Anterior Interosseous to Ulnar Motor Nerve Transfer – Standard

Publicado el 16/01/2014
Anterior Interosseous to Ulnar Motor Nerve Transfer
Extended Edition (130912.130911)

Injury to the ulnar nerve results in clawing of the hand due to lost of ulnar intrinsic hand muscles, lost of ulnar-innervated wrist/finger flexion, and numbness/pain within the ulnar nerve territory of the hand. To prevent clawing and reconstruct the ulnar intrinsic hand muscles, the anterior interosseous to ulnar motor nerve transfer is an available option. This involves transferring the distal pronator quadratus branch of the anterior interosseous nerve to the fascicular motor component of the ulnar nerve. This patient had an ulnar nerve injury following two ulnar nerve transpositions and reported pain and motor deficit immediately following surgery. He presented to our institution eight months post-injury and an end-to-end nerve transfer was elected due to the electrodiagnostic findings of fibrillations and no motor unit potentials by that time point. A Guyon’s canal release, flexor digitorum profundus tenodesis for grip strength, and second revision ulnar nerve transposition was performed. This video includes details on the Guyon’s canal release and anterior interosseous to ulnar motor end-to-end nerve transfer.

Table of Contents (Extended)
00:30 Orientation / Incision / Distal Exposure
01:42 Identifying Guyon’s Canal and Distal Antebrachial Fascia
03:24 Releasing Guyon’s Canal
05:38 Exposing the Tendinous Leading-edge of the Hypothenar Muscles
07:08 Releasing the Hypothenar Muscles and Deep Motor Branch of Ulnar Nerve
10:00 Proximal Exposure
12:43 Identifying the Pronator Quadratus with the Anterior Interosseous Nerve and Vessels
13:29 Dividing the Pronator Quadratus to Identify the Donor AIN Nerve Branches
17:04 Exposure of the Ulnar Nerve
18:31 Identifying the Motor Component of Ulnar Nerve and Interfascicular Dissection
19:37 Confirming (Distal) the Identification of the Motor Component of Ulnar Nerve (Proximal)
22:08 Proximal Interfascicular Dissection of the Ulnar Nerve
23:42 Dividing the Donor AIN Distal and Recipient Ulnar Motor Component Proximal
26:21 Anterior Interosseous to Ulnar Motor Nerve Transfer

Narration: Susan E. Mackinnon
Videography: Andrew Yee

Surgical Release for Tarsal Tunnel Syndrome

Surgical Release for Tarsal Tunnel Syndrome

Surgical Release for Tarsal Tunnel Syndrome

Source: http://nervesurgery.wustl.edu
Tarsal tunnel syndrome describes the compression of the tibial nerve through the tarsal tunnel which results in pain and numbness in the plantar aspect of the foot. The tibial nerve has three major branches which include the calcaneal, medial plantar, and lateral plantar nerve branches. There are two primary structures responsible for compression of the tibial nerve: (1) flexor retinaculum and (2) a septum that compartmentalizes the medial and lateral plantar nerves and the overlying fascia of the abductor hallucis muscle. The tarsal tunnel release involves releasing these structures. In this case, the patient had a traumatic injury to the lower leg, which required open reduction and internal fixation. The patient had pain and numbness in the tibial nerve distribution along with Tinel’s sign and positive scratch collapse at the tarsal tunnel.
Details of Surgical Demonstration:

00:45 Incision / Exposure of Proximal Incision

02:30 Identifying and Dividing the Superficial Fascia through Scar Tissue

03:48 Identification of the Posterior Tibial Vessels

04:48 Identifying and Dividing the Flexor Retinaculum Proximally

06:33 Identification of the Tibial Nerve Proper

07:20 Incision / Exposure of Distal Incision

09:07 Identifying and Incising the Tendinous Fascia Superficial to the Abductor Hallucis

09:46 Retracting the Abductor Hallucis and Identifying the Deep Fascia to the Abductor Hallucis

10:16 Dividing the Deep Fascia Superficial to the Lateral Plantar Nerve

11:30 Identifying the Abductor Hallucis Fascia Superficial to the Medial Plantar Nerve

13:29 Dividing the Abductor Hallucis Fascia Superficial to the Medial Plantar Nerve

14:22 Identification and Release of the Calcaneal Nerve Branch

14:50 Identifying and Dividing the Flexor Retinaculum Distally

15:26 Further Division of the Abductor Hallucis Fascia Superficial to the Lateral Plantar Nerve

Narration: Susan E. Mackinnon

Videography: Andrew Yee

Cómo y pórque inmobilizar las MTCFs y las IFPs

http://cirugiadelamanoyelcarpo.com/2013/03/17/como-y-porque-inmobilizar-las-mtcfs-y-las-ifps/

Cómo y pórque inmobilizar las MTCFs y las IFPs

En el post anterior he colgado una foto de la posición correcta de inmobilización de las articulaciones MTCF, IFP e IFD.Inmobilizar en esta posición de Flexión de MTCF a 90º, extensión completa de IFP e IFD obvia MUUUCHOS problemas funcionales posteriores. Porqué?
1- Los ligamentos colaterals de la articulación MTCF se hallan en su máxima elongación en flexión de 90º de la articulación: por lo tanto, por muchos días que debamos tener la articulación inmobilizada, por mucho edema de la mano que haya, los ligamentos no se retraerán porque están distendidos y posteriormente la flexión articular no se verá limitada.
2-En las articulaciones Interfalángicas es al contrario: la máxima elongación de los ligamentos colaterales  ( fascículo principal y accesorio) y de la placa palmar es en la extesión completa. Si no inmobilizamos las IFPs y las IFDs en extensión completa, los ligamentos y la placa volar se retraerán y el dedo presentará una rigidez en flexión.
Una férula digital o una férula digitopalmar colocada sin pensar en las retracciones de partes blandas ( ligamentos, cápsula, placa palmar, repliegus sinoviales) que seguirán a la reparación de una lesión puede ser mucho más problemática que la lesión original!!!
Posición funcional de inmobilización de las articulaciones MTCF, IFP e IFD