Transmuscular Ulnar Nerve Transposition in a Case of Traumatic Medial Cord Injury - Dr. Susan E. Mackinnon

Video Description

Cubital tunnel syndrome can present with pain/numbness in the ulnar nerve territory and weakness in the ulnar-innervated extrinsic/intrinsic muscles. The etiology for cubital tunnel syndrome depends on the case and includes various points of compression along the course of the ulnar nerve. The most common compression point is the medial epicondyle at which the fascial leading-edge of the flexor carpi ulnaris and the aponeurosis superficial to the cubital tunnel compress the nerve. However other compressive points can exist and can be under-recognized. The transmuscular ulnar nerve transposition (TUNT) addresses these compressive points by releasing and transposing the nerve through a transmuscular bed within the pronator-flexor muscle bundle. In this case, the patient had a traumatic medial cord injury and presented 1-year following with associated ulnar neuropathy and fibrillations/motor unit potentials. The TUNT was elected with a supercharge anterior interosseous to ulnar motor nerve transfer, Guyon’s canal release, and FDP tenodesis. This video highlights details of the TUNT.

Table of Contents
00:30 Orientation / Incision / Exposure
02:50 Identifying the Medial Antebrachial Cutaneous
04:30 Exposing the Medial Epicondyle and Common Flexor Tendon
06:51 Identifying the Ulnar Nerve and Releasing the Cubital Tunnel Aponeurosis
07:34 Creating the Medial and Lateral Fascial Tendon Flaps
10:12 Resecting the Fascial Septum “T” between the Pronator-Flexor Muscle Bundle
11:37 Resecting the Medial Intermuscular Septum
13:30 Resecting the Distal Intermuscular Septum
15:00 Releasing the Aponeurosis of Flexor Carpi Ulnaris and Transverse Vessels
15:32 Releasing the Deep Pronator-Flexor Aponeurosis
15:43 Releasing the Intermuscular Septum
17:27 Neurolyzing the Flexor Carpi Ulnaris Branch from the Ulnar Nerve
18:57 Creating the Transmuscular Bed
19:42 Transmuscular Ulnar Nerve Transposition
22:13 Checking Compression through the Arcade of Struthers

Narration: Susan E. Mackinnon
Videography: Andrew Yee

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