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Combined Lesions of the Median and Ulnar Nerves

- See: Nerve Repair:

- Discussion:
    - 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.