Surgical Procedures

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 leading-edge of the flexor carpi ulnaris and the aponeurosis superficial to the cubital tunnel compress the nerve. However other compressive points can exist and can be under-recognized. The transmuscular ulnar nerve transposition (TUNT) addresses these compressive points by releasing and transposing the nerve through a transmuscular bed within the pronator-flexor muscle bundle. In this case, the patient had a traumatic medial cord injury and presented 1-year following with associated ulnar neuropathy and fibrillations/motor unit potentials. The TUNT was elected with a supercharge anterior interosseous to ulnar motor nerve transfer, Guyon’s canal release, and FDP tenodesis. This video highlights details of the TUNT.

Standard 120405

Extended 120405

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.
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  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.
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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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