Revision Ulnar Nerve Transposition Following Failed Submuscular Ulnar Nerve Transposition 1 Mackinnon SE1 Yee A1 August 30, 2016Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.Failed surgical management of cubital tunnel syndrome may warrant a revision ulnar nerve transposition. Revision surgery is associated with increased technical difficulty depending on the primary procedure. The senior author's preferred technique for management of cubital tunnel syndrome is a transmuscular ulnar nerve transposition. The technique for revision surgery incorporates methods towards a transmuscular transposition. In this case, a 23-year-old patient presented with a three-year history of significant and continuous ulnar neuropathy two-years following an anterior submuscular ulnar nerve transposition. Examination revealed ulnar intrinsic atrophy and decreased ulnar nerve sensation with normal and intact medial antebrachial cutaneous nerve sensation. Electrodiagnostic studies include small ulnar CMAP amplitude with absent SNAP and fibrillations with motor unit potentials. The scratch collapse test with ethyl chloride hierarchy revealed positive provocations in the order of the cubital tunnel, Guyon's canal, and Struthers' ligament. Surgical management for this case includes revision ulnar nerve transposition, supercharge anterior interosseous to ulnar motor nerve transfer for motor recovery, side-to-side bridging nerve grafts with acellularized nerve allografts from median to ulnar sensory nerves for early sensory recovery, and a flexor digitorum profundus tenodesis. This video documents the revision transposition component of this patient's surgical management.Keywords: ulnar nerve transpositionrevision surgerycubital tunnel syndromecompression neuropathyulnar nervefailed cubital tunnel syndrome You must login to view the full article and extended video on this page. Standard Edition Table of Contents- Slow down- Frustration00:00:00 - Introduction00:00:20 - Incision and Superficial Dissection00:01:12 - Proximal Superficial Dissection00:01:35 - Identifying the Ulnar Nerve Proximally and Remnant Medial Intermuscular Septum00:02:10 - Distal Superficial Dissection00:02:20 - Identifying a Branch of Medial Antebrachial Cutaneous Nerve00:03:07 - Identifying and Dissecting in the Interval between the Flexor Musculature00:04:19 - Identifying the Ulnar Nerve Distally and Distal Intermuscular Septum00:05:36 - Proximal Dissection through Scar Tissue00:06:25 - Elevating Superficial Fascia to Reveal the Pronator-Flexor Musculature00:07:09 - Identifying the Medial Antebrachial Cutaneous Nerve00:07:39 - Dissecting and Identifying the Proximal and Distal Extent of the Submuscular Transposition00:08:09 - Creating the Medial and Lateral Fascial Flaps00:08:51 - Proximal Dissection of Ulnar Nerve through Pronator-Flexor Musculature00:09:50 - Distal Dissection of Ulnar Nerve through Pronator-Flexor Musculature00:11:58 - Release of the Ulnar Nerve from Submuscular Transposition00:12:14 - Release of the Distal Intermuscular Septum00:13:03 - Creating the Transmuscular Bed00:13:26 - Elevating the Ulnar Nerve from Submuscular Transposition00:13:40 - Examining and Releasing the Medial Antebrachial Cutaneous Nerve00:14:23 - Neurolysis of the Ulnar Nerve and Neurolyzing the Flexor Carpi Ulnaris Branch Proximally00:15:19 - Resecting the Fascial Septum "T" between the Pronator-Flexor Musculature00:15:50 - Resecting Remnant Medial Intermuscular Septum00:16:07 - Elevating the Ulnar Nerve to the Transmuscular Bed00:16:56 - Additional Examining and Releasing the Medial Antebrachial Cutaneous Nerve00:17:43 - Suturing the Fascial Flaps for a Revision Transmuscular Transposition00:18:10 - Proximal Dissection and Release of Struthers' Ligament00:19:21 - Credits You must login to view the full article and extended video on this page. Leave a Comment Cancel replyYou must be logged in to post a comment.