Anterior Interosseous to Ulnar Motor Nerve Transfer

Injury to the ulnar nerve results in clawing of the hand due to lost of ulnar intrinsic hand muscles, lost of ulnar-innervated wrist/finger flexion, and numbness/pain within the ulnar nerve territory of the hand. To prevent clawing and reconstruct the ulnar intrinsic hand muscles, the anterior interosseous to ulnar motor nerve transfer is an available option. This involves transferring the distal pronator quadratus branch of the anterior interosseous nerve to the fascicular motor component of the ulnar nerve. This patient had an ulnar nerve injury following two ulnar nerve transpositions and reported pain and motor deficit immediately following surgery. He presented to our institution eight months post-injury and an end-to-end nerve transfer was elected due to the electrodiagnostic findings of fibrillations and no motor unit potentials by that time point. A Guyon’s canal release, flexor digitorum profundus tenodesis for grip strength, and second revision ulnar nerve transposition was performed. This video includes details on the Guyon’s canal release and anterior interosseous to ulnar motor end-to-end nerve transfer.

Standard:

Extended:

POSITION

Supine.

INCISION

Ulnar incision from thenar crease, Brunner’s incision over wrist crease, and proximal forearm incision.

REFERENCES

1. Brown JM, Yee A, Mackinnon SE. Distal median to ulnar nerve transfers to restore ulnar motor and sensory function within the hand: technical nuances. Neurosurgery. 2009 Nov;65(5):966-77; discussion 977-8. PMID: 19834412.
2. Novak CB, Mackinnon SE. Distal anterior interosseous nerve transfer to the deep motor branch of the ulnar nerve for reconstruction of high ulnar nerve injuries. J Reconstr Microsurg. 2002 Aug;18(6):459-64. PMID: 12177812.
3. Mackinnon SE, Novak CB. Nerve transfers. New options for reconstruction following nerve injury. Hand Clin. 1999 Nov;15(4):643-66, ix. Review. PMID: 10563268.

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