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High Ulnar Nerve Lesions



- See:
    - Tendon transfers:
    - Nerve Repair:
    - Combined Injuries of the Median and Ulnar Nerves:

- Discussion:
    - ulnar innervated intrinsic muscles of hand, FCU, & FDP units to ring & little fingers & part of long finger;
    - functional deficit:
         - opening the hand:
         - power grip:
                  - pts w/ high ulnar nerve lesions may lose 60-80% of their grip strength;
         - grasping and closing the hand;
                  - w/ ulnar nerve lesion, there is a noticeable deficit in all activities requiring pinch and grasp;
                  - becacuse of loss of intrinsics, pinch strength in ulnar nerve palsy is reduced by over 80%, w/ palmaradduction strength 
                         reduced by 75%;
    - results of nerve repair:
          - after repair of ulnar nerve lacerations above the elbow, return of extrinsic function can be expected, but return of intrinsics are 
                 often poor;

- Transfers:
    - tendon transfers will improve pinch and grasp:
           - only EPL & FPL  remain functional in terms of thumb adduction;
           - arthrodesis may be used to improve pinch strength;
                  - pts complain more of loss of MP arthrodesis
                  - ECRB adductorplasty w/ MP fusion can double pinch strength & is most successful pinch procedure;
    - FDP deficit:
           - reinforced by ECRL to the long, ring, and little fingers;
    - adductor pollicis deficit:
           - reinforced by FDS thru interosseous membrane & under pulley of ECU, w/ insertion into proximal phalanx of thumb;
           - note that FDS harvest from the ring finger may be problematic in high ulnar nerve palsy, since this may significantly decrease 
                  power grip;
    - APL deficit:
           - brachioradialis (reroute) to APL;
           - suture to other tendons (w/ or w/o ECRL) for power;

- Operative Correction of Intrinsic Deficit:
    - Burkhalter Transfer
          - procedure of choice;
    - Bunnell Transfer:
          - involves FDS transfer to the lateral bands;
          - interosseous & lumbricals muscles of ring finger and little fingers, substituted by the FDS of ring finger, in order to improve clawing 
                 and to improve flexion at the MP joint;
          - first dorsal interosseous muscle substituted by ECRL & split FDS of ring finger w/ one half to first lumbrical & one half to first 
                 dorsal interosseous;
                 - half the tendon is passed dorsally thru the 1st interosseous, where as the other half of the tendon is passed volarly to the 
                       lumbrical;
          - main complication is creation of intrinsic plus hand, which preferentially extends PIP joint w/ minimal flexion of the MPJ;
                 - this is exacerbated by the PIP flexion lost from the FDS harvest;
    - Zancolli Volar Capsulorraphy:
          - performed thru a volar approach;
          - goal is to create a MPJ flexion contracture, preventing claw deformity



Restoration of pinch in ulnar nerve palsy by transfer of split extensor digiti minimi and extensor indicis.

A new tendon transfer for ulnar clawhand: use of the palmaris longus extended with the palmar aponeurosis.

Early Tendon Transfers in Upper Extremity Peripheral Nerve Injury.

Studies on the hand in ulnar nerve paralysis. A clinical experimental investigation in normal and anomalous innervation.

Three tendon transfer methods in reconstruction of ulnar nerve palsy.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, May 9, 2012 12:40 pm