Advertisement

HAND

, Volume 10, Issue 3, pp 555–558 | Cite as

Ulnar nerve transection during Tommy John surgery: novel findings and approach to treatment

  • Benjamin Z. PhillipsEmail author
  • Christopher Stockburger
  • Susan E. Mackinnon
Article

Introduction

While iatrogenic injuries to peripheral nerves in sports-related surgeries are rare, the morbidity of a peripheral nerve injury can be substantial, particularly in the young, active patient population [8]. Medial ulnar collateral ligament (UCL) reconstruction with tendon graft (Tommy John surgery) is a safe and effective operative intervention in treating medial elbow instability in overhead throwing athletes [6, 9] and complications are rare. Ulnar nerve neurapraxia is the most commonly recognized nerve complication [4]. However, median nerve transection during tendon graft harvest has been reported [5, 7, 10, 11, 13]. We report the first documented case of a complete ulnar nerve transection following UCL reconstruction and present a novel surgical intervention to address this serious complication.

Case Report

A 19-year-old right hand-dominant male with medial UCL instability underwent UCL reconstruction. In the course of the surgical procedure, the ulnar nerve was...

Keywords

Ulnar Nerve Tendon Graft Ulnar Collateral Ligament Nerve Transfer Anterior Interosseous Nerve 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of Interest

Benjamin Z. Phillips declares that he has no conflict of interest.

Christopher Stockburger declares that he has no conflict of interest.

Susan E. Mackinnon declares that she has no conflict of interest.

Statement of Human and Animal Rights

No human subjects or animals were involved in this study.

Statement of Informed Consent

No informed consent was obtained for this retrospective review.

Supplementary material

Video 1

(WMV 42154 kb)

References

  1. 1.
    Barbour J, Yee A, Kahn LC, Mackinnon SE. Supercharged end-to-side anterior interosseous to ulnar motor nerve transfer for intrinsic musculature reinnervation. J Hand Surg [Am]. 2012;37(10):2150–9.CrossRefGoogle Scholar
  2. 2.
    Brown JM, Yee A, Mackinnon SE. Distal median to ulnar nerve transfers to restore ulnar motor and sensory function within the hand: technical nuances. Neurosurgery. 2009;65(5):966–77.CrossRefPubMedGoogle Scholar
  3. 3.
    Cain EL, Andrews JR, Dugas JR, et al. Outcome of ulnar collateral ligament reconstruction of the elbow in 1281 athletes: results in 743 athletes with minimum 2-year follow-up. Am J Sports Med. 2010;38(12):2426–34. doi: 10.1177/0363546510378100.CrossRefPubMedGoogle Scholar
  4. 4.
    Conway JE, Jobe FW, Glousman RE, Pink M. Medial instability of the elbow in throwing athletes. Treatment by repair or reconstruction of the ulnar collateral ligament. J Bone Joint Surg Am. 1992;74(1):67–83.PubMedGoogle Scholar
  5. 5.
    Geldmacher J. Median nerve as free tendon graft. Hand. 1972;4(1):56.CrossRefPubMedGoogle Scholar
  6. 6.
    Jobe FW, Stark H, Lombardo SJ. Reconstruction of the ulnar collateral ligament in athletes. J Bone Joint Surg Am. 1986;68(8):1158–63.PubMedGoogle Scholar
  7. 7.
    Kovacsy A. Removal of the median nerve instead of the palmaris longus tendon. Magy Traumatol Orthop Helyreall Seb. 1980;23(2):156–8.Google Scholar
  8. 8.
    Maak TG, Osei D, Delos D, Taylor S, Warren RF, Weiland AJ. Peripheral nerve injuries in sports-related surgery: presentation, evaluation, and management: AAOS exhibit selection. J Bone Joint Surg. 2012;94(16):e1211–10. doi: 10.2106/JBJS.K.01448.CrossRefPubMedGoogle Scholar
  9. 9.
    Purcell DB, Matava MJ, Wright RW. Ulnar collateral ligament reconstruction: a systematic review. Clin Orthop Relat Res. 2007;455:72–7. doi: 10.1097/BLO.0b013e31802eb447.CrossRefPubMedGoogle Scholar
  10. 10.
    Toros T, Vatansever A, Ada S. Accidental use of the median nerve as an interpositional material in first carpometacarpal joint arthroplasty. J Hand Surg (Br). 2006;31B(5):574–5.CrossRefGoogle Scholar
  11. 11.
    Vastamaki M. Median nerve as free tendon graft. J Hand Surg (Br). 1987;12(2):187–8.CrossRefGoogle Scholar
  12. 12.
    Vitale MA, Ahmad CS. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Am J Sports Med. 2008;36(6):1193–205. doi: 10.1177/0363546508319053.CrossRefPubMedGoogle Scholar
  13. 13.
    Weber RV, Mackinnon SE. Median nerve mistaken for palmaris longus tendon: restoration of function with sensory nerve transfers. Hand (N Y). 2007;2(1):1–4. doi: 10.1007/s11552-006-9011-5.CrossRefGoogle Scholar
  14. 14.
    Zhang J, Moore AE, Stringer MD. Iatrogenic upper limb nerve injuries: a systematic review. ANZ J Surg. 2011;81:227–36.CrossRefPubMedGoogle Scholar

Copyright information

© American Association for Hand Surgery 2014

Authors and Affiliations

  • Benjamin Z. Phillips
    • 1
    Email author
  • Christopher Stockburger
    • 2
  • Susan E. Mackinnon
    • 1
  1. 1.Division of Plastic and Reconstructive SurgeryWashington University School of MedicineSt. LouisUSA
  2. 2.Department of Orthopedic SurgeryWashington University School of MedicineSt. LouisUSA

Personalised recommendations