This protocol applies to patients with cubital tunnel syndrome presenting with first dorsal interosseous muscle weakness or intrinsic hand muscle atrophy and a decreased compound muscle action potential amplitude on electrodiagnostic studies — in whom a prior surgical nerve transfer approach failed to achieve the expected neurological and functional recovery.
The defining electrodiagnostic and clinical features of this scenario include:
The previous treatment — in situ decompression of the ulnar nerve at the cubital tunnel with supercharge end-to-side anterior interosseous nerve to ulnar motor nerve transfer (and Guyon's canal release where double crush syndrome was present) — was expected to achieve the following goals. This protocol applies when those goals were not met at 6 to 7 months after nerve transfer:
When the prior nerve transfer approach does not achieve the expected functional and electrodiagnostic recovery, a revision surgical procedure involving transposition of the ulnar nerve is the next step. The complete structured protocol — including the specific operative approach and decision criteria — is available in the full regimen.
DOI: 10.1016/j.jhsg.2022.07.008
Severe findings of EDX include decreased CMAP with/without abnormal electromyography findings.
Hand weakness, clawing.
Atrophy of intrinsic hand muscles with profound sensory disturbances.
The most common revision surgery is submuscular transposition of the ulnar nerve (75%).
In the revision setting, we recommend anterior submuscular transposition.
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