Sensory Neurotization of the Ulnar Nerve, Surgical Techniques and Functional Outcomes: A Review

Abstract

When ulnar nerve lesions happen above the wrist level, sensation recovery after acute repair or nerve grafting is often challenging. Distal sensory nerve transfers may be an option for overcoming these sequelae. However, little data has been published on this topic. This study aims to review the surgical procedures currently proposed, along with their functional results. Six donor nerves have been described at the wrist level: the palmar branch of the median nerve, the cutaneous branch of the median nerve to the palm with or without fascicles of the ulnar digital nerve of the index finger, the posterior interosseous nerve, the third palmar digital nerve, the radial branch of the superficial radial nerve, the median nerve, and the fascicule for the third web space. Three donor nerves have been reported at the hand level: the ulnar digital nerves of the index, and the radial or ulnar digital nerves of the long finger. Three target sites were used: the superficial branch of the ulnar nerve, the dorsal branch of the ulnar nerve, and the ulnar digital branch of the fifth digit. All the technical points have been illustrated with anatomical dissection pictures. After assessing sensory recovery using the British Medical Research Council scale, a majority of excellent recoveries scaled S3+ or S4 have been reported in the targeted territory for each technique.

Epithelioid malignant peripheral nerve sheath tumour of the ulnar nerve around the elbow: a diagnostic and therapeutic challenge

“…Nerve transfer surgery,7 first described by Novak and Mackinnon, facilitates faster recovery because the healing and regeneration occur closer to the target site and require microsurgical expertise. Nguyen et al , in their review article on sensory neurotisation of the ulnar nerve, showed excellent recoveries (S3+MRC) 8. A tendon transfer is reserved as a life boat at the later stage if nerve transfer fails.…”

“…Though there are several methods for treating neurological impairments, such as nerve grafting and tendon transfer, the patient’s condition must be addressed using a reconstructive strategy that can hasten neurological recovery 7. Distal nerve transfers are methods that potentially circumvent the traditional nerve recovery pattern and allow for speedier neurological recovery including both motor and sensory components 8. An epithelioid variety of MPNST emerging from the ulnar nerve in the right elbow of a young girl in her second decade is described in this report.…”