Median & Ulna Nerve

IssuesMedian and ulna nerve injury

 

Extremely difficult

- goals of rehab must be realistic

- limited number of donors

- static procedures more prominent

- fusions, tenodesis and capsulodeses must be used

 

Goals

 

1.  Thumb Opposition

 

EIP to APB and EPL 

- via pulley around Pisiform and FCR

- alternative is Palmaris longus or ADM

 

2.  Thumb Adduction 

 

BR / ECRB + PL graft to P1

- via base of MC III as Adductor

 

3.  Thumb to index tip pinch

 

APL slip with free graft to 1st dorsal interosseous

 

+/- Arthrodesis thumb MP

 

4.  Thumb to LF tip pinch

 

EDM to deep transverse lig

EDC to little must work

 

5.  Power Flexion of fingers 

 

ECRL to all 4 fingers

 

Technique

- using 4 tail graft to lateral sheath or A2 pulley via lumbrical path

 

Alternative

- free gracilis graft

- into FDP

- insert vascularized ulna graft to power

 

6.  Sensation median nerve

 

Superficial radial nerve translocation