Christopher J. Dy

Background: Despite the well-known functional impacts of peripheral nerve injury (PNI), little is understood about its financial burden (monetary strain), financial worry (stress), and return-to-employment outcomes. Financial toxicity has been studied in many different patient populations, but little is known in PNI patients. We aimed to use validated questionnaires to assess these aspects following PNI. Methods: In this retrospective study, we surveyed patients (≥18 years) who underwent operative treatment for PNI between May 2021 and November 2023 at a single institution. Data on employment status, financial difficulties, and disability applications were collected. Two validated scales, the Financial Burden Composite Score and Financial Worry Scale, were used to collect data on financial burden and worry. Participants were included if they were 6 to 36 months postsurgery. Univariate analyses were performed to identify factors associated with financial burden and worry. Results: Among 35 respondents in a 6- to 36-month postoperative timeframe, 51.4% had a financial burden score ≥4, and 45.7% had a financial worry score ≥4. Participants aged 40 to 60 years experienced the highest burden (mean = 4.5), compared with those aged 60 to 80 years (mean = 1.4, P < .01). High financial worry was significantly linked to employment status, job modifications, and inability to return to work ( P < .05). Overall, 61% of participants returned to work after an average absence of 7.3 months; 57.1% required job modifications, and 30% changed professions. Conclusions: Financial burden and worry are common among individuals recovering from PNI, particularly in those unable to return to work. This exploratory study begins to describe the interplay between financial burden and worry, return-to-work outcomes, and rehabilitation barriers. Beyond improving limb function, care teams may collaborate with social workers, community health workers, and vocational rehabilitation experts to support patient well-being and facilitate a successful return to employment.

Several wearable devices, image analysis systems, and smartphone apps have been developed to increase the accuracy and reliability of hand range of motion measurement. While their performances have been assessed independently, there has been no comparison of devices across different groups. This study aims to compare the accuracy, reliability, and telehealth applicability of hand goniometry devices across methodological classes. PubMed, Embase, Scopus, and CINAHL were queried for studies evaluating the accuracy and reliability of hand goniometry technologies. The inquiry focused on tools that were directly compared to manual goniometry. 13 studies met inclusion criteria, representing 2 wearable devices, 7 image analysis systems, and 4 smartphone apps. Wearable devices had the highest accuracy (mean difference [MD] < 1 ^o ) but had low telehealth integration scores (TIS = 38 out of 50). Image analysis systems had high reliability (interclass correlation coefficient [ICC] > .67) and telehealth usability (TIS = 42) but lacked accuracy (MD 1°–35°). Similarly, smartphone apps had low accuracy (MD 1°–12°) but high reliability (ICC > 0.83). No single device class outperforms others across all metrics. Future studies should focus on creating technologies that combine the strengths of multiple device classes.

Distal radius fractures (DRFs) are among the most common adult fractures, yet outcome reporting across studies remains inconsistent. Variability in assessed domains, measurement tools, and follow-up timing limits evidence synthesis and hinders standardized, patient-centered care. We systematically reviewed 179 English-language clinical studies evaluating DRF management across 5 treatment categories: casting, surgical intervention, physical therapy, pharmacotherapy, and operative versus nonoperative comparison. Data were extracted on study characteristics, outcome domains, measurement tools, and timing, and risk of bias was assessed using RoB 2.0 for randomized trials and MINORS (Methodological Index for Non-Randomized Studies) for nonrandomized studies. Patient-reported outcome measures were most frequent, with Disabilities of the Arm, Shoulder, and Hand (DASH/QuickDASH; n = 110) and Patient-Rated Wrist Evaluation (PRWE; n = 71) most common. Functional outcomes such as grip strength (n = 124) and range of motion (n = 140) were widely reported, particularly in therapy studies, while radiographic outcomes predominated in surgical and casting studies. Sixty percent of studies reported outcomes at 12 months or longer, and most exhibited low risk of bias. This review highlights heterogeneity in outcome reporting for DRF management, supporting development of a core outcome set and integration of longitudinal, real-world monitoring approaches such as digital phenotyping. This review demonstrates that outcome reporting in DRF studies remains fragmented, with variability in domains, instruments, and follow-up timing. Such heterogeneity prevents meaningful comparison across studies, reduces the feasibility of meta-analysis, and hampers the development of best-practice guidelines. A standardized core outcome set would address these limitations by ensuring consistent minimum reporting, while emerging methods such as digital phenotyping could complement traditional measures and provide continuous, patient-centered monitoring in future research.

Ballistic peripheral nerve injuries (PNIs) are a distinct and complex form of nerve trauma caused by high-energy mechanisms and frequently accompanied by soft tissue and skeletal damage. Despite their prevalence in both military and civilian trauma, the literature on diagnosis, timing, treatment, and outcomes remains fragmented. We conducted a systematic review of PubMed, Embase, and Scopus (1975–2025) following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and included 27 studies with more than 2500 patients that reported original data on ballistic PNIs. Diagnostic approaches were inconsistent, with variable use of electrodiagnostics, imaging, and clinical assessment. The timing of diagnosis and surgery ranged from days to more than a year postinjury, and surgical strategies included neurolysis, direct repair, and nerve grafting. Outcome reporting was heterogeneous, with motor recovery often assessed using the Medical Research Council scale, while sensory and functional outcomes were less consistently measured and rarely evaluated with validated instruments. Across studies, many patients achieved partial motor recovery, but the lack of standardized diagnostic protocols and uniform outcome measures limited comparability. Overall, the evaluation and management of ballistic PNIs remain highly variable, underscoring the need for standardized diagnostic pathways and consistent, validated outcome reporting to guide future research and clinical care.

Nerve injuries are uncommon, yet significant complications following reverse total shoulder arthroplasty (rTSA), with the axillary nerve being most frequently injured. We report a case of a 67‐year‐old female who developed persistent motor dysfunction and decreased sensation in the axillary distribution following rTSA for a comminuted proximal humerus fracture. Electrodiagnostic studies confirmed right axillary nerve injury with reduced motor unit recruitment. After no improvement in deltoid function at three months following rTSA, we discussed treatment options for the patient, who opted for surgical intervention. Based on intraoperative findings, we performed a reverse end‐to‐side triceps‐to‐axillary nerve transfer. Postoperative evaluations over a four‐year follow‐up revealed substantial improvements in range of motion, strength, and patient‐reported outcomes. Ultrasound and magnetic resonance imaging studies obtained at four years post-op demonstrated mild deltoid atrophy and fatty infiltration, despite the excellent clinical result. The triceps‐to‐axillary nerve transfer has potential as a viable intervention for non-recovering axillary nerve injuries after rTSA.

Background: Sterile Alpha and TIR Motif Containing 1 (SARM1) is the central executioner of Wallerian degeneration (WD) following axonal injury, with its inhibition having been shown to delay WD. However, little is known about its effect on functional recovery after nerve transection and repair. This study aimed to evaluate whether recovery after nerve transection and delayed repair is enhanced in an SARM1 knockout (KO) model. Methods: A total of 16 SARM1 KO and 16 wild-type (WT) Lewis rats underwent sciatic nerve transection, followed by repair at 4 days with functional analysis at either 2 or 6 weeks. Primary outcome measures included muscle tetanic force, compound nerve action potential (CNAP) amplitude and latency, and sciatic function index (SFI). Both SARM1 KO and WT groups were compared using independent t tests with a priori level of significance of P ≤ .05. Results: The SARM1 KO rats displayed significantly lower tibialis anterior (1.43 ± 0.98 N vs 2.56 ± 1.43 N, P = .016) and gastrocnemius (2.35 ± 0.64 N vs 4.48 ± 1.32 N, P = .002) muscle strength at 6 weeks. There were no differences in CNAP amplitudes or latencies at 2 or 6 weeks after delayed repair compared with WT. There was no difference in SFI between SARM1 KO and WT groups at 2 or 6 weeks after repair. Conclusions: The SARM1 KO impeded recovery of muscle strength after nerve transection and delayed repair. Knockout rodents also appeared to have increased scarring, reflective of poor axonal regeneration. Further work should aim to better understand the inhibitory effects of SARM1 deletion and its role in nerve regeneration.

Background: Lateral antebrachial cutaneous nerve neuropathy (LABCN) is a known complication following distal biceps tendon repair; however, potential risk factors leading to this are not well described. This retrospective study of distal biceps repairs seeks to determine associations between patient demographics, surgical technique, and injury characteristics associated with postoperative LABCN. Methods: A retrospective chart review was performed on 275 patients with partial- or full-thickness biceps tendon ruptures who underwent operative repair. Patient characteristics were recorded including utilization of tobacco, alcohol, age, and body mass index, along with surgical factors including tourniquet time, approach, prior shoulder surgery, and tendon repair techniques. Lateral antebrachial cutaneous nerve neuropathy was identified by description of “numbness, tingling, burning, or decreased sensation” at postoperative visits. Chi-square and t tests were used to analyze differences in LABCN development rate for the listed variables. Results: Sixty-three of 275 (22.9%) patients were identified as having some form of LABCN postoperatively. Age, body mass index, and tourniquet time were not correlated with LABCN ( P > .05). The 2-incision technique and the use of corkscrew anchor fixation correlated with lower LABCN rates ( P < .05). Chronic biceps rupture, partial thickness tear, and history of prior ipsilateral shoulder surgery correlated with higher LABCN rates ( P > .05). Conclusions: Multiple factors affect the risk of LABCN after distal biceps repair. Patient-related factors do not appear to be associated with increased risk, except in cases where patients have a history of shoulder surgery or chronic distal biceps rupture. Surgical factors such as approach and method of tendon fixation demonstrate differences in the rate of postoperative LABCN.