scholarly journals Anatomical considerations of fascial release in ulnar nerve transposition: a concept revisited

2015 ◽  
Vol 123 (5) ◽  
pp. 1216-1222 ◽  
Author(s):  
Mark A. Mahan ◽  
Jaime Gasco ◽  
David B. Mokhtee ◽  
Justin M. Brown
Keyword(s):  
Ulnar Nerve ◽  
Elbow Flexion ◽  
Anterior Transposition ◽  
Flexor Carpi Ulnaris ◽  
Proximal Site ◽  
Anatomical Relationship ◽  
The Common ◽  
Proximal Forearm ◽  
Flexor Digitorum ◽  
Relationship Of

OBJECT Surgical transposition of the ulnar nerve to alleviate entrapment may cause otherwise normal structures to become new sources of nerve compression. Recurrent or persistent neuropathy after anterior transposition is commonly attributable to a new distal compression. The authors sought to clarify the anatomical relationship of the ulnar nerve to the common aponeurosis of the humeral head of the flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS) muscles following anterior transposition of the nerve. METHODS The intermuscular septa of the proximal forearm were explored in 26 fresh cadaveric specimens. The fibrous septa and common aponeurotic insertions of the flexor-pronator muscle mass were evaluated in relation to the ulnar nerve, with particular attention to the effect of transposition upon the nerve in this region. RESULTS An intermuscular aponeurosis associated with the FCU and FDS muscles was present in all specimens. Transposition consistently resulted in angulation of the nerve during elbow flexion when this fascial septum was not released. The proximal site at which the nerve began to traverse this fascial structure was found to be an average of 3.9 cm (SD 0.7 cm) from the medial epicondyle. CONCLUSIONS The common aponeurosis encountered between the FDS and FCU muscles represents a potential site of posttransposition entrapment, which may account for a subset of failed anterior transpositions. Exploration of this region with release of this structure is recommended to provide an unconstrained distal course for a transposed ulnar nerve.

ANATOMIC CHARACTERISTICS OF A FASCIA AND ITS BANDS OVERLYING THE ULNAR NERVE IN THE PROXIMAL FOREARM: A CADAVER STUDY

2007 ◽  
Vol 32 (3) ◽  
pp. 302-307 ◽  
Author(s):  
M. SIEMIONOW ◽  
G. AGAOGLU ◽  
R. HOFFMANN
Keyword(s):  
Ulnar Nerve ◽  
Cadaver Study ◽  
Upper Extremities ◽  
Flexor Digitorum Profundus ◽  
Type I ◽  
Type Ii ◽  
Flexor Carpi Ulnaris ◽  
The Mean ◽  
Proximal Forearm ◽  
Flexor Digitorum

This study describes the characteristics of a fascia overlying the ulnar nerve for 10 cm distal to the midpoint of the retrocondylar groove. A total of 28 cadaver upper extremities were dissected. The ulnar nerve between the flexor carpi ulnaris and flexor digitorum profundus was traced distally underneath a thin fascia. The length of the fascia was measured and examined for the presence of segmental fascial thickenings, referred to as ‘Bands’. Two types of fascia were found. In Type I, three Bands were identified within the fascia and the mean length of the fascia was 5.6 cm. In Type II, four Bands were identified and the mean length of the fascia was 7.7 cm. The presence of Bands within the fascia overlying the ulnar nerve in the proximal forearm may require release at the time of decompression, or anterior transposition, of the ulnar nerve at the cubital tunnel.

scholarly journals Post-Operative Assessment of Ulnar Nerve Tension Using Shear-Wave Elastography

2021 ◽  
Vol 13 (3) ◽  
pp. 469-476
Author(s):  
Sebastien Durand ◽  
Wassim Raffoul ◽  
Thierry Christen ◽  
Nadine Pedrazzi
Keyword(s):  
Elastic Modulus ◽  
Shear Wave ◽  
Ulnar Nerve ◽  
Shear Wave Elastography ◽  
Elbow Flexion ◽  
Ulnar Nerve Compression ◽  
Nerve Decompression ◽  
Shear Elastic Modulus ◽  
Anterior Transposition ◽  
Operative Assessment

Background: Ulnar nerve compression at the elbow level is the second-most common entrapment neuropathy. The aim of this study was to use shear-wave elastography for the quantification of ulnar nerve elasticity in patients after ulnar nerve decompression with anterior transposition and in the contralateral non-operative side. Method: Eleven patients with confirmed diagnosis and ulnar nerve decompression with anterior transposition were included and examinations were performed on an AixplorerTM ultrasound system (Supersonic Imagine, Aix-en-Provence, France). Results: We observed significant differences at 0-degree (p < 0.001), 45-degree (p < 0.05), 90-degree (p < 0.01) and 120-degree (p < 0.001) elbow flexion in the shear elastic modulus of the ulnar nerve in the operative and non-operative sides. There were no statistically significant differences between the elasticity values of the ulnar nerve after transposition at 0-degree elbow flexion and in the non-operative side at 120-degree elbow flexion (p = 0.39), or in the ulnar nerve after transposition at 120-degree elbow flexion and in the non-operative side at 0-degree elbow flexion (p = 0.09). Conclusion: Shear-wave elastography has the potential to be used postoperatively as a method for assessing nerve tension noninvasively by the estimation of mechanical properties, such as the shear elastic modulus.

Surgery of ulnar neuropathy at the elbow: 16 cases treated by decompression without transposition

1973 ◽  
Vol 38 (6) ◽  
pp. 780-785 ◽  
Author(s):  
Donald H. Wilson ◽  
Robert Krout
Keyword(s):  
Ulnar Nerve ◽  
Nerve Palsy ◽  
Medial Epicondyle ◽  
Ulnar Neuropathy ◽  
Cubital Tunnel ◽  
Content Type ◽  
Anterior Transposition ◽  
Ulnar Nerve Palsy ◽  
Flexor Carpi Ulnaris ◽  
Fine Print

✓ The authors report 16 consecutive cases of ulnar nerve palsy at the elbow successfully relieved by simple division of the tendinous insertions of the flexor carpi ulnaris, which form the roof of the “cubital tunnel.” They believe the more complex procedures of anterior transposition of the nerve or resection of the medial epicondyle are unnecessary, and even undesirable.

scholarly journals The 7 Structures Distal to the Elbow That Are Critical to Successful Anterior Transposition of the Ulnar Nerve

Hand ◽  
2018 ◽  
Vol 14 (6) ◽  
pp. 776-781 ◽  
Author(s):  
John M. Felder ◽  
Susan E. Mackinnon ◽  
Megan M. Patterson
Keyword(s):  
Ulnar Nerve ◽  
Ulnar Artery ◽  
Cubital Tunnel Syndrome ◽  
Medial Epicondyle ◽  
Cubital Tunnel ◽  
Anterior Transposition ◽  
Straight Line ◽  
Tunnel Syndrome ◽  
Poor Outcomes ◽  
Flexor Digitorum

Background: Ulnar nerve transposition (UNT) surgery is performed for the treatment of cubital tunnel syndrome. Improperly performed UNT can create iatrogenic pain and neuropathy. The aim of this study is to identify anatomical structures distal to the medial epicondyle that should be recognized by all surgeons performing UNT to prevent postoperative neuropathy. Methods: Ten cadaveric specimens were dissected with attention to the ulnar nerve. Intramuscular UNT surgery was simulated in each. Distal to the medial epicondyle, any anatomical structure prohibiting transposition of the ulnar nerve to a straight-line course across the flexor-pronator mass was noted and its distance from the medial epicondyle was measured. Results: Seven structures were found distal to the medial epicondyle whose recognition is critical to ensuring a successful anterior transposition of the ulnar nerve: (1) Branches of the medial antebrachial cutaneous (MABC) nerve; (2) Osborne’s fascia; (3) branches from the ulnar nerve to the flexor carpi ulnaris (FCU); (4) crossing vascular branches from the ulnar artery to the FCU; (5) the distal medial intermuscular septum between the FCU and flexor digitorum superficialis (FDS); (6) the combined muscular origins of the flexor-pronator muscles; and (7) the investing fascia of the FDS. Measurements are given for each structure. Conclusions: Poor outcomes and unnecessary revision surgeries for cubital tunnel syndrome can be avoided with intraoperative attention to 7 structures distal to the medial epicondyle. Surgeons should expect to dissect up to 12 cm distal to the medial epicondyle to adequately address these and prevent kinking of the nerve in transposition.

A DYNAMIC ANATOMICAL STUDY OF ULNAR NERVE MOTION AFTER ANTERIOR TRANSPOSITION FOR CUBITAL TUNNEL SYNDROME

Hand Surgery ◽  
2002 ◽  
Vol 07 (02) ◽  
pp. 177-182 ◽  
Author(s):  
M. D. Nikitins ◽  
P. A. Griffin ◽  
S. Ch'ng ◽  
N. J. Rice
Keyword(s):  
Ulnar Nerve ◽  
Anatomical Study ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Upper Limbs ◽  
Anterior Transposition ◽  
Flexor Carpi Ulnaris ◽  
Tunnel Syndrome ◽  
Full Flexion ◽  
Subcutaneous Transposition

Cubital tunnel syndrome is the second most commonly encountered compression neuropathy of the upper limb. Multiple techniques for surgical management have been proposed but no universally accepted algorithm for management exists. Six cadaveric upper limbs underwent ulnar nerve decompression and anterior transposition into subcutaneous and then submuscular positions. After marking nerves with tungsten, radiological examination of nerve motion was performed and nerve angulations were measured in the region of the flexor carpi ulnaris (FCU) origin. Comparison of ulnar nerves in each position revealed statistically significant greater angulation after subcutaneous transposition than after submuscular transposition with the elbow held in full flexion. This point of angulation may act as a secondary point of compression or as a focus for neuritis and scar formation. This finding can contribute to the understanding of why differing outcomes may be observed after different forms of anterior transposition.

The Muscular Branching Patterns of the Ulnar Nerve to the Flexor Carpi Ulnaris and Flexor Digitorum Profundus Muscles

2005 ◽  
Vol 27 (4) ◽  
pp. 322-326 ◽  
Author(s):  
Tania Marur ◽  
Salih Murat Akkιn ◽  
Mehmet Alp ◽  
Selman Demirci ◽  
Levent Yalçιn ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Flexor Digitorum Profundus ◽  
Flexor Carpi Ulnaris ◽  
Branching Patterns ◽  
Flexor Digitorum

Factors associated with failed ulnar nerve fascicle to biceps motor branch transfer: a case control study

2019 ◽  
Vol 44 (9) ◽  
pp. 913-919 ◽  
Author(s):  
Andrew J. Lovy ◽  
Nicholas Pulos ◽  
Michelle F. Kircher ◽  
Robert J. Spinner ◽  
Allen T. Bishop ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Medical Research Council ◽  
Elbow Flexion ◽  
Level Of Evidence ◽  
Motor Branch ◽  
British Medical Research Council ◽  
Flexor Carpi Ulnaris ◽  
Nerve Fascicle ◽  
Control Study

We sought to identify predictors of failed ulnar nerve fascicle (to flexor carpi ulnaris) to biceps motor branch transfer. A retrospective review of adult brachial plexus patients treated with flexor carpi ulnaris to biceps transfer with a minimum 1-year follow-up was performed. Failure, defined as modified British Medical Research Council grade <3 elbow flexion was compared with randomly selected controls (M ≥ 4−). Ninety-one patients, of which 80% regained >M3 flexion met criteria. Eighteen failures and 18 controls, with similar follow-up (20 vs 23 months) were evaluated. Preoperative flexor carpi ulnaris weakness (M < 5) was significantly more common in failures (78% vs 33%). The rate of flexor carpi ulnaris recovery after operation was significantly higher in controls (86% vs 7%). Increased failure risk can be expected with impaired preoperative flexor carpi ulnaris function. The challenge is how to identify which patients will regain near normal flexor carpi ulnaris strength as excellent outcomes can be obtained. Level of evidence: III

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