Anterior Interosseous to Ulnar Motor Supercharge Nerve Transfer

The supercharge nerve transfer is a procedure that coapts the distal end of a donor nerve to the side of the recipient nerve. Nerve regeneration is facilitated from donor to recipient through a perineurial window to enhance regeneration from the proximal regenerating nerve. This procedure can be used in cases of 2nd/3rd degree nerve injuries […]

Median to Radial Nerve Tendon Transfers: PT to ECRB, FCR to EDC, PL to EPL

Tendon transfers are an available option for reconstructing wrist and finger/thumb extension following radial nerve injury when nerve transfers are contra-indicated. The donor median-innervated tendons are used to reconstruct the recipient radial-innervated tendons. This tutorial describes the following tendon transfers: (1) pronator teres (PT) to extensor carpi radialis brevis (ECRB), (2) flexor carpi radialis (FCR) […]

Median (FCR/FDS) to Radial (PIN/ECRB) Nerve Transfer with Pronator Teres to ECRB Tendon Transfer

The median to radial nerve transfer is an available option for restoring radial nerve hand function following nerve injury. This nerve transfer specifically involves the transferring of two sets of nerves. That is, the flexor carpi radialis (FCR) to posterior interosseous nerve (PIN) and the flexor digitorum superficialis (FDS) to extensor carpi radialis brevis (ECRB) […]

Ganglion Cyst Removal in the Common Peroneal Nerve at the Fibular Head

There are various causes of common peroneal nerve palsy, however common peroneal nerve palsy caused by a ganglion cyst is uncommon. A benign tumor within the nerve sheath can cause compression and present with symptoms of neuropathy depending on the level of injury. In this specific case, the patient presented with a ganglion cyst in […]

Pectoral Fascicle of the Middle Trunk to Spinal Accessory Nerve Transfer

The pectoral fascicle of the middle trunk is an available donor nerve to transfer to restore spinal accessory nerve function. This procedure involves identifying the brachial plexus and the accessory nerve through a supraclavicular exposure. The pectoral fascicle is identified on the anterior aspect of the middle trunk deep to the identified upper trunk. Typically, […]

Tarsal Tunnel Release

Tarsal tunnel syndrome describes the compression of the tibial nerve through the tarsal tunnel which results in pain and numbness in the plantar aspect of the foot. The tibial nerve has three major branches which include the calcaneal, medial plantar, and lateral plantar nerve branches. There are two primary structures responsible for compression of the […]

Superficial Peroneal Nerve Release in the Lower Leg

Symptoms of a compressed superficial peroneal nerve in the lower leg includes numbness and tingling in the dorsal aspect of the foot and lateral aspect of the lower leg. These symptoms can be exaggerated when the peroneal nerve is under tension during movements of the leg and foot. Compression of the superficial peroneal nerve occurs […]

Common Peroneal Nerve Release at the Fibular Head

Compression of the common peroneal nerve at the fibular head is under recognized. Symptoms range from numbness and tingling in the posterior and lateral aspect of the lower leg and dorsal aspect of the foot to foot drop in severe cases of denervation. Symptoms can be exaggerated when the peroneal nerve is under tension during […]

Flexor Digitorum Profundus Tenodesis (Median FDP to Ulnar FDP)

For paralysis of ulnar-innervated flexor digitorum profundus (FDP) to the ring and small finger, tenodesis of the ulnar-innervated FDP tendons will allow the median-innervated FDP to drive the function of the ulnar-innervated FDP function. Specifically, the ulnar-innervated FDP tendons are sutured to the FDP tendon to the long finger, while the FDP tendon to the […]

Thoracic Outlet Decompression

Neurological thoracic outlet ‘inlet’ syndrome (TOS) involves compression of the brachial plexus through the thoracic inlet. The neurologic symptoms of TOS can range from mild paresthesias and numbness in the upper extremity to intrinsic hand muscle atrophy. Thoracic outlet decompression entails decompressing the upper, middle, and lower trunks by dividing the anterior and middle scalene […]

Medial Triceps Branch to Axillary Nerve Transfer

The medial triceps branch to axillary nerve transfer is an available option for reconstructing patients with shoulder deficits that include an axillary nerve injury. Not presented in this tutorial, the accessory to suprascapular nerve transfer is additionally performed to stabilize the humerus during its range-of-motion in these patients. The triceps to axillary nerve transfer specifically […]

Medial Antebrachial Cutaneous Nerve Graft Harvest

The medial antebrachial cutaneous (MABC) nerve is a viable donor for nerve grafts and our institution’s preferred donor nerve graft for upper extremity nerve reconstructions. The MABC nerve is harvested from the medial aspect of the arm and is found branching distally into an anterior and posterior branch. The anterior and/or posterior branch can be […]

Flexor Digitorum Superficialis to Anterior Interosseous Nerve Transfer

For isolated anterior interosseous nerve palsies, the nerve to the flexor digitorum superficialis (FDS) is an available donor to innervate the anterior interosseous nerve (AIN) for transfer. The FDS and AIN branch are found branching from the median nerve within the same upper-middle forearm region. The nerve to the FDS branches from the median nerve […]

Tibial Nerve Decompression at the Soleus

Compression of the tibial nerve by the tendinous leading-edge of the soleus is rare but under recognized. The tibial nerve is decompressed by dividing the soleus arch found deep within the lower leg. The surgical approach involves proceeding between the lateral and medial gastrocnemius muscles. The soleus muscle is then identified deep to the gastrocnemius […]

Thoracodorsal to Long Thoracic Nerve Transfer

Patients with long thoracic nerve injuries exhibit scapular winging and sever shoulder deficits that include the inability to forward flex the shoulder past 90 degrees of range of motion. Thoracodorsal to long thoracic nerve transfer utilizes a distal posterior branch of the thoracodorsal nerve to reinnervate the distal half of the long thoracic nerve. This […]

Submuscular Ulnar Nerve Transposition

A submuscular ulnar nerve transposition is performed to decompress the ulnar nerve in the cubital tunnel at the elbow. The medial antebrachial cutaneous nerve is identified and protected. Proximally, the medial intermuscular septum is resected. A step-lengthening of the fascia of the flexor-pronator muscles is performed. The ulnar nerve is placed in a transmuscular location. […]

Double Fascicular Transfer: Median Fascicle to Biceps Branch and Ulnar Fascicle to Brachialis Branch Nerve Transfers

The double fascicular transfer (DFT) includes two nerve transfers: (1) median fascicle to biceps branch and (2) ulnar fascicle to brachialis branch. The median fascicle contains nerve fibers that innervate flexor digitorum superficialis / flexor carpi radialis. The ulnar fascicle contains nerve fibers that innervate flexor carpi ulnaris. The donor fascicles can be used for […]

Anterior Interosseous to Ulnar Motor (Reverse End-to-side) Nerve Transfer

The donor anterior interosseous nerve (AIN) is transferred to the side of the recipient ulnar motor fascicular group within the distal forearm to preserve ulnar nerve motor intrinsics. Guyon’s canal release is a required part and is completed prior to this procedure. Specific to this case, a revision ulnar nerve transposition was completed proximally. This […]

Carpal Tunnel Release

A carpal tunnel release is performed by decompressing the median nerve in the wrist through the carpal tunnel. This procedure involves transecting the transverse carpal ligament. Standard: POSITION Supine. INCISION An incision is made ulnar to the thenar crease between the palmar sensory territories of the median and ulnar nerve. In addition, this approach allows […]

Median Nerve Forearm Decompression

The median nerve is decompressed in the forearm. A Z-plasty lengthening is performed on the pronator teres tendon. In addition, the tendon of the deep head of the pronator teres is transected and the flexor digitorum superficialis tendinous arch is released. Standard: Extended: POSITION Supine. INCISION A lazy-S incision is made over the proximal forearm. […]

Guyon’s Canal Release and Carpal Tunnel Release

The ulnar nerve is decompressed in the wrist through Guyon’s canal and in the hand, specifically the deep motor branch of the ulnar nerve. This deep motor branch is released by dividing the tendious arch of the hypothenar muscles. In addition, a carpal tunnel release is performed by transecting the transverse carpal ligament. Standard: Extended: […]