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Ulnar Nerve Transposition at the Elbow

February 01, 2014

Contributors: Ryan Sullivan, MD; Randipsingh R Bindra, FRACS, FRCS, MD; Randipsingh R Bindra, FRACS, FRCS, MD

The ulnar nerve at the elbow is vulnerable to stretch and compression because it lies posterior to the medial epicondyle. Anterior transposition of the nerve is performed for patients with ulnar neuropathy that fails nonsurgical management. Nerve transposition or surgical procedures around the medial aspect of the elbow such as ligament reconstruction and internal fixation also may be required to treat symptomatic subluxation. The ulnar nerve has a segmental blood supply that can be compromised during transposition. This video will demonstrate the surgical technique of anterior subcutaneous transposition of the ulnar nerve at the elbow. The vascular anatomy and its preservation during surgery will be emphasized. The key steps of cutaneous nerve preservation, ulnar nerve mobilization with its vascular leash, and creation of a fascial sling are demonstrated in a surgical case. Pitfalls of surgery will be explained, with illustrative cases to enable viewers to learn how to avoid them. The video is critical viewing for general orthopaedic surgeons who operate around the medial side of the elbow.

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