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Restoration of ulnar nerve motor function by pronator quadratus motor branch: an anatomical study

  • Experimental research - Neurosurgical Anatomy
  • Published:
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Abstract

Background

The traditional surgical approach to repair of brachial plexus lesions involves use of whole segment ulnar nerve graft for contralateral seventh cervical (cC7) nerve root transfer, which sabotages the possibility of ulnar nerve recovery. We assessed the anatomical feasibility of a new approach that involves preservation of the motor branch of ulnar nerve (MBUN), for a later stage repair using the recovered pronator quadratus motor branch (PQMB), subsequent to the cC7 transfer procedure.

Methods

Twenty-seven adult cadaver arms and one side of fresh adult cadaver were used in this study. The anterior interosseous nerve and its PQMB, as well as the motor and sensory branches of the ulnar nerve were dissected. The distances from the end of PQMB to the mid-point of a line joining the radial styloid and ulnar styloid, as well as to the point of divergence of the ulnar nerve, were measured. The MBUN was dissected from distal to proximal and the maximum length was measured. The diameter and number of axons of the nerve branches were also recorded.

Results

The distance from the end of the PQMB to the midpoint of the radial styloid and ulnar styloid was 6.04 ± 0.52 cm, and that to the point of divergence of the ulnar nerve was 8.02 ± 0.63 cm. The maximum length of the MBUN after its dissociation was 9.70 ± 1.38 cm. The mean diameters of axons of the MBUN and PQMB were 0.09 ± 0.02 cm and 0.05 ± 0.01 cm, respectively. The corresponding mean numbers of axons were 2913 ± 624 and 757 ± 183, respectively.

Conclusions

The results indicate that the PQMB is suitable for transferring to the MBUN without nerve graft. This anatomical study paves the way for further testing of this new procedure after cC7 transfer in clinical settings.

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Authors and Affiliations

  1. Department of Hand Surgery, Huashan Hospital, Fudan University, No. 12 Wulumuqizhong Road, Shanghai, 200040, People’s Republic of China

    Jing Rui, Yingjie Zhou, Le Wang, Yudong Gu & Jie Lao

  2. Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, 200040, People’s Republic of China

    Jing Rui, Jifeng Li & Yudong Gu

  3. Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, 200040, People’s Republic of China

    Jifeng Li & Jie Lao

Authors
  1. Jing Rui
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  2. Yingjie Zhou
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  3. Le Wang
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  4. Jifeng Li
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  5. Yudong Gu
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  6. Jie Lao
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Corresponding author

Correspondence to Jie Lao.

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Funding

Huashan Hospital, Fudan University provided financial support in the form of Scientific Research project (Grand No. 2013QD02). The National Natural Science Foundational of China provided financial support in the form of National Natural Science Fund of China (Grand No. 81572127). The sponsor had no role in the design or conduct of this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Comment

This article demonstrates the anatomical feasibility of performing distal neurotization of the motor branch of the ulnar nerve with a distal median nerve branch to the pronator quadratus muscle. Although surgically feasible, as the authors point out only future clinical trials will demonstrate whether this procedure has any clinical benefit, especially in the setting of a severe brachial plexus injury treated with a contralateral C7 here transfer mediated by an ulnar nerve graft.

Michel Kliot

Illinois, USA

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Rui, J., Zhou, Y., Wang, L. et al. Restoration of ulnar nerve motor function by pronator quadratus motor branch: an anatomical study. Acta Neurochir 158, 755–759 (2016). https://doi.org/10.1007/s00701-016-2728-1

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  • DOI: https://doi.org/10.1007/s00701-016-2728-1

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