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. 2025 Jun 9;17(6):e85597.
doi: 10.7759/cureus.85597. eCollection 2025 Jun.

Anterior Interosseous Nerve to Pronator Quadratus Transfer to Restore Intrinsic Function: An Adjunct to Cubital Tunnel Decompression

Ahmed Elfaki  1 , William M Nabulyato  2 , Haneen Abed  1 , Mohini Panikkar  1 , David Izadi  1
Affiliations

Anterior Interosseous Nerve to Pronator Quadratus Transfer to Restore Intrinsic Function: An Adjunct to Cubital Tunnel Decompression

Ahmed Elfaki et al. Cureus. .

Abstract

Background Injury or compression of the ulnar nerve impairs fine motor control, intrinsic hand function, and sensation in the small and ulnar side of the ring finger. Anterior interosseous nerve to pronator quadratus (AINPQ) transfer offers a potential solution, leveraging this expendable nerve to enhance the recovery of the ulnar nerve's motor function. Method This single-unit retrospective case series evaluates seven patients undergoing combined cubital tunnel decompression and AINPQ transfer for severe ulnar neuropathy. Data were collected from December 2020 to January 2023, including age, hand dominance, affected limb, and symptom duration (pain, sensory changes, motor weakness). The cohort comprised cases of both compressive and traumatic ulnar nerve injuries. Electrophysiological findings, intraoperative observations, postoperative assessments, and complications were recorded. Outcomes were measured using the Disabilities of the Arm, Shoulder, and Hand questionnaire at least six months postoperatively, with success defined as a ≥1 Medical Research Council (MRC) grade improvement or a score of >3 in thumb adduction, intrinsic function, or grip strength. Results All patients demonstrated a motor function improvement of ≥1 MRC grade following AINPQ transfer. The complication rate was low, with no reported cases of functional deterioration or infection, consistent with existing literature. One patient reported a painful scar, attributed to the cubital tunnel decompression procedure. Conclusion This study supports the adjunctive use of AINPQ with cubital tunnel decompression in severe ulnar nerve compression or injury cases. AINPQ shows potential in accelerating reinnervation and improving hand function within 12-14 months of symptom onset, though larger prospective studies are necessary for validating and refining patient selection criteria.

Keywords: ain; hemi-end-to-end; nerve; transfer; ulnar.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Schematic representation of the hemi-ETE AINPQ transfer after intrafascicular dissection of the volar sensory and motor components of the ulnar nerve
Image Credits: Ahmed Elfaki Hemi-ETE: hemi-end-to-end; AINPQ: anterior interosseous nerve to pronator quadratus
Figure 2
Figure 2. Incision to locate the AINPQ branch prior to its dissection with relevant anatomy demonstrated
AINPQ: anterior interosseous nerve to pronator quadratus; UN: ulnar nerve
Figure 3
Figure 3. The AINPQ branch has been dissected out and transposed to the motor component of the UN prior to nerve transfer
AINPQ: anterior interosseous nerve to pronator quadratus; UN: ulnar nerve
See this image and copyright information in PMC

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