0:01

This is just a quick, uh, lesson and do no harm.

0:04

I was mentioning to Don that, uh, I have yet

0:07

to see a happy person, uh, with an ulnar nerve transfer that

0:11

that ulnar nerve just doesn't like to be touched at all.

0:15

And, uh, so, so now folks have gone away from, uh,

0:19

transposing the nerve, which this patient has had done,

0:23

and they've, they've simply gone to doing a release

0:26

of the roof, uh, of the, uh, cubital tunnel.

0:30

Now, uh, you know, obviously there's a tremendous

0:32

amount of scar here.

0:33

They did do the transposition.

0:34

The patient is quite symptomatic.

0:37

And you, you mentioned beautifully some of the key

0:42

observations that you make when you're looking at nerves.

0:44

Even though this is an orthopedic course, you know,

0:48

angulation, uh, abrupt change in direction.

0:51

It gets big, it gets little, it gets big.

0:53

Again, it's high signal, it's low signal. You may have both.

0:56

It may alternate.

0:58

You may have that paradoxical fibrosis around the outside,

1:01

or you may have cystic degeneration on the inside.

1:04

And, and once again, I do not like to see nerves, uh,

1:08

even have a little bit

1:09

of hyperintensity on a non-fat

1:11

suppressed T two weighted image.

1:12

This patient is awfully symptomatic

1:14

and there is the nerve just getting crushed

1:17

by all this surrounding scar tissue,

1:19

as it usually does with this procedure.

1:22

And any comments, Megan, on this one?

1:24

No, this is a great case.

1:25

Um, we see a lot of these, right?

1:27

Which means that there's a lot of complications

1:29

or symptomatic patients, uh, after this procedure.

1:32

So, yeah. Thank you. Great example.

1:35

Shall we go onto the next.