Surgical Procedures

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. More importantly, the distal fascial septum between the flexor carpi ulnaris and the flexor-pronator muscles is removed.

Standard 110307

Extended 110307

POSITION

Supine.

INCISION

Incision is placed behind the medial epicondyle along the course of the nerve. The dotted line denotes the course of the medial antebrachial cutaneous branch across the incision and is found approximately 3.5cm distal to the medial epicondyle.

REFERENCES

  1. Mackinnon SE. Comparative clinical outcomes of submuscular and subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome. J Hand Surg Am. 2009 Oct;34(8):1574-5; author reply 1575. PMID: 19801113.
  2. Brown JM, Mokhtee D, Evangelista MS, Mackinnon SE. Scratch Collapse Test Localizes Osborne’s Band as the Point of Maximal Nerve Compression in Cubital Tunnel Syndrome. Hand (NY). 2010 Jun;5(2):141-7. PMID: 19774420.
  3. Cheng CJ, Mackinnon-Patterson B, Beck JL, Mackinnon SE. Scratch collapse test for evaluation of carpal and cubital tunnel syndrome. J Hand Surg Am. 2008 Nov;33(9):1518-24. PMID: 18984333.
  4. Novak CB, Mackinnon SE. Selection of operative procedures for cubital tunnel syndrome. Hand (NY). 2009 Mar;4(1):50-4. PMID: 18807093.
  5. Mackinnon SE, Novak CB. Operative findings in reoperation of patients with cubital tunnel syndrome. Hand (NY). 2007 Sep;2(3):137-43. PMID: 18780075.
  6. Lowe JB 3rd, Maggi SP, Mackinnon SE. The position of crossing branches of the medial antebrachial cutaneous nerve during cubital tunnel surgery in humans. Plast Reconstr Surg. 2004 Sep 1;114(3):692-6. PMID: 15318047.
  7. Novak CB, Mackinnon SE, Stuebe AM. Patient self-reported outcome after ulnar nerve transposition. Ann Plast Surg. 2002 Mar;48(3):274-80. PMID: 11862032.
  8. Lowe JB 3rd, Novak CB, Mackinnon SE. Current approach to cubital tunnel syndrome. Neurosurg Clin N Am. 2001 Apr;12(2):267-84. PMID: 11525206.
  9. Watchmaker GP, Lee G, Mackinnon SE. Intraneural topography of the ulnar nerve in the cubital tunnel facilitates anterior transposition. J Hand Surg Am. 1994 Nov;19(6):915-22. PMID: 7876489.
  10. Watchmaker GP, Lee G, Mackinnon SE. Intraneural topography of the ulnar nerve in the cubital tunnel facilitates anterior transposition. J Hand Surg Am. 1994 Nov;19(6):915-22. PMID: 7876489.
  11. Novak CB, Lee GW, Mackinnon SE, Lay L. Provocative testing for cubital tunnel syndrome. J Hand Surg Am. 1994 Sep;19(5):817-20. PMID: 7806810.
  12. Dellon AL, MacKinnon SE. Injury to the medial antebrachial cutaneous nerve during cubital tunnel surgery. J Hand Surg Br. 1985 Feb;10(1):33-6. PMID: 3998599.

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

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