by idiopathic or iatrogenic etiologies (31%) and traumatic or ischemic nerve injury (23%). The ulnar nerve was most frequently stimulated (64%), followed by the median nerve (23%) and radial/posterior interosseous nerves (14%). Mean total stimulation time was 64 minutes (IQR 52–73.5). Stimulation persisted through surgical completion in 11 cases (mean operative time 60.8 ± 15.1 minutes). In the remaining cases, effective stimulation was lost prior to completion of the procedure, most commonly involving the ulnar nerve (82%). In this subgroup, mean stimulation duration was 55.5 ± 24.0 minutes at 0.5 mA, with an additional 12.9 ± 14.1 minutes achieved at 2.0 mA, yielding a mean total stimulation duration of 68.4 ± 23.4 minutes.

Conclusion During upper-extremity nerve surgery, intraoperative nerve stimulation under tourniquet conditions is typically maintained for approximately one hour, providing a reliable window for nerve localization and functional assessment. Earlier loss of stimulation was more frequently observed in patients with chronic compressive or degenerative neuropathy, suggesting that underlying nerve pathology may influence stimulation reliability. These findings provide practical guidance for surgical sequencing and intraoperative planning in tourniquet-assisted hand and upper-extremity nerve procedures.

Background: Hand infections can pose significant morbidity in both incarcerated and non-incarcerated patients. The present study aims to compare hand infections in these populations to identify risk factors for adverse outcomes and resource utilization.

Methods: A retrospective cohort study was performed by identifying hand infections in a public, acute care, teaching hospital after IRB approval. Data collected included demographics, comorbidities, substance use, injury mechanism, microbiology, antibiotic patterns, and surgical interventions. Outcomes assessed were amputation (early and delayed), length of stay (LOS), and unexpected returns to ED and readmissions. Multivariable models adjusted for age, gender, incarceration status, and comorbidities.

Results: Incarcerated patients were predominantly male (92% vs. 67%, p<0.05) and presented later than civilians (8.6 vs. 4.6 days, p<0.05). They underwent more procedures, had higher amputation rates, longer LOS, and had more frequent readmissions (all p<0.05). Civilian patients were more often discharged from the ED, had fewer deep infections, and followed up less frequently (all p<0.05). MRSA incidence was higher among incarcerated patients, while civilians had more gram-negative infections (all p<0.05). Substance use was common across groups (p=0.63). Regression analyses showed incarceration status was not an independent predictor of amputation, LOS, ED visits, or readmissions (p>0.05). Substance use was a significant predictor for unexpected ED visits and readmissions (all p<0.05).

Conclusions: While incarceration alone did not predict adverse outcomes, associated factors, such as substance use and delayed presentation, represent targets for improving care and reducing resource utilization.

Purpose: Carpal tunnel release (CTR) is common, safe, and effective, though patient-reported outcomes vary and established risk factors do not fully explain this variability. This study evaluates the association between the five-item modified frailty index (mFI-5) and postoperative symptom relief and functional outcomes following CTR.

Methods: A single-center, retrospective review was performed of patients undergoing isolated open CTR between January 2021 and September 2023. Patients younger than 40 and those undergoing concurrent procedures were excluded to minimize confounding variables. mFI-5 scores were calculated for all patients, with patients categorized as non-frail (mFI-5 <2) or frail (mFI-5 ≥2). Pre-operative EMG data was also documented when available. Postoperative complications (surgical site infection (SSI), wound dehiscence, hematoma, seroma, return to operating room, need for postoperative local wound care or debridement, and relevant 90-day emergency department visits) were documented. Patient-reported outcomes were assessed using quickDASH surveys administered by telephone at long-term follow-up. Statistical significance was set at p < 0.05.

Results: A total of 175 patients were identified: 119 non-frail and 56 frail. Mean age in the entire cohort was 56.1 years, with frail patients being four years older than non-frail patients (58.6 vs 54.8 years, p=0.03). Patient race, sex distribution, comorbidities, pre-operative symptom duration, and BMI were similar between groups. Pre-operative EMG parameters were also similar between groups, including median distal sensory (p=0.99) and motor (p=0.19) latencies and the presence of APB sharp waves/fibrillations (p=1.00). Mean postoperative clinic follow-up was 3.1 months. Postoperative surgical complications were rare and did not differ between cohorts (p=1.00). Survey data was captured for 31% of patients (34 non-frail, 20 frail), an average of 3.56 years after surgery; there were no significant differences in surveyed patients in regard to demographics, EMG data, comorbidities or postoperative complications. While frail patients demonstrated higher mean QuickDASH scores compared to non-frail patients (26.0 ± 29.3 vs. 13.6 ± 24.0, p = 0.10), this difference did not reach statistical significance.

Conclusions: Frail and non-frail patients demonstrate similar complication rates and patient-reported outcomes after CTR, suggesting frail patients derive comparable benefit from surgery. Frailty alone should not necessarily preclude patients from CTR, though further prospective studies are warranted.

Introduction: Intraoperative photography is widely used across surgical specialties to document injuries and treatment, guide operative planning, and provide patient education (1,2). Studies in other disciplines have shown increased patient satisfaction after viewing their clinical images and report improved understanding of their condition (3,4). No studies have assessed the impact of viewing intraoperative photographs on patient satisfaction in hand surgery. It is hypothesized that viewing intraoperative photographs will enhance patient satisfaction in elective hand surgery compared to standard care without photographs.

Methods: A retrospective observational study of patients undergoing elective hand surgery was performed. Inclusion criteria were completion of pre- and postoperative patient reported outcomes measures (PROMs) and the HAND-Q, a validated postoperative satisfaction survey. The study had two groups: those who viewed intraoperative photographs and controls who did not. Patients who viewed their photographs were also asked questions about their perception of the images. Clinical variables, including procedure type and demographics, were obtained from the medical record. Questionnaire results were compared between the groups; categorical variables with Chi-square or Fisher's exact tests, and continuous variables with t-tests or Mann-Whitney U tests. Pre-post changes were calculated per participant.

Results: 72 patients were included; 39 in the photo group and 33 controls. Demographics were similar between groups, except for a higher proportion of males in the photo group. The distribution of procedure types was similar, with most involving nerve procedures (71%). Baseline PROMs, including pain levels, did not differ significantly between groups (p>0.05). Postoperatively, both groups demonstrated improvement in PROMs with no significant differences in the magnitude of change between groups (p>0.05). However, overall satisfaction on the HAND-Q was significantly higher in the photo group compared with control (28 vs 26, p=0.024). The photo group patients also reported strongly positive perceptions of the photos' educational value.

Conclusion: Viewing intraoperative photographs was associated with significantly higher overall patient satisfaction, despite no differences in pain, function, or neurocognitive postoperative outcomes between groups. This suggests that the increased satisfaction is likely attributed to viewing the photographs, rather than differences in surgical outcomes. This highlights the potential use of clinical photographs to enhance perceived surgical success in elective hand surgery.

References: 1. Yen RW, Durand MA, Harris C, et al. Text-only and picture conversation aids both supported shared decision making for breast cancer surgery. Patient Educ Couns. 2020;103(11):2235–2243. doi:10.1016/j.pec.2020.07.015 2. Cohen SM, Baimas-George M, Ponce C, et al. Is a picture worth a thousand words? A scoping review of the impact of visual aids on patients undergoing surgery. J Surg Educ. 2024;81(5):1276–1292. doi:10.1016/j.jsurg.2024.06.002 3. Gomez-Rice A, Madrid C, Izquierdo E, et al. Does clinical photography influence satisfaction in spine surgery? Int J Spine Surg. 2021;14(6):1037–1042. doi:10.14444/7155 4. Del Balso C, Taylor MA, Ching M, et al. Preoperative photography improves patient satisfaction following hallux valgus surgery. Foot Ankle Surg. 2022;28(4):492–496. doi:10.1016/j.fas.2021.12.011

Background: Trapeziectomy with interposition is one of the most common and effective surgical treatment for symptomatic thumb carpometacarpal (CMC) arthritis. Selective thumb CMC joint denervation has emerged as a novel alternative; however, data regarding its long-term durability and rates of subsequent definitive surgery are limited. We aimed to evaluate the incidence of conversion to trapeziectomy with interposition following CMC denervation and to identify patient-level predictors of failure.

Methods: Using the TriNetX Research Network, we identified adult patients with a diagnosis of thumb CMC arthritis who underwent CMC denervation (index procedure was defined using nerve excision CPT codes), excluding patients with prior trapeziectomy. The primary outcome was the incidence of subsequent trapeziectomy with interposition (either with ligament reconstruction and tendon interposition [LRTI] or prosthesis) at 1, 3, 5, and 10 years following denervation. Multivariable Cox regression identified predictors of conversion, including demographics, comorbidities, pain-related diagnoses, as well as history of hand/wrist procedures.

Results: A total of 2256 patients met inclusion criteria, of which 129 (5.7%) underwent subsequent conversion. The cumulative incidence of conversion to trapeziectomy was 2.0% at 1 year, 3.7% at 3 years, 4.6% at 5 years, and 5.0% at 10 years following index denervation. Kaplan Meier analysis demonstrated a 92.7% and 89.2% probability of not requiring conversion at 5 and 10 years post-op, respectively. On multivariable cox proportional hazards analysis, significant factors associated with increased risk of conversion included a generalized chronic pain diagnosis (HR 1.71) and CMC osteoarthritis refractory to conservative treatment including occupational therapy (HR 1.81) and non-ultrasound guided joint injection (HR 1.70) (all with p < 0.05).

Conclusion: Thumb CMC denervation demonstrates low rates of conversion to trapeziectomy with interposition through long term follow-up. Patient-level predictors of conversion to trapeziectomy include factors that may be suggestive of increased severity of thumb CMC arthritis.

Background: Brachial plexus birth palsy (BPBP) remains a significant cause of neonatal morbidity despite advances in obstetric care. Established perinatal risk factors include shoulder dystocia, gestational diabetes, and high birth weight; however, the independent impact of maternal parity on these risk factors and subsequent treatment outcomes remains incompletely defined. This study aimed to evaluate differences in BPBP-associated risk factors and clinical outcomes between primiparous and multiparous births at a single tertiary pediatric center.

Methods: A retrospective review was conducted of patients presenting with BPBP between January 2005 and May 2023. Patients were identified using ICD-9 and ICD-10 codes. Inclusion criteria consisted of infants with BPBP sustained at birth and complete birth history data. Demographics, obstetric risk factors, neonatal complications, and treatment variables were collected. Patients were stratified by parity into primiparous (first born) and multiparous (subsequent born) groups. Univariate and multivariate analyses were performed to assess differences in risk factors and treatment outcomes.

Results: A total of 463 patients met inclusion criteria, including 175 (37.8%) born to primiparous women and 288 (62.2%) born to multiparous women. Children born to multiparous women had significantly higher birth weights compared with first-born infants (4.1 kg vs. 3.8 kg, p<0.001) and were more likely to be born to mothers with gestational diabetes (31.7% vs. 18.7%, p=0.007). There were no significant differences between groups in rates of shoulder dystocia, preeclampsia, difficult or assisted delivery, neonatal fractures, respiratory complications, Horner's syndrome, hemidiaphragm paralysis, or need for NICU admission (Figure 1). Clinical outcomes were similar between groups, with no significant differences in time to orthopedic presentation, likelihood of surgical intervention, age at initial surgery, or need for multiple surgeries. Overall, parity was not associated with differences in injury severity or treatment course.

Conclusions: In this large single-institution cohort, most established BPBP risk factors and treatment outcomes were similar between first-born and subsequent-born infants. While multiparous births were associated with higher birth weight and increased rates of gestational diabetes, parity alone did not influence injury severity, timing of presentation, or need for surgical intervention. These findings suggest that BPBP risk assessment and prevention strategies should focus on modifiable prenatal risk factors rather than parity alone. Education and surveillance remain critical for all pregnancies, regardless of birth order.

Background: Timely triage of hand trauma and infection is critical to ensure appropriate access to care. However, prior studies suggest that up to 60–70% of transfers may not meet structured referral criteria. The American Society for Surgery of the Hand (ASSH) established referral guidelines to standardize triage and transfer decisions with Category C requiring emergent transfer and evaluation by a hand surgeon. This study aimed to evaluate the appropriateness of interfacility hand trauma and infection transfers using ASSH criteria and to identify factors associated with transfers that did not meet these criteria.

Methods: A retrospective review was conducted of patients transferred to a tertiary care center for evaluation of isolated hand trauma or infection between October 2023 and October 2024. Primary presentations, burns, polytrauma, infection proximal to the elbow, or incomplete documentation were excluded. Patients were retrospectively categorized using ASSH criteria based on presumptive referral diagnoses. Triage appropriateness was assessed by comparing ASSH category at transfer with clinical outcomes. Overtriage was defined as emergent transfers that were discharged without admission or operative intervention; undertriage, as lower-acuity transfers requiring operative management. Descriptive and comparative statistics were performed, and multivariate logistic regression identified factors independently associated with transfers that did not meet ASSH criteria.

Results: A total of 721 of 983 transferred patients met the inclusion criteria. The median age was 39 years (Interquartile range [IQR], 23-55). Trauma accounted for 73.4% of transfers, while infections comprised 26.6%. Most transfers originated from hospital-based emergency departments (84.6%), with 15.4% from freestanding emergency centers. The median transfer distance was 21.9 miles (IQR, 12.1-32.3). Overall, 424 patients (58.8%) met ASSH criteria for emergent transfer (Category C), while 297 (41.2%) were categorized as lower acuity (Categories A/B). Category C transfers had significantly higher operative rates (81.4% vs 4.04%, p < 0.001) and longer median length of stay (1.86 vs 0.67 days, p <0.001). However, 6.13% of Category C and 20.1% of Category A/B transfers were discharged without admission, bed-side procedures, or surgery. On multivariate logistic regression, shorter transfer distance was independently associated with transfers not meeting ASSH criteria (Odds Ratio 0.99, 95% Confidence Interval 0.99–1.00, p = 0.047), while facility type and insurance status were not significant predictors.

Discussion: Nearly 41% of interfacility hand transfers did not meet ASSH emergent referral criteria. One in five of non-emergent transfers did not require intervention nor admission, representing a significant opportunity for resource optimization. These findings suggest substantial overtriage and highlight opportunities to improve triage precision. Broader adoption of standardized referral criteria, coupled with enhanced provider education, may reduce potentially avoidable transfers, optimize resource utilization, and preserve timely access to specialized care.

Introduction: Electrodiagnostic studies, including electromyography (EMG), are widely used in carpal tunnel syndrome (CTS) patients. This study aimed to evaluate the association between electrodiagnostic severity and clinical symptoms and to develop a multivariable model to identify predictors of abnormal EMG findings for improved risk stratification and selective use of electrodiagnostic testing.

Methods: We conducted a retrospective chart review of patients who underwent EMG testing for CTS between 2018 and 2023 at a single academic institution. All patients were seen in the clinics of two surgeons. EMG severity was categorized on a 5-point scale and dichotomized as normal/mild vs moderate–to–severe for predictive modeling. Separate multivariable logistic regression models were constructed for each symptom, adjusting for demographic, metabolic, comorbidity, treatment, and sensory variables. Adjusted predicted probabilities were calculated to evaluate dose–response relationships. A clinical prediction model for abnormal EMG was assessed using area under the curve (AUC), sensitivity, and specificity.

Results: A total of 516 patients were included (mean age 56.5 ± 16.4 years; 61.8% female). Type 2 diabetes was present in 22.3%, hypertension in 52.3%, and cardiovascular disease in 47.1%. Overall, 31.8% demonstrated very severe and 17.1% severe EMG abnormalities, while 17.8% had normal studies. Increasing EMG severity was associated with higher odds of numbness (left: OR 4.84, 95% CI 1.28-18.20; right: OR 14.2, 95% CI 4.02-47.67), tingling (right: OR 8.27, 95% CI 2.90-23.55), pain (right: OR 13.85, 95% CI 4.02-47.67), night symptoms (right: OR 12.46, 95% CI 3.95-39.31), and weakness (right: OR 4.18, 95% CI 1.58-11.04). Adjusted predicted probabilities demonstrated a dose–response relationship for right-sided tingling, weakness, night symptoms, and pain, and for left-sided weakness and night symptoms. On multivariable analysis, increasing age (OR 1.06 per year, 95% CI 1.02-1.10, p = 0.002) and hypertension (OR 3.00, 95% CI 1.00-8.98, p = 0.049) were independently associated with abnormal EMG, while cardiovascular disease was associated with lower odds (OR 0.33, 95% CI 0.12-0.89, p = 0.028). The clinical prediction model demonstrated good discrimination (AUC = 0.75, 95% CI 0.67–0.83), with 82.6% sensitivity, 56.3% specificity, and 71.8% overall accuracy.

Conclusion: Clinical symptoms demonstrate a graded relationship with EMG severity, particularly for right-sided tingling, pain, night symptoms, and weakness. Increasing age and hypertension independently predict abnormal EMG findings. Our multivariable prediction model shows good discrimination and may help identify patients at high risk for moderate-to-severe disease, improving the value and selectivity of electrodiagnostic testing in carpal tunnel syndrome.

BACKGROUND: Motor neurons have the capacity to regenerate axons and reinnervate target muscles, yet meaningful functional recovery remains slow and incomplete. Prolonged denervation can lead to irreversible degeneration of neuromuscular junctions and progressive muscle atrophy, severely limiting functional recovery. We identified a distinct population of alternatively activated neutrophils (aaNs) by polarizing bone marrow–derived neutrophils with IL-4 and G-CSF ex vivo that had neuroprotective properties and drove regeneration of dorsal root ganglia axons into the spinal cord. METHODS: Murine Murine aaNs were generated by isolating Ly6G⁺ bone marrow neutrophils from C57BL/6 mice and polarizing them with IL-4 and G-CSF. C57BL/6 mice (8–10 weeks old) were randomized into two groups (n=10 each): (1) sham cut and repair and (2) repair with intraneural injection of IL-4/G-CSF–polarized aaNs. Four mice from each group were sacrificed two weeks postoperatively for histology. The remaining mice underwent functional testing for 12 weeks, including compound muscle action potential (CMAP), motor unit number estimation (MUNE), twitch and tetanic force, hindlimb grip strength, and the horizontal ladder test. RESULTS: Mice treated with aaNs showed greater CMAP from weeks 6–10 and elevated MUNE at weeks 7 and 9 compared with controls. Muscle tetanic force was similar among groups, but hindlimb grip strength was higher in the aaN-treated group at weeks 6–10. The horizontal ladder test showed fewer foot faults in the aaN group at week 10. Histological evaluation of sciatic nerve samples, including axon counts and G-ratio analysis, is ongoing and will be completed by the time of presentation. Conclusion: Our study demonstrates that aaNs enhance recovery after nerve injury in vivo and may represent a promising cellular therapy for peripheral nerve repair. Ongoing histological analyses aim to further define the cellular milieu involved.

Purpose: To compare outcomes of incision and drainage (I&D) for flexor tenosynovitis performed at the bedside versus in the operating room (OR) in a single academic hand surgery practice. Prior work in hand surgery suggests that minor procedures performed outside the main OR can achieve similar complication and infection rates with improved efficiency and resource use, but evidence specific to bedside incision and drainage for flexor tenosynovitis remains limited.

Methods: After institutional review board approval, we conducted a retrospective review of 165 consecutive patients who underwent incision and drainage for flexor tenosynovitis in the hand surgery division of a plastic surgery department at a single academic center between June 2019 and September 2026. Cases were grouped according to the location of the initial incision and drainage (bedside vs operating room). Of these, 89 patients had 1 month follow up visit at plastic surgery clinic and were included in the outcomes analysis. Demographic variables, comorbidities, Kanavel signs, and location of surgery were recorded. Primary outcomes included readmission rate with the same symptoms, being able to make a fist at follow-up, rate of amputation, need for subsequent incision and drainage. Secondary outcomes included additional need for outpatient treatment and length of stay.

Results: Among 89 patients included in the cohort, 36 (40.4%) underwent bedside I&D and 53 (59.6%) underwent OR I&D. Bedside management was associated with superior functional outcomes compared with OR I&D, with a higher proportion of patients achieving full fist closure (20/36, 55.6% vs 16/53, 30.2%), whereas partial fist function was more frequent following OR I&D (67.9% vs 36.1%; χ²(4) = 212.7, p < 0.001). Repeat I&D was more commonly required after bedside treatment than OR treatment (33.3% vs 15.1%; χ²(1) = 4.1, p = 0.043), corresponding to approximately two-fold increased odds of reoperation (OR 2.21, 95% CI 1.00–4.86). Length of stay was comparable between groups (Mann–Whitney U = 770.0, p = 0.96). Rates of delayed amputation (Fisher's exact p = 0.54; OR 0.64, 95% CI 0.19–2.16) and readmission (22.2% vs 15.1%; Fisher's exact p = 0.41; OR 0.62, 95% CI 0.21–1.85) did not differ significantly between bedside and OR I&D.

Conclusions: Bedside I&D provides comparable safety to operative I&D, with no significant differences in length of stay, delayed amputation, or readmission rates, but yields better functional outcomes at the cost of higher reoperation rates. Bedside I&D provides comparable safety to operative I&D, with no significant differences in length of stay, delayed amputation, or readmission, but offers superior functional outcomes at the cost of higher reoperation rates. These findings support bedside I&D as an effective initial strategy for carefully selected patients with flexor tenosynovitis, while underscoring the need for close follow-up and a low threshold for operative escalation when indicated.