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Peripheral Nerve Issues after Orthopedic Surgery pp 167–185Cite as

Median and Ulnar Nerve Injury at the Elbow and Wrist

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Abstract

Cubital tunnel and carpal tunnel releases are amongst the most frequently performed orthopedic procedures. Iatrogenic nerve injury during these procedures is relatively uncommon but when it occurs, results in devastating outcomes for patients. Additionally, the ulnar nerve at the elbow and median nerve at the wrist are often encountered during periarticular elbow injuries and distal radius fractures, respectively. Thus, it is crucial for surgeons to understand the relevant anatomy and surgical technique to avoid complications. Failed cubital tunnel release may require revision which involves neurolysis, transposition, and nerve wrapping with an adipose fat flap or biologic implants. Ulnar nerve injury at the elbow most commonly results in loss of thumb adduction and a clawing deformity due to loss of intrinsic function. Salvage procedures following ulnar nerve injury at the elbow include nerve transfer techniques such as AIN to ulnar nerve and numerous tendon transfer techniques. Similarly, revision carpal tunnel necessitates an extensive neurolysis and possible nerve wrapping. Median nerve injury at the wrist results in loss of thumb opposition and abduction due to the loss of innervation of the thenar muscles; there are several tendon transfers described that can help restore function.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery at Vanderbilt University Medical Center, Nashville, TN, USA

    Callie Jewett

  2. Division of Hand and Upper Extremity, Department of Orthopaedic Surgery at Vanderbilt University Medical Center, Nashville, TN, USA

    Mihir Desai

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  1. Callie Jewett
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  2. Mihir Desai
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Correspondence to Callie Jewett .

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Editors and Affiliations

  1. Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA

    Christopher J. Dy

  2. Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA

    David M. Brogan

  3. Department of Orthopedic Surgery, Emory University, Atlanta, GA, USA

    Eric R. Wagner

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Jewett, C., Desai, M. (2022). Median and Ulnar Nerve Injury at the Elbow and Wrist. In: Dy, C.J., Brogan, D.M., Wagner, E.R. (eds) Peripheral Nerve Issues after Orthopedic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-84428-8_8

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