Skip to main content
SpringerLink
Log in

Nerve Transfers for Neuropathies of the Median and Ulnar Nerve

  • Chapter
  • First Online:
Compressive Neuropathies of the Upper Extremity

  • 806 Accesses

Abstract

Nerve transfers involve taking an expendable motor or sensory nerve and anastomosing it to a damaged nerve for restoration of critical motor function or sensation. The use of nerve transfers, while rare in compressive neuropathies, can be considered in cases of severe proximal compression leading to axonal loss or in cases of iatrogenic injury from previous surgery. Nerve transfers are classically described using end to end nerve coaptation; however, in cases of nerve compression we would recommend the use of distal end to side transfers as it allows for the augmentation of proximal native nerve recovery while allowing for early reinnervation. Recent data suggests that nerve transfers can help to restore motor function and protective sensibility in cases of compressive ulnar neuropathy. Here we describe the principles of nerve transfers and strategies for both motor and sensory transfers in cases of median and ulnar compressive neuropathies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Tung TH, Barbour JR, Gontre G, Daliwal G, Mackinnon SE. Transfer of the extensor digiti minimi and extensor carpi ulnaris branches of the posterior interosseous nerve to restore intrinsic hand function: case report and anatomic study. J Hand Surg Am. 2013;38(1):98–103.

    Article  Google Scholar 

  2. Farber SJ, Glaus SW, Moore AM, Hunter DA, Mackinnon SE, Johnson PJ. Supercharge nerve transfer to enhance motor recovery: a laboratory study. J Hand Surg Am. 2013;38(3):466–77.

    Article  Google Scholar 

  3. Isaacs J, Patel G, Mallu S, et al. Effect of reverse end-to-side (supercharging) neurotization in long processed acellular nerve allograft in a rat model. J Hand Surg Am. 2019;44(5):419.e1–419.e10.

    Article  Google Scholar 

  4. Baltzer H, Woo A, Oh C, Moran SL. Comparison of ulnar intrinsic function following supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer: a matched cohort study of proximal ulnar nerve injury patients. Plast Reconstr Surg. 2016;138(6):1264–72.

    Article  CAS  Google Scholar 

  5. Felder JM, Power H, Hill E, Hasak J, Mackinnon SE. Cross-cross sensory nerve grafts to enhance sensory recovery in complex ulnar neuropathy [abstract]. Paper presented at: American Society of Peripheral Nerve Annual Meeting, Phoenix, Arizona; 12–14 Jan 2018.

    Google Scholar 

  6. Brown JM, Mackinnon SE. Nerve transfers in the forearm and hand. Hand Clin. 2008;24(4):319–40, v.

    Article  Google Scholar 

  7. Moran SL, Steinmann SP, Shin AY. Adult brachial plexus injuries: mechanism, patterns of injury, and physical diagnosis. Hand Clin. 2005;21(1):13–24.

    Article  Google Scholar 

  8. Gordon T, Tyreman N, Raji MA. The basis for diminished functional recovery after delayed peripheral nerve repair. J Neurosci. 2011;31(14):5325–34.

    Article  CAS  Google Scholar 

  9. Sammer DM, Chung KC. Tendon transfers: part I. Principles of transfer and transfers for radial nerve palsy. Plast Reconstr Surg. 2009;123(5):169e–77e.

    Article  CAS  Google Scholar 

  10. Schreiber JJ, Byun DJ, Khair MM, Rosenblatt L, Lee SK, Wolfe SW. Optimal axon counts for brachial plexus nerve transfers to restore elbow flexion. Plast Reconstr Surg. 2015;135(1):135e–41e.

    Article  CAS  Google Scholar 

  11. Power HA, Sharma K, El-Haj M, Moore AM, Patterson MM, Mackinnon SE. Compound muscle action potential amplitude predicts the severity of cubital tunnel syndrome. J Bone Joint Surg Am. 2019;101(8):730–8.

    Article  Google Scholar 

  12. Davidge KM, Yee A, Moore AM, Mackinnon SE. The supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer for restoring intrinsic function: clinical experience. Plast Reconstr Surg. 2015;136(3):344e–52e.

    Article  CAS  Google Scholar 

  13. Woo A, Bakri K, Moran SL. Management of ulnar nerve injuries. J Hand Surg Am. 2015;40(1):173–81.

    Article  Google Scholar 

  14. Barbour J, Yee A, Kahn LC, Mackinnon SE. Supercharged end-to-side anterior interosseous to ulnar motor nerve transfer for intrinsic musculature reinnervation. J Hand Surg Am. 2012;37(10):2150–9.

    Article  Google Scholar 

  15. Novak CB, Mackinnon SE. Distal anterior interosseous nerve transfer to the deep motor branch of the ulnar nerve for reconstruction of high ulnar nerve injuries. J Reconstr Microsurg. 2002;18(6):459–64.

    Article  Google Scholar 

  16. Magdi Sherif M, Amr AH. Intrinsic hand muscle reinnervation by median-ulnar end-to-side bridge nerve graft: case report. J Hand Surg Am. 2010;35(3):446–50.

    Article  CAS  Google Scholar 

  17. Bertelli JA. Distal sensory nerve transfers in lower-type injuries of the brachial plexus. J Hand Surg Am. 2012;37(6):1194–9.

    Article  Google Scholar 

  18. Ray WZ, Chang J, Hawasli A, Wilson TJ, Yang L. Motor nerve transfers: a comprehensive review. Neurosurgery. 2016;78(1):1–26.

    Article  Google Scholar 

  19. Brown JM, Yee A, Mackinnon SE. Distal median to ulnar nerve transfers to restore ulnar motor and sensory function within the hand: technical nuances. Neurosurgery. 2009;65(5):966–77; discussion 977-968

    Article  Google Scholar 

  20. Brunelli GA. Sensory nerves transfers. J Hand Surg Br. 2004;29(6):557–62.

    Article  Google Scholar 

  21. Ruchelsman DE, Price AE, Valencia H, Ramos LE, Grossman JA. Sensory restoration by lateral antebrachial cutaneous to ulnar nerve transfer in children with global brachial plexus injuries. Hand (N Y). 2010;5(4):370–3.

    Article  Google Scholar 

  22. Moore AM, Franco M, Tung TH. Motor and sensory nerve transfers in the forearm and hand. Plast Reconstr Surg. 2014;134(4):721–30.

    Article  CAS  Google Scholar 

  23. Sallam AA, El-Deeb MS, Imam MA. Nerve transfer versus nerve graft for reconstruction of high ulnar nerve injuries. J Hand Surg Am. 2017;42(4):265–73.

    Article  Google Scholar 

  24. Oberlin C, Teboul F, Severin S, Beaulieu JY. Transfer of the lateral cutaneous nerve of the forearm to the dorsal branch of the ulnar nerve, for providing sensation on the ulnar aspect of the hand. Plast Reconstr Surg. 2003;112(5):1498–500.

    Article  Google Scholar 

  25. Bertelli JA, Soldado F, Rodrigues-Baeza A, Ghizoni MF. Transfer of the motor branch of the abductor digiti quinti for thenar muscle reinnervation in high median nerve injuries. J Hand Surg Am. 2018;43(1):8–15.

    Article  Google Scholar 

  26. Ozkan T, Ozer K, Gulgonen A. Restoration of sensibility in irreparable ulnar and median nerve lesions with use of sensory nerve transfer: long-term follow-up of 20 cases. J Hand Surg Am. 2001;26(1):44–51.

    Article  CAS  Google Scholar 

  27. Schultz RJ, Aiache A. An operation to restore opposition of the thumb by nerve transfer. Arch Surg. 1972;105(5):777–9.

    Article  CAS  Google Scholar 

  28. Wang Y, Zhu S. Transfer of a branch of the anterior interosseus nerve to the motor branch of the median nerve and ulnar nerve. Chin Med J. 1997;110(3):216–9.

    CAS  PubMed  Google Scholar 

  29. Bertelli JA, Ghizoni MF. Very distal sensory nerve transfers in high median nerve lesions. J Hand Surg Am. 2011;36(3):387–93.

    Article  Google Scholar 

  30. Turnbull F. Restoration of digital sensation after transference of nerves. J Neurosurg. 1963;20:238–40.

    Article  CAS  Google Scholar 

  31. Harris RI. The treatment of irreparable nerve injuries. Can Med Assoc J. 1921;11(11):833–41.

    CAS  PubMed  PubMed Central  Google Scholar 

  32. Hsiao EC, Fox IK, Tung TH, Mackinnon SE. Motor nerve transfers to restore extrinsic median nerve function: case report. Hand (N Y). 2009;4(1):92–7.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Maine General Medical Center, Department of Plastic Surgery, Augusta, ME, USA

    Joshua Allan Gillis

  2. Division of Plastic Surgery & Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA

    Steven L. Moran

Authors
  1. Joshua Allan Gillis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steven L. Moran
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven L. Moran .

Editor information

Editors and Affiliations

  1. Orthopaedic Specialists - UPMC, University of Pittsburgh, Pittsburgh, PA, USA

    Dean G. Sotereanos

  2. Orthopaedic Specialists - UPMC, University of Pittsburgh, Pittsburgh, PA, USA

    Loukia K. Papatheodorou

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Gillis, J.A., Moran, S.L. (2020). Nerve Transfers for Neuropathies of the Median and Ulnar Nerve. In: Sotereanos, D., Papatheodorou, L. (eds) Compressive Neuropathies of the Upper Extremity. Springer, Cham. https://doi.org/10.1007/978-3-030-37289-7_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-37289-7_18

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-37288-0

  • Online ISBN: 978-3-030-37289-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation