Abstract
Purpose
The supercharged end-to-side (SETS) anterior interosseous to ulnar nerve transfer is increasingly used to augment intrinsic muscle recovery in patients with severe ulnar neuropathy. However, there is a lack of standardized outcome measures to evaluate the effectiveness of this procedure. This study aimed to develop a consensus-based core set of outcome measures applicable to ulnar nerve surgery, with a specific focus on the SETS transfer.
Methods
A two-round modified Delphi process was conducted involving 15 multidisciplinary experts in hand surgery and upper limb rehabilitation. The initial survey was informed by a comprehensive literature review and expert opinion. Participants ranked outcome domains and corresponding measurement tools based on their relevance in both clinical and research settings. Consensus was defined as ≥75% agreement. A second-round survey was conducted to refine the results and focus specifically on outcomes applicable to SETS procedures.
Results
In Round 1, experts reached consensus on several key domains including motor function, functional ability, quality of life, pain, dexterity, and sensory evaluation. In Round 2, a refined core outcome set for SETS procedures was established. Lateral pinch strength and daily living function self-assessment were prioritized across both settings. Validated tools endorsed included the Patient-Rated Ulnar Nerve Evaluation, Short Form-12, visual analog scale, nine-hole peg test, and two-point discrimination.
Conclusions
This Delphi study established a consensus-based core outcome set for evaluating surgical outcomes following ulnar nerve reconstruction, with specific application to SETS procedures. The proposed framework integrates patient-reported and clinician-rated measures and may support standardization in future research and clinical practice.
Clinical relevance
The lack of standardized outcomes for ulnar nerve transfers limits cross-study comparisons and evidence synthesis. This study provides a structured outcome set to support consistent evaluation and improve decision making in patients undergoing SETS or related procedures.
Key words: Cubital tunnel syndrome, Delphi study, Nerve transfer, Supercharged end-to-side, Ulnar neuropathy
The ulnar nerve is essential for coordinated hand function, innervating the majority of intrinsic hand muscles and providing sensation to the ulnar aspect of the hand. Injury to the ulnar nerve can disrupt the balance between flexor and extensor forces, leading to a loss of lateral pinch strength and digital dexterity, and in some cases, resulting in claw hand deformity, particularly in low ulnar nerve injuries where flexor digitorum profundus function is preserved.1 These injuries often result in poor motor recovery because of the long distance required for axonal regeneration to reach distal motor endplates, which may degenerate irreversibly before reinnervation occurs.2,3
Among compressive neuropathies, ulnar neuropathy at the elbow—commonly known as cubital tunnel syndrome—is reported as the second most frequent type.4 Although conservative treatment is effective for mild cases, severe forms typically require surgical intervention.5 A variety of surgical approaches have been described, yet no single technique has demonstrated clear superiority.6, 7, 8, 9 In recent years, distal nerve transfers, particularly from the anterior interosseous nerve (AIN) to the motor branch of the ulnar nerve, have gained attention as adjunct procedures in the management of severe ulnar neuropathy, especially in cubital tunnel syndrome cases unresponsive to decompression alone.7
Traditional end-to-end AIN to ulnar motor nerve transfers result in complete reliance on the donor nerve, bypassing native ulnar regeneration entirely.10 In contrast, the supercharged end-to-side (SETS) approach involves coapting the AIN to the ulnar motor branch via a perineural window, with the intention of providing earlier reinnervation while maintaining the potential for proximal ulnar regeneration, thereby offering "double innervation".11 However, this concept remains controversial, with limited high-quality evidence supporting its functional benefits or biological plausibility in humans.
Despite the increasing application of SETS transfers, variability in outcome reporting persists across studies, hindering comparison and evidence synthesis.6,7,12 Furthermore, there is no established core outcome set specific to distal ulnar nerve surgeries or nerve transfers. This lack of standardization complicates the evaluation of surgical success, particularly in newer procedures like SETS.
In response, this Delphi study was designed to establish expert consensus on outcome measures relevant to ulnar nerve surgeries, with a focus on the SETS AIN to ulnar nerve transfer. The study sought to define key domains for assessment, inform future research, and contribute to a standardized framework for evaluating patient outcomes in both clinical and research contexts.
Materials and Methods
The Delphi method, originally developed by the RAND Corporation in the 1960s, is a structured technique designed to achieve consensus among experts through anonymous, iterative rounds of surveys and feedback.13 It has since been widely adopted across medical, scientific, and policy fields to address areas of uncertainty where empirical evidence is limited. The method promotes independent judgment and reduces bias by preventing dominance of certain individuals in group discussions.13,14
This study applied a two-round modified Delphi approach to achieve expert consensus on outcome measures relevant to ulnar nerve surgeries, with a specific focus on the SETS AIN to ulnar nerve transfer. Following completion of two survey rounds, the steering committee concluded that additional rounds were unlikely to yield important new insights, based on stability in responses and convergence of expert opinion.14,15 The process enabled the inclusion of a geographically and professionally diverse group of experts, enhancing the generalizability and relevance of the findings.16,17
Survey development
The initial survey was developed based on a comprehensive review of the literature concerning upper-extremity musculoskeletal conditions and surgical interventions, including ulnar nerve injuries and transfer techniques. This included relevant published literature reviews that comprehensively mapped the available evidence and informed the development of the initial survey.18 The review was supplemented by the clinical expertise of the study investigators to ensure practical relevance. To construct the list of survey items, the team synthesized information from peer-reviewed studies, clinical practice guidelines, and expert opinion to identify outcome domains commonly assessed following ulnar nerve surgery, including SETS AIN to ulnar nerve transfer.6,19, 20, 21, 22, 23, 24, 25, 26, 27
Key outcome constructs included domains such as pain19, sensation20, functional ability6,21, strength22,23, range of motion24, quality of life19,27, patient satisfaction25, and perceived change over time.26 These were further categorized into those applicable to clinical practice and those more relevant for research contexts. Where appropriate, validated measurement tools were linked to each construct to provide participants with reference options. Demographic information for each invited expert—such as age, sex, profession, years of experience, country of practice, and clinical focus—was confirmed for accuracy by the senior author (JM).
Eligibility criteria and expert participation
Expert panel members were selected based on predefined inclusion criteria. Eligible participants were registered health care professionals—physicians, surgeons, or therapists—recognized for their expertise in upper-extremity nerve repair, particularly the SETS AIN to ulnar nerve transfer. Each expert had a minimum of 5 years of experience in either hand surgery or therapy, with documented clinical or academic engagement in nerve transfer procedures.
Potential participants were identified through professional networks, relevant publications, and conference proceedings. An information letter outlining the study objectives and procedures was sent to eligible experts. Those who agreed to participate provided electronic informed consent and received individualized survey links via email. Specialists without direct experience performing or managing the SETS procedure were excluded. Ethics approval for the study was granted by the institutional research ethics board (WREM HSREB 123698).
First-round ranking
In the first round, experts were asked to evaluate a comprehensive list of outcome measures and rank them based on their perceived importance in assessing the results of ulnar nerve surgeries. Procedures covered in this round included nerve decompression (eg, transposition), nerve repair, and nerve transfer. Participants were instructed to rate each outcome measure based on its importance in evaluating surgical outcomes in both clinical and research settings. They were informed that outcome measures reaching ≥75% agreement would be considered for inclusion. They were also invited to provide optional free-text comments to elaborate on their rankings or suggest additional outcome domains.
Consensus of the first round
A predetermined agreement threshold was used to define consensus. Outcome measures that were rated within the top two Likert scale categories (ie, “very important” or “extremely important”) by ≥75% of participants were classified as consensus measures.28 Responses were analyzed using descriptive statistics and stratified by level of agreement. Items that reached consensus were retained and carried forward into the second-round survey.
Survey Revision for the Second Round
The second-round survey was modified based on first-round results. Items that reached high agreement (≥75% endorsement in the top response category) were retained, whereas those with low endorsement or redundancy were removed or revised for clarity. The revised survey emphasized outcome measures specifically relevant to the SETS procedure. Participants were informed of this scope refinement and instructed to re-rank items based on their relevance to SETS.
Second-Round Ranking
In the second round, participants re-evaluated the refined list of outcome measures, again rating their importance for use in both clinical and research settings. The aim of this round was to further refine and confirm consensus around a core outcome set for SETS AIN to ulnar nerve transfer procedures. Outcome measures that met consensus in round 1 were included again in round 2 to determine their priority in the specific context of the SETS procedure.
Determination of study conclusion and reporting
Following the second round, the research team reviewed the results to determine whether consensus had been adequately achieved. As the responses demonstrated convergence and limited variability, the Delphi process was concluded after two rounds. A final list of core outcome measures was compiled and reported, along with recommended measurement tools aligned with expert consensus.
Results
First round
The first round of the Delphi process served as a foundational step in identifying key outcomes relevant to ulnar nerve surgery, including the SETS procedure. All 15 invited experts agreed to participate, reflecting a strong collective commitment to the study’s objectives.
The expert panel comprised 15 participants (Table 1), predominantly men (n = 11, 73%), with a mean age of 44.5 ± 10.31 years and an average of 8.66 ± 5.79 years of clinical experience related to SETS procedures. Professional representation included hand and microsurgery surgeons (n = 8, 53%; 7 orthopedic, 1 plastic), hand therapists (n = 6, 40%), and one physiatrist (n = 1, 7%). Geographical representation was primarily from Canada (n = 7, 46%) and Thailand (n = 6, 40%), with additional participants from the United States of America and Iran (n = 1 each, 7%). The racial composition included Asian (46%), White (40%), Middle Eastern (7%), and Latino (7%) experts.
Table 1.
Expert demographics
| Demographics | (n, %) | |
|---|---|---|
| Specialists | Physician (physiatrist) | 1, 7% |
| Specialists | Hand and microsurgery surgeons | 8, 53% |
| Specialists | Hand therapists | 6, 40% |
| Race | Asian | 7, 46% |
| Race | White | 6, 40% |
| Race | Middle Eastern | 1, 7% |
| Race | Latino | 1, 7% |
| Country of practice | Canada | 7, 46% |
| Country of practice | Thailand | 6, 40% |
| Country of practice | USA | 1, 7% |
| Country of practice | Iran | 1, 7% |
| Sex (men) | 11, 73% | |
| Mean ± SD | ||
| Average years practicing in the SETS surgery | 8.66 ± 5.79 | |
| Mean age | 44.5 ± 10.31 | |
Panelists brought a wide range of expertise in nerve surgery and rehabilitation, with research and clinical interests spanning elbow surgery, brachial plexus injury, tendon and nerve reconstruction, spasticity, peripheral nerve conditions, neuropathic pain, biologics, hand therapy, and upper limb outcome measurement.
During the first-round survey, participants ranked a broad set of outcomes relevant to ulnar nerve surgery. Restoration of motor function emerged as the most highly prioritized goal, followed closely by improvement in functional performance. Additional outcomes proposed by experts included postoperative correction of claw hand deformities, restoration of sensory function, and reduction of pain. Experts also emphasized the importance of preventing muscle atrophy and preserving motor unit function. Frequently cited measurement approaches included the Medical Research Council scale, pinch strength testing, patient-reported outcome measures such as the Patient-Rated Ulnar Nerve Evaluation (PRUNE) and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and quantitative EMG.
For the purpose of interpretation, we defined endorsement levels as follows: strongly endorsed, ≥90% agreement; broadly supported, 75% to 89%; moderately supported, 70% to 74%.
In the context of research applications, strong consensus emerged for domains such as health-related quality of life, self-reported functional ability, work limitations, grip strength, and patient satisfaction. Broad support was noted for lateral pinch strength, pain severity, and sensory threshold assessments. Moderately endorsed domains included finger abduction/adduction strength, performance-based dexterity measures, and health status over time.
For clinical practice, strongly endorsed outcomes included self-assessed daily living functions, work capacity evaluations, and patient satisfaction. Lateral pinch strength, grip strength, finger movement assessments, and quality of life were broadly supported. Pain intensity and functional assessments related to sports and recreational activities were moderately endorsed (Table 2).
Table 2.
Round 1 Consensus Outcomes
| Consensus Level: Strongly Endorsed (90% to 100%) | |
|---|---|
| Research Study | Clinical Setting |
| Health-related quality of life | Daily living functions self-assessment |
| Self-reported functional ability in daily life | Work-related functional capacity self-assessment |
| Self-reported work limitations | Patient satisfaction evaluation |
| Grip strength assessment | |
| Patient satisfaction evaluation | |
| Consensus Level: Broadly Supported (75% to 89%) | |
|---|---|
| Lateral pinch strength | Lateral pinch strength measurement |
| Pain severity | Grip strength assessment |
| Sensory threshold | Finger movement strength evaluation |
| Health-related quality of life assessment | |
| Consensus Level: Moderately Supported (70% to 74%) | |
|---|---|
| Performance-based tests of dexterity | Pain intensity assessment |
| Finger abduction/adduction strength | Sports and recreational activities Functional self-assessment |
| Health status over time | |
In addition to outcome domains, consensus was achieved regarding preferred measurement instruments. For quality of life assessment, the Short Form (SF)-36, SF-12, and EuroQol- 5 Dimension (EQ-5D) were favored. Patient-reported functional measures included PRUNE and QuickDASH. Pain was evaluated using the numeric rating scale, visual analog scale (VAS), and interference measures from the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire and the Brief Pain Inventory. Sensory function was most commonly assessed through two-point discrimination, localization of touch, Tinel’s sign, and Ten-Test for sensation. Dexterity was evaluated using the nine-hole peg test, Purdue pegboard test, and Jebsen-Taylor Hand Function Test. Global rating of change tools, both patient- and clinician-rated, were also endorsed.
Second round
Of the 15 initial participants, 14 (93%) completed the second round. This phase refined the focus to outcomes specifically applicable to the SETS procedure, based on first-round feedback.
From the general list developed in round 1, the panel reached consensus on a core outcome set for evaluating SETS procedures. In research settings, lateral pinch strength, finger abduction/adduction strength, and performance-based dexterity tests were the most consistently prioritized domains. In clinical settings, daily living function self-assessment and lateral pinch strength measurement emerged as top priorities (Table 3).
Table 3.
Core Outcome Set for Research and Clinical Use Following the SETS AIN to Ulnar Nerve Transfer (Round 2)
| Research Study |
Clinical Setting |
||
|---|---|---|---|
| Core SETS | Mean Rank (no. of participants ranked) | Core SETS | Mean Rank (no. of participants ranked) |
| Lateral pinch strength | 1.92 (13) | Daily living functions self-assessment | 2.23 (13) |
| Performance-based tests of dexterity | 3.2 (10) | Lateral pinch strength measurement | 2.79 (14) |
| Finger abduction/adduction strength | 3.54 (13) | ||
Preferred instruments for measuring SETS outcomes were reaffirmed in this round. The SF-12 was most frequently selected for health-related quality of life assessment, and PRUNE was identified as the preferred patient-reported functional outcome tool. For pain assessment, experts endorsed the VAS and the PROMIS pain interference subscale. Two-point discrimination remained the most widely supported measure for sensory evaluation, and the nine-hole peg test was reaffirmed for dexterity assessment. The patient-rated global rating of change was the most preferred tool for capturing perceived recovery.
The consistency of expert responses between rounds, alongside a lack of notable variation in rankings, supported the conclusion that consensus had been reached. As a result, the Delphi process was concluded after the second round. A summary of prioritized outcome domains and tools is presented in Table 2, Table 3, Table 4.
Table 4.
Preferred Measurement Tools (Round 2)
| Outcome Domain | Mean Rank (No. of Participants Ranked) |
|---|---|
| Health status or health-related quality of life | |
| The Short Form-36 Health Survey | 1.57 (7) |
| The Short Form-12 Health Survey | 1.125 (8) |
| The EuroQol-5 Dimension | 1.83 (6) |
| Patient-rated outcome measures | |
| Patient-Rated Ulnar Nerve Evaluation | 1.25 (12) |
| QuickDASH | 1.58 (12) |
| Pain intensity measures | |
| Numeric rating scale | 1.625 (8) |
| Visual analog scale | 1.11 (9) |
| Pain interference measures | |
| Pain interference subscale of the PROMIS questionnaire | 1 (9) |
| Brief Pain Inventory | 2 (4) |
| Sensation | |
| Two-point discrimination | 1.125 (12) |
| Localization of touch | 2.5 (4) |
| Tinel's sign | 3.67 (3) |
| The ten tests for sensation | 1.57 (7) |
| Dexterity | |
| Nine-hole peg test | 1.2 (10) |
| Purdue peg board test | 2 (4) |
| The Jebsen-Taylor Hand Function Test | 1.7 (10) |
| Patient’s global rating of status or change | |
| Patient-rated global rating of change | 1 (11) |
| Clinician-rated global rating of change | 2 (5) |
Discussion
This Delphi study aimed to establish expert consensus on outcome measures relevant to ulnar nerve surgeries, with specific application to the SETS AIN to ulnar nerve transfer. Through two iterative rounds of consultation among multidisciplinary experts, the study identified domains and tools for assessing surgical outcomes in both research and clinical contexts.
Restoration of motor function and improvement in hand performance were consistently prioritized across both rounds. This reflects the clinical imperative to restore intrinsic hand control in patients with severe ulnar neuropathy, particularly where timely reinnervation is critical to preserving muscle function. The consensus process also identified the importance of patient-centered domains—such as quality of life, pain, dexterity, and daily function—that align with modern rehabilitation frameworks and shared decision-making principles.
Although SETS procedures have gained popularity in severe ulnar nerve pathologies, their mechanism and clinical benefit remain under debate.29, 30, 31 The technique involves connecting the AIN to the ulnar motor branch via a perineural window, theoretically enabling "double innervation" by preserving native axonal regeneration while facilitating earlier reinnervation via the donor nerve. However, the biological plausibility and consistency of this dual reinnervation process have not been robustly validated in human studies.30,31 Several authors have raised concerns regarding donor site morbidity, mismatched axon types, fatigue because of cocontraction, and altered neural control strategies.32
Our findings, although supportive of SETS as a surgical option requiring standardized evaluation, do not imply superiority of this method over other nerve repair or decompression techniques. Rather, the proposed outcome framework aims to improve consistency and comparability in future studies assessing any form of distal ulnar nerve intervention. The outcome domains identified—such as lateral pinch strength, finger abduction strength, and dexterity—are likely applicable across multiple ulnar nerve reconstruction approaches.33,34
Compared to the existing literature, our Delphi study offers a broader and more integrative outcome framework. Dunn et al35 (2021) conducted a systematic review of SETS procedures and highlighted improvements in grip and key pinch strength as common findings. These performance-based outcomes were also prioritized in our consensus process. However, our study expanded the outcome set to include sensation, pain interference, and quality of life—areas not consistently reported in prior reviews.18 Notably, experts in our panel emphasized the importance of tools such as the PRUNE36 and the nine-hole peg test37 for capturing both patient-reported and performance-based metrics of recovery.
Similarly, Dabbagh et al38 systematically reviewed patient-reported outcome measures (PROMs) for ulnar nerve entrapment and concluded that the PRUNE demonstrates strong psychometric properties for this population. This aligns with our Delphi findings, where PRUNE was the most commonly endorsed PROM for both general ulnar nerve surgery and SETS-specific evaluations. Our study builds upon that work by integrating PROMs with clinician-rated measures and identifying preferred tools across multiple domains.
Although this Delphi process yielded clear consensus, several limitations should be acknowledged. First, the study relied on subjective judgment from a relatively small panel of 15 experts. Although the panel included experienced surgeons and therapists across multiple countries and specialties, it may not fully represent all perspectives within the global ulnar nerve surgery community. Moreover, expertise levels varied. Although all participants met the inclusion threshold of at least five years of clinical experience, some reviewers questioned whether this constituted sufficient authority on a procedure as nuanced as SETS.
Second, although the Delphi method promotes structured consensus building, it does not eliminate bias entirely. Group convergence can reflect shared training backgrounds or institutional norms rather than objective superiority of certain outcomes or tools. The study also used a fixed threshold of 75% agreement for defining consensus, which, although consistent with prior Delphi studies,28 remains an arbitrary cut-off.
Third, the Delphi process is inherently limited in scope—it does not validate the psychometric properties of outcome tools, nor does it determine their predictive value for functional recovery. Future research should assess whether the proposed outcome set correlates with patient satisfaction, return to work, or long-term functional independence.
Despite these limitations, this study provides a foundational framework for future clinical trials and cohort studies involving SETS and other distal ulnar nerve procedures. The inclusion of both patient-reported and clinician-rated outcomes enhances the comprehensiveness of the proposed core set. Importantly, although some measures (eg, SF-12, PRUNE, VAS) are widely validated, others—such as finger abduction strength and performance-based dexterity tests—warrant further investigation for responsiveness and interpretability in this population.
Rather than positioning SETS as a superior technique, the findings emphasize the need for standardized and comprehensive outcome assessment across all distal ulnar nerve reconstruction procedures. The inclusion of both clinician-rated and patient-reported measures reflects a commitment to holistic, patient-centered care and provides a structured foundation for future research and clinical audits.
This consensus framework may guide the design of prospective studies and facilitate comparisons across surgical techniques. However, further validation is required to evaluate the responsiveness and predictive utility of the proposed measures. Ongoing work should aim to align outcome selection with long-term functional recovery, reintegration into activities of daily living, and quality of life in individuals undergoing ulnar nerve repair.
Conflicts of Interest
Joy MacDermid's support includes the Canada Research Chair in Musculoskeletal Health Outcomes and Knowledge Translation, as well as the Dr James Roth Chair in Musculoskeletal Measurement and Knowledge Translation. Additionally, her work receives funding from a foundation grant from the Canadian Institutes of Health Research (#167284). Maryam Farzad was supported by Mitacs through the Mitacs Accelerate program. This work was presented as a podium presentation at the IFSSH–IFSHT 2025 Triennial Congress in Washington, DC. No benefits in any form have been received or will be received by the other authors related directly to this article.
Acknowledgments
The authors would like to thank all expert panel members for their valuable contributions to this Delphi study.
References
- 1.Woo A., Bakri K., Moran S.L. Management of ulnar nerve injuries. J Hand Surg Am. 2015;40(1):173–181. doi: 10.1016/j.jhsa.2014.04.038. [DOI] [PubMed] [Google Scholar]
- 2.Kommalage M., Gunawardena S. Influence of age, gender, and sidedness on ulnar nerve conduction. J Clin Neurophysiol. 2013;30(1):98–101. doi: 10.1097/WNP.0b013e31827ed6aa. [DOI] [PubMed] [Google Scholar]
- 3.Lan C.Y., Tien H.Y., Lin Y.T., Hsu C.-C., Lin C.-H., Chen S.-H. Prognosis of traumatic ulnar nerve injuries: a systematic review. Ann Plast Surg. 2019;82(1S):S45–S52. doi: 10.1097/SAP.0000000000001727. [DOI] [PubMed] [Google Scholar]
- 4.Palmer B.A., Hughes T.B. Cubital tunnel syndrome. J Hand Surg Am. 2010;35(1):153–163. doi: 10.1016/j.jhsa.2009.11.004. [DOI] [PubMed] [Google Scholar]
- 5.Ferguson D.P., Grewal R. Cubital tunnel syndrome: review of diagnosis and management. Handchir Mikrochir Plast Chir. 2022;54(3):253–262. doi: 10.1055/a-1808-6973. [DOI] [PubMed] [Google Scholar]
- 6.Tsang P., Larocerie-Salgado J., MacDermid J.C., Miller T.A., Doherty C., Ross D.C. Postoperative management and rehabilitation after the supercharged end-to-side anterior interosseous nerve to ulnar motor nerve transfer: a report of 3 cases. J Hand Ther. 2021;34(3):469–478. doi: 10.1016/j.jht.2020.03.021. [DOI] [PubMed] [Google Scholar]
- 7.Baron A., Strohl A. Severe cubital tunnel syndrome: considerations for nerve transfer surgery. Curr Rev Musculoskelet Med. 2020;13:708–716. doi: 10.1007/s12178-020-09676-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Kim D.H., Han K., Tiel R.L., Murovic J.A., Kline D.G. Surgical outcomes of 654 ulnar nerve lesions. J Neurosurg. 2003;98(5):993–1004. doi: 10.3171/jns.2003.98.5.0993. [DOI] [PubMed] [Google Scholar]
- 9.Ruijs A.C., Jaquet J.B., Kalmijn S., Giele H., Hovius S.E.R. Median and ulnar nerve injuries: a meta-analysis of predictors of motor and sensory recovery after modern microsurgical nerve repair. Plast Reconstr Surg. 2005;116(2):484–494. doi: 10.1097/01.prs.0000172896.86594.07. discussion 495. [DOI] [PubMed] [Google Scholar]
- 10.Novak C.B., Mackinnon S.E. Distal anterior interosseous nerve transfer to the deep motor branch of the ulnar nerve for reconstruction of high ulnar nerve injuries. J Reconstr Microsurg. 2002;18(6):459–464. doi: 10.1055/s-2002-33326. [DOI] [PubMed] [Google Scholar]
- 11.Barbour J., Yee A., Kahn L.C., Mackinnon S.E. Supercharged end-to-side anterior interosseous to ulnar motor nerve transfer for intrinsic musculature reinnervation. J Hand Surg Am. 2012;37(10):2150–2159. doi: 10.1016/j.jhsa.2012.07.022. [DOI] [PubMed] [Google Scholar]
- 12.Thakkar M., Rose A., King W., Engelman K., Bednarz B. Anterior interosseous nerve to ulnar nerve transfer: a systematic review. JPRAS Open. 2022;32:195–210. doi: 10.1016/j.jpra.2022.02.007. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Dalkey N., Helmer O. An experimental application of the Delphi method to the use of experts. Manag Sci. 1963;9(3):458–467. [Google Scholar]
- 14.Eubank B.H., Mohtadi N.G., Lafave M.R., et al. Using the modified Delphi method to establish clinical consensus for the diagnosis and treatment of patients with rotator cuff pathology. BMC Med Res Methodol. 2016;16:56. doi: 10.1186/s12874-016-0165-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.von der Gracht H.A. Consensus measurement in Delphi studies: review and implications for future quality assurance. Technol Forecast Soc Change. 2012;79(8):1525–1536. [Google Scholar]
- 16.Holey E.A., Feeley J.L., Dixon J., Whittaker V.J. An exploration of the use of simple statistics to measure consensus and stability in Delphi studies. BMC Med Res Methodol. 2007;7:52. doi: 10.1186/1471-2288-7-52. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Shariff N.J. Utilizing the Delphi survey approach: a review. J Nurs Care. 2015;4(3):246. [Google Scholar]
- 18.Jiravichitchai T., Farzad M., MacDermid J.C., et al. A scoping review of the supercharged end-to-side anterior interosseous nerve to ulnar nerve transfer. J Hand Surg Glob Online. 2024;6(3):184–191. doi: 10.1016/j.jhsg.2024.06.003. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Jarvie G., Hupin-Debeurme M., Glaris Z., Daneshvar P. Supercharge end-to-side anterior interosseous nerve to ulnar motor nerve transfer for severe ulnar neuropathy: two cases suggesting recovery secondary to nerve transfer. J Orthop Case Rep. 2018;8(5):25–28. doi: 10.13107/jocr.2250-0685.1194. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Staples J.R., Calfee R. Cubital tunnel syndrome: current concepts. J Am Acad Orthop Surg. 2017;25(10):e215–e224. doi: 10.5435/JAAOS-D-15-00261. [DOI] [PubMed] [Google Scholar]
- 21.Knight S., Miller T.A., McIntyre A., Larocerie-Salgado J., Ross D.C. The hand diagram: a novel outcome measure following supercharged end-to-side anterior interosseous nerve to ulnar nerve transfer in severe compressive ulnar neuropathy. J Hand Ther. 2024;37(3):348–354. doi: 10.1016/j.jht.2023.09.005. [DOI] [PubMed] [Google Scholar]
- 22.Chen S.H., Mao S.H., Lan C.Y., et al. End-to-side anterior interosseous nerve transfer: a valuable alternative for traumatic high ulnar nerve palsy. Ann Plast Surg. 2021;86(2S Suppl 1):S102–S107. doi: 10.1097/SAP.0000000000002657. [DOI] [PubMed] [Google Scholar]
- 23.Dengler J., Dolen U., Patterson J.M.M., et al. Supercharge end-to-side anterior interosseous–to–ulnar motor nerve transfer restores intrinsic function in cubital tunnel syndrome. Plast Reconstr Surg. 2020;146(4):808–818. doi: 10.1097/PRS.0000000000007167. [DOI] [PubMed] [Google Scholar]
- 24.Warwick L., Seradge H. Early versus late range of motion following cubital tunnel surgery. J Hand Ther. 1995;8(4):245–248. doi: 10.1016/s0894-1130(12)80115-3. [DOI] [PubMed] [Google Scholar]
- 25.Evans A., Padovano W.M., Patterson J.M.M., et al. Beyond the cubital tunnel: use of adjunctive procedures in the management of cubital tunnel syndrome. Hand (N Y) 2023;18(2):203–213. doi: 10.1177/1558944721998022. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Kamper S.J., Maher C.G., Mackay G. Global rating of change scales: a review of strengths and weaknesses and considerations for design. J Man Manip Ther. 2009;17(3):163–170. doi: 10.1179/jmt.2009.17.3.163. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Shah C.M., Calfee R.P., Gelberman R.H., Goldfarb C.A. Outcomes of rigid night splinting and activity modification in the treatment of cubital tunnel syndrome. J Hand Surg Am. 2013;38(6):1125–1130.e1. doi: 10.1016/j.jhsa.2013.02.039. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Lange T., Kopkow C., Lützner J., et al. Comparison of different rating scales for the use in Delphi studies: different scales lead to different consensus and show different test-retest reliability. BMC Med Res Methodol. 2020;20:28. doi: 10.1186/s12874-020-0912-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Li C.W., Wu J.C.H., Lan C.Y., et al. Prospective outcome analysis of ulnar tunnel syndrome: comparing traumatic versus non-traumatic etiologies. Asian J Surg. 2023;46(1):180–186. doi: 10.1016/j.asjsur.2022.03.006. [DOI] [PubMed] [Google Scholar]
- 30.Peters B.R., Jacobson L., Pripotnev S., Mackinnon S.E. Abductor digiti minimi and anterior interosseous to ulnar motor nerve transfer: the super turbocharge end-to-side transfer. Plast Reconstr Surg. 2023;151(4):815–820. doi: 10.1097/PRS.0000000000010003. [DOI] [PubMed] [Google Scholar]
- 31.Li C.W., Huang R.W., Lin C.H., et al. Supercharge end-to-side nerve transfer from anterior interosseous nerve to augment intrinsic recovery in high ulnar nerve injuries of varying magnitudes. Asian J Surg. 2024;47(8):3499–3506. doi: 10.1016/j.asjsur.2024.03.142. [DOI] [PubMed] [Google Scholar]
- 32.Pathiyil R.K., Alzahrani S., Midha R. Reverse end-to-side transfer to ulnar motor nerve: evidence from preclinical and clinical studies. Neurosurgery. 2023;92(4):667–679. doi: 10.1227/neu.0000000000002325. [DOI] [PubMed] [Google Scholar]
- 33.McLeod G.J., Peters B.R., Quaife T., Clark T.A., Giuffre J.L. Anterior interosseous–to–ulnar motor nerve transfers: a single center’s experience in restoring intrinsic hand function. Hand (N Y) 2022;17(4):609–614. doi: 10.1177/1558944720928482. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34.Xie Q., Shao X., Song X., et al. Ulnar nerve decompression and transposition with versus without supercharged end-to-side motor nerve transfer for advanced cubital tunnel syndrome: a randomized comparison study. J Neurosurg. 2022;136(3):845–855. doi: 10.3171/2021.2.JNS203508. [DOI] [PubMed] [Google Scholar]
- 35.Dunn J.C., Gonzalez G.A., Fernandez I., Orr J.D., Polfer E.M., Nesti L.J. Supercharge end-to-side nerve transfer: systematic review. Hand (N Y) 2021;16(2):151–156. doi: 10.1177/1558944719836213. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 36.MacDermid J.C., Grewal R. Development and validation of the patient-rated ulnar nerve evaluation. BMC Musculoskelet Disord. 2013;14:146. doi: 10.1186/1471-2474-14-146. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.Mathiowetz V., Weber K., Kashman N., Volland G. Adult norms for the nine hole peg test of finger dexterity. Occup Ther J Res. 1985;5(1):24–38. doi: 10.5014/ajot.39.6.386. [DOI] [PubMed] [Google Scholar]
- 38.Dabbagh A., Saeidi S., MacDermid J.C. Psychometric properties of the patient-reported outcome measures for people with ulnar nerve entrapment at the elbow: a systematic review. Phys Ther. 2022;102(10) doi: 10.1093/ptj/pzac103. [DOI] [PubMed] [Google Scholar]