153 Ulnar Nerve Submuscular Transposition
♦ Preoperative
Special Equipment
- Basic tray
Operating Room Set-up
- Headlight
- Loupes
Anesthetic Issues
- General anesthesia in most cases of transposition; regional blocks are preferred by some practitioners and/or institutions.
- Perioperative antibiotics (first generation cephalosporin)
- Pad patient appropriately.
Miscellaneous
- A simple decompression is generally appropriate for all patients as a first procedure (Fig. 153.1); some practitioners prefer to begin with a transposition procedure rather than a simple decompression when preoperative examination reveals an ulnar nerve that translocates out of the ulnar groove during elbow flexion.
- If the patient’s condition fails to improve several months following a simple decompression, then a submuscular decompression may be used as a bailout procedure.
- Some practitioners prefer a submuscular over the subcutaneous transposition procedure.
♦ Intraoperative
Positioning
- Patient is supine, arm outstretched at 90 degrees on an armboard in a position of supination
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