Examination of a Patient with Deep Motor Branch Ulnar Neuropathy

Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. Examination of patients with distal ulnar compressive neuropathy requires a systematic approach to eliminate proximal issues from the diagnosis. Through a proximal to distal approach by examining the hand for motor/sensory and extrinsic/intrinsic function […]

Mini-Laparoscopic Cholecystectomy w/IOC (Brunt, 2017)

Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. Minimal invasive laparoscopic cholecystectomy is the typical surgical treatment for cholelithiasis (gallstones), where patients present with a history of upper abdominal pain and episodes of biliary colic. The classic technique for minimal invasive laparoscopic […]

Superficial Radial Sensory Nerve Release with Tenotomy of the Brachioradialis Tendon

The superficial radial sensory nerve can be entrapped between the brachioradialis and extensor carpi radialis longus tendons as the radial sensory nerve courses superficially from its deep origin. Compression of the radial sensory nerve presents with numbness and/or pain on the dorsal radial aspect of the hand. Pronation of the hand exacerbates these symptoms as […]

Common Peroneal Nerve Release at the Fibular Head

Entrapment of the common peroneal nerve (CPN) at the fibular head is an under-recognized lower extremity neuropathy that contributes to weakness of the musculature within the anterior and lateral compartments of the leg and progress to foot drop. As well, there can be numbness/pain within the territory of the superficial and deep peroneal nerve. Compression […]

Superficial Peroneal Nerve Release in the Lower Leg

Compression of the superficial peroneal nerve (SPN) is due to the superficial fascial layer that encapsulates the SPN and its distal entrapment point called the transverse crural ligament. These structures are typically the cause for numbness and pain in the territory of the SPN. Release of the SPN involves the longitudinal release of the superficial […]

Revision Ulnar Nerve Transposition Following Failed Submuscular Ulnar Nerve Transposition

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. […]

Examination of a Patient with Multiple Nerve Injuries and Neuropathic Pain Following a Laceration at the Distal Forearm

Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. Examining patients with multiple nerve injuries and neuropathic pain can be difficult due to the number of nerves that have overlapping sensory territories. As well, it is important to distinguish pain from nerve compression […]

Saphenous Nerve Release

Entrapment of the saphenous nerve is probably under-recognized and presents with numbness/pain in the infrapatellar region and the medial aspect of the lower leg. The vastoadductor intermuscular septum is responsible for entrapment symptoms as it forms the anterior fascia of the adductor canal, deep to the sartorius muscle. The femoral vessels and saphenous nerve have […]

Medial Triceps to Anterior Branch of Axillary Nerve Transfer: A Case of Specific Reinnervation

The axillary nerve has several distal branches that provide shoulder function through the innervation of the anterior, middle, and posterior deltoid and teres minor, as well as sensation to the lateral arm. Injury to the axillary nerve has been traditionally viewed as either a complete non-favorable injury where recovery does not occur or a favorable […]

Medial Triceps to Axillary Nerve Transfer

Injury to the axillary nerve results in the loss of shoulder function, specifically deltoid and teres minor deficits. This injury can either be isolated or more commonly associated with an upper brachial plexus injury that includes the C5,6 roots. The medial triceps is an available donor for nerve transfer into the axillary nerve and is […]

Brachialis to Anterior Interosseous Nerve Transfer with Extended Forearm Incision

Loss of flexor pollicis longus and radial profundus function results in a deficit of pinch and reduced grip strength in the hand. This palsy can be isolated or commonly included in a lower brachial plexus injury. The brachialis nerve is an available, synergistic, and powerful donor for transfer in these scenarios, especially in C7,8,T1 injuries […]

Median (FCR/FDS) to Radial (PIN/ECRB) Nerve Transfers with PT to ECRB Tendon Transfer

Radial nerve palsy is a debilitating nerve injury that results in lost of wrist and finger extension, which classically presents as wrist drop. The two reconstructive options for managing this injury are tendon transfers and nerve transfers, each with their advantages and disadvantages. Nerve transfers are able to provide independent finger extension, however there is […]

Stage 1 – Cross-Facial Nerve Grafting for Smile

Facial paralysis causes significant morbidity and dynamic reconstruction aims to address functional, aesthetic, and psychological aspects of the impairment. Cross-facial nerve grafting is a reconstructive strategy used to restore smile function and eye closure in both acute and chronic unilateral injury. In an acute injury, nerve grafting provides regenerating fibers from the donor nerve on […]

Segmental Gracilis Muscle Transfer for Smile in a Case of Möbius Syndrome

Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. Facial paralysis causes significant morbidity and dynamic reconstruction aims to address functional, aesthetic, and psychological aspects of the impairment. Segmental gracilis muscle transfer is a reconstructive strategy used to restore smile function in a […]

Posterior Approach – Spinal Accessory to Suprascapular Nerve Transfer

Reconstructing shoulder function following a nerve injury is a challenge due to its dynamic movement originating from several muscles. The supra/infraspinatus muscles are critical for shoulder function in that they initiate abduction of the arm, external rotation, and stabilization of the shoulder joint. In upper brachial plexus injuries, it is common to find a deficit […]

Superficial Peroneal and Sural Neuroma Transposition in a Case of Neuropathic Pain Following Foot Surgery

Pain resulting from nerve injury can originate from the site of injury (local neuroma pain) and from the collateral sprouting of adjacent sensory territories into the deinnervated territory (hyperalgesic pain). Surgical management of neuropathic pain is controversial and typical management of neuroma pain includes excision and transposition. In our institution, management includes a proximal crush […]

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 […]

Revision Carpal Tunnel Release in a Case of Persistent Symptoms and Incomplete Release

Failure to resolve symptoms of carpal tunnel syndrome following a release of the flexor retinaculum can occur for a number of reasons. Failed carpal tunnel can be classified into three categories and include (1) persistent symptoms, (2) recurrent symptoms, and (3) new symptoms. Persistent symptoms of median nerve dysfunction can imply an incomplete release and/or […]

Posterior Interosseous Nerve Release

Compression of the posterior interosseous nerve can exhibit clinical weakness or functional loss of finger / thumb extension and lack of ulnar wrist extension. Provocative tests can confirm whether the radial tunnel in the region of the posterior interosseous nerve is the area of compression. Multiple anatomical structures can be involved in compressing the nerve […]

Transmuscular Ulnar Nerve Transposition in a Case of Traumatic Medial Cord Injury

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 […]

3rd Webspace to Sensory Component of Ulnar Nerve Transfer and PCM to DCU Nerve Transfer

Sensory nerve transfers are an available option for restoring sensation to critical deinnervated territories. Multiple strategies exist for restoring sensation, which include end-to-end nerve transfers for critical territories and end-to-side nerve transfers for non-critical territories. For sensory deficits in the ulnar nerve, the 3rd webspace fascicle from the median nerve can be utilized as a […]

Median Nerve Release in the Forearm

Compression neuropathy of the median nerve in the forearm, also known as pronator syndrome, typically presents with pain in the forearm +/- paresthesia/pain in the median nerve territory. The anterior interosseous nerve can be involved with a mononeuritis. While this usually resolves without surgery, occasionally will require this approach for reconstruction or release. Related anatomical […]

Carpal Tunnel Release

Carpal tunnel syndrome is a compression neuropathy of the median nerve as it travels through the carpal tunnel deep to the transverse carpal ligament. This causes paresthesia and pain in the territory of the median nerve and weakness of the thenar muscles depending on the severity of the neuropathy. Paresthesia is most typically in the […]