End-To-Side Transfer of the Anterior Interosseous Nerve (Supercharged End-To-Side) In Severe Compressive Neuropathies of the Ulnar Nerve

Abstract

Cubital tunnel syndrome is the second most common compressive neuropathy in the upper extremity after carpal tunnel syndrome. Severe cubital tunnel syndrome is confirmed by axonal loss in electromyography and conduction velocity less than 40 meters/second in the nerve conduction study. As the severity of compressive neuropathy of the ulnar nerve increases, the results of surgical treatment worsen. Axonal regeneration progresses at a rate of 1 to 3 millimeters per day; However, the muscle is irreversibly denervated after 12 to 18 months. Due to the great distance between the location of the compression, the elbow, and the intrinsic muscles of the hand, reinnervation race against time so that irreversible degeneration of the motor plate and subsequent muscle atrophy does not occur. The supercharged end-to-side transfer of the anterior interosseous nerve to the motor fascicle of the ulnar nerve, to treat severe compressive neuropathies, allows earlier neuroregeneration of the intrinsic muscles of the hand, maintaining the viability of the motor plate, while the affected ulnar nerve regenerates throughout its journey.