Alexander Y. Shin, M.D.

The purpose of this study is to assess pre- and postoperative neuropathic pain in patients with traumatic brachial plexus injuries to determine if intraoperative ketamine infusion affect neuropathic pain associated with avulsion injuries of the brachial plexus. 

A secondary goal is to determine the duration of pain relief following ketamine infusions.

Regenerating axons from a severed nerve forms a neuroma when it does not have the distal end to grow into.  The proximal end forms a thickening that contains myofibroblasts, inflammatory cells, disorganized regenerating axons with a larger proportion of small diameter, unmyelinated fibers, and an unrestrained growth of perineural cells. Not all neuromas are painful, but a symptomatic neuroma can cause significant physical and psychological disability.  Painful neuromas develop in 2% to 60% of patients with a nerve injury.  Numerous pharmacologic, physical, psychological, and surgical interventions have been described; but there is no consensus on the optimal treatment.  Meta-analyses on surgical treatment showed that surgical intervention significantly reduced pain in 70 to 77% of patients.  There were no significant differences between excision only, excision and transposition, excision and cap, excision and repair, or neurolysis and coverage.

Relocation nerve grafting is one technique of excision and transposition wherein the axons regenerating after excision of the neuroma are given a runway to a less stimulating destination.  This runway is provided by a nerve allograft microsurgically repaired to the proximal end of the cut nerve and its free terminal end is directed away from the painful area.  A nerve allograft aids in translocating neuromas growing near branch points where there is no more proximal length of nerve to redirect.  It also decreases the amount of nerve dissection necessary for translocation, decreasing the risk of injuring other cutaneous nerve branches and forming new neuromas. The terminal end of the allograft was shown in rats to have reduced axon numbers compared to an untreated injured nerve end.6  Relocation nerve grafting to interossei after excision of digital nerve neuromas in an amputated index finger resulted in complete pain resolution in one case report. 

The purpose of this study is to review the long-term results of relocation nerve grafting for management of painful neuromas.

The purpose of this study is to review the clinical outcomes of our spinal accessory and intercostal nerve transfers to musculocutaneous nerve (MCN for) elbow flexion in brachial plexus injury (BPI) patients and determine which transfer had more patients recovering MRC grade 4 elbow flexion.

The purpose of this study is to provide a more objective way to measure strength than the current standard medical research council manual muscle testing.

The purpose of the proposed research is to establish the test-retest reliability of a novel objective measurement of upper extremity function.

The goal of this study is to define what difficulties brachial plexus clinic patients with brachial plexus birth palsy (BPBP) are experiencing, what options for treatment are available, and, if treatment is completed, whether the treatment decreases their disability.

The aim of this study is to look at the number of axons, myelinated fiber area, and total axon area of the SAN and ICNs, in addition to the obturator nerve of the gracilis muscle.

The purpose of this study is to update rates of union after medial femoral condyle bone grafting for scaphoid nonunion, determine subjective patient outcomes after this procedure, determine radiographic results after this procedure.

The purpose of this study is to determine if complete pan plexus injury patients will not be able to operate a body powered prosthesis to feed themselves.   

The purpose of this study is to examine and report nerve injury patterns that occur during shoulder replacement. We will also look at the outcomes of these injuries over time.

The purpose of this study is to evaluate different alternatives in management of Brachial Plexus Injuries for patients who require tendon transfer for improvement of function.

The purpose of this study is to review published information, describe the surgical technique, and review the results of past cases of triceps muscle transfer secured with an endobutton for elbow flexion reconstruction in patients who have chronic brachial plexus injury. 

The purpose of this study is to establish the safety and effectiveness of the ultra-minimally invasive thread carpal tunnel release technique versus the mini-open carpal tunnel release (standard of care).

The purpose of this study is to find out if digital media can be used to accurately evaluate a patient's range of motion after surgery, and save them trips back to the clinic for possibly unnecessary follow-up.