Peripheral Nerve Injury -Repair and Reconstruction-Case: Peripheral Nerve Injuries

Case: Peripheral Nerve Injuries

Pdf Summary

A 42-year-old female presented with an ulnar nerve injury after a ski accident. She had undergone ulnar nerve repair at another hospital 4 weeks prior. On examination, she had a 10cm incision at the medial aspect of her elbow and mild clawing of the ring and small fingers. The operative site was minimally painful upon palpation. The patient had no movement in her FDI, RF, and SF FDP muscles, and was unable to discern sensation in her ring and small fingers.<br /><br />The treatment options discussed were continued postoperative monitoring or a "super-charge" reverse end-to-side (SETS) anterior interosseous nerve (AIN) to ulnar motor fascicle nerve transfer. It was noted that nerves regenerate at a rate of approximately 1 mm per day or 1 inch per month. Motor recovery depends on the time it takes for muscle reinnervation and the number of regenerated motor axons. If the motor end plate cannot be reached in time, an end-to-end AIN to ulnar motor transfer may be considered. However, if the motor end plate can be reached in time, a SETS AIN to ulnar motor transfer can be performed to augment and "babysit" the motor end plates.<br /><br />The document provided a diagram showing the topography of the ulnar nerve and AIN, with the sensory portion innervating the volar ring and small fingers on the radial side and the motor portion in the center. Regarding nerve repair, the document emphasized the importance of freshening the nerve ends until healthy sprouting nerve fascicles can be seen and avoiding tension. Correct alignment of the nerve ends and matching nerve fascicle bundles were mentioned as important considerations.<br /><br />The document also mentioned clinical pearls such as axonal regeneration occurring at a rate of 1 mm per day or 1 inch per month and the value of Tinel's test, which is a promising sign for regenerating axons across a nerve repair site. A non-advancing Tinel's test that is painful to palpation at the repair site suggests an inadequate nerve repair.<br /><br />References are provided for further reading on nerve transfers for upper extremity reconstruction, reverse end-to-side neurotization in a regenerating nerve, the supercharge end-to-side AIN to ulnar motor nerve transfer, and distal median to ulnar nerve transfers to restore ulnar motor and sensory function within the hand.

Keywords

ulnar nerve injury

ulnar nerve repair

clawing of fingers

operative site

super-charge reverse end-to-side

anterior interosseous nerve

nerve regeneration

motor recovery

Tinel's test

nerve transfers