ULNAR NERVE RECONSTRUCTION ppt
-
Upload
diyar-abdulwahid-salih -
Category
Documents
-
view
150 -
download
6
description
Transcript of ULNAR NERVE RECONSTRUCTION ppt
![Page 1: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/1.jpg)
ULNAR NERVE ULNAR NERVE INJURYINJURY
Dr. Diyar A. Salih
Plastic Surgery Resident
KURDISTAN, SLEMANI
![Page 2: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/2.jpg)
Main branch of the medial cord
![Page 3: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/3.jpg)
Axilla: post (bet. Axillary A. & V)
Arm: medial to brachial A.
Elbow: post. to medial epicondyle (Cubital tunnel) bet. FCU heads.
Forearm: along medial side of FDP, adjacent to ulnar A.Wrist: Guyon’s tunnel, adjacent to pisiform, deep to ulnar art.
Superficial sensory branch
Brachial A.
Deep motor branch
![Page 4: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/4.jpg)
SensationSensation
![Page 5: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/5.jpg)
Forearm:Forearm:1.1. FCU.FCU.2.2. FDP (ring & little finger).FDP (ring & little finger).
HandHand::1.1. Hypothenar M:Hypothenar M:
• Abductor digiti minimi M.Abductor digiti minimi M.• Flexor digiti minimi.Flexor digiti minimi.• Oppenens digiti minimi.Oppenens digiti minimi.
2.2. Seven interosseous M. (4 dorsal & 3 palmar).Seven interosseous M. (4 dorsal & 3 palmar).3.3. Adductor pollicis.Adductor pollicis.4.4. Ring & little finger lumbricals.Ring & little finger lumbricals.5.5. Flexor pollicis brevis.Flexor pollicis brevis.
MotorMotor
![Page 6: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/6.jpg)
ForearmForearm
FDP (ring & FDP (ring & little finger)little finger)
![Page 7: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/7.jpg)
4 dorsal & 3 palmar interosseous4 dorsal & 3 palmar interosseous
![Page 8: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/8.jpg)
Hypothenar musclesHypothenar muscles
![Page 9: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/9.jpg)
Lumbricals (ring & little finger)Lumbricals (ring & little finger)
![Page 10: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/10.jpg)
Adductor pollicisAdductor pollicis
![Page 11: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/11.jpg)
Flexor pollicis brevisFlexor pollicis brevis
35% overlap by Median nerve.
![Page 12: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/12.jpg)
1.1. Neuropraxia.Neuropraxia.
2.2. Axonotmesis.Axonotmesis.
3.3. Neurotmesis.Neurotmesis.
Types of injuriesTypes of injuries
![Page 13: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/13.jpg)
UpperUpper Lower Lower
CLASSIFICATIONCLASSIFICATION
NeckNeck
Brachial plexusBrachial plexus
At ElbowAt Elbow
Below elbowBelow elbow
WristWrist
![Page 14: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/14.jpg)
Causes
1. ACUTE1. ACUTE• Trauma (fracture)Trauma (fracture)• Wrong postureWrong posture• SurgerySurgery• Electrical burnElectrical burn
2. CHRONIC2. CHRONIC• Tight nerve passagesTight nerve passages• TumorsTumors
CausesCauses
![Page 15: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/15.jpg)
Presentations
1.1. PainPain2.2. Sensation lossSensation loss3.3. Motion lossMotion loss4.4. Power lossPower loss5.5. Reflexes lossReflexes loss6.6. WastingWasting7.7. Trophic changes Trophic changes (skin,sc,neurovascular,bones,muscles)(skin,sc,neurovascular,bones,muscles)
8.8. ContracturesContractures
PresentationsPresentations
![Page 16: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/16.jpg)
• Clinical examinationClinical examination
• X-RAYX-RAY
• EMG (electromyography).EMG (electromyography).
• NCS (nerve conduction studies).NCS (nerve conduction studies).
• MRIMRI
DiagnosisDiagnosis
![Page 17: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/17.jpg)
• F:\Ulnar nerve exam.flv
Ulnar nerve examinationUlnar nerve examination
![Page 18: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/18.jpg)
Low ulnar nerve palsyLow ulnar nerve palsy
![Page 19: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/19.jpg)
Claw deformityClaw deformity
![Page 20: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/20.jpg)
Lumbrical muscles palsy
![Page 21: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/21.jpg)
Adductor pollicis
1st dorsal interosseous
![Page 22: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/22.jpg)
CompensationCompensation
FPL (stabilize thumb)
EPL (adduct thumb)Froment’s sign
![Page 23: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/23.jpg)
Froment’s signFroment’s sign
AtrophyAtrophy
NormalNormal
![Page 24: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/24.jpg)
Wartenburg’s signWartenburg’s sign
Inability to Inability to adduct little adduct little finger against finger against EDM pull.EDM pull.
Little finger ulnar deviation
![Page 25: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/25.jpg)
Earle’s signEarle’s sign
• Inability to abduct the middle finger to cross over the index finger dorsally.
![Page 26: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/26.jpg)
High ulnar nerve palsyHigh ulnar nerve palsy
• Less clawing.
• Reconstruction can improve function but not total improvement.
![Page 27: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/27.jpg)
Treatment of injuriesTreatment of injuries
• Direct repair (tension free)
![Page 28: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/28.jpg)
Nerve graft
• If > 1 cm defect or repaired under tension.
![Page 29: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/29.jpg)
Nerve conduit
![Page 30: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/30.jpg)
Tendon transferTendon transfer
![Page 31: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/31.jpg)
IncisionsIncisions
Upper arm: Medial incision
![Page 32: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/32.jpg)
At the elbow: over cubital tunnel
![Page 33: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/33.jpg)
Forearm: along ulnar mid-axial line, splitting FCU two heads.
![Page 34: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/34.jpg)
At the wrist: at the pisiform, extending distally parallel to the skin crease at the base of thenar eminence
![Page 35: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/35.jpg)
Low ulnar nerve injury repair
• F:\Low ulnar nerve injury.flv
![Page 36: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/36.jpg)
Other measures (alone or with Other measures (alone or with Tendon transfer)Tendon transfer)
• Prevention of MCP joint hyperextension:
1. MCP joint arthrodesis.
2. MCP joint capsulodesis.
3. Bone block on the dorsum of the MCP joint head.
![Page 37: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/37.jpg)
Guyon’s tunnel syndromeGuyon’s tunnel syndrome(Handlebar palsy)(Handlebar palsy)
Palmar sensory branchPalmar sensory branch
Motor branchMotor branch
Ulnar A.Ulnar A.
Intrinsic M.Intrinsic M.
Hypothenar M.Hypothenar M.
![Page 38: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/38.jpg)
GTS causesGTS causes
Direct traumaDirect trauma
Ulnar A. Ulnar A. aneurysmaneurysm
![Page 39: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/39.jpg)
Sensation lossSensation loss
Not dorsal surfacesNot dorsal surfaces:
Ulnar N. branch 4-5 cm above Guyon’s canal (subcutaneously, distal to ulnar styloid process).
![Page 40: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/40.jpg)
GTSGTS treatment (surgical treatment (surgical decompression)decompression)
Pisohamate ligament
![Page 41: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/41.jpg)
Cubital tunnel syndromeCubital tunnel syndrome
Post. to MEC
![Page 42: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/42.jpg)
![Page 43: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/43.jpg)
Cubital tunnel syndromeCubital tunnel syndrome
Strong fibrous Strong fibrous conduitconduit
•True nerve compression.
•Nerve adhesion.
•Prevent nerve gliding.
•Stretch ischemiaischemia.
•Impairs nerve conduction
![Page 44: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/44.jpg)
Sensation lossSensation loss
Dorsal surfacesDorsal surfaces
![Page 45: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/45.jpg)
Cubital tunnel syndromeCubital tunnel syndrome
• Acute flexion of elbow for 30 min30 min accentuates the sensory symptoms.
• cubital tunnel.flv
![Page 46: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/46.jpg)
• F:\Tinel test & Froment test.flv
Tinel sign & Froment testTinel sign & Froment test
![Page 47: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/47.jpg)
• Early cases: static elbow extension splint.
TreatmentTreatment
![Page 48: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/48.jpg)
• Chronic cases: Ulnar nerve transposition anterior to the elbow axis of rotation.
TreatmentTreatment
![Page 49: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/49.jpg)
Incision over the cubital tunnel
![Page 50: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/50.jpg)
Posterior to MECPosterior to MEC
Anterior to MECAnterior to MEC
Medial epicondyle
![Page 51: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/51.jpg)
Ulnar nerve anterior Ulnar nerve anterior transpositiontransposition
• F:\Anterior transposition of the ulnar nerve.flv
![Page 52: ULNAR NERVE RECONSTRUCTION ppt](https://reader033.fdocuments.us/reader033/viewer/2022061116/54664077b4af9f645d8b4d0a/html5/thumbnails/52.jpg)