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Supercharge End-to-Side Anterior Interosseous-to-Ulnar Motor Nerve Transfer Restores Intrinsic Function in Cubital Tunnel Syndrome
Jana Dengler, MD, Washington University School of Medicine, St Louis, MO; Sunnybrook Health Sciences Centre, Toronto, ON, Canada, Utku Dolen, MD, Washington University, St Louis, MO, J. Megan M. Patterson, MD, Department of Orthopaedics, University of North Carolina, Chapel Hill, NC, Kristen M Davidge, MD, MSc, FRCS(C), The Hospital for Sick Children, Toronto, ON, Canada, Lorna C. Kahn, PT, CHT, Milliken Hand Rehabilitation Center, The Rehabilitation Institute of St Louis, Saint Louis, MO, Andrew Yee, BS, Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO and Susan E Mackinnon, MD, Washington University School of Medicine, Saint Louis, MO

Background
The supercharge end-to-side anterior interosseous nerve (AIN)-to-ulnar motor nerve transfer (SETS) offers a viable option to enhance recovery of intrinsic function following ulnar nerve injury. However, in the setting of chronic ulnar nerve compression neuropathy where the timing of onset of axonal loss is unclear, there is a deficit in the literature on outcomes after SETS nerve transfer.

Methods
A retrospective study of patients who underwent SETS for severe cubital tunnel syndrome over a 5 year period was performed. The primary outcomes were improvement in first dorsal interosseous (FDI) Medical Research Council (MRC) grade at final follow-up and time to re-innervation. Change in key pinch strength, grip strength, and Disabilities of the Arm Shoulder and Hand (DASH) questionnaire scores were also evaluated using paired t-tests and Wilcox signed-rank tests.

Results
Forty-two patients with severe cubital tunnel syndrome were included in this study. Postoperative FDI muscle strength, key pinch strength, and DASH scores improved significantly from baseline. In three patients, SETS was unsuccessful. Other than age, there were no significant clinical or diagnostic variables that were predictive of failure. There was no threshold of CMAP amplitude below which SETS was unsuccessful.

Conclusion
This study provides the first cohort of outcomes following SETS in chronic ulnar compression neuropathy alone and underscores the importance of appropriate patient selection. Prospective cohort studies and randomized controlled trials with standardized outcome measures are required.


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