Anterior Interosseous to Ulnar Motor Nerve Transfer Extended Edition (130912.130911)
Injury to the ulnar nerve results in clawing of the hand due to lost of ulnar intrinsic hand muscles, lost of ulnar-innervated wrist/finger flexion, and numbness/pain within the ulnar nerve territory of the hand. To prevent clawing and reconstruct the ulnar intrinsic hand muscles, the anterior interosseous to ulnar motor nerve transfer is an available option. This involves transferring the distal pronator quadratus branch of the anterior interosseous nerve to the fascicular motor component of the ulnar nerve. This patient had an ulnar nerve injury following two ulnar nerve transpositions and reported pain and motor deficit immediately following surgery. He presented to our institution eight months post-injury and an end-to-end nerve transfer was elected due to the electrodiagnostic findings of fibrillations and no motor unit potentials by that time point. A Guyon’s canal release, flexor digitorum profundus tenodesis for grip strength, and second revision ulnar nerve transposition was performed. This video includes details on the Guyon’s canal release and anterior interosseous to ulnar motor end-to-end nerve transfer.
Table of Contents (Extended) 00:30 Orientation / Incision / Distal Exposure 01:42 Identifying Guyon’s Canal and Distal Antebrachial Fascia 03:24 Releasing Guyon’s Canal 05:38 Exposing the Tendinous Leading-edge of the Hypothenar Muscles 07:08 Releasing the Hypothenar Muscles and Deep Motor Branch of Ulnar Nerve 10:00 Proximal Exposure 12:43 Identifying the Pronator Quadratus with the Anterior Interosseous Nerve and Vessels 13:29 Dividing the Pronator Quadratus to Identify the Donor AIN Nerve Branches 17:04 Exposure of the Ulnar Nerve 18:31 Identifying the Motor Component of Ulnar Nerve and Interfascicular Dissection 19:37 Confirming (Distal) the Identification of the Motor Component of Ulnar Nerve (Proximal) 22:08 Proximal Interfascicular Dissection of the Ulnar Nerve 23:42 Dividing the Donor AIN Distal and Recipient Ulnar Motor Component Proximal 26:21 Anterior Interosseous to Ulnar Motor Nerve Transfer
Narration: Susan E. Mackinnon Videography: Andrew Yee
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