Combined Lesions of the Median and Ulnar Nerves
- See: Nerve Repair:
- digit flexors are restored by transferring ECRL to FDP tendons;
- FPL is reinforced by Brachioradialis and, in certain instances, the distal joint of the thumb is arthrodesed;
- MP joint of the thumb is arthrodesed if this joint is unstable;
- opposition and abduction of the thumb are secured by transfer of FDS around FCU, which if denervated can be formed into a pulley
by use of ECU as active motor to FDS;
- first dorsal interosseous is reinforced by either EIP or EPB, & MP joint of the thumb is arthrodesed;
- Low Median and Low Ulnar Nerve Lesions:
- loss of palm sensation: correct contractures & fuse IP if required;
- loss of Intrinsic: ECRB - tendon graft - intrinsics (Brand)
- thumb opposition: FDS (ring finger) to FCU pulley to EPL (Riordan)
- thumb adduction: EIP to Adductor;
- High Median and High Ulnar Nerve Lesions;
- hand anesthesia: need arthrodesis of thumb MCP (Zancolli)
- loss of flexors and intrinsic s:
- need capsulodesis of MCP joints, ECRL to FDP , & BR to FPL, & ECU (with graft) to EPB;
- Burkhalter Transfer for Claw Deformity:
Tendon transfers and arthrodeses in combined median and ulnar nerve paralysis.
Treatment of interphalangeal hyperflexion and metacarpophalangeal hyperextension of the thumb in combined low median - ulnar nerve palsy.
Original Text by Clifford R. Wheeless, III, MD.
Last updated by Data Trace Staff on Wednesday, April 11, 2012 11:13 am