Download PDF
CC BY 4.0 · J Brachial Plex Peripher Nerve Inj 2023; 18(01): e1-e5
DOI: 10.1055/s-0042-1760097
Original Contribution

Outcomes after Anterior Interosseous Nerve to Ulnar Motor Nerve Transfer

Jeffrey N. Gross 
1   Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States
,
Steven E. Dawson
1   Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States
,
Gerald J. Wu
1   Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States
,
Scott Loewenstein
2   Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
,
Gregory H. Borschel
1   Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States
,
Joshua M. Adkinson
1   Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Background Ulnar nerve lesions proximal to the elbow can result in loss of intrinsic muscle function of the hand. The anterior interosseous nerve (AIN) to deep motor branch of the ulnar nerve (DBUN) transfer has been demonstrated to provide intrinsic muscle reinnervation, thereby preventing clawing and improving pinch and grip strength. The purpose of this study was to evaluate the efficacy of the AIN to DBUN transfer in restoring intrinsic muscle function for patients with traumatic ulnar nerve lesions.

Methods We performed a prospective, multi-institutional study of outcomes following AIN to DBUN transfer for high ulnar nerve injuries. Twelve patients were identified, nine of which were enrolled in the study. The mean time from injury to surgery was 15 weeks.

Results At final follow-up (mean postoperative follow-up 18 months + 15.5), clawing was observed in all nine patients with metacarpophalangeal joint hyperextension of the ring finger averaging 8.9 degrees (+ 10.8) and small finger averaging 14.6 degrees (+ 12.5). Grip strength of the affected hand was 27% of the unaffected extremity. Pinch strength of the affected hand was 29% of the unaffected extremity. None of our patients experienced claw prevention after either end-to-end (n = 4) or end-to-side (n = 5) AIN to DBUN transfer.

Conclusion We conclude that, in traumatic high ulnar nerve injuries, the AIN to DBUN transfer does not provide adequate intrinsic muscle reinnervation to prevent clawing and normalize grip and pinch strength.

Keywords

nerve transfer - peripheral nerve surgery - ulnar nerve - median nerve - plastic surgery - ulnar nerve trauma - anterior interosseous nerve - deep motor branch ulnar nerve

Informed Consent

Witten informed consent was obtained from all subjects before the study.


Ethical Approval

Ethical approval for this study was obtained from Indiana University Health Institutional Review Board (#10180)




Publication History

Received: 28 July 2022

Accepted: 07 September 2022

Article published online:
11 January 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Polatsch DB, Melone Jr CP, Beldner S, Incorvaia A. Ulnar nerve anatomy. Hand Clin 2007; 23 (03) 283-289
    CrossrefPubMedGoogle Scholar
  • 2 Valone JA. Paralysis of the ulnar nerve and management of its deformity. J Neurosurg 1953; 10 (02) 138-144
    CrossrefPubMedGoogle Scholar
  • 3 McCormick CA, Rath S, Patra PN, Pereira J, Wilkinson M. A qualitative study of common functional problems experienced by people with complete ulnar nerve paralysis. Lepr Rev 2008; 79 (02) 154-161
    CrossrefPubMedGoogle Scholar
  • 4 Bertelli JA. Prior to repair functional deficits in above- and below-elbow ulnar nerve injury. J Hand Surg Am 2020; 45 (06) 552.e1-552.e10
    CrossrefPubMedGoogle Scholar
  • 5 Gaul Jr JS. Intrinsic motor recovery–a long-term study of ulnar nerve repair. J Hand Surg Am 1982; 7 (05) 502-508
    Google Scholar
  • 6 Sakellarides H. A follow-up study of 172 peripheral nerve injuries in the upper extremity in civilians. J Bone Joint Surg Am 1962; 44-A: 140-148
    CrossrefPubMedGoogle Scholar
  • 7 Ruijs AC, Jaquet JB, Kalmijn S, Giele H, Hovius SE. Median and ulnar nerve injuries: a meta-analysis of predictors of motor and sensory recovery after modern microsurgical nerve repair. Plast Reconstr Surg 2005; 116 (02) 484-494 , discussion 495–496
    CrossrefPubMedGoogle Scholar
  • 8 Millesi H, Meissl G, Berger A. The interfascicular nerve-grafting of the median and ulnar nerves. J Bone Joint Surg Am 1972; 54 (04) 727-750
    CrossrefPubMedGoogle Scholar
  • 9 Loewenstein SN, Adkinson JM. Tendon transfers for peripheral nerve palsies. Clin Plast Surg 2019; 46 (03) 307-315
    CrossrefPubMedGoogle Scholar
  • 10 Wang Y, Zhu S. Transfer of a branch of the anterior interosseus nerve to the motor branch of the median nerve and ulnar nerve. Chin Med J (Engl) 1997; 110 (03) 216-219
    Google Scholar
  • 11 Brown JM, Yee A, Mackinnon SE. Distal median to ulnar nerve transfers to restore ulnar motor and sensory function within the hand: technical nuances. Neurosurgery 2009; 65 (05) 966-977 , discussion 977–978
    Google Scholar
  • 12 Novak CB, Mackinnon SE. Distal anterior interosseous nerve transfer to the deep motor branch of the ulnar nerve for reconstruction of high ulnar nerve injuries. J Reconstr Microsurg 2002; 18 (06) 459-464
    Google Scholar
  • 13 Sallam AA, El-Deeb MS, Imam MA. Nerve transfer versus nerve graft for reconstruction of high ulnar nerve injuries. J Hand Surg Am 2017; 42 (04) 265-273
    CrossrefPubMedGoogle Scholar
  • 14 Flores LP. Comparative study of nerve grafting versus distal nerve transfer for treatment of proximal injuries of the ulnar nerve. J Reconstr Microsurg 2015; 31 (09) 647-653
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 McLeod GJ, Peters BR, Quaife T, Clark TA, Giuffre JL. Anterior interosseous-to-ulnar motor nerve transfers: a single center's experience in restoring intrinsic hand function. Hand (N Y) 2022; 17 (04) 609-614
    CrossrefPubMedGoogle Scholar
  • 16 Arami A, Bertelli JA. Effectiveness of distal nerve transfers for claw correction with proximal ulnar nerve lesions. J Hand Surg Am 2021; 46 (06) 478-484
    Google Scholar
  • 17 Kettle SJ, Starritt NE, Glasby MA, Hems TEJ. End-to-side nerve repair in a large animal model: how does it compare with conventional methods of nerve repair?. J Hand Surg Eur Vol 2013; 38 (02) 192-202
    CrossrefPubMedGoogle Scholar
  • 18 Rönkkö H, Göransson H, Taskinen HS, Paavilainen P, Vahlberg T, Röyttä M. Comparison of peripheral nerve regeneration with side-to-side, end-to-side, and end-to-end repairs: an experimental study. Plast Reconstr Surg Glob Open 2016; 4 (12) e1179
    CrossrefPubMedGoogle Scholar
  • 19 Tateshita T, Ueda K, Kajikawa A. End-to-end and end-to-side neurorrhaphy between thick donor nerves and thin recipient nerves: an axon regeneration study in a rat model. Neural Regen Res 2018; 13 (04) 699-703
    CrossrefPubMedGoogle Scholar
  • 20 Chen SH, Mao SH, Lan CY. et al. End-to-side anterior interosseous nerve transfer: a valuable alternative for traumatic high ulnar nerve palsy. Ann Plast Surg 2021; 86 (2S, Suppl 1) S102-S107
    CrossrefPubMedGoogle Scholar
  • 21 Schenck TL, Stewart J, Lin S, Aichler M, Machens HG, Giunta RE. Anatomical and histomorphometric observations on the transfer of the anterior interosseous nerve to the deep branch of the ulnar nerve. J Hand Surg Eur Vol 2015; 40 (06) 591-596
    Google Scholar
  • 22 Snyder-Warwick AK, Fattah AY, Zive L, Halliday W, Borschel GH, Zuker RM. The degree of facial movement following microvascular muscle transfer in pediatric facial reanimation depends on donor motor nerve axonal density. Plast Reconstr Surg 2015; 135 (02) 370e-381e
    CrossrefPubMedGoogle Scholar
  • 23 Rafuse VF, Gordon T. Incomplete rematching of nerve and muscle properties in motor units after extensive nerve injuries in cat hindlimb muscle. J Physiol 1998; 509 (Pt 3): 909-926
    CrossrefPubMedGoogle Scholar
  • 24 Methot J, Chinchalkar SJ, Richards RS. Contribution of the ulnar digits to grip strength. Can J Plast Surg 2010; 18 (01) e10-e14
    CrossrefPubMedGoogle Scholar