Spinal cord injury patients present a challenge to identify when to offer surgery and what type of surgery to offer. Nerve transfers have become increasingly popular, but are they better than the traditional tendon transfer options? We will also discuss patient engagement and the patient experience surrounding upper extremity reconstruction.

Objectives: Following this session, the participant will be able to:

1. Discuss how to identify SCI patients who would benefit from surgery
2. Identify how electrodiagnostic studies can help to plan the best surgery and maximize outcome
3. Discuss the use of nerve and tendon transfers to reconstruct upper extremity function in patients with SCI
4. Discuss how to increase patient engagement through social media and the patient experience surrounding reconstruction

Failure after nerve releases for compression neuropathy can be for many reasons - possibly from an incomplete release, a wrong diagnosis, a new injury or recurrent compression. We will discuss strategies for revision nerve surgery after common nerve releases in carpal and cubital tunnel syndrome and expected outcomes of these procedures.

Objectives: Following this session, the participant will be able to:

1. Discuss the etiology of failed nerve release and how to diagnose the underlying problem
2. Identify how electrodiagnostic studies and other imaging modalities can help to plan the best surgery and maximize outcome
3. Discuss the use of autologous flaps/wraps, alloplastic materials and nerve transfers to improve outcomes in revision nerve surgery
4. Develop an algorithmic approach to revision nerve release of the upper extremity

As our understanding of carpal instability continues to expand, we realize we are still on the edge of new discovery and reasoning. Carpal anatomy and kinematics demonstrate significant importance in multiple planes and dimensions. This course will review what we know about carpal instability, our understanding of treatment, and what the future holds for further learning.

Objectives: Following this session, the participant will be able to:

1. Discuss carpal anatomy, kinematics and related pathology.
2. Discuss minimally invasive and arthroscopic options for treatment.
3. Discuss options for reconstruction and salvage.
4. Review therapy options as an alternative to surgery

Gunshot wounds to the upper extremity can affect multiple organ systems which require careful assessment and planning for successful treatment of the extremity and patient. This course will address each organ system individually and then use case discussions to combine the principles for a fluid surgical plan.

Evaluate both simple and complex ballistic injuries of the upper extremity and the affected patient.

Recognize the specific organ systems involved in gunshot wounds to the upper extremity.

Discuss management of defects of the bone, articular surfaces, and nerves.

Apply strategies of acute and definitive management of GSW injuries to the upper extremity, including complex injuries involving multiple organ systems.

From simple to complex, hand anomalies are seen in almost all practices. This course will provide an overview of the more common congenital conditions and includes practical information for treatment and referral.

Objectives: Following this session, the participant will be able to:

1. Discuss some of the more common congenital pediatric hand and upper extremity anomaliesde.
2. Review what a specialized hand therapist can provide for pediatric patients.
3. Discuss which pathologies can be treated by the standard hand surgeon.
4. Discuss which anomalies might be best treated by specialized hand surgeons who commonly treat them.

We learn most from our complications. The session will provide the opportunity to learn from challenging and unexpected complications encountered by master nerve surgeons, who will emphasize critical lessons learned and the strategies employed to navigate these difficult scenarios.

Objectives: Following this session, the participant will be able to:

1. Identify potential complications in nerve surgery
2. Understand how to avoid specific complications before they occur
3. Learn strategies for managing complications

Value based health care (VBHC) is becoming increasingly important in medicine, and peripheral nerve surgery is no exception. Patient reported outcomes and experiences play a central role in defining and quantifying VBHC. This course will highlight the key concepts in PROM’s and PREM’s and how to effectively employ them in your nerve surgery practice. The “Porter model” describes VBHC: ‘Patient value’ is defined as patient-relevant outcomes divided by the costs per patient across the full cycle of care to achieve these outcomes. Ideally, all patients should be able to give their take on results of their treatment. Creating a broad consent will facilitate to do so.

Objectives: Following this session, the participant will be able to:

1. Understand the importance and key concepts of VBHC.
2. Identify available PROM’s and PREM’s for nerve surgery and their pros/cons.
3. Discuss the challenges to pursue broad informed consent to be able employ VBHC in practice.

The central goal in treating arthritis of the hand and wrist is alleviation of pain. Joint denervation offers a strategy to achieve this aim that avoids the morbidity associated with the surgical alternatives such as arthroplasty and fusion. There is growing interest in denervation procedures with new approaches and indications being described in recent years. This course will provide a comprehensive overview of the contemporary denervation procedures being used to address painful arthritis in the hand and wrist.

Objectives: Following this session, the participant will be able to:

1. Learn anatomic innervation to the joints in the hand and wrist pertinent to denervation procedures
2. Understand the indications and pre-operative work-up
3. Become familiar with technical steps for the denervation procedures presented
4. Understand the treatment outcomes that can be anticipated post-operatively.

Restoration of motor function following nerve injury can be achieved with tendon or nerve transfers, with each offering advantages and drawbacks. There is ongoing debate amongst proponents of tendon and nerve transfers. At the epicenter of this debate are the specific clinical scenarios in which the use of nerve transfers will limit the options for subsequent tendon transfers as bail-out options. The decision-making regarding whether to employ nerve transfers or tendon transfers in these scenarios is particularly challenging and critical and will be the focus of this panel discussion in which master surgeon present both sides of the debate.

Objectives: Following this session, the participant will be able to:

1. Identify the nerve transfer and tendon transfer procedures that are used to restore radial nerve and shoulder function.
2. Understand the advantages and disadvantages or nerve transfers and tendon transfers in these scenarios
3. Develop a treatment algorithm to employ in practice based on the salient considerations that will be presented.

Neuropathic pain arising from nerve damage has classically been associated with aberrations in the nervous system. Yet, over the years it has become apparent that the mechanisms that drive nerve pain are not solely based of aberrant nerve function but also includes interactions between immune cells and neurons. In his talk Dr. Eijkelkamp will highlight some of his recent work on how macrophages interact with the nervous system to control pain, and that these cell can either resolve or maintain pain. Moreover, what is learned about this neuro-immune interactions can also be used for the development of putative new pain therapies that target endogenous resolution pathways. He will highlight some preclinical work on the development of a novel immunotherapy that is based on the fusion of immunomodulatory cytokines to treat various types of chronic pain including nerve pain.

Partial hand amputations make up the majority of extremity amputations in North America. Large partial hand defects traditionally would be reconstructed using free tissue transfer, however, recent advances in prosthetics have produced commercially available externally powered partial-hand prosthetics. This panel will debate the time-tested toe to hand transfer versus myoelectric or more traditional prosthetics to restore function to those with partial hand amputations.

Objectives: Following this session, the participant will be able to:

1. Discuss the indication for toe to hand transfers for partial hand amputees.
2. Discuss ways to improve outcomes following toe to hand transfers.
3. Discuss the use of myoelectric prosthetics for partial hand amputees.
4. Discuss the use of more traditional prosthetics for partial hand amputees.

The first ever course of its kind, the ASRM Functional Extremity Reconstruction Course with ASPN as Guest Society will be a limited offering to only 30 registrants. Focusing on technically challenging and novel reconstructive procedures, this course will enable the registrants to participate in cadaveric demonstrations in small groups (3 registrants per group) with experts from around the globe.

Ultrasound is increasing used in both the peripheral nerve and microsurgeon's practice. This course will discuss how ultrasound can be used to improve diagnosis and prognosis of nerve pathology, including injury and compression neuropathy. It will also touch on the role of point-of-care ultrasound to optimize patient care in the clinic and emergency setting. In addition, it will describe the use of ultrasound for pre-operative flap planning and perforator dissection to allow rapid dissection and thin flap harvest.

Objectives: Following this session, the participant will be able to:

1. Discuss the current modalities available to the nerve surgeon to image peripheral nerves.
2. Discuss the role of ultrasound in pre-operative perforator identification and flap planning.
3. Identify the benefits and limitations of current imaging techniques for nerve surgery and flap planning.
4. Discuss the role of point-of-care ultrasound in the clinic and emergency setting.

Soft tissue defects of the hand from trauma, malignancy or infection can be approached in a variety of ways. Oftentimes soft tissue reconstruction can be successful using a variety of local or regional flaps. This course will discuss non-microsurgical reconstruction of the hand, including composite reconstruction for bone and tendon reconstruction and sensory fingertip reconstruction.

Objectives: Following this session, the participant will be able to:

1. Discuss the role of local and regional flaps to reconstruct soft tissue defects of the hand.
2. Discuss the use of local and regional flaps to reconstitute sensory reconstruction to the fingertips.
3. Identify options for composite defect reconstruction of the hand.

Sensory neurotization procedures are increasingly being employed to address sensory deficits arising from nerve injury and to optimize functional outcomes from reconstructive procedures. The goals of sensory neurotization vary widely, ranging from restoration protective sensation to weight bearing areas to providing erogenous sensation in breast and genital reconstruction. This course will provide a comprehensive overview of the contemporary sensory neurotization procedures being used for a variety of clinical scenarios.

Objectives: Following this session, the participant will be able to:

1. Understand the pros and cons of the various donor nerves available for phalloplasty neurotization
2. Understand the indications and techniques used for sensory neurotization of fasciocutaneous flaps in lower extremity reconstruction
3. Learn the emerging options being used for breast and nipple neurotization.

Finger replantation success and enthusiasm increased dramatically after the first successful replanted digit. However, finger amputations are not all equal and enthusiasm is waning across North America, with reducing rates of attempted replantation. This course will discuss the utility of replantation and techniques to improve success.

Objectives: Following this session, the participant will be able to:

1. Discuss the current trends in finger replantation.
2. Compare the functional outcomes of replantation versus revision amputation.
3. Discuss ways to increase success and improve replantation outcomes

This course will provide an update for diagnosis, patient selection, timing of intervention, and surgical techniques in the management of chronic headaches, neuralgia, and migraines. Invited faculty will highlight pearls and pitfalls in the management of this challenging patient population.

Objectives: Following this session, the participant will be able to:

1. Indentify the role nerve surgery for individuals with chronic headaches, neuralgia, and migraines.
2. Identify how to select and diagnose patients who could be could be candidates for surgery .
3. Discuss standard and novel surgical techniques in headache management.
4. Learn about potential complications, and the management of refractory cases

Objectives: Following this session, the participant will be able to:

1. Discuss Nobel Prizes related to Peripheral Nerve.
2. Identify what areas besides nerve repair, nerve graft, CTS release have developed to enlarge the field of Peripheral Nerve Surgery.
3. Discuss what can be done to improve education about Peripheral Nerves for Medical Students, Medical Residents, and Doctors in Practice

The thumb plays a critical role in hand function. We have seen an explosion of new nerve transfer options in recent years to restore the various functions of the thumb - flexion, opposition, and adduction. The traditional tendon transfer options to address these functions continue to have an important role in devising optimal treatment strategies. This course will provide an in depth overview of the recently described nerve transfer options and the corresponding tendon transfer options that can be used to restore motor function to the paralyzed thumb.

Objectives: Following this session, the participant will be able to:

1. Understand the indications, technical approaches, and anticipated outcomes from nerve and tendon transfer procedures to restore thumb function
2. Develop a treatment algorithm to address various deficits affecting thumb function

Parsonage Turner Syndrome (PTS), or neuralgic amyotrophy, is an idiopathic neurologic condition that results in sudden onset of motor palsy often preceded by a pain prodrome. This condition has traditionally been treated non-surgically. However, the presence of localized ‘hour-glass’ lesions have recently been described that are amenable to surgical intervention. This course with provide an overview of the pertinent clinical features of this disease process; the diagnostic modalities that can be used to identify and localize the resulting pathologic lesions in the affected nerves; and a comprehensive treatment algorithm including the surgical approach used to address these lesions.

Objectives: Following this session, the participant will be able to:

1. Describe the clinical features and epidemiology of PTS
2. Understand the diagnostic tools used for PTS and how to employ them
3. Understand the surgical approach and treatment algorithm for PTS

This course will focus on the current management of peripheral nerve tumors. Experts in the field will share updates on clinical assessment and decision-making, surgical techniques, and treatment of benign and malignant peripheral nerve sheath tumors, as well as other mass lesions involving peripheral nerves.

Objectives: Following this session, the participant will be able to:

1. Identify how to best investigate a patient with a peripheral nerve mass, including advances in imaging techniques.
2. Discuss indications and options for surgical intervention of nerve tumors.
3. Review current controversies and outcomes in the management of peripheral nerve tumors.

Brachial plexus injuries (BPI) are devastating for upper limb function. Historically BPI were treated with autologous nerve grafts to reconstruct the defects. With detailed knowledge of nervous anatomy, new strategies were developped. Considerable progress in outcome has been made since the introduction of (distal) nerve transfers.

Objectives: Following this session, the participant will be able to:

1. Diagnose BPI and know the proper work-up.
2. Discuss different techniques for root reconstruction.
3. Identify different techniques for nerve transfers and their outcomes from complications.

Diabetes is one of the most common chronic diseases. About half of the patients with diabetes suffer from pain, dysesthesias and numbness. These symptoms are caused by the peripheral diabetic neuropathy as well by superimposed nerve compressions. The lower extremities are predominantly involved. Surgical nerve decompressions have shown to improve symptoms and even prevent ulcers and subsequent amputations. Recent high-level studies have shed further light on the utility of surgical decompression for this disease process.

Objectives: Following this session, the participant will be able to:

1. Identify epidemiology and etiology of diabetic peripheral nerve compressions.
2. Discuss how to diagnose these compressions as well as indications for surgery.
3. Identify surgical technique and pitfalls along with outcomes and complications.

Nerve compressions occur frequently in the upper extremity, especially the median nerve at the wrist and the ulnar nerve at the elbow. After primary surgery the majority of patients improve. But how do we deal with persist or residual symptoms?

Objectives: Following this session, the participant will be able to:

1. Discuss know how to do a work-up for failed nerve decompressions.
2. Identify a differential diagnosis for persisting symptoms
3. Discuss surgical approaches to treat symptoms and outcomes of redo surgeries.