Anterior Interosseous Nerve to Ulnar Nerve Transfers: A Systematic Review

2021 ◽  
Author(s):  
Melanie D. Luikart ◽  
Justin M. Kistler ◽  
David Kahan ◽  
Richard McEntee ◽  
Asif M. Ilyas
Keyword(s):  
Grip Strength ◽  
Nerve Injury ◽  
Ulnar Nerve ◽  
Nerve Graft ◽  
Pinch Strength ◽  
Nerve Injuries ◽  
Nerve Transfers ◽  
Strength Recovery ◽  
Anterior Interosseous Nerve ◽  
Ulnar Nerve Injury

Abstract Background There has been an increasing utilization of end-to-end (ETE) and reverse “supercharged” end-to-side (SETS) anterior interosseous nerve (AIN) to ulnar nerve transfers (NTs) for treatment of high ulnar nerve injury. This study aimed to review the potential indications for, and outcomes of, ETE and SETS AIN–ulnar NT. Methods A literature review was performed, and 10 articles with 156 patients who had sufficient follow-up to evaluate functional outcomes were included. English studies were included if they reported the outcome of patients with ulnar nerve injuries treated with AIN to ulnar motor NT. Outcomes were analyzed based on the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores, grip and key pinch strength, and interosseous Medical Research Council–graded motor strength. Comparisons were made using the independent t-test and the chi-square test. No nerve graft control group was required for eligibility. Ulnar nerve injury types varied. Results NT resulted in 77% of patients achieving M3+ recovery, 53.7 ± 19.8 lb grip strength recovery, 61 ± 21% key pinch recovery, and a mean DASH score of 33.4 ± 16. In this diverse group, NT resulted in significantly greater M3+ recovery and grip strength recovery measured in pounds than in the nerve graft/conventional treatment group, and ETE repairs had significantly better outcomes compared with SETS repairs for grip strength, key pinch strength, and DASH scores, but heterogeneity limits interpretation. Conclusion ETE and SETS AIN–ulnar NTs produce significant restoration of ulnar nerve motor function for high ulnar nerve injuries. For ulnar nerve transection injuries at or above the elbow, ETE NT results in superior motor recovery compared with nerve grafting/conventional repair. However, further research is needed to determine the best treatment for other types of ulnar nerve injury and the role of SETS NT.

Acellular Nerve Allografts in Major Peripheral Nerve Repairs: An Analysis of Cases Presenting With Limited Recovery

Hand ◽  
2021 ◽  
pp. 155894472110031
Author(s):  
Blair R. Peters ◽  
Matthew D. Wood ◽  
Daniel A. Hunter ◽  
Susan E. Mackinnon
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Ulnar Nerve ◽  
Current Literature ◽  
Axonal Regeneration ◽  
Large Diameter ◽  
Nerve Injuries ◽  
Myelinated Axons ◽  
Acellular Nerve Allograft ◽  
Ulnar Nerve Injury

Background: Acellular nerve allografts have been used successfully and with increasing frequency to reconstruct nerve injuries. As their use has been expanded to treat longer gap, larger diameter nerve injuries, some failed cases have been reported. We present the histomorphometry of 5 such cases illustrating these limitations and review the current literature of acellular nerve allografts. Methods: Between 2014 and 2019, 5 patients with iatrogenic nerve injuries to the median or ulnar nerve reconstructed with an AxoGen AVANCE nerve allograft at an outside hospital were treated in our center with allograft excision and alternative reconstruction. These patients had no clinical or electrophysiological evidence of recovery, and allograft specimens at the time of surgery were sent for histomorphological examination. Results: Three patients with a median and 2 with ulnar nerve injury were included. Histology demonstrated myelinated axons present in all proximal native nerve specimens. In 2 cases, axons failed to regenerate into the allograft and in 3 cases, axonal regeneration diminished or terminated within the allograft. Conclusions: The reported cases demonstrate the importance of evaluating the length and the function of nerves undergoing acellular nerve allograft repair. In long length, large-diameter nerves, the use of acellular nerve allografts should be carefully considered.

Injury to the Human Median and Ulnar Nerves in the Forearm – Analysis of Costs for Treatment and Rehabilitation of 69 Patients in Southern Sweden

2005 ◽  
Vol 30 (1) ◽  
pp. 35-39 ◽  
Author(s):  
H. E. ROSBERG ◽  
K. S. CARLSSON ◽  
S. HÖJGÅRD ◽  
B. LINDGREN ◽  
G. LUNDBORG ◽  
...  
Keyword(s):  
Health Care ◽  
Nerve Injury ◽  
Ulnar Nerve ◽  
Tendon Injuries ◽  
Health Care Sector ◽  
Nerve Injuries ◽  
Southern Sweden ◽  
Factors Affecting ◽  
Factors Associated ◽  
Ulnar Nerve Injury

This study analysed the costs of median and ulnar nerve injuries in the forearm in humans and factors affecting such costs. The costs within the health-care sector and costs of lost production were calculated in 69 patients with an injury to the median and/or ulnar nerve in the forearm, usually caused by glass, a knife, or a razorblade. Factors associated with the variation in costs and outcome were analysed. The total median costs for an employed person with a median and an ulnar nerve injury were EUR 51,238 and EUR 31,186, respectively, and 87% of the total costs were due to loss of production. All costs were higher for patients with concomitant tendon injuries (≥4 tendons). The costs within the health-care sector were also higher for patients who changed work after the injury and if both nerves were injured. Outcome was dependent on age and repair method.

Direct End-to-End Neurorrhaphy for Wrist-Level Long Nerve Defect with Fixation of the Wrist in Flexion: Technique Note

2021 ◽  
Author(s):  
Chun-Ching Lu ◽  
Hui-Kuang Huang ◽  
Jung-Pan Wang
Keyword(s):  
Nerve Injury ◽  
Ulnar Nerve ◽  
Nerve Graft ◽  
Sensory Function ◽  
Wrist Flexion ◽  
Tension Free ◽  
End To End ◽  
Ulnar Nerve Injury ◽  
K Wires

Abstract Background For a nerve gap, end-to-end neurorrhaphy would either be difficult or would include tension. The use of a nerve graft or conduit could be a solution, but it might compromise the reinnervation. We describe a method for wrist-level ulnar and/or median long nerve injury by fixing the wrist in the flexion position with K-wire (s) to make possible an end-to-end and tension-free neurorrhaphy. Patients and Methods Two patients had wrist-level ulnar nerve injury for 2 and 3 months and nerve gaps of 2.5 cm and 3.5 cm, respectively, after the neuroma excision. K-wires were used to transfix from the radius to carpal bones, in order to keep their wrists in flexion of 45 and 65 degrees, respectively, with which the tension-free end-to-end neurorrhaphy could be achieved. The K-wires were removed in 6 weeks after surgery, and their wrists were kept in the splint for a progressive extension program. Results Both patients were noted to have an improved claw hand deformity 4 months after the surgery. The ulnar nerve motor and sensory function could be recovered mostly in the 12-month follow-up. The wrist flexion and extension motion arc both achieved, at least, 150 degree in the 12-month follow-up. There were no complications related to the K-wire fixation. Conclusion With the wrist fixed in a flexed position, maintaining a longer nerve gap to achieve a direct end-to-end and tension-free neurorrhaphy would be more likely and safer. Without the use of nerve graft, innervation of the injured nerve would be faster.

Radial Nerve Palsy: Nerve Transfer Versus Tendon Transfer to Restore Function

Hand ◽  
2021 ◽  
pp. 155894472098812
Author(s):  
J. Megan M. Patterson ◽  
Stephanie A. Russo ◽  
Madi El-Haj ◽  
Christine B. Novak ◽  
Susan E. Mackinnon
Keyword(s):  
Radial Nerve ◽  
Tendon Transfer ◽  
Nerve Palsy ◽  
Nerve Transfer ◽  
Pinch Strength ◽  
Radial Nerve Palsy ◽  
Nerve Injuries ◽  
Tendon Transfers ◽  
Nerve Transfers ◽  
Transfer Group

Background: Radial nerve injuries cause profound disability, and a variety of reconstruction options exist. This study aimed to compare outcomes of tendon transfers versus nerve transfers for the management of isolated radial nerve injuries. Methods: A retrospective chart review of 30 patients with isolated radial nerve injuries treated with tendon transfers and 16 patients managed with nerve transfers was performed. Fifteen of the 16 patients treated with nerve transfer had concomitant pronator teres to extensor carpi radialis brevis tendon transfer for wrist extension. Preoperative and postoperative strength data, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and quality-of-life (QOL) scores were compared before and after surgery and compared between groups. Results: For the nerve transfer group, patients were significantly younger, time from injury to surgery was significantly shorter, and follow-up time was significantly longer. Both groups demonstrated significant improvements in grip and pinch strength after surgery. Postoperative grip strength was significantly higher in the nerve transfer group. Postoperative pinch strength did not differ between groups. Similarly, both groups showed an improvement in DASH and QOL scores after surgery with no significant differences between the 2 groups. Conclusions: The nerve transfer group demonstrated greater grip strength, but both groups had improved pain, function, and satisfaction postoperatively. Patients who present early and can tolerate longer time to functional recovery would be optimal candidates for nerve transfers. Both tendon transfers and nerve transfers are good options for patients with radial nerve palsy.

Ulnar nerve injury with martin-gruber anastomosis

1987 ◽  
Vol 10 (1) ◽  
pp. 37-39 ◽  
Author(s):  
L. Duinslaeger ◽  
A. DeBacker ◽  
L. Ceulemans ◽  
P. Wylock
Keyword(s):  
Nerve Injury ◽  
Ulnar Nerve ◽  
Ulnar Nerve Injury
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