Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Health and Rehabilitation Sciences

Supervisor

MacDermid, Joy C.

Abstract

Navigating the complexities of proximal ulnar nerve lesions presents a formidable challenge, prompting an urgent call for standardized outcome measures in the realm of supercharged end-to-side (SETS) anterior interosseous nerve (AIN) to ulnar nerve transfer, compounded by the intricacies of ulnar nerve transposition. This thorough thesis takes a dual-method approach, utilizing a rigorous Delphi study in addition to a scoping review methodology to clarify the complex terrain of SETS procedures.

The scoping review comprehensively delves into the outcomes and associated factors of SETS procedures, unraveling the intricate recovery trajectories while shedding light on the hurdles of standardization. Additionally, it incorporates an expert insight consultation part, providing a unique perspective from seasoned practitioners in the field. Meanwhile, the Delphi study engages expert practitioners in discerning a consensus on essential outcome measures for AIN to ulnar nerve transfers, encompassing SETS and ulnar nerve decompression. Through iterative rounds of questionnaires, the study distills expert insights into a core set of outcome measures, providing a comprehensive framework for post-operative evaluation.

The culmination of these endeavors yields vital conclusions, emphasizing the imperative of bridging the knowledge gap surrounding outcome measures and advocating for the utility of SETS procedures, particularly in addressing severe cubital tunnel syndrome. The significance of this work transcends academic boundaries, extending its reach to guide both research and clinical practices, offering a nuanced understanding of upper extremity nerve transfers and charting a course for future advancements in the field.

Summary for Lay Audience

This research project delves into the complex world of hand function and nerve injuries, specifically focusing on the ulnar nerve, which plays a vital role in controlling hand movements and providing sensation to the ulnar side of the hand. When this nerve is disrupted, it can lead to a range of issues, including loss of pinch strength and digital dexterity, potentially resulting in a deformity known as claw hand. The project addresses the challenges associated with severe consequences of ulnar nerve injuries, particularly in cases of cubital tunnel syndrome or proximal ulnar nerve lesions.

We explore innovative surgical techniques, such as the supercharged end-to-side (SETS) transfer, to aid in the recovery of severe cases of ulnar neuropathy. Traditional approaches often face limitations, especially in cases where injuries are proximal, leading to poor motor function recovery. The SETS procedure overcomes these challenges by connecting nerves in a way that allows for quicker reinnervation, resulting in "double innervation" and potentially better functional outcomes.

To ensure the success of this surgical intervention, our project includes a scoping review with expert insights, comprehensively examining outcomes and factors associated with SETS procedures. We also conduct a Delphi study, engaging expert practitioners to establish a consensus on crucial outcome measures for the ulnar nerve decompression and the specific nerve transfer, providing a standardized approach for post-operative evaluations.

This research is crucial not only for clinicians and researchers but also for individuals facing the prospect of these surgeries. By addressing gaps in knowledge and standardizing outcome measures, our project aims to enhance the recovery process and guide future treatments for those affected by proximal ulnar nerve lesions. The findings have the potential to improve the lives of individuals dealing with the consequences of these injuries, offering hope for better functional recovery and overall hand health.

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