Interfascicular Anatomy of the Motor Branch of the Ulnar Nerve: A Cadaveric Study

Chambers, Spencer B; Wu, Kitty; Smith, Corey A.; Potra, Robert; Ferreira, Louis M.; Gillis, Joshua A.

doi:10.1016/j.jhsa.2021.10.012

Cited by 4 publications

(3 citation statements)

References 15 publications

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“…A final point on the relevant anatomy to be considered in an AIN to MUN SETS transfer is brought to light by Chambers et al in their 2021 work looking at the interfascicular anatomy of the MUN in cadaveric samples [7]. Their research demonstrated a predictable arrangement of the motor fascicles in all specimens.…”

Section: Figure 3: Illustration Of Ulnar and Ain Nerve Anatomy In Set...mentioning

confidence: 99%

“…In the original clinical description of SETS for AIN to MUN transfer by Barbour et al the donor AIN is harvested using sharp neurotomy proximal to its branching point [1]. Mackinnon elaborates on this in her response letter to Isaacs describing that fascicles of the cut end of the AIN can be "fanned out" prior to coaptation [5,7].…”

Section: Variables Surrounding the Donor Nerve Harvest And Coaptationmentioning

confidence: 99%

“…The site of coaptation to the MUN, whether this be radial/midline or ulnar is not specifically mentioned in most articles but may hold clinical significance based on the work by Chambers et al referenced earlier [7]. Standardisation of this coaptation site is something that may be considered based on patient presenting features.…”

Section: Variables Surrounding the Recipient Nerve Preparationmentioning

confidence: 99%

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Supercharged End-to-Side Nerve Transfer for Ulnar Neuropathy: Redefining Nomenclature and Recommendations for Standardisation of Surgical Technique Description

Kulenkampff,

Duraku,

George

et al. 2023

Cureus

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Supercharged end-to-side (SETS) nerve transfers have been described as a treatment option for ulnar neuropathy, however, there is inconsistency in the nomenclature used to describe the microsurgical technique. The purpose of this article is to systematically review the available literature on the SETS nerve transfer technique and to provide an overview of the technical variations to facilitate standardisation of surgical method.A literature review was performed through PubMed, MEDLINE, and Ovid databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that reported surgical technique of anterior interosseous nerve (AIN) to ulnar nerve SETS transfer were included. Studies were excluded when not referencing SETS/reverse end-to-side (RETS) nerve transfers, studies referencing nerve transfers other than AIN to motor fascicle bundle of the ulnar nerve (MUN), animal studies, and studies not reporting technique.Of the 168 studies found, 14 articles were included. In five articles, distal visualisation of the MUN in Guyon's canal was specifically cited. In the four studies that commented on donor preparation, sharp neurectomy proximal to the AIN branching point was undertaken. Recipient preparation was commented on in seven of the included studies. Two studies referred to an epineurial window only while five specifically recommended a perineurial window. Coaptation site was specified in four studies and all studies used sutures for coaptation, with four articles stipulating that 9-0 nylon was used. Additionally, fibrin glue was used in conjunction with suture technique in four studies.Consistency in nomenclature used to describe SETS microsurgical technique is needed before case series measuring outcome can be reliably interpreted. This review allowed for the development of suggestions for standardisation of nomenclature and minimal reporting requirements when describing SETS technique. Standardisation of technique will allow for reproducibility and facilitate future evaluations of outcome in prospective randomised control trials.

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Section: Figure 3: Illustration Of Ulnar and Ain Nerve Anatomy In Set...mentioning

confidence: 99%

Section: Variables Surrounding the Donor Nerve Harvest And Coaptationmentioning

confidence: 99%

Section: Variables Surrounding the Recipient Nerve Preparationmentioning

confidence: 99%

See 1 more Smart Citation

Supercharged End-to-Side Nerve Transfer for Ulnar Neuropathy: Redefining Nomenclature and Recommendations for Standardisation of Surgical Technique Description

Kulenkampff,

Duraku,

George

et al. 2023

Cureus

View full text Add to dashboard Cite

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Anatomic Study of the Motor Branch of the Ulnar Nerve Regarding Carpal Tunnel Surgery: A Cadaveric Study

Siriwittayakorn

SAOSARN

Fongsri

et al. 2023

J Hand Surg Asian-Pac Vol

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Background: Motor branch of the ulnar nerve (MUN) injury during carpal tunnel surgery is rare and it should never be injured during carpal tunnel release (CTR). However, an iatrogenic injury of the MUN can cause catastrophic physical and mental suffering. The aim of our study is to understand the anatomy of the MUN in relation to carpal tunnel in order to prevent iatrogenic injury during CTR. Methods: We dissected 34 fresh cadaver hands and located the MUN in relation to the anatomical axis used for carpal tunnel surgery. Possible mechanisms of injury and the vulnerable area of the MUN were determined along the dissection. Results: The MUN turned towards the thumb distal to hook of hamate. It then travelled on the floor of the carpal tunnel which was formed by intrinsic hand muscles under flexor tendons. The nerve located at 29.39 ± 7.41, 35.01 ± 3.14 and 38.79 ± 4.03 mm (Mean ± SD) in the central axis of ring finger, the vertical axis of the third web-space and the central axis of middle finger respectively. The nerve’s turning point, 10.9 ± 2.63 mm distal to the centre of hook of hamate where it lies just below the level of the transverse carpal ligament. Conclusions: Surgeons should be aware of the nerve’s location. Surgical dissection or passing of any surgical instruments around the hook of hamate should be done with care. Level of Evidence: Level IV (Therapeutic)

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Anterior Interosseus to Ulnar Motor Nerve Transfers: A Canadian Perspective

Chambers

Ross

et al. 2023

Hand (New York, N,Y.)

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Background: The anterior interosseus nerve (AIN) to ulnar motor nerve transfer has been popularized as an adjunct to surgical decompression in patients with severe cubital tunnel syndrome (CuTS) and high ulnar nerve injuries. The factors influencing its implementation in Canada have yet to be described. Methods: An electronic survey was distributed to all members of the Canadian Society of Plastic Surgery (CSPS) using REDCap software. The survey examined 4 themes: previous training/experience, practice volume of nerve pathologies, experience with nerve transfers, and approach to the treatment of CuTS and high ulnar nerve injuries. Results: A total of 49 responses were collected (12% response rate). Of all, 62% of surgeons would use an AIN to ulnar motor supercharge end-to-side (SETS) transfer for a high ulnar nerve injury. For patients with CuTS and signs of intrinsic atrophy, 75% of surgeons would add an AIN-SETS transfer to a cubital tunnel decompression. Sixty-five percent would also release Guyon’s canal, and the majority (56%) use a perineurial window for their end-to-side repair. Eighteen percent of surgeons did not believe the transfer would improve outcomes, 3% cited lack of training, and 3% would preferentially use tendon transfers. Surgeons with hand fellowship training and those less than 30 years in practice were more likely to use nerve transfers in the treatment of CuTS ( P < .05). Conclusions: Most CSPS members would use an AIN-SETS transfer in the treatment of both a high ulnar nerve injury and severe CuTS with intrinsic atrophy.

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Interfascicular Anatomy of the Motor Branch of the Ulnar Nerve: A Cadaveric Study

Cited by 4 publications

References 15 publications

Supercharged End-to-Side Nerve Transfer for Ulnar Neuropathy: Redefining Nomenclature and Recommendations for Standardisation of Surgical Technique Description

Supercharged End-to-Side Nerve Transfer for Ulnar Neuropathy: Redefining Nomenclature and Recommendations for Standardisation of Surgical Technique Description

Anatomic Study of the Motor Branch of the Ulnar Nerve Regarding Carpal Tunnel Surgery: A Cadaveric Study

Anterior Interosseus to Ulnar Motor Nerve Transfers: A Canadian Perspective

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