Pronator Teres (PT) to the Extensor Carpi Radialis Brevis (ECRB) Tendon Transfer

2016 ◽  
pp. 507-509
Author(s):  
Odette Abou Ghanem ◽  
Joseph Y. Bakhach
Keyword(s):  
Tendon Transfer ◽  
Pronator Teres ◽  
Extensor Carpi Radialis

Functional restoration after early tendon transfer in high radial nerve paralysis

2010 ◽  
Vol 36 (2) ◽  
pp. 135-140 ◽  
Author(s):  
V. Dabas ◽  
T. Suri ◽  
P. K. Surapuraju ◽  
S. Sural ◽  
A. Dhal
Keyword(s):  
Radial Nerve ◽  
Tendon Transfer ◽  
Hand Function ◽  
Precision Grip ◽  
Functional Restoration ◽  
Nerve Paralysis ◽  
Power Grip ◽  
Pronator Teres ◽  
Junction Site ◽  
Extensor Carpi Radialis

We assessed the effect of an early transfer of pronator teres to extensor carpi radialis brevis on hand function in patients with high radial nerve paralysis. Power grip and precision grip were measured preoperatively and postoperatively using a dynamometer. Fifteen patients were operated on, of which ten could be assessed at the end of 6 months. At 6 months after surgery, there was a median increase of 48% in power grip, 162% in tip pinch, 90% in key pinch and 98% in palmar pinch. Decreased palmar flexion was seen in four patients. Fraying of the periosteal extension and rupture of sutures at the junction site were each seen in one patient, leading to unsatisfactory results. Early tendon transfer quickly restored efficient grip while awaiting reinnervation of wrist extensors, avoiding the need for prolonged external splintage.

Tendon transfer for radial nerve palsy: a single tendon to restore finger extension as well as thumb extension/radial abduction

2012 ◽  
Vol 37 (9) ◽  
pp. 855-862 ◽  
Author(s):  
M. M. Al-Qattan
Keyword(s):  
Radial Nerve ◽  
Tendon Transfer ◽  
Nerve Palsy ◽  
Radial Nerve Palsy ◽  
Wrist Movement ◽  
Pronator Teres ◽  
Finger Extension ◽  
A Prospective Study ◽  
Extensor Carpi Radialis

Since 1994, the author has been treating irreparable radial nerve palsy with pronator teres to the extensor carpi radialis brevis (for wrist extension) and a single tendon (flexor carpi radialis or ulnaris) transfer to restore finger extension as well as thumb extension/radial abduction. We sought to investigate whether these patients are able to flex the fingers with the thumb in abduction/extension posture. This was a prospective study over a 5-year period, and the results of this transfer in 15 consecutive patients (mean age 28 years) were analyzed. At final follow-up (mean 30 months), all patients had reasonable wrist movement, finger extension, and thumb extension/radial abduction. The overall results were rated excellent in 12 patients and good in the remaining three patients according to the Bincaz scale. More interesting was the ability of all patients to flex their fingers with only mild relaxation of the extended/abducted thumb.

scholarly journals Median to radial nerve transfer after traumatic radial nerve avulsion in a pediatric patient

2019 ◽  
Vol 24 (2) ◽  
pp. 209-214 ◽  
Author(s):  
Ellen L. Larson ◽  
Katherine B. Santosa ◽  
Susan E. Mackinnon ◽  
Alison K. Snyder-Warwick
Keyword(s):  
Pediatric Patient ◽  
Radial Nerve ◽  
Sensory Nerve ◽  
Nerve Transfer ◽  
Orthopedic Procedures ◽  
Pronator Teres ◽  
Nerve Transfers ◽  
Muscle Groups ◽  
Flexor Digitorum ◽  
Extensor Carpi Radialis

This case report describes an isolated radial nerve avulsion in a pediatric patient, treated by combination sensory and motor median to radial nerve transfers. After traumatic avulsion of the proximal radial nerve, a 12-year-old male patient underwent end-to-end transfer of median nerve branches to flexor carpi radialis and flexor digitorum superficialis to the posterior interosseous nerve and extensor carpi radialis nerve, respectively. He underwent end-to-side sensory transfer of the superficial radial sensory to the median sensory nerve. Pronator teres to extensor carpi radialis brevis tendon transfer was simultaneously performed to power short-term wrist extension. Within months after surgery, the patient had regained 9–10/10 sensation in the hand and forearm. In the following months and years, he regained dexterity, independent fine-finger and thumb motions, and 4–5/5 strength in all extensors except the abductor pollicis longus muscle. He grew 25 cm without extremity deformity or need for secondary orthopedic procedures. In appropriate adult and pediatric patients with proximal radial nerve injuries, nerve transfers have advantages over tendon transfers, including restored independent fine finger motions, regained sensation, and reinnervation of multiple muscle groups with minimal donor sacrifice.

Tendon transfer to restore the extension of the thumb using the extensor carpi radialis brevis: A long-term follow-up

2017 ◽  
Vol 70 (11) ◽  
pp. 1577-1581 ◽  
Author(s):  
Shusen Cui ◽  
Guang Yang ◽  
Qiang Li ◽  
Guangzhi Wu ◽  
Zhenxing Wang ◽  
...  
Keyword(s):  
Tendon Transfer ◽  
Long Term Follow Up ◽  
Extensor Carpi Radialis

scholarly journals Tendon transfer of pronator teres to flexor pollicis longus to restore thumb flexion in incomplete tetraplegia

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Nathan P. Jarrett ◽  
Gregory A. Merrell
Keyword(s):  
Tendon Transfer ◽  
Spinal Cord Injuries ◽  
Hand Function ◽  
Daily Activities ◽  
Neutral Position ◽  
Flexor Pollicis Longus ◽  
Pronator Teres ◽  
Before And After ◽  
The Difference ◽  
Flexor Pollicis Longus Tendon

Background and Hypothesis: Incomplete tetraplegia creates immense barriers to autonomy for individuals with spinal cord injuries. These patients may retain control of some forearm extensors, but use of flexors is largely eliminated, affecting many movements necessary for daily activities. Although tendon transfers using brachioradialis and other muscles to restore hand function are standard practice, pronator teres has not been extensively studied as a donor for flexors. The purpose of this study is to quantify forearm pronation capability pre- and post-tendon transfer of pronator teres to flexor pollicis longus in a cadaver model. We hypothesize that tendon transfer will make thumb flexion possible, while preserving forearm pronation against gravity at a minimum.  Experimental Design: Five cadaver arms were evaluated for pronation capability against gravity before and after tendon transfer. In both stages, the arms were also assessed for the pronation forces produced at the wrist when pulling pronator teres with 25, 50, and 75 N of force. With each force, the arms were tested in full supination and neutral position.  Results: All five arms were capable of pronating against gravity before and after the tendon transfer. Following the transfer, pronation force decreased, but the difference was not statistically significant.  Conclusion and Potential Impact: Pronator teres to flexor pollicis longus tendon transfer produces thumb flexion while retaining the forearm’s ability to pronate. Used in conjunction with well-established donors, such as brachioradialis, pronator teres’ expendability could offer an additional motor unit for restoring hand function in tetraplegic patients. 

A prospective study on transfer of pronator teres to extensor carpi radialis brevis for forearm and wrist deformity in children with cerebral palsy

2020 ◽  
pp. 175319342096033
Author(s):  
Gobinder Singh ◽  
Vivek Singh ◽  
Sabeel Ahmad ◽  
R. B. Kalia ◽  
Shobha S. Arora ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Pronator Teres ◽  
Upper Limb Function ◽  
Children With Cerebral Palsy ◽  
Group 2 ◽  
A Prospective Study ◽  
Extensor Carpi Radialis ◽  
Manual Ability Classification System

We prospectively evaluated the clinical and functional outcomes of pronator teres to extensor carpi radialis brevis transfer in children with cerebral palsy. Patients were followed-up at 6 months postoperatively, and functionally assessed using the House classification, Manual Ability Classification System (MACS) and Upper Extremity Functional Index (UEFI). Fifteen children with a mean age of 8.1 years underwent tendon transfers. All patients were of Gschwind and Tonkin Grade 2 for pronation deformity; eight patients were of Zancolli’s classification Group 1 and seven, Group 2 for wrist flexion deformity. The average gain in active supination was 67°, and wrist extension 15°. An increase of 7.0 in the UEFI score was recorded, although no significant improvement in MACS and House classification was observed. We conclude that the pronator teres to extensor carpi radialis brevis transfer improves upper limb function through effective correction of forearm pronation and wrist flexion deformities. Level of evidence: II

Intraoperative Measurement and Biomechanical Modeling of the Flexor Carpi Ulnaris-to-Extensor Carpi Radialis Longus Tendon Transfer

1997 ◽  
Vol 119 (4) ◽  
pp. 386-391 ◽  
Author(s):  
R. L. Lieber ◽  
J. Fride´n
Keyword(s):  
Tendon Transfer ◽  
Sarcomere Length ◽  
Wrist Joint ◽  
Muscle Length ◽  
Normative Values ◽  
Radial Nerve Palsy ◽  
Biomechanical Modeling ◽  
Moment Arms ◽  
Flexor Carpi Ulnaris ◽  
Extensor Carpi Radialis

Sarcomere length was measured intraoperatively in five patients undergoing tendon transfer of the flexor carpi ulnaris (FCU) to the extensor carpi radialis longus (ECRL) for radial nerve palsy. All measurements were made with the elbow in 20 deg of flexion. Prior to tendon transfer, FCU sarcomere length ranged from 2.84 ±. 12 μm (mean ± SEM) with the wrist flexed to 4.16 ± .15 μm with the wrist extended. After transfer into the ECRL tendon, sarcomere length ranged from 4.82 ± .11 μm with the wrist flexed (the new longest position of the FCU) to 3.20 ± .09 μm with the wrist extended, resulting in a shift in the sarcomere length operating range to significantly longer sarcomere lengths (p < 0.001). At these longer sarcomere lengths, the FCU muscle was predicted to develop high active tension only when the wrist was highly extended. A biomechanical model of this tendon transfer was generated using normative values obtained from previous studies of muscle architectural properties, tendon compliance, and joint moment arms. Predicted sarcomere lengths pre- and post-tendon transfer agreed well with intraoperative experimental measurements. The theoretical wrist extension moment-wrist joint angle relationship was also calculated for a variety of values of FCU muscle length. These different lengths represented the different conditions under which the FCU could be sutured into the ECRL tendon. Variation in FCU muscle length over the range 200 mm to 260 mm resulted in large changes in absolute peak moment produced as well as the angular dependence of peak moment. This was due to the change in the region of FCU operation on its sarcomere length-tension curve relative to the magnitude of the ECRL moment arm. These data demonstrate the sensitivity of a short-fibered muscle such as the FCU to affect the functional outcome of surgery. In addition, we demonstrated that intraoperative sarcomere length measurements, combined with biomechanical modeling provide the surgeon with a powerful method for predicting the functional effect of tendon transfer surgery.

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