Arcade of Struthers and Forearm Instability

Chuck and Chris catch up and discuss a few clinical scenarios including the Arcade of Struthers and indications to address it with ulnar nerve transposition.  They also discuss adolescent forearm instability, especially in congenital conditions, and the role of the one- bone forearm


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Transcript

Podcast Summary

Patient Travel for Surgery Discussion

Charles and Christopher discussed the experience of having patients travel for surgery, with Christopher sharing his perspective as a younger surgeon who sometimes feels pressure but isn't competitive with established medical centers. Charles described his approach of building relationships with out-of-town patients, including checking in regularly and meeting them outside the hospital, though he acknowledged this was a self-imposed burden. Christopher expressed that he currently lacks the emotional energy to maintain such extensive patient relationships due to focusing on family time.

Patient Relationships in Healthcare

Charles and Christopher discussed patient relationships in healthcare, with Charles noting that bonds tend to be stronger with patients undergoing larger surgeries compared to routine procedures like carpal tunnel releases. Christopher shared a positive experience of being recognized by a former patient at Costco and described a meaningful speaking engagement at a hand therapy meeting where he participated in a panel about brachial plexus care. The conversation also touched on clinical communication styles, with Charles explaining his typically business-like approach in clinic and sharing that he rarely experiences issues when sharing his cell phone number with patients.

Ulnar Nerve Transposition Discussion

Charles shared a clinical picture of a 17-year-old pitcher with cubital tunnel syndrome who also had nerve irritation higher up the arm than typically seen. Christopher discussed the historical description of Arcade of Struthers being about eight centimeters proximal to the medial epicondyle. They discussed how to determine when to stop going proximal in ulnar nerve transposition surgery, with Christopher suggesting that while you can never be completely certain, there are diminishing returns and clinical examination can help identify when to stop.

Triceps Snapping Surgery Discussion

Charles discussed his approach to handling muscle overlying nerves during transposition surgery, noting that in his case the nerve was not compressed after transposition so no muscle resection was necessary. He estimated that symptomatic snapping triceps occurs in about 1 out of 20 cubital tunnel procedures he performs. Christopher mentioned seeing asymptomatic snapping triceps less frequently and shared that he had performed triceps resections near the olecranon and medial epicondyle for symptomatic cases. The discussion ended with Christopher referring to an article Charles co-wrote with Curt Henn about outcomes in younger athlete populations, asking about current thinking on the topic.

Adolescent Thrower Treatment Approaches

Charles discussed his approach to treating adolescent throwers, explaining that he typically performs nerve transposition rather than decompression due to traction and torque issues. 

One- Bone Forearm

Charles explained the clinical scenario and treatment considerations for one-bone forearm creation, comparing it to radial ulnar fusion, and noted that while patients lose forearm rotation, the procedure provides better outcomes and relieves pain. Charles shared that he has performed a large number of these surgeries with largely positive results.