Article
Hand Therapy program following AIN-to-ulnar motor group nerve transfer after failed cubital tunel surgery with intrinsic palsy applying specific “donator push” techniques, splinting and desensitization programme
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Authors
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Martina Pollwein
- PhysioCanarias Centro de Fisioterapia y Terapia de la Mano, Santa Cruz de Tenerife, Spain
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Roberto Sánchez Rosales
- GECOT Unidad de Cirugía de la Mano y Microcirugía, San Cristobal de La Laguna, Spain
| Published: | February 6, 2020 |
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Outline
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Clinical issue/s: The purpose of this work is to present the specific treatment in postoperative follow-up of Anterior Interosseous Nerve (AIN) to ulnar motor nerve Supercharge End-to-side (SETS) transfer in patients with severe neuropathy of the ulnar nerve at the elbow secondary to failed Cubital Tunnel surgery. Transfer of the AIN of the pronator quadratus (PQ) muscle as donor to the ulnar nerve muscle fascicles allows an accelerated regeneration to the damaged nerve and early recovery of the corresponding intrinsic muscles.
Rehabilitation includes facilitation of intrinsic muscles by specific "donator push" exercises, adjuvant splinting and nerve desensitization programme.
A case series.
Clinical reasoning: Inclusion criteria: Severe neuropathy of the ulnar nerve at elbow level with atrophy of the tributary intrinsic muscles treated by anterior transposition of the ulnar nerve at the elbow plus AIN transposition to motor fascicle of the ulnar nerve in the distal 1/3 of the forearm.
Exclusion criteria: Absence of active motor plates in intrinsic muscles proved by neurophysiological study.
Measurements: Froment Test, muscle testing in FDM, 1st Dorsal Interoseous, key pinch force test and strength of grip.
Results: At 12 weeks correction of deformities is observed as the sign of Wartenberg, the 5th finger abducted position, the deformity of clawing of the 4th and 5th finger as well as the Froment Test.
Clinical design: A case series of 3 patients.
Innovative, analytical or new approach: The simultaneous activation of both donator (PQ) and recipient (Intrinsic) muscles in rehabilitation after SETS nerve transposition accelerates recuperation of the damaged nerve and muscle recovery.
Contribution to advancing HT practice: A strict postoperative exercise protocol progressing from assistive to active-resistive with "donator push" in combination with thermoplastic splints used during night, day or while exercising to prevent undesirable compensatory activity ensured optimal benefit for nerve recuperation and recovery of the affected intrinsic muscles within the window of muscle reinnervation.
