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2012 VuMedi - Transmuscular Transposition of the Ulnar Nerve

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Andrew Yee

on 7 January 2013

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Transcript of 2012 VuMedi - Transmuscular Transposition of the Ulnar Nerve

Transmuscular Transposition of the Ulnar Nerve Susan E. Mackinnon, MD Plastic and Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO 2012 VuMedi Webinar - AAHS - The Ulnar Nerve I, Susan E. Mackinnon MD, am the co-inventor of Synovis PGA Neurotube and have received research funding from AxoGen. Disclosure Cubital Tunnel Surgery Pain Evaluation Peripheral Nerve Worksheet Phalen's Test Transmuscular Transposition of the Ulnar Nerve Physical
Examination Surgical
Management Post-operative Management In Situ Release Endoscopic Release Transmuscular Transposition Subcutaneous Transposition vs. +1 Simple Decompression +1 Submuscular Transposition Meta-analysis - Procedure Camps Cubital Tunnel Surgery Improving Patient Outcomes Important Strategies and Topics Ulnar Nerve Compression Elbow Wrist Shoulder Thoracic Outlet
Posture Imbalance
Muscle Imbalance Forward Flexion of Neck Shoulder Ab/Adduction Shoulder Flexion/Extension Scratch Collapse Test Scratch Collapse Points Scratch Collapse Heirarchy SCT(-) Cubital Tunnel
w/ EtCL SCT(+) Guyon's Canal 1 - Cubital Tunnel 2 - Guyon's Canal Inital Test: Secondary Test: SCT(+) Cubital Tunnel SCT(-) Guyon's Canal Patient Education - Rate of Recovery Dynamic Ischemic Injury
immediate recovery


Demyelination Injury
3-4 months for remyelination


Axonal Injury
recovery rate at 1" per month


Mixed Injury
mixture of recovery rates Cubital Tunnel Surgery Specifics for Transposition No "best" surgical procedure


Avoid injury to MABC nerve

Complete release of compressive anatomical structures

Prevent new compressive points with transpostion Surgical Procedure Decompression Subluxation Surgical Management Transmuscular Transposition "Supercharge"
AIN to Ulnar Motor Nerve Transfer Guyon's Canal Release "Supercharge" Nerve Transfer Experimental Studies "Supercharge" AIN to Ulnar Motor Nerve Tranfer Donor - Anterior Interosseous Nerve "Supercharge" AIN to Ulnar Motor Nerve Tranfer Operative Technique Post-operative Management Marcaine incision

Marcaine infusion pump

Suction drain

Range-of-motion at 2 days post-operative

Night sling for 2-3 weeks (per patient)

Strengthen 4-6 weeks FDP Tenodesis Operative Technique I. II. III. Orientation Medial Antebrachial Cutaneous Nerve Medial Intermuscular Septum Distal Intermuscular Septum - FCR / FCU Transmuscular Canal Transmuscular Ulnar Nerve Transposition Post-operative Outcome Revision Ulnar Nerve Transposition
"Supercharge" AIN to Ulnar Motor Nerve Transfer
Guyon's Canal Release Recipient - Ulnar Motor Nerve Shoulder
Thoracic outlet, postural/muscle imbalance

Elbow
Avoid injury to MABC nerve

Complete release of compressive anatomical structures

Prevent new compressive points with transpostion

Hand
Guyon's canal release with deep motor branch

"Supercharge" intrinsic ulnar motor nerve

FDP tenodesis for early extrinsic function No "best" surgical
procedure Peripherial Nerve Surgery Education
nervesurgery.wustl.edu

Surgical Video Library
https://vimeo.com/user6062882

Prezi Presentation
http://prezi.com/user/yeeandrew/ Credits Andrew Yee, BS Scratch Collapse Heirarchy TOS Deep Motor Branch Cubital Tunnel Antebrachial Fascia Arcade of Struthers EtCl EtCl EtCl EtCl I. II. III. IV. V. (2012 VuMedi - Transmuscular Transposition of the Ulnar Nerve)
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