Revision Ulnar Nerve Transposition Following Failed Submuscular - Standard (Feat. Dr. Mackinnon)

Video Description

Revision Ulnar Nerve Transposition Following Failed Submuscular Ulnar Nerve Transposition - Standard
Authors: Mackinnon SE1, Yee A1
Published: August 30, 2016

AUTHOR INFORMATION
1 Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri

DISCLOSURE
No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.

ABSTRACT
Failed surgical management of cubital tunnel syndrome may warrant a revision ulnar nerve transposition. Revision surgery is associated with increased technical difficulty depending on the primary procedure. The senior author's preferred technique for management of cubital tunnel syndrome is a transmuscular ulnar nerve transposition. The technique for revision surgery incorporates methods towards a transmuscular transposition. In this case, a 23-year-old patient presented with a three-year history of significant and continuous ulnar neuropathy two-years following an anterior submuscular ulnar nerve transposition. Examination revealed ulnar intrinsic atrophy and decreased ulnar nerve sensation with normal and intact medial antebrachial cutaneous nerve sensation. Electrodiagnostic studies include small ulnar CMAP amplitude with absent SNAP and fibrillations with motor unit potentials. The scratch collapse test with ethyl chloride hierarchy revealed positive provocations in the order of the cubital tunnel, Guyon's canal, and Struthers' ligament. Surgical management for this case includes revision ulnar nerve transposition, supercharge anterior interosseous to ulnar motor nerve transfer for motor recovery, side-to-side bridging nerve grafts with acellularized nerve allografts from median to ulnar sensory nerves for early sensory recovery, and a flexor digitorum profundus tenodesis. This video documents the revision transposition component of this patient's surgical management.