Results of the Musculofascial Lengthening Technique for Submuscular Transposition of the Ulnar Nerve at the Elbow by A. Lee Dellon, and J. Henk Coert JBJS

Results of the Musculofascial Lengthening Technique for Submuscular Transposition of the Ulnar Nerve at the

Elbow

by A. Lee Dellon, and J. Henk Coert

JBJS Essent Surg TechVolume os-86(1 suppl 2):169-179

September 1, 2004

©2004 by The Journal of Bone and Joint Surgery, Inc.

The incision for the submuscular transposition of the ulnar nerve crosses the territories of the medial antebrachial and medial brachial cutaneous nerves, injury to either of which may be the

source of postoperative incisional pain and the formation of a pa...

A. Lee Dellon, and J. Henk Coert J Bone Joint Surg Am 2004;os-86:169-179


The fascia from the medial head of the triceps to the medial intermuscular septum is opened to reveal the ulnar nerve inferiorly and posteriorly.



The medial antebrachial cutaneous nerve is protected with a vessel loop as the medial intermuscular septum is excised.



The roof of the cubital tunnel is then opened.



The musculofascial lengthening is best understood in terms of a z-cut or step-cut in the flexor-pronator muscle mass.



Intraoperative photograph showing the neurolysis of the ulnar nerve completed and the markings for the musculofascial lengthening drawn on the flexor-pronator fascia.



The common flexor tendon is divided down to the elbow joint capsule.



The common flexor tendon is dissected from the joint capsule, distally, so that the surgeon does not leave a fibrous ridge on which the ulnar nerve might lie.



Intraoperative photograph demonstrating distal division of the lacertus fibrosus to permit distal rotation of the muscle flap.



The periosteal origin of the flexor carpi ulnaris muscle, the analog of the medial intermuscular septum proximally, is released distally from the ulna.



The submuscular transposition is completed by elevating the flap from the medial humeral epicondyle so that it can reach the fascial flap.



Intraoperative photograph showing the ulnar nerve transposed to lie on the brachialis muscle.



The ulnar nerve now lies anteriorly on the brachialis muscle.



Intraoperative photograph showing the two flaps sutured in the advanced or lengthened position with use of three horizontal mattress sutures.



Intraoperative photograph demonstrating that there is room for the surgeon's finger to pass beneath the flap.



Documents

Results of the Musculofascial Lengthening Technique for Submuscular Transposition of the Ulnar Nerve at the Elbow by A. Lee Dellon, and J. Henk Coert JBJS