American Society for Peripheral Nerve
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Ulnar Nerve Compression After Biceps-to-Triceps Tendon Transfer for Elbow Extension Reconstruction in Tetraplegia: Presentation of a Clinical Entity and Surgical Technique
Elie Boghossian, MD, M.Sc., FRCSC1; Valérie Gervais, MD2; Dominique Tremblay, MD, OT3; Scott H Kozin, MD?
1CIUSSS de l'Est-de-l'Ile-de-Montreal, Montreal, QC, Canada; 2Université de Montréal, Montreal, QC, Canada; 3CIUSSS de l’Est-de-l’Ile-de-Montreal, Montreal, QC, Canada; 4Shriners Hospital for Children Philadelphia, Philadelphia, PA

Introduction
Medially routed biceps-to-triceps tendon transfer for elbow extension reconstruction in C7 and above spinal cord injury (SCI) patients has proven itself to be a successful and reliable procedure. The technique classically placed the tendon transfer superficial to a non-functional ulnar nerve, with a theoretical risk of compression neuropathy. The authors have changed their surgical technique to diminish this potential risk and place the tendon deep to the ulnar nerve.
Material and Methods
The authors present a case of symptomatic delayed bilateral ulnar nerve compression after a biceps-to-triceps transfer in a C6-level SCI patient. He complained of shooting arm pain and augmented upper extremity spasms after repetitive elbow flexion motion. Nerve conduction studies and dynamic ultrasound tests confirmed the compression neuropathy.
Results
The ulnar nerve was found to be severely compressed by the tendinous part of the transfer in bilateral arms. The authors describe the surgical technique used to decompress the nerve and perform an anterior transposition without taking down the rerouted biceps tendon. The patient presented favorable outcomes following surgery without any loss in elbow extension.
Conclusion Ulnar nerve compression after a biceps-to-triceps tendon transfer is a recognized entity. Although rare and potentially symptomatic, this complication can be managed surgically by anterior nerve transposition without taking down the rerouted biceps tendon. This tendon transfer should be performed deep to the ulnar nerve at the elbow to avoid this complication.


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