Systematic review/meta-analysis, level III.

Systematic review, level III.

Ultrasound was performed in 116 wrists of asymptomatic volunteers to determine the prevalence and morphology of anomalous muscles in Guyon's canal in the normal population. The size of the muscle was correlated with sex, hand-dominance and occupation. Anomalous muscles were identified in 47% of volunteers and 35% of wrists (male prevalence (50%); female prevalence (21%)). All were variants of abductor digiti minimi. Bilateral muscles were present in 50% of index cases in both sexes. Mean muscle thickness was 1.7 mm overall with no inter-sex variation. Muscle thickness did not vary with hand dominance or manual employment. The prevalence of anomalous muscles is higher than previously reported and may be sex-linked. The size of the muscle may be an important factor in determining whether an anomalous muscle is significant in cases of ulnar nerve compression at Guyon's canal.

OBJECTIVE To determine if beta-(β)-blockers improve outcomes after acute traumatic brain injury (TBI). BACKGROUND There have been no new inpatient pharmacologic therapies to improve TBI outcomes in a half-century. Treatment of TBI patients with β-blockers offers a potentially beneficial approach. METHODS Using MEDLINE, EMBASE, and CENTRAL databases, eligible articles for our systematic review and meta-analysis (PROSPERO CRD42016048547) included adult (age≥16 years) blunt trauma patients admitted with TBI. The exposure of interest was β-blocker administration initiated during the hospitalization. Outcomes were mortality, functional measures, quality of life, cardiopulmonary morbidity (e.g. hypotension, bradycardia, bronchospasm, and/or congestive heart failure). Data were analyzed using a random-effects model, and represented by pooled odds ratio (OR) with 95% confidence intervals (CI) and statistical heterogeneity (I2). RESULTS Data were extracted from 9 included studies encompassing 2005 unique TBI patients with β-blocker treatment and 6240 unique controls. Exposure to β-blockers after TBI was associated with a reduction of in-hospital mortality (pooled OR 0.39, 95%CI: 0.27–0.56; I2=65%, p<0.00001). None of the included studies examined functional outcome or quality of life measures, and cardiopulmonary adverse events were rarely reported. No clear evidence of reporting bias was identified. CONCLUSIONS In adults with acute TBI, observational studies reveal a significant mortality advantage with β-blockers; however, quality of evidence is very low. We conditionally recommend the use of in-hospital β-blockers. However, we recommend further high-quality trials to answer questions about the mechanisms of action, effectiveness on subgroups, dose-response, length of therapy, functional outcome, and quality of life after β-blocker use for TBI.

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Anomalous variations of abductor digiti minimi are commonly found at Guyon's canal but rarely cause ulnar nerve compression. We report such a case with particular emphasis on the effectiveness of ultrasound to detect and delineate anatomical structures in this region.

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This guideline consists of three conditional evidence-based recommendations. First, we conditionally recommend proximal diversion for management of these injuries. Second, we conditionally recommend the avoidance of routine presacral drains and distal rectal washout in the management of these injuries.