How is intramuscular transposition performed for ulnar neuropathy?

Updated: Jun 08, 2018
  • Author: Charles F Guardia, III, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
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Answer

A longitudinal incision 15-20 cm in length is made over the course of the ulnar nerve, and the nerve is decompressed in the same manner as for subcutaneous transposition. The proximal border of the pronator teres and the medial intermuscular septum are excised from the midhumerus to the elbow. The nerve is then temporarily transposed, and the position of the nerve on the flexor-pronator mass is noted.

The ulnar nerve is replaced in the epicondylar groove, and a 5 mm deep trough is made in line with the nerve in its transposed position on the flexor-pronator mass. The fibrous septum separating the flexor-pronator muscles is then excised to provide a soft vascularized muscle bed. The nerve is transposed. The flexor-pronator fascia is closed over the nerve with the forearm fully pronated and the elbow flexed 90°. Finally, a simple soft compressive dressing is applied.


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