Procedure 26-14. Ulnar Nerve Transposition

Through which anatomical structure does the ulnar nerve travel at the elbow?
a) Carpal tunnel
b) Cubital tunnel
c) Radial groove
d) Guyon’s canal

b) Cubital tunnel

Where is the cubital tunnel located?
a) Over the lateral epicondyle of the elbow
b) Under the medial epicondyle of the elbow
c) In the wrist near the pisiform bone
d) At the base of the neck

b) Under the medial epicondyle of the elbow

What is the common nickname for the area where the ulnar nerve passes under the medial epicondyle?
a) The pinch point
b) The funny bone
c) The nerve groove
d) The elbow pit

b) The funny bone

In relation to the ulna, where does the ulnar nerve travel at the elbow?
a) Over the muscles
b) Under the muscles
c) Along the bone surface only
d) Through the carpal tunnel

b) Under the muscles

As the ulnar nerve enters the hand, through which tunnel does it pass?
a) Carpal tunnel
b) Cubital tunnel
c) Guyon’s canal
d) Tarsal tunnel

c) Guyon’s canal

Where is the incision made during ulnar nerve transposition?
a) Over the radial nerve
b) Over the median nerve
c) Over the ulnar nerve
d) Over the brachial artery

c) Over the ulnar nerve

Which instruments are used to dissect the ulnar nerve free from surrounding soft tissue?
a) Scalpel and needle holder
b) Metzenbaum scissors and Crile hemostatic forceps
c) Kelly clamp and Mayo scissors
d) Rongeur and bone curette

b) Metzenbaum scissors and Crile hemostatic forceps

What materials can be passed around the freed nerve segment to aid in handling during dissection?
a) Silk sutures
b) Umbilical tapes, vessel loops, or Penrose tubing
c) Cotton balls
d) Surgical towels

b) Umbilical tapes, vessel loops, or Penrose tubing

Why might the muscle and fascia entered by the nerve at each end be slit during the procedure?
a) To prevent infection
b) To prevent nerve kinking
c) To reduce bleeding
d) To enlarge the cubital tunnel

b) To prevent nerve kinking

What is done to the fascial flap overlying the medial epicondyle of the humerus during ulnar nerve transposition?
a) It is removed entirely
b) It is cut and elevated
c) It is left intact
d) It is cauterized

b) It is cut and elevated

Where is the ulnar nerve transposed to during the procedure?
a) Beneath the fascial flap overlying the medial epicondyle
b) Into the cubital tunnel
c) Into the carpal tunnel
d) Into the radial groove

a) Beneath the fascial flap overlying the medial epicondyle

How is the fascia treated after transposition of the ulnar nerve?
a) It is left open
b) It is loosely reapproximated to the fascial edge on the epicondyle
c) It is tightly sutured to prevent movement
d) It is stapled shut

b) It is loosely reapproximated to the fascial edge on the epicondyle

How is the wound closed at the end of the ulnar nerve transposition procedure?
a) Closed in layers
b) Closed with staples only
c) Left open for drainage
d) Closed with skin adhesive only

a) Closed in layers

During ulnar nerve transposition surgery, where does the CST usually sit in relation to the surgeon?
a) Next to the surgeon on the same side as the affected arm
b) Opposite the surgeon with the affected arm between them
c) At the foot of the operating table
d) Behind the surgeon

b) Opposite the surgeon with the affected arm between them

What is important about the positioning of instruments and supplies during the procedure?
a) They should be placed near the anesthesia machine
b) They should be within reach of the CST only
c) They should be positioned where the surgeon can easily reach them
d) They should be kept off the sterile field

c) They should be positioned where the surgeon can easily reach them

What should the CST avoid doing once seated during the procedure?
a) Talking to the surgeon
b) Standing up until the procedure is complete
c) Passing instruments
d) Monitoring the sterile field

b) Standing up until the procedure is complet