How is submuscular 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 anterior skin flap is raised until the bicipital aponeurosis is visualized. The overlying fascia is incised, with care taken to identify and protect the median nerve. Because of the extensive venous system in this area, meticulous hemostasis is important. [177]

With the nerves protected, the margins of the flexor-pronator mass are delineated. A plane is developed with blunt dissection between the flexor-pronator mass and the flexor digitorum superficialis and the ulnar collateral ligament. A hemostat is passed in this plane, with care taken to protect the nerves. The flexor-pronator mass is incised in a Z-cut fashion 1-2 cm distal to the medial epicondyle, and then reflected distally. The ulnar collateral ligament must be protected.

The tourniquet is then released and hemostasis obtained. The ulnar nerve is transposed adjacent and parallel to the median nerve. The lengthened flexor-pronator mass is reattached with nonabsorbable sutures with the elbow flexed and the arm pronated.


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