Types of Ulnar Nerve Transposition

Ulnar Nerve Transposition is the most common surgical way to treat a trapped ulnar nerve. The ulnar nerve is one of three primary nerves of one’s arm. It passes from one’s neck down to his/her hand and it can also be tapered in different places during its path. Based on the position of its compression, it may cause severe pain in one’s elbow, hand, wrist and fingers. The state of compression of the ulnar nerve is known as the ulnar nerve entrapment.

The compression may occur anywhere like below the collarbone or in the neck region. The most common position of nerve compression is behind the elbow. On the other hand, the ulnar nerve entrapment refers to a condition in which the nerve becomes swollen due to injury to the hand or the elbow. The symptoms of ulnar nerve entrapment include the swelling and softness around the elbow and severe muscle weakness which results in decreased grip strength of the hand. This can be treated by surgical as well as non-surgical methods. The most commonly practiced option is the ulnar nerve transposition.

Ulnar nerve damage at the elbow

Ulnar nerve damage at the elbow

The ultra nerve transposition can be of three types. They are the subcutaneous and intramuscular transposition, sub muscular transposition and the anterior sub muscular transposition. Without performing the transposition it is practically not possible for the compression forces to be relieved from the ulnar nerve’s position. In case of the subcutaneous type of transposition, this nerve is placed in between the forearm and arm just below the sub-cutaneous fat. In order to maintain the position, a fascia flap is present above the transposed nerve of the skin. The primary advantage of adopting this technique is that there are negligible chances of scar formation and the compression at the place of transposition. But sometimes it so happens that in patients with scant subcutaneous tissue this may be vulnerable. The intramuscular transposition facilitates a properly vascularized position for this nerve.
Sub cutaneous transposition is a technique in which this nerve is placed in an inter-muscular interval. This is the place where the nerves usually run. In this technique, the nerve is placed in a vascular bed which is comparatively free from the scar formation. Moreover it provides a direct path from the position of arm to the forearm. There may be some complications as like the elbow contracture. Submuscular transposition has proved to be far better than the cubital tunnel surgery. The former has been considered as the best revision surgery in case of failure of this cubital tunnel surgery. This technique proves to be the most effective in case of moderate ulnar nerve compression.
The anterior ulnar nerve transposition is done using a non compressing fasciodermal sling. The medial intermuscular sling is considered as the fascial sling. This sling is used to provide a control to the posterior nerve subluxation. The approximate length of the fascial band is 1cm. The inter-muscular septum is divided and its free end has been sutured to the fascia. The complications in this technique include the injury of the medial cutaneous nerve. There are chances of recurrent compression to occur because of the proximal sutures. As compared to other techniques of transposition, this technique has shown more scarring.