Supercharged end-to-side anterior interosseous nerve transfer to restore the intrinsic motor function in osteoarthritis-induced cubital tunnel syndrome.

Abstract

There have been no reports on treating motor deficits caused by ulnar nerve palsy (cubital tunnel syndrome) in patients with elbow osteoarthritis, except for traditional ulnar nerve management around the elbow joint. Herein, we report favorable outcomes of supercharged end-to-side anterior interosseous nerve (AIN) transfer to the motor branch of the ulnar nerve in patients with concurrent elbow arthritis based on a retrospective case series. From 2019 to 2022, 27 patients with high ulnar nerve lesions showing intrinsic muscle wasting, paralysis, and weakness in the hand were analyzed. Elbow arthritis was diagnosed by radiographs, and neuropathy was evaluated using electrophysiologic studies (nerve conduction studies and electromyograms). We fully adhered to Mackinnon's refined electrophysiologic criteria for deciding on an additional AIN transfer as an adjunct to the primary ulnar nerve procedure at the elbow. In the 27 patients, the mean age was 54 years. The mean duration of symptom onset was 23 ± 5 months. Thirteen patients were categorized as having stage 1 elbow arthritis and 14 were categorized as having stage 2 elbow arthritis. The mean preoperative flexion-extension arc was 121°. The dominant hand was affected in 14 patients. Additional procedures beyond decompression for cubital tunnel syndrome, such as spur resection, ganglionectomy, and anterior transposition of the ulnar nerve, were performed in 15 patients. Grip strength and grip strength modifications were all statistically significant after surgery. Key and oppositional pinch strengths and Disabilities of the Arm, Shoulder, and Hand scores significantly improved (P < .001). However, when these improvements were compared based on hand dominance, only the recovery of the first dorsal interosseous-Medical Research Council grade and Disabilities of the Arm, Shoulder, and Hand scores were statistically significant in cases with dominant hand involvement. In cases of compressive ulnar nerve palsy associated with elbow arthritis, supercharged end-to-side AIN should be considered a viable option for restoring hand function by reinforcing intrinsic muscle strength, in addition to managing the arthritic elbow and performing various decompression procedures at the cubital tunnel.