The Journal of Hand Surgery - European Volume - April 2018 - 11

BSSH Spring meeting abstracts
Funding: NIHR RfPB (PB-PG-0613-31083). The views
expressed are those of the author(s) and not necessarily those of the NHS, NIHR or Department of
Health.

S11
The Free Vascularized Pedicled Nerve Functioning
Muscle Transfer: A Novel Concept for Brachial
Plexus Reconstructionn
Ms Roisin Dolan and Professor Henk Giele
John Radcliffe Hospital
Time in programme: Friday 4th May 2018 09:25

The Scratch Collapse Test: A Systematic Literature
Review
Dr Ursˇka Cebron and Dr Catherine Curtin
Stanford University
Time in programme: Friday 4th May 2018 09:15

Aims: The 'Scratch Collapse Test' (SCT) has emerged
as a new provocative test to assist in the identification of the level peripheral nerve compression. This
study aims to review the data on the reliability of the
SCT as a diagnostic test for entrapment neuropathy
through a systematic literature review.
Methods: A literature search of all years was conducted using PubMed and Google Scholar databases.
Case reports, articles not citing primary data and articles in languages other than English, Spanish and
Italian were excluded. 10 publications matched our
criteria: 1 in Spanish and 9 in English, and all were
included in the review.
Results: 3 of the papers studied the SCT as a diagnostic test exclusively for ulnar nerve entrapment, 5
of them studied it as a diagnostic test for median
nerve entrapment, 1 looked at it to diagnose both
ulnar and median nerve entrapment and 1 paper
examined the SCT as a tool to diagnose peroneal
nerve entrapment.
We found that the PPV and specificity values were
high in all studies: between 0.71 and 0.99 and 0.6 and
0.99 respectively, while other values were very variable among studies: individual NPV values ranged
from 0.15 to 0.92 and the sensitivity values ranged
from 0.24 to 0.77
Conclusions: The SCT is a potentially useful tool in
the clinical diagnosis of entrapment neuropathy as it
can be performed on most peripheral nerves.
However, SCT is one tool of many and should not
be used as a sole diagnostic method of a compression neuropathy but as an addition to a surgeon's
diagnostic repertoire. Importantly, there is a paucity
of studies on the reliability of the SCT as a diagnostic
tool. The biggest hurdle separating the SCT from
mainstream use is its difficulty to be learned and
correctly performed by novice users.

Aims: Free functioning muscle transfers are limited
by the availability and regeneration of neural
donors.We explore the novel concept of a free vascularized but pedicled nerve muscle transfer (using the
rectus abdominus muscle) that overcomes the need
for neural regeneration and adds to the reconstructive options in brachial plexus pathology.
Methods: Anatomical dissection of the nerve and
blood supply of six rectus abdominus muscles in
three cadavers showed that it was possible to elevate
the rectus abdominus on its intercostal nerve supply
and dissect these to the mid-axillary line allowing the
muscle to be pedicled on its nerve supply to the arm.
We present five clinical cases of reconstruction of
elbow flexion in four cases of complete traumatic
brachial plexus avulsion injuries (C5-T1) and one
case of poliomyelitis.
Results: The cadaveric study demonstrated that
neural dissection of the intercostal nerves supplying
rectus abdominus was possible to the axilla, and
therefore transferable. Five clinical cases were performed using this technique. There were no perioperative
complications.
Surgical
outcomes
demonstrated good elbow flexion with M4- power
and shoulder stability regained in 4 out of 5 cases.
Two patients developed post-operative abdominal
wall hernias secondary to denervation requiring subsequent mesh repair.
Conclusions: We describe a novel reconstructive
concept of a free vascularized pedicled nerve reconstruction adding to our armamentarium in the reconstruction of brachial plexus pathology.

Efficacy of Ultrasound vs. Fluoroscopic Guided
Steroid Injections of Small Joints in the Hand:
Patient Pathways, Clinical Outcomes and Cost
Miss Vi Vien Toh, Miss Victoria Teoh,
Dr Muthusamy Chandramohan and Mr Zakir Shariff
Bradford Teaching Hospitals NHS Trust
Time in programme: Friday 4th May 2018 09:29

Aim: To perform a cost analysis and service evaluation of patients receiving steroid injections of small
joints of the hand, comparing an ultrasound-assisted

Table of Contents for the Digital Edition of The Journal of Hand Surgery - European Volume - April 2018