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Targeted reinnervation has an efferent and an afferent component. Targeted muscle reinnervation is a method by which a spare muscle (the target muscle) of an amputated patient is denervated (its original nerves cut and/or de-activated), then reinnervated with residual nerves of the amputated limb. [1]
In general, reconstruction of the upper limb can only be performed if active elbow extension is present. This stabilizes the elbow and gives the patient a reach. It will also allow the transfer of the other muscles crossing the elbow joint (like the m. brachioradialis and m. extensor carpi radialis longus).
Trauma to the nerve by cutting out each fascicle and fibrosis, a build up of tissue as a reaction, that develops due to the dissections and number of sutures is a problem. [5] Group fasicular repair involves suturing group fascicles in the intraneural epineurium to line up the groups of fascicles.
Ulnar neuropathy at the cubital tunnel is diagnosed based on characteristic symptoms and signs. Intermittent or static numbness in the small finger and ulnar half of the ring finger, weakness or atrophy of the first dorsal interosseous, positive Tinel sign over the ulnar nerve proximal to the cubital tunnel, and positive elbow flexion test (elicitation of paresthesia in the small and ring ...
A harvested tendon, such as the palmaris tendon [11] from the forearm of the same or opposite elbow, the patellar tendon, hamstring, toe extensor or a donor's tendon , is then woven in a figure-eight pattern through the holes and anchored. [10] The ulnar nerve is usually moved to prevent pain, as scar tissue can apply pressure to the nerve. [11]
Various types of tissue may be transferred as a "free flap" including skin and fat, muscle, nerve, bone, cartilage (or any combination of these), lymph nodes and intestinal segments. An example of "free flap" could be a "free toe transfer" in which the great toe or the second toe is transferred to the hand to reconstruct a thumb.
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Acute or chronic disruption and/or attenuation of the ulnar collateral ligament often result in medial elbow pain, valgus instability, and impaired throwing performance. There are both non-surgical and surgical treatment options. [5]