Combined median and ulnar nerve decompressions surgical technique
Subscribe to get full access to this operation and the extensive Upper Limb & Hand Surgery Atlas.
Learn the Combined median and ulnar nerve decompressions surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Combined median and ulnar nerve decompressions surgical procedure.
Compression of the ulnar nerve within Guyon’s canal is uncommon and is often seen in association with a local space occupying lesion such as an aneurysm or a piso-triquetral ganglion.
Median nerve compression within the carpal tunnel however, represents the commonest peripheral nerve entrapment treated by hand surgeons.
Decompression of each nerve individually is dealt with in the relevant sections on Orthoracle.com
In the rare situation that both median and ulnar nerves are compressed at the wrist, decompression and complete visualisation of both nerves may be achieved through a single ulnar sided approach which is described here.
All of the typical causes of median or ulnar nerve entrapment described elsewhere may contribute to a combined compression.
In the setting of a peripheral nerve clinic, combined compression of both median and ulnar nerves at the wrist is often seen in the context of a more proximal, cord or trunk level brachial plexus injury. Observing such patients recovery over several months may reveal a sudden slowing or even arrest of regeneration as the regenerating front approaches a fibro-osseous canal or tunnel. Although still poorly understood, some authors suggest that this phenomenon relates to an auto-compression of the nerve as it’s volume increases during axonal regeneration.
The key factors for a successful outcome in combined median and ulnar nerve decompression through a Guyons canal approach are firstly, adequate decompression and visualisation of the deep motor branch of the ulnar nerve by careful division of the hypothenar tendinous arch at the hook of hamate, and secondly, decompression of the median nerve by release of the transverse carpal ligament from its ulnar sided attachments.
Author: Tahseen Chaudhry, Consultant in hand and peripheral nerve surgery
Institution: University Hospitals Birmingham Birmingham, UK
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
Our content is designed for both Surgeons in independent practice and Surgeons in training.