Ulnar Nerve Palsy - Rob Lee 20/10/2005Low Ulnar Nerve PalsySome intrinsic may continue to function due to Martin Gruber communication between AIN and the ulnar nerve There will be loss of 50-80 % of pinch strength, 50% loss of grip strength An isolated tendon transfer cannot restore all of the power requirements Need to improve pinch grip and grasp Single FDS tendon transfer to improve integration of the MP joint and interphalangeal joint flexion, key pinch of the thumb, and the flattened metacarpal arch (Omer 1974) 1st MCPJ arthrodesed FDS (IV) is freed and split in to 2 slips One slip to ADP insertion. Traction on the transferred tendon should adduct and pronate the first metacarpal. Other slip split in 2 tails and anchored to radial side of extensor aponeurosis of ring and little fingers Traction on the transferred slips should flex the MP joint and extend the proximal interphalangeal joint The MP joints of the claw fingers are placed in 45° flexion, and the proximal interphalangeal joints are placed in 0° extension. The first metacarpal is adducted so that it is parallel to the plane of the second metacarpal. This position is maintained in plaster immobilization for 4 weeks. The transfer of a single FDS tendon and arthrodesis of the thumb MP joint improves 2/3 of lost motor functions in a person with low distal ulnar nerve palsy. Methods for managing other motor losses associated with ulnar nerve palsy include the following: Transfer to restore thumb adduction - Pinch Grip BR or radial wrist extensor (ECRL) to adductor tubercle (Boyes) FDS (IV) to radial aspect thumb (Brand) FDS (IV) – split into 2 slips and pass to EPL and ADP (Royle-Thompson) Tendon transfer for index finger abduction - Pinch Grip EIP to 1st Dorsal Interosseus Slip of APL to 1st Dorsal Interosseus (Nevaiser, Wilson and Gardner) Transfer of FDS (modified Bunnell)– Claw Deformity FDS tendon is divided into 4 slips and inserted into the lateral band of the dorsal apparatus or into the second annular pulley of the flexor sheath Transfer of ECRL/ECRB (Brand) – Claw Deformity ECRL/ECRB tendon prolonged with graft and split into 4 tails Passed to finger extensor aponeuroses Capsulodesis of the MCPJs (Zancolli) – Claw Deformity If MCPJ stabilised, long finger extensors can extend IPJs Indicated if muscles not strong enough fro transfer Dorsal tenodesis (Riordan) – Claw Deformity As above, to stabilise MCPJs if no muscles available for transfer ECRL and ECU cut at the junction of the middle and distal thirds of the muscle Each half tendon is then split once longitudinally to obtain 4 slips Each slip is routed through the interosseous space and passed to the radial side of each finger Indicated if muscles not strong enough fro transfer High Ulnar Nerve Palsy May lose 60-80% of their grip strength Restore FDP function of ring and little finger by side to side tenodesis of the profundus tendons of the ring and little fingers to the profundus of the long finger in the forearm Also restore pinch grip and intrinsic function as above Combined lesions of the median and ulnar nerves Low lesions Loss of intrinsic: ECRB - tendon graft - intrinsics (Brand) Loss of thumb opposition: FDS (ring finger) to FCU pulley to APB (Riordan) Loss of thumb adduction: EIP to adductor tubercle or FDS (IV) to radial aspect thumb (Brand) High lesions Hand anaesthesia: need arthrodesis of thumb MCPJ Capsulodesis of all MCPJs (Zancolli) ECRL to FDP BR to FPL ECU with graft to EPB Please log in to view the content of this page. If you are having problems logging in, please refer to the login help page. |
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