Operative Techniques in Orthopedics: Ulnar Nerve Transfers

Abstract

Ulnar nerve injuries, whether traumatic or iatrogenic, lead to profound motor and sensory impairments, including reduced grip strength, fine motor dysfunction, and deformities like claw hand. The ulnar nerve, originating predominantly from the C8-T1 roots, traverses anatomically significant regions like the cubital tunnel and Guyon's canal, where it innervates muscles critical for hand function and provides sensory input to the ulnar hand and fingers. Functional recovery is constrained by the slow axonal regeneration rate (1 mm/day) and delayed presentation, necessitating alternative treatments such as nerve and tendon transfers. Diagnostic evaluation, including electrodiagnostic testing, imaging, along with clinical assessment is essential for treatment planning. Commonly performed transfers include the anterior interosseous nerve (AIN)-to-ulnar nerve transfers for proximal injuries and the opponens pollicis to deep ulnar motor branch for distal injuries. The development of novel nerve transfer and improved surgical techniques have demonstrated promising success for improving motor reinnervation and sensory restoration. These techniques have transformed the prognosis for ulnar nerve injuries, offering functional recovery and improved quality of life.