Repetitive use injuries are commonly seen by musculoskeletal providers, usually in the form of tendinopathies. However, focal peripheral nerve entrapment can mimic or coexist with tendon pathology, particularly when weakness, sensory symptoms, or imaging findings are subtle or nonspecific. This review provides a practical, symptom-first framework to help clinicians distinguish tendon-dominant, nerve-dominant, and mixed presentations in clinical practice. Five clinically relevant tendon-nerve mimic pairs are emphasized: (1) rotator cuff tendinopathy versus suprascapular neuropathy; (2) lateral epicondylitis versus radial tunnel syndrome; (3) iliotibial band syndrome versus common peroneal neuropathy; and (4) peroneal tendinopathy versus superficial or deep peroneal nerve entrapment; (5) plantar fasciitis versus tarsal tunnel syndrome or Baxter nerve entrapment. Across these conditions, diagnosis is most strongly informed by symptom pattern, pain distribution, and focal neurologic deficits, with imaging and adjunctive testing used selectively when they are likely to clarify the diagnosis or change management. Therefore, a symptom-first approach may reduce diagnostic anchoring, improve recognition of atypical or refractory presentations, and support more targeted rehabilitation strategies.

This report describes a case in which orthotic therapy and the reversed application of a knitted hand function enhancement glove (Nigirukun®) were used to treat an intrinsic-plus-like movement pattern persisting after recovery from wrist drop secondary to radial nerve palsy. The patient was a man in his 20s who developed radial nerve palsy after a traffic accident. Although wrist drop and sensory disturbance improved during recovery, an intrinsic-plus-like movement pattern characterized by metacarpophalangeal joint flexion with proximal and distal interphalangeal joint extension persisted in the left hand, resulting in difficulty in grasping objects, particularly with the ring and little fingers. The intrinsic tightness test showed no evidence of structural shortening, suggesting that abnormal movement was mainly related to a fixed motor control strategy associated with intrinsic muscle overactivity. Initial treatment consisted of thermotherapy, range-of-motion exercises, and orthotic therapy designed to maintain the interphalangeal joints in flexion. To modify the flexion onset pattern during grasping, a knitted hand function enhancement glove was applied in a reversed orientation to assist interphalangeal joint flexion during the early phase of grasping, thereby reducing intrinsic muscle-dominant activation. Immediately after the introduction of the reversed glove, the patient reported improved ease of grasping, accompanied by increases in grip strength and active motion indices. By hospital day 59, total passive motion showed little change; however, improvements in finger flexor strength, active movement measures, and patient-reported outcomes were observed, suggesting that functional recovery may have been related more to changes in motor strategy than to structural joint changes. These findings suggest that the reversed use of a knitted hand function enhancement glove may support sensorimotor re-education and facilitate the relearning of coordinated flexion patterns in daily activities.

Background and Objectives: Radial nerve palsy is one of the most clinically important neurological complications associated with humeral shaft fractures. This study aimed to evaluate the incidence of radial nerve palsy in adult humeral shaft fractures and to investigate recovery patterns and functional outcomes in surgically treated patients. Materials and Methods: This single-center retrospective observational study included adult patients with humeral shaft fractures treated between November 2022 and January 2025. All adult humeral shaft fractures during the study period were screened to determine the overall rate of radial nerve palsy. The final functional analysis included surgically treated patients with radial nerve palsy. Demographic data, fracture characteristics, injury energy, fracture type, timing of radial nerve palsy, treatment modality, operative time, radial nerve exploration, additional surgery, time to nerve recovery, and QuickDASH scores were evaluated. Conservatively managed patients with radial nerve palsy were included in the calculation of overall incidence and recovery rates but were not included in the final functional analyses. Results: A total of 469 adult patients with humeral shaft fractures were evaluated. Radial nerve palsy was identified in 77 patients, corresponding to an overall rate of 16.4%. The rate was 46.4% in open fractures and 14.5% in closed fractures. Among the 77 patients with radial nerve palsy, 49 underwent surgical treatment and constituted the final analysis cohort, whereas 28 were managed conservatively. Recovery was observed in 25 of 28 conservatively managed patients (89.3%) and in 35 of 49 surgically treated patients (71.4%). Overall, radial nerve function recovered in 60 of 77 patients (77.9%). New-onset postoperative radial nerve palsy developed in 29 of 129 surgically treated patients without preoperative palsy (22.5%); however, recovery occurred in 22 of these 29 patients (75.9%), and the rate of persistent postoperative palsy was 5.4% among patients without preoperative palsy. In the surgical cohort, open fracture, longer operative time, and higher initial Cobb angle were associated with non-recovery. Recovery of radial nerve function was the only factor independently associated with better QuickDASH scores. Conclusions: Radial nerve palsy was more frequent in open humeral shaft fractures. Although recovery was high among conservatively managed patients, surgically treated cases showed a lower recovery rate, likely reflecting greater injury complexity. New-onset postoperative radial nerve palsy was relatively frequent, but most cases recovered. Recovery of radial nerve function was strongly associated with better upper extremity functional outcomes.

Background/Objectives: Supracondylar humerus fractures are among the most common pediatric fractures and may be associated with neurovascular complications. Brachial artery entrapment is a rare but limb-threatening condition requiring urgent recognition and management. Methods: We present two pediatric cases of brachial artery entrapment associated with displaced supracondylar humerus fractures. Clinical presentation, imaging findings, surgical management, and outcomes were analyzed. Results: Both patients presented with absent radial pulse following trauma. Initial fracture reduction and fixation did not restore vascular flow. CT angiography confirmed brachial artery compromise. Surgical exploration with arterial decompression resulted in restoration of perfusion. One patient achieved full recovery, while the other developed severe neuropathy with partial recovery after rehabilitation. Conclusions: Brachial artery entrapment should be suspected in cases of persistent vascular compromise after fracture reduction. Prompt surgical intervention and thorough perioperative neurovascular assessment are essential to prevent long-term morbidity.

High-voltage electrical burns present as complex peripheral nerves damage, with complete recovery of nerve function rarely seen, especially in mixed motor and sensory innervation injury. Current treatments such as autografts carry the risk of donor site morbidity and potential neuropathy. In this case, a 35-year-old line worker sustained an electrical burn while at work and examination revealed a large volar burn along the right arm, hand, left hand, chest, and leg. After debridement, exposure of the radial artery, median nerve, and flexor tendons in the right upper extremity was noted. Further operative examination confirmed compartment syndrome of the volar compartment. The median nerve was identified as extensively damaged but physically intact. A multimodality approach was taken to avoid donor site morbidity, with a right upper extremity fasciocutaneous anterolateral thigh free tissue transfer and an Axoguard Nerve Protector (40 × 7 mm). Functional recovery was demonstrated at 8-month follow up.

Pediatric humeral shaft fractures associated with radial nerve palsy are rare, with an incidence of 4-4.35%. There exists one study on this topic; this systematic review and pooled analysis aim to shift the focus from incidence to recovery, apply patient-level analyses, reassess previously reported associations, identify discrepancies to inform clinical decision-making, and elucidate possible factors associated with poor recovery using exploratory and hypothesis-generating analyses. PubMed, Cochrane Central, and Google Scholar were searched using the following terms: (radial nerve palsy) AND (humerus fracture) AND (pediatrics OR children). Inclusion criteria included case reports, retrospective or systematic reviews, patients aged 1-18 years, and humeral shaft fractures with radial nerve palsy. Exclusion criteria included non-English studies. This yielded 13 studies; 11 provided sufficient data for analysis (32 patients). Oblique fractures were observed more frequently with delayed recovery (>4 months) or no recovery (P = 0.040). Neurotmesis and fibrosis surrounding the nerve were observed with delayed recovery (P = 0.002). Closed reduction and fixation were associated with worse nerve outcomes than conservative treatment (P = 0.013). Patients undergoing nerve procedures were frequently observed with impaired nerve recovery (P = 0.017). However, when evaluating for ordinal differences in recovery, there was no significant difference (Kruskal-Wallis H test P = 0.282). This review found that, unlike adults, distal and oblique humeral shaft fractures in children are associated more frequently with poorer outcomes of radial nerve injury. Clinicians may consider careful, early assessment of the radial nerve in displaced, distal, oblique humeral fractures.

Background and Objectives: Many patients suffer from chronic pain of the shoulder, neck, upper back, and/or arm. They may be diagnosed with fibromyalgia, complex regional pain syndrome, myofascial pain, thoracic outlet, subacromial pain, cervical radiculopathy, cervicogenic headaches, post-mastectomy pain, and/or occupational shoulder disorder. The pectoralis minor (PM) is the only muscle of the scapula controlled by the lower trunk of the brachial plexus. In the Human Disharmony Loop (HDL), this neurologic asymmetry produces persistent protraction of the scapula. Protraction deforms the scapula's connections, generating headaches and neck stiffness, upper back tightness, shoulder weakness, and hand numbness. We hypothesize patients with the above who meet HDL diagnostic criteria will benefit from PM tenotomy with brachial plexus neurolysis (PM+ICN). Materials and Methods: Patients diagnosed with the above disorders who also met HDL criteria of medial coracoid tenderness and scapula protraction on exam underwent PM+ICN, with secondary neurolysis after 3 months if needed. Clinical neuropathy was diagnosed via the scratch-collapse test. Outcomes included self-reported Visual Analogue Score pain scores, active shoulder abduction range of motion (ROM), prevalence of occipital headaches. Results: N = 318 patients were included. Average age was 51; 68.0% were female. Following treatment, average pain decreased from 7.3/10 to 2.1/10 (p < 0.001), average shoulder ROM increased from 96 to 170 degrees (p < 0.001), and occipital headaches decreased from 76.7% to 1.6% (p < 0.001). Scapular protraction normalized from 98.8% static to 92.5% none (p < 0.001). Overall, 17% required subsequent neurolysis, chiefly of the axillary, radial, and ulnar nerves. The pain reductions were statistically indistinguishable across all diagnoses (p = 0.709, I[2] = 0.02%). Average follow-up was 22 months. Conclusions: PM+ICN significantly reduced self-reported pain and headaches in select intractable patients. The PM pathologizing the scapula may constitute a shared anatomic mechanism that contributes to chronic pain across heterogenous disorders of the upper limb.