Operative Techniques: Hand and Wrist Surgery

Tendon transfers for high median nerve injury

Indications In contrast to low median nerve injuries, the anterior interosseous nerve (AIN) is harmed in high median nerve injuries. This causes a loss of thumb interphalangeal (IP) joint flexion and index finger IP joint flexion. Both high and low…

Tendon transfers for low median nerve injury

Indications Median nerve injuries are classified as “low” injuries if they arise distal to the branch of the anterior interosseous nerve, causing functional loss that is limited to the intrinsic muscles of the hand: the abductor pollicis brevis (APB), the…

Median nerve epineural and group fascicular nerve repair

Indications Any deficits attributable to the median nerve with an associated laceration or injury along the course of the nerve, high-energy injuries associated with blunt trauma and no appreciable median nerve recovery on examination, and prior median nerve repairs with…

Ulnar nerve group fascicular repair

Indications Any deficit attributable to the ulnar nerve with an associated laceration or injury along the course of the nerve. High-energy injuries associated with blunt trauma and no appreciable recovery on examination. Prior nerve repairs with no appreciable recovery on…

Digital nerve repair

Indications The major mechanisms of nerve injury include crush/compression, tension/traction, and laceration of the digits. From superficial to deep, the layers of a peripheral nerve include the epineurium, perineurium, and endoneurium. Nerve injury can occur at any or all of…

Radial nerve decompression

Introduction Radial neuropathy can result from direct trauma or compression anywhere along the radial nerve’s course, from the brachial plexus through the spiral groove, radial tunnel, posterior interosseous nerve (PIN), or superficial branch of the radial sensory nerve. Three types…

Procedures for ulnar compressive neuropathy

Introduction The ulnar nerve is a mixed motor and sensory nerve. Compression leads to a constellation of symptoms that vary depending on the location. The two most common areas of compression include the elbow (the “cubital tunnel”) and the wrist/palm…

Endoscopic carpal tunnel release

Indications Indications are similar to those described for open carpal tunnel release ( Chapter 55 ). Clinical examination The clinical examination is similar to that described for open carpal tunnel release ( Chapter 55 ). EXAMINATION PEARLS The wrist is…

Open carpal tunnel release

Indications Signs and symptoms of carpal tunnel syndrome (CTS) include paresthesias, pain or numbness in the median nerve distribution (volar thumb, index, middle and radial one-half of ring finger), nocturnal neuropathic symptoms, and/or thenar muscle weakness or wasting. Carpal tunnel…