Intraoperative positioning related injury of superficial radial nerve after shoulder arthroscopy – a rare iatrogenic injury: a case report

Arthroscopy of the shoulder is a well-established and routine procedure. The role is expected to increase further with an ever-increasing list of indications reflecting the gratifying results. Intraoperative injuries of nerves related to positioning are known but, fortunately, rare with shoulder arthroscopy. Appropriate assessment of patient and careful positioning is paramount in prevention of these injuries. Despite robust preventive measures, these injuries continue to occur from time to time. Although there are few reports of position-related intraoperative nerve injuries associated with shoulder arthroscopy, the involvement of superficial radial nerve (SRN) has never been described before. We report a rare case of positioning related injury of SRN in a 35-year-old female after arthroscopic rotator cuff repair and discuss the preventive and legal aspects. To authors' knowledge this is the first reported case of intraoperative positioning related injury of SRN

Research Recommendations Following the Discovery of Pain Sensitizing IgG Autoantibodies in Fibromyalgia Syndrome

BACKGROUND: Fibromyalgia syndrome (FMS) is the most common chronic widespread pain condition in rheumatology. Until recently, no clear pathophysiological mechanism for fibromyalgia had been established, resulting in management challenges. Recent research has indicated that serum IgGs may play a role in FMS. We undertook a research prioritisation exercise to identify the most pertinent research approaches that may lead to clinically implementable outputs. METHODS: Research priority setting was conducted in five phases: situation analysis; design; expert group consultation; interim recommendations; consultation and revision. A dialogue model was used, and an international multi-stakeholder expert group was invited. Clinical, patient, industry, funder, and scientific expertise was represented throughout. Recommendation-consensus was determined via a voluntary closed eSurvey. Reporting guideline for priority setting of health research were employed to support implementation and maximise impact. RESULTS: Arising from the expert group consultation (n = 29 participants), 39 interim recommendations were defined. A response rate of 81.5% was achieved in the consensus survey. Six recommendations were identified as high priority- and 15 as medium level priority. The recommendations range from aspects of fibromyalgia features that should be considered in future autoantibody research, to specific immunological investigations, suggestions for trial design in FMS, and therapeutic interventions that should be assessed in trials. CONCLUSIONS: By applying the principles of strategic priority setting we directed research towards that which is implementable, thereby expediating the benefit to the FMS patient population. These recommendations are intended for patients, international professionals and grant-giving bodies concerned with research into causes and management of patients with fibromyalgia syndrome

Bony landmarks as an aid for intraoperative facial nerve identification

Identification of the facial nerve trunk is essential during surgery of the parotid gland. Numerous landmarks have been researched and used. The relation between the facial nerve to two constant bony landmarks, the tip of the mastoid process and the central point of the transverse process of the atlas was investigated. Forty cadavers were dissected. A preauricular incision exposed the nerve trunk. Bony landmarks were identified and marked. The distance from the nerve trunk to the mastoid process and the atlas was measured. The mean distance between the mastoid process and nerve for the left was 9.18 ± 2.05 mm and for the right, 9.35 ± 1.67 mm. The mean distance between the atlas and the nerve for the left was 14.31 ± 3.59 mm and for the right, 13.76 ± 4.65 mm. Confidence intervals were determined. The importance of the aforementioned data revolves around minimizing the chance of injury to the facial nerve during surgery. The applicability of these landmarks needs to be studied in the clinical setting