Prospective Evaluation of Reverse End to Side Anterior Interosseous Nerve to Ulnar Nerve Transfer for Severe Compressive Ulnar Neuropathy at the Elbow
Severe Compressive Ulnar Nerve Neuropathy (McGowan Grade III)
About this trial
This is an interventional treatment trial for Severe Compressive Ulnar Nerve Neuropathy (McGowan Grade III)
Eligibility Criteria
Inclusion Criteria:
- Adult patients (greater than 18 years) with severe compressive ulnar nerve neuropathy (McGowan grade III) at the elbow who consent to either ulnar nerve decompression with transposition alone or ulnar nerve decompression with transposition plus nerve transfer.
Exclusion Criteria:
- Patients under the age of 18 and over 70.
- Patients with ulnar neuropathy at multiple anatomic locations along the course of the nerve.
- Patients with mild to moderate ulnar neuropathy (McGowan grade I and II).
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Reverse End-to-side
Surgery:standard care
Surgery: a "reverse" end-to-side AIN to ulnar nerve transfer whereby the motor branch of the ulnar is left intact and the end of the AIN nerve is coapted to the side of the ulnar motor fascicle(5,6). The advantage of this technique is it preserves the continuity of the ulnar motor branch for axons if they do eventually reinnervate the intrinsic muscles while augmenting or "babysitting" these muscles during the time period until this occurs.
Surgery: the anterior interosseous (AIN) to motor branch of the ulnar nerve transfer has been established as an effective means to reinnervate ulnar innervated intrinsic hand muscles (without loss of function from using the AIN) when nerve injury is too proximal for recovering axons to reach the hand by 18 months. . The procedure (surgery) is presently the standard of care