Nerve Transfers for Ulnar Nerve Injury

Brachial plexus injury, and in particular injury to the ulnar nerve, represents a debilitating and complex disease process due to multifocal loss of hand function including wrist flexion, flexion of the ring and small finger, finger abduction and adduction, finger pinch, and dorsoulnar hand sensation. Workup for these injuries begins with a thorough history and physical examination and can include electrodiagnostic testing, as well as standard and advanced neuroimaging techniques. Timing of surgical intervention depends on a number of factors, including whether there is an open or closed injury mechanism, if the injury is proximal or distal, and if there is spontaneous recovery seen on serial electrodiagnostic testing. While historically surgical interventions for hand reanimation have been unsuccessful, advances in nerve transfer techniques in recent decades, including the anterior interosseous and posterior interosseous nerve branches to the deep motor branch of the ulnar nerve, have provided encouraging results for functional improvement. Undoubtedly, the development of future techniques with novel nerve donors will lead to further meaningful advancements in this field.