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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.

Nerve surgery for unmeasurable upper extremity neuropathophysiology - such as pronator syndrome, supinator syndrome/radial tunnel syndrome, lacertus syndrome, and neurogenic thoracic outlet syndrome - remains a subject of ongoing debate due to the lack of objective reference tests confirming the diagnoses. This round table discussion outlines the perspectives of five expert surgeons navigating the clinical and ethical uncertainties of offering surgery for theoretical neuropathies presenting as non-specific pain. The panel explores the balance between subjective patient reporting and objective diagnostic limitations, the ethical implications of surgical placebo effects, and how to determine treatment effectiveness. The discussion highlights the divergent strategies among specialists regarding risk tolerance, overtreatment, and the implementation of shared decision-making in the absence of measurable disease.

Supracondylar humerus fractures are among the most common paediatric injuries. Although neurologic complications are often seen in these fractures, iatrogenic nerve injuries following closed reduction and percutaneous pinning remain relatively uncommon. Radial nerve palsy is particularly rare in this context, and most cases represent neuropraxic injuries that recover spontaneously. This report describes a rare case of iatrogenic high radial nerve palsy following closed reduction and K-wire fixation of a comminuted supracondylar humerus fracture in a child, with complete functional recovery under conservative management. An eight-year-old boy sustained a comminuted supracondylar humerus fracture after a fall on an outstretched hand. Preoperative neurovascular examination was normal. The patient underwent closed reduction and crossed K-wire fixation, requiring multiple reduction attempts due to fracture comminution. Postoperatively, he developed wrist and finger drop, loss of thumb abduction, and dorsal hand hypoesthesia, consistent with high radial nerve palsy, despite intact distal perfusion and normal postoperative radiographs. Conservative management with close follow-up was initiated. Early neurological improvement was observed at four to six weeks, with radiographic fracture union and K-wire removal at six weeks. By eight weeks, the patient demonstrated complete recovery of wrist extension, thumb abduction, and full elbow range of motion. Radial nerve injury in supracondylar fractures is typically due to traction or entrapment by fracture fragments. Iatrogenic injuries most commonly occur with repeated manipulations during difficult reductions or pin placement. Most such injuries are neuropraxias and recover without surgical intervention. Current evidence supports conservative management unless neurological improvement is absent. To conclude, this case highlights that iatrogenic radial nerve palsy following closed reduction and K-wire fixation, although rare, is usually transient. Thorough clinical assessment and close follow-up are essential. Conservative management can result in complete neurological recovery, and early surgical exploration is generally unnecessary unless deficits persist beyond the expected recovery timeframe.

Nontraumatic posterior interosseous nerve (PIN) palsy is an uncommon entrapment neuropathy, and there is limited evidence regarding ultrasound-guided nerve mobilization as part of rehabilitation. Here, we report a case of PIN palsy associated with a ganglion cyst in the radial tunnel, focusing on the clinical course and ultrasound-based evaluation of nerve morphology and motion. The patient presented with dorsal forearm pain, marked weakness of the fingers, and thumb extension. Ultrasonography revealed a hypoechoic ganglion compressing and flattening the PIN near the arcade of Frohse. The initial management consisted of weekly ultrasound-guided aspiration of the ganglion combined with conventional physical therapy, including low-frequency electrical stimulation, stretching, and active-assist exercises for finger extension. Although pain decreased promptly after decompression, motor recovery remained limited, and follow-up ultrasonography showed persistent nerve flattening and reduced longitudinal gliding. Therefore, an ultrasound-guided nerve mobilization program was added to restore nerve gliding around the compression site while continuously monitoring the nerve and its surrounding structures. Over subsequent sessions, finger extension strength and hand function improved in parallel with a reduction in the nerve cross-sectional area, normalization of the flattening ratio, and qualitative recovery of nerve sliding on ultrasonography. This case suggests that ultrasound-guided nerve mobilization may be a useful adjunct to decompression and exercise therapy in PIN palsy related to ganglion compression and highlights the value of serial ultrasound assessment, including quantitative evaluation such as particle image velocimetry (PIV), for guiding and validating rehabilitation in peripheral nerve disorders.