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We report a case of a bilateral glass injury to the wrist with transection of flexor tendons and the ulnar nerve and artery in a 60-year-old male patient. Two days after his accident, we repaired all divided structures, and on the right hand, we added the transfer of the opponens motor branch to the deep terminal division of the ulnar nerve aimed at first dorsal interosseous and adductor pollicis muscle reinnervation. After surgery, the patient was followed over 24 months. Postoperative dynamometry of the hand, which included grasping, key-pinch, subterminal-key-pinch, pinch-to-zoom, and first dorsal interosseous muscle strength, indicated recovery only in the nerve transfer side.

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Lipomas are well-defined tumors of the adipose tissue that often occur in the torso or the extremities of adult patients. These tumors usually develop painlessly and insidiously, but theymay compress adjacent structures. The objective of the present study is to describe the case of a 68-year-old female patient with a giant lipoma located at the hypothenar region, with manifestation of compression of the common palmar digital nerves, the ulnar nerve, andthe abductormuscle of theVfinger. Regarding the symptoms, the patient feltmoderate pain in the hypothenar region, with no Tinel sign, and no changes in the motor function or sensibility of the digits innervated by the ulnar nerve. Lipomasmay present a varied range of histological characteristics, and malignant tumors may be a differential diagnosis. An imaging exammay aid in the diagnosis, which is confirmed by a histopathological study. For the present case, as recommended in the literature, a surgical procedure was performed for the resection of the tumor, which resulted in the control of the symptoms.

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Upper limb nerve injuries are common, and their treatment poses a challenge for physicians and surgeons. Experimental models help in minimum exploration of the functional characteristics of peripheral nerve injuries of forelimbs. This study was conducted to characterize the functional recovery (1, 3, 7, 10, 14, and 21 days) after median and ulnar nerve crush in mice and analyze the histological and biochemical markers of nerve regeneration (after 21 days). Sensory-functional impairments appeared after 1 day. The peripheral nerve morphology, the nerve structure, and the density of myelin proteins [myelin protein zero (P0) and peripheral myelin protein 22 (PMP22)] were analyzed after 21 days. Cold allodynia and fine motor coordination recovery occurred on the 10th day, and grip strength recovery was observed on the 14th day after injury. After 21 days, there was partial myelin sheath recovery. PMP22 recovery was complete, whereas P0 recovery was not. Results suggest that there is complete functional recovery even with partial remyelination of median and ulnar nerves in mice.

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Patients with hand muscular atrophy due to damage of the ulnar nerve could be stigmatized for their appearance. Unsatisfactory results in the attempt to correct the atrophy are reported in the literature. Fat grafting is an autologous and easily obtainable graft, antigenic response is very unlikely, it does not require any special material, and the procedure has a low cost. The technique of autologous fat grafting by using fat block, to remodel the first interdigital space, is useful and safe in correcting muscle atrophy of the first interdigital space caused by the injury of the ulnar nerve. This technique is suitable for muscular atrophy caused by injury of the ulnar nerve and nerve compression as well as patients present with esthetic complaints. Fifteen cases were operated using this technique. After the surgery, the resorption of the graft ranged between 12.5% and 66.7%, averaging 28%. Patients were able to check the benefit provided by filling of the atrophied area, which allowed a serene return to their daily life activities, living with others, reducing the need to hide their hands, and even facilitating their reintegration into the labor market.

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OBJECTIVE: In this study, we propose a modification to the simple decompression technique that contains the ulnar nerve in the cubital fossa, thus preventing subluxation during forearm flexion movements. METHODS: Five consecutive patients with leprosy-associated cubital tunnel syndrome underwent surgery with the modified technique between July 2011 and October 2012. RESULTS: The most common symptoms were neuropathic pain and sensory changes (both 60%). On the McGowan scale, three patients maintained their preoperative score and two patients improved by two points, while on the Louisiana State University Health Sciences Center scale, two patients maintained the same scores, two improved by two points, and one improved by one point. Four patients were able to discontinue corticosteroid use. The mean follow-up time was 25.6 months (range 2-48 months). There were no recurrences or subluxations in the long-term. CONCLUSION: This alternative technique resulted in excellent functional results, as well as successful withdrawal from corticosteroids. Furthermore, it resulted in no ulnar nerve subluxations.

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ABSTRACT Objective In this study, we propose a modification to the simple decompression technique that contains the ulnar nerve in the cubital fossa, thus preventing subluxation during forearm flexion movements. Methods Five consecutive patients with leprosy-associated cubital tunnel syndrome underwent surgery with the modified technique between July 2011 and October 2012. Results The most common symptoms were neuropathic pain and sensory changes (both 60%). On the McGowan scale, three patients maintained their preoperative score and two patients improved by two points, while on the Louisiana State University Health Sciences Center scale, two patients maintained the same scores, two improved by two points, and one improved by one point. Four patients were able to discontinue corticosteroid use. The mean follow-up time was 25.6 months (range 2-48 months). There were no recurrences or subluxations in the long-term. Conclusion This alternative technique resulted in excellent functional results, as well as successful withdrawal from corticosteroids. Furthermore, it resulted in no ulnar nerve subluxations.

RESUMO Objetivo Neste manuscrito apresentamos uma modificação da técnica de descompressão simples do nervo ulnar no túnel cubital que impede a subluxação do nervo em movimentos de flexão do antebraço. Métodos Foram incluídos cinco pacientes consecutivos acometidos por síndrome do túnel cubital (Hanseníase) submetidos à cirurgia entre 2011 e 2012. Resultados Os sintomas mais comuns foram dor neuropática e alterações sensitivas (60%). No pós-operatório, três pacientes mantiveram o mesmo escore e dois melhoraram dois pontos na escala de McGowan, enquanto na escala Louisiana State University Health Sciences Center, dois pacientes mantiveram o mesmo escore, dois melhoraram dois pontos e um melhorou um ponto. Os corticosteróides foram descontinuados em quatro pacientes. O tempo médio de seguimento foi 25,6 meses (variação 2-48 meses). Não foram observadas recorrência ou subluxação no longo prazo. Conclusões A técnica alternativa apresentou excelentes resultados funcionais e foi bem sucedida na retirada dos corticosteróides. Ademais, subluxações do nervo ulnar não foram observadas.

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BACKGROUND: Positioning during neurosurgical procedures is a challenge for surgical teams even if precautions are taken, the mechanisms underlying peripheral nerve injury (elongation, compression or ischaemia) are latent and it is important to know the frequency of occurrence in our environment. OBJECTIVE: To analyze the frequency of peripheral nerve injury secondary to surgical positioning. MATERIALS AND METHODS: Prospective study including 163 patients scheduled for neurosurgical procedures. Four groups: supine, lateral, ventral and park bench were analyzed by neurological exploration in order to detect injury and relate with risk factors already described. RESULTS: In this study 112 patients were included, two patients who were under park bench position experienced paresthesias in ulnar region of less than 24 hours' duration; statistically significant correlation with body weight greater than 85kg. CONCLUSION: The incidence of peripheral nerve injury is low, understanding the mechanisms that may originate it helps towards prevention and early detection of complications.

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Esse estudo tem por objetivo avaliar a capacidade funcional da mão das pessoas atingidas pela hanseníase na realização das atividades básicas e instrumentais da vida diária. A amostra foi constituída por 50 pacientes, maiores de 18 anos, que estavam sendo acompanhados no ambulatório do Instituto Lauro de Souza Lima. Para avaliação das características sociodemográficas e clínicas foi elaborado um questionário próprio. As dificuldades manuais para realizar atividades nas áreas de vestuário, alimentação, higiene pessoal, cuidados com a casa, escrita e outros foram avaliados por meio da Avaliação Funcional das Mãos em Hanseníase. Os resultados demonstram que em todas as atividades houve algum grau de dificuldade, porém, a maioria dos pacientes as realiza com independência. As atividades consideradas mais difíceis de serem executadas pelos pacientes com garra ulnar foram: pegar objetos pequenos em superfície plana, abrir/fechar fecho de corrente e cortar unhas. Na população de pacientes com garra ulnar/mediano foram: pegar objetos pequenos em superfície plana, abotoar/desabotoar, dar laço/ amarrar cadarço e abrir/fechar fecho de corrente. As atividades são realizadas com algum grau de dificuldade, porém, com independência pela maioria dos indivíduos que tem ou tiveram hanseníase e apresentam deformidades visíveis. Muitas dessas dificuldades podem ser minimizadas por meio de transferências tendinosas ou pela indicação, confecção e uso de tecnologia assistiva(AU).

This study aims to assess the functional capacity of the hand of people affected by leprosy in carrying out basic and instrumental activities of daily living. The sample consisted of 50 patients, aged over 18, who were being followed up at the outpatient clinic of the Instituto Lauro de Souza Lima. A questionnaire was developed to assess sociodemographic and clinical characteristics. Manual difficulties in carrying out activities in the areas of clothing, food, personal hygiene, home care, writing and others were assessed through the Functional Hand Assessment in Leprosy. The results show that in all activities there was some degree of difficulty, however, most patients perform them independently. The activities considered most difficult to be performed by patients with an ulnar claw were: picking up small objects on a flat surface, opening / closing the chain clasp and cutting nails. In the population of patients with an ulnar / median claw were: picking up small objects on a flat surface, buttoning / unbuttoning, looping / tying shoelaces and opening / closing chain fastening. The activities are performed with some degree of difficulty, however, independently by the majority of individuals who have or have had leprosy and have visible deformities. Many of these difficulties can be minimized by means of tendon transfers or by the indication, preparation and use of assistive technology(AU).

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Snapping triceps es la luxación del vientre medial del tríceps por encima de la epitróclea, asociada o no a la luxación del nervio cubital. En algunos casos publicados, los pacientes eran intervenidos por luxación del nervio cubital y, durante la cirugía, se diagnosticaba la luxación del vientre medial del tríceps, incluso algunos pacientes eran operados en varias oportunidades. Presentamos un paciente de 16 años que refiere un resalto en la región medial de ambos codos. En el examen físico, es evidente un doble resalto tanto del nervio cubital, como del vientre medial del tríceps. Estos hallazgos se confirman por ecografía comparativa bilateral. El tratamiento quirúrgico consistió en la transposición cubital transmuscular y la resección del vientre medial del tríceps que se luxaba anterior a la epitróclea. Los dos codos fueron operados con diferencia de un mes. El paciente tuvo una excelente evolución sin complicaciones a los dos meses de las operaciones. Esta patología poco frecuente debe ser considerada con atención, ya que puede llevar a errores de diagnóstico y de tratamiento. Nivel de Evidencia: IV.

Snapping triceps is the dislocation of the medial triceps belly above the medial epicondyle, with or without the ulnar nerve. In some cases described in the literature, patients were operated on by ulnar nerve dislocation and dislocation of the medial triceps belly was diagnosed during surgery; some patients were even operated on several occasions. We report the case of a 16-year-old patient with a snap in the medial region of both elbows. Physical examination reveals a clear doublé click of the ulnar nerve and the medial triceps belly. These findings are confirmed by bilateral comparative ultrasound. Surgical treatment consisted of transmuscular ulnar transposition and resection of dislocated medial triceps belly. Both elbows were operated on one month apart. Two months after surgeries, the patient achieved an excellent outcome without complications. This rare condition must be carefully considered since it may lead to diagnostic and therapeutic errors. Level of Evidence: IV.

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Resumen: Antecedentes: Las lesiones de nervio periférico, principalmente las traumáticas, tienen efectos devastadores para la función. Tradicionalmente las opciones eran en forma temprana el injerto nervioso y en forma tardía la transferencia tendinosa. Durante los últimos años se han venido realizando transferencias nerviosas cuando la lesión es temprana y la placa motora aún es viable. Los resultados en su mayoría son superiores a los injertos nerviosos y a las transferencias tendinosas. Métodos y resultados: Se presenta el caso de una paciente que sufrió lesión de nervio mediano y cubital en el antebrazo y se utilizaron las ramas redundantes de los músculos extensor carpi ulnaris y extensor digiti quinti. Los resultados fueron buenos a los cuatro años. Conclusión: Cuando existe un déficit de la musculatura intrínseca cubital de la mano, el donador favorito es la rama terminal del nervio interóseo anterior. Cuando éste no se encuentra, debemos tener opciones para restaurar esta función.

Abstract: Background: The peripheral nerve injuries are devastating for the patient; the classic reconstructive options are the Nerve Graft and Tendon Transfers. Lately the Nerve Transfers are being used more and more broadly. They are an excellent option on early injuries and when the motor plate is still alive. The advantages are numerous, because the functional recovery is much better. Methods and results: We report the case of a patient who sustained and injury on the median and ulnar nerve, so the EDQ and ECU branches were used to restore the Ulnar Intrinsic Function. The 4-year follow-up showed good results. Conclusion: The ulnar intrinsic innervations provide dexterity; fine motor function and pinch, which is essential for a functioning hand. The most popular donor to restore the function of the motor branch of the ulnar nerve is the anterior interosseous nerve. When this is unavailable the use of the redundant branches of the EDQ and ECU must be considered.

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BACKGROUND: Mirror therapy has been used as an alternative stimulus to feed the somatosensory cortex in an attempt to preserve hand cortical representation with better functional results. OBJECTIVE: To analyze the short-term functional outcome of an early re-education program using mirror therapy compared to a late classic sensory program for hand nerve repair. METHOD: This is a randomized controlled trial. We assessed 20 patients with median and ulnar nerve and flexor tendon repair using the Rosen Score combined with the DASH questionnaire. The early phase group using mirror therapy began on the first postoperative week and lasted 5 months. The control group received classic sensory re-education when the protective sensation threshold was restored. All participants received a patient education booklet and were submitted to the modified Duran protocol for flexor tendon repair. The assessments were performed by the same investigator blinded to the allocated treatment. Mann-Whitney Test and Effect Size using Cohen's d score were used for inter-group comparisons at 3 and 6 months after intervention. RESULTS: The primary outcome (Rosen score) values for the Mirror Therapy group and classic therapy control group after 3 and 6 months were 1.68 (SD=0.5); 1.96 (SD=0.56) and 1.65 (SD=0.52); 1.51 (SD=0.62), respectively. No between-group differences were observed. CONCLUSION: Although some clinical improvement was observed, mirror therapy was not shown to be more effective than late sensory re-education in an intermediate phase of nerve repair in the hand. Replication is needed to confirm these findings.

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BACKGROUND: Mirror therapy has been used as an alternative stimulus to feed the somatosensory cortex in an attempt to preserve hand cortical representation with better functional results. OBJECTIVE: To analyze the short-term functional outcome of an early re-education program using mirror therapy compared to a late classic sensory program for hand nerve repair. METHOD: This is a randomized controlled trial. We assessed 20 patients with median and ulnar nerve and flexor tendon repair using the Rosen Score combined with the DASH questionnaire. The early phase group using mirror therapy began on the first postoperative week and lasted 5 months. The control group received classic sensory re-education when the protective sensation threshold was restored. All participants received a patient education booklet and were submitted to the modified Duran protocol for flexor tendon repair. The assessments were performed by the same investigator blinded to the allocated treatment. Mann-Whitney Test and Effect Size using Cohen's d score were used for inter-group comparisons at 3 and 6 months after intervention. RESULTS: The primary outcome (Rosen score) values for the Mirror Therapy group and classic therapy control group after 3 and 6 months were 1.68 (SD=0.5); 1.96 (SD=0.56) and 1.65 (SD=0.52); 1.51 (SD=0.62), respectively. No between-group differences were observed. CONCLUSION: Although some clinical improvement was observed, mirror therapy was not shown to be more effective than late sensory re-education in an intermediate phase of nerve repair in the hand. Replication is needed to confirm these findings.

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BACKGROUND: The peripheral nerve injuries are devastating for the patient; the classic reconstructive options are the Nerve Graft and Tendon Transfers. Lately the Nerve Transfers are being used more and more broadly. They are an excellent option on early injuries and when the motor plate is still alive. The advantages are numerous, because the functional recovery is much better. METHODS AND RESULTS: We report the case of a patient who sustained and injury on the median and ulnar nerve, so the EDQ and ECU branches were used to restore the Ulnar Intrinsic Function. The 4-year follow-up showed good results. CONCLUSION: The ulnar intrinsic innervations provide dexterity; fine motor function and pinch, which is essential for a functioning hand. The most popular donor to restore the function of the motor branch of the ulnar nerve is the anterior interosseous nerve. When this is unavailable the use of the redundant branches of the EDQ and ECU must be considered.

ANTECEDENTES: Las lesiones de nervio periférico, principalmente las traumáticas, tienen efectos devastadores para la función. Tradicionalmente las opciones eran en forma temprana el injerto nervioso y en forma tardía la transferencia tendinosa. Durante los últimos años se han venido realizando transferencias nerviosas cuando la lesión es temprana y la placa motora aún es viable. Los resultados en su mayoría son superiores a los injertos nerviosos y a las transferencias tendinosas. MÉTODOS Y RESULTADOS: Se presenta el caso de una paciente que sufrió lesión de nervio mediano y cubital en el antebrazo y se utilizaron las ramas redundantes de los músculos extensor carpi ulnaris y extensor digiti quinti. Los resultados fueron buenos a los cuatro años. CONCLUSIÓN: Cuando existe un déficit de la musculatura intrínseca cubital de la mano, el donador favorito es la rama terminal del nervio interóseo anterior. Cuando éste no se encuentra, debemos tener opciones para restaurar esta función.

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BACKGROUND: The prognosis for motor recovery associated with ulnar nerve injuries at a level proximal to the elbow is usually considered poor. Nerve transfers techniques were introduced as an alternative for the management of nerve lesions of the upper limb, aiming to improve the surgical results of those nerves for which direct reconstruction has not historically yielded good outcomes. METHODS: A retrospective chart review was conducted to compare the outcomes obtained using nerve grafting (20 cases) with those of distal nerve transfer (15 patients) for the treatment of proximal injuries of the ulnar nerve. Nerve transfer combined the suture of the anterior interosseous nerve to the motor branch of the ulnar nerve and the cooptation of its sensory branch to the third common digital nerve via an end-to-side suture. RESULTS: The Medical Research Council M3/M4 outcomes were observed significantly more often in the nerve transfer group (80 vs. 22%), and the mean values for handgrip strength were higher (31.3 ± 5.8 vs. 14.5 ± 7.2 kg). The groups were similar in attaining good sensory recovery (40 vs. 30%) and mean two-point-discrimination (grafting: 11 ± 2 mm; nerve transfer: 9 ± 1 mm). The mean value of the disabilities of arm, shoulder, and hand for the nerve transfer group (23.6 ± 6.7) was significantly lower than for grafting (34.2 ± 8.3). CONCLUSIONS: Distal nerve transfer resulted in better motor and functional outcomes than nerve grafting. Both techniques resulted in similar sensory outcomes, and nerve grafting was demonstrated to be a better technique for managing the painful symptoms associated with the nerve injury.

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Surgeons believe that in high ulnar nerve lesion distal interphalangeal joint (DIP) flexion of the ring and little finger is abolished. In this article, we present the results of a study on innervation of the flexor digitorum profundus of the ring and little fingers in five patients with high ulnar nerve injury and in 19 patients with a brachial plexus, posterior cord, or radial nerve injury. Patients with ulnar nerve lesion were assessed clinically and during surgery for ulnar nerve repair we confirmed complete lesion of the ulnar nerve in all cases. In the remaining 19 patients, during surgery, either the median nerve (MN) or the anterior interosseous nerve (AIN) was stimulated electrically and DIP flexion of the ring and little fingers evaluated. All patients with high ulnar nerve lesions had active DIP flexion of the ring and little fingers. Strength scored M4 in the ring and M3-M4 in the little finger. Electrical stimulation of either the MN or AIN produced DIP flexion of the ring and little fingers. Contrary to common knowledge, we identified preserved flexion of the distal phalanx of the ring and little fingers in high ulnar nerve lesions. On the basis of these observations, nerve transfers to the AIN may provide flexion of all fingers.

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BACKGROUND: This study was conducted to test whether the IBB Forelimb Scale (Irvine et al., 2010) which was originally developed for rats with spinal cord injury, is also capable of measuring the functional performance of Swiss mice with lesions of the median and ulnar nerves inflicted via crushing with standardized strength. NEW METHOD: This test was performed at days 1, 3, 7, 10, 14 and 21 after surgery and each animal gives a score of 9, where 0 represented the worst functionality and 9 represented the habitual behavior. RESULTS: The control animals usually exhibited movements in the task that were scored as 9 during the experimental period. The lesion group began with a score of 2 on the 1st and 3rd post-operative days. On the 7th and 10th postoperative days, respectively, they scored 7, and on the 14th post-operative day, they achieved a score of 8. Only on the 21st post-operative day, did they exhibit habitual skillful behaviors. COMPARISON WITH EXISTING METHOD(S): IBB Forelimb Scale is effective for determining how the animals perform the movements in detail, which is not readily revealed by other methods. Furthermore, this test show similar recovery periods with grasping test, staircase test and seems to be more sensitive than paw print analysis for this type of lesion. CONCLUSIONS: Our data demonstrate that IBB scale was capable of measuring gradual improvements in motor forelimb functions in this model and may be a new and effective assessment tool for peripheral nerve injury.

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The most disabling aspect of human peripheral nerve injuries, the majority of which affect the upper limbs, is the loss of skilled hand movements. Activity-induced morphological and electrophysiological remodeling of the neuromuscular junction has been shown to influence nerve repair and functional recovery. In the current study, we determined the effects of two different treatments on the functional and morphological recovery after median and ulnar nerve injury. Adult Wistar male rats weighing 280 to 330 g at the time of surgery (N = 8-10 animals/group) were submitted to nerve crush and 1 week later began a 3-week course of motor rehabilitation involving either "skilled" (reaching for small food pellets) or "unskilled" (walking on a motorized treadmill) training. During this period, functional recovery was monitored weekly using staircase and cylinder tests. Histological and morphometric nerve analyses were used to assess nerve regeneration at the end of treatment. The functional evaluation demonstrated benefits of both tasks, but found no difference between them (P > 0.05). The unskilled training, however, induced a greater degree of nerve regeneration as evidenced by histological measurement (P < 0.05). These data provide evidence that both of the forelimb training tasks used in this study can accelerate functional recovery following brachial plexus injury.

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The most disabling aspect of human peripheral nerve injuries, the majority of which affect the upper limbs, is the loss of skilled hand movements. Activity-induced morphological and electrophysiological remodeling of the neuromuscular junction has been shown to influence nerve repair and functional recovery. In the current study, we determined the effects of two different treatments on the functional and morphological recovery after median and ulnar nerve injury. Adult Wistar male rats weighing 280 to 330 g at the time of surgery (N = 8-10 animals/group) were submitted to nerve crush and 1 week later began a 3-week course of motor rehabilitation involving either "skilled" (reaching for small food pellets) or "unskilled" (walking on a motorized treadmill) training. During this period, functional recovery was monitored weekly using staircase and cylinder tests. Histological and morphometric nerve analyses were used to assess nerve regeneration at the end of treatment. The functional evaluation demonstrated benefits of both tasks, but found no difference between them (P > 0.05). The unskilled training, however, induced a greater degree of nerve regeneration as evidenced by histological measurement (P < 0.05). These data provide evidence that both of the forelimb training tasks used in this study can accelerate functional recovery following brachial plexus injury.

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O uso da reabilitação virtual através do video game visa simulação de situações reais; percebe-se que o uso desta, afasta o paciente do foco da dor ou do incomodo; melhora na funcionalidade dos membros acometidos e o leva a retomar as atividades nas áreas de desempenho ocupacional. Este estudo teve como objetivo verificar o uso da reabilitação virtual, como recurso terapêutico ocupacional, em um paciente com lesão alta dos nervos mediano e ulnar, bem como descrever e comparar os graus da amplitude de movimento das articulações do membro lesado. Trata- se de uma pesquisa do tipo longitudinal com um paciente de 09 anos de idade, sexo masculino, diagnosticado com lesão nervosa, na Clínica Escola de Terapia Ocupacional da Universidade Potiguar, no período de maio a setembro de 2010. Nos 13 encontros, foram utilizados televisão, o videogame Nintendo® Wii e quatro jogos e um goniômetro como instrumentos de intervenção e coleta de dados. Na reavaliação, observou-se a movimentação ativa e o aumento da amplitude de movimento em todas as articulações medidas: cotovelo em flexão e extensão; antebraço em pronação e supinação; punho em flexão, extensão, desvio ulnar e desvio radial; polegar em flexão de metacarpofalangiana, flexão interfalangiana, abdução e estágio III de oponência (Kapangji); II, III, IV e V quirodátilos. Os metacarpos apresentaram ganhos em flexão e extensão. Os resultados desse estudo evidenciaram a eficácia do videogame, comprovado através da avaliação goniométrica. O indivíduo estudado voltou a realizar as atividades de vida diária de forma independente e retornou as suas atividades esportivas de forma competitiva.

The use of virtual rehabilitation with video games aims to simulate real situations. It has been observed that the use of video games as a rehabilitation tool allows the patient to focus on something other than the pain or discomfort. It improves functionality of affected limbs, and helps the patient to resume activities involving occupational performance. The intent of this study was to verify the application of virtual rehabilitation as a resource for occupational therapy for a patient with high median and high ulnar nerve injuries, and to describe and compare the levels of range of motion of the injured limb joints. This was a longitudinal survey with a 9 years old patient, male, diagnosed with nerve damage at the Potiguar University School of Occupational Therapy Clinic. The survey was carried out from May to September of 2010. Throughout the 13 sessions, a television and a Nintendo ® Wii video game (with four games) were used as intervention tools, and a goniometer was used for collecting data. During reassessment, active movement and increased range of motion in all joints assessed were observed: elbow flexion and extension; forearm pronation and supination; wrist flexion, extension, radio and ulnar deviation; thumb metacarpophalangeal flexion, interphalangeal flexion, abduction and opponency at stage III (Kapandji); II, III, IV and V fingers. The metacarpals presented improvements in flexion and extension. The results showed the effectiveness of video games as evidenced by goniometric evaluation. The patient studied regained the ability to perform activities of daily living independently and to play sports competitively.

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OBJECTIVE: To demonstrate the results of a double nerve transfer at the level of the hand for recovery of the motor and sensory function of the hand in cases of high ulnar nerve injuries. METHOD: Five patients underwent a transfer of the distal branch of the anterior interosseous nerve to the deep ulnar nerve, and an end-to-side suture of the superficial ulnar nerve to the third common palmar digital nerve. RESULTS: Two patients recovered strength M3 and three cases were graded as M4; recovery of protective sensation (S3+ in three patients and S4 in two) was observed in the fourth and fifth fingers, and at the hypothenar region. The monofilament test showed values of 3.61 or less in all cases and the two-point discrimination test demonstrated values of 7 mm in three cases and 5 mm in two. CONCLUSION: This technique of double nerve transfer is effective for motor and sensory recovery of the distal ulnar-innervated side of the hand.

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