Transfer of the ulnar nerve refers to a procedure in which the nerve is repositioned. The nerve is moved from the bony tunnel around the elbow (cubital tunnel) to a new bed in the muscle more proximal to the front of the elbow (anterior transposition). This procedure is performed when conservative treatment for ulnar nerve damage (ulnar neuropathy) has failed.
Ulnar neuropathy refers most often to ulnar nerve entrapment that occurs when the ulnar nerve, one of the main nerves in the arm, is compressed, impairing nerve function. The nerve normally passes under the muscles of the inside of the arm into the hand on the side of the little finger; in the hand itself it passes through a tunnel called Guyon's canal, The most frequent site of compression is behind the elbow. Nerve entrapment can happen as a result of previous elbow fracture, bone spurs, elbow swelling, or cysts in Guyon's canal. Ulnar neuropathy can be irritated by a direct injury or repetitive activity.
The transfer procedure decreases the angle the nerve travels, reduces irritation from compression during elbow bending, and maintains the blood supply to the nerve. To further decrease irritation from friction, the bump on the bone on the inside border of the elbow (medial epicondyle) may also be removed (medial epicondylectomy) during the procedure.
About half of individuals affected with mild ulnar neuropathy can be treated successfully with conservative measures such as anti-inflammatory medications, specific exercises to open the tunnels, and application of heat or cold packs. Local steroid injections can reduce the pain during variable periods of time but are not generally used because of the risks of infection and nerve damage. Other individuals may need surgical intervention to prevent irreversible nerve damage and loss of muscle function beyond the elbow. Decompression surgery may be performed instead of anterior transposition in cases in which the ulnar nerve is compressed locally by the retaining ligament (retinaculum) of the cubital tunnel (Regan).
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Source: Medical Disability Advisor
Ulnar nerve transfer is done to treat ulnar neuropathy at the elbow. Moving the nerve provides relief from irritation caused by compression along the nerve route. The procedure follows failure of conservative management of the neuropathy.
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Source: Medical Disability Advisor
Regional or general anesthesia is required for this outpatient procedure.
Through an incision along the back inner side of the elbow (posterior medial), the nerve is explored and removed from the bony tunnel (along with the arteries and veins that supply blood to the nerve) and sutured (stitched) into a new space created in the muscle in front of the tunnel (anterior transposition). The nerve can also be moved to a position under the skin and fatty tissue but at the top of the muscle (subcutaneous transposition), under the muscle (submuscular transposition), or within the muscle (intermuscular transposition). Many factors are involved in deciding which position is right for the individual, including whether the nerve is compressed at both the elbow and the wrist. If a cyst in Guyon’s canal is causing compression, the cyst will be removed.
After surgery, a soft, bulky dressing is applied and left in place for at least 10 days. A splint may be put in place over the dressing to prevent bending (flexion) of the elbow.
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Source: Medical Disability Advisor
Results of transposition surgery, regardless of the site of relocation of the nerve, are usually good. Anterior transposition offers the advantage of addressing all sites of disease (Regan). Relief of aching, gradual improvement in sensation, and decreased tingling and burning (paraesthesia) should occur fairly quickly. It may take 4 to 5 months for gripping strength in the hand to begin to return (Regan). Full function in the small muscles of the hand may take 1 to 1.5 years to return (Regan).
Damage to the nerve may be permanent, resulting in little or no improvement of weakness in the small (intrinsic) muscles in the hand.
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Source: Medical Disability Advisor
Gentle mobilization of the elbow, followed by muscle strengthening exercises, usually begins 7 to 10 days after surgery. Rehabilitation usually lasts 4 to 6 weeks.
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Source: Medical Disability Advisor
Infection and bleeding are possible complications of any surgery. This procedure may result in increased nerve damage and pain, as well as loss of function. Depending on the extent of nerve compression and the presence or absence of muscle wasting, nerve function may be permanently impaired ("Ulnar Nerve Entrapment").
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Source: Medical Disability Advisor
Elbow function in individuals recovering from ulnar nerve transfer is restricted for several weeks. After return to work, accommodating devices, such as phone headsets, may be recommended.
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Source: Medical Disability Advisor
| Cited "Ulnar Nerve Entrapment." Your Orthopaedic Connection. 1 Oct. 2007. American Academy of Orthopaedic Surgeons. 16 Jul. 2009 <http://orthoinfo.aaos.org/topic.cfm?topic=a00069>. |
| GeneralRegan, William D., and Bernard F. Morrey. "Ulnar Neuropathy at the Elbow: Cubital Tunnel Syndrome." DeLee and Drez's Orthopaedic Sports Medicine. Eds. Jesse DeLee and David Drez. 2nd ed. 2 vols. Philadelphia: W.B. Saunders, 2003. 1331-1334. MD Consult. Elsevier, Inc. 16 Jul. 2009 <http://www.mdconsult.com>. |
Source: Medical Disability Advisor