Browsing by Subject "Median nerve"

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    Decreased Rate of Complications in Carpal Tunnel Release with Hand Fellowship Training
    (Thieme, 2018-04) Mathen, Santosh J.; Nosrati, Naveed N.; Merrell, Gregory A.; Graduate Medical Education, IU School of Medicine
    Purpose: In many procedures, both high case volumes and fellowship training have been shown to improve outcomes. One of the most common procedures performed by hand surgeons, the carpal tunnel release (CTR) is also performed by several other specialties without specialty training in a hand fellowship. This study analyzed the effect that hand fellowship training has on outcomes of CTRs. Materials and Methods: Using the American Board of Orthopedic Surgeons (ABOS) Part II candidates' case list submissions, a database was created for all open and endoscopic CTRs. Surgeon training, demographics, technique, and complications were recorded. Complications were then categorized and broken down by technique. Results were then analyzed for statistical significance. Results: A total of 29,916 cases were identified. Hand fellowship-trained surgeons performed six times more CTRs at 31 cases per surgeon compared with five for non-hand fellowship-trained surgeons. They also improved outcomes in rates of infection, wound dehiscence, and overall complications. Rates of nerve injury or recurrence showed no statistical difference. This held true for the open release subset. Endoscopically, fellowship-trained surgeons had only improved rates of overall complications. Conclusion: Surgeons undergoing additional hand fellowship training may show improved outcomes in the surgical treatment of carpal tunnel syndrome. However, no effect was seen on nerve injury or recurrence of symptoms.
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    Outcomes after Anterior Interosseous Nerve to Ulnar Motor Nerve Transfer
    (Thieme, 2023-01-11) Gross, Jeffrey N.; Dawson, Steven E.; Wu, Gerald J.; Loewenstein, Scott; Borschel, Gregory H.; Adkinson, Joshua M.; Surgery, School of Medicine
    Background: Ulnar nerve lesions proximal to the elbow can result in loss of intrinsic muscle function of the hand. The anterior interosseous nerve (AIN) to deep motor branch of the ulnar nerve (DBUN) transfer has been demonstrated to provide intrinsic muscle reinnervation, thereby preventing clawing and improving pinch and grip strength. The purpose of this study was to evaluate the efficacy of the AIN to DBUN transfer in restoring intrinsic muscle function for patients with traumatic ulnar nerve lesions. Methods: We performed a prospective, multi-institutional study of outcomes following AIN to DBUN transfer for high ulnar nerve injuries. Twelve patients were identified, nine of which were enrolled in the study. The mean time from injury to surgery was 15 weeks. Results: At final follow-up (mean postoperative follow-up 18 months + 15.5), clawing was observed in all nine patients with metacarpophalangeal joint hyperextension of the ring finger averaging 8.9 degrees (+ 10.8) and small finger averaging 14.6 degrees (+ 12.5). Grip strength of the affected hand was 27% of the unaffected extremity. Pinch strength of the affected hand was 29% of the unaffected extremity. None of our patients experienced claw prevention after either end-to-end ( n  = 4) or end-to-side ( n  = 5) AIN to DBUN transfer. Conclusion: We conclude that, in traumatic high ulnar nerve injuries, the AIN to DBUN transfer does not provide adequate intrinsic muscle reinnervation to prevent clawing and normalize grip and pinch strength.