Median to ulnar nerve transfer in severe cubital tunnel syndrome

Document Type : Original Articles

Authors

1 neurosurgery department, alexandria university, alexandria, egypt

2 Neurosurgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt

Abstract

Introduction
Cubital tunnel syndrome is a common entrapment neuropathy averaging about 30 per 100,000 person. Patients harboring cubital tunnel syndrome suffers from sensory disturbance involving the medial side of the ring finger and the little finger. Exacerbation of symptoms is noted at night. In severe entrapment, patients may suffer from weakness in the small muscles of the hand.
Patients with severe degree of compression don’t recover completely following simple decompression at the elbow.
Objective
Assessment of the results of end to side supercharge transfer of the motor branch to the pronator quadratus muscle to the motor branch of the ulnar nerve in patients suffering from severe cubital tunnel syndrome.
Methods
We had 15 cases of severe cubital tunnel syndrome where pronator quadratus branch of the anterior interosseous nerve was transferred in an end to side fashion to the motor branch of the ulnar nerve with transposition of the ulnar nerve at the elbow and release at the guyon canal. Over 18 months follow up period, we had improved function and some recovery of the muscle atrophy in 13 out of 15 patients more than grade 3 MRC scale and all patients had some subjective sensory improvement.
Conclusion
The pronator quadratus branch of anterior interosseous nerve end-to-side transfer to the motor branch of the ulnar nerve helps with enhancing the recovery of hand muscles motor functions together with ulnar nerve transposition at the elbow and surgical decompression at the wrist in patients with severe ulnar entrapment at the elbow.

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