Brachioradialis Transfer for Digital Palsy

1990 ◽  
Vol 15 (3) ◽  
pp. 312-316
Author(s):  
J. M. FAILLA ◽  
C. A. PEIMER ◽  
F. S. SHERWIN
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Tendon Transfer ◽  
Flexor Digitorum Profundus ◽  
Flexor Pollicis Longus ◽  
Pinch Grip ◽  
The Common ◽  
Finger Motion ◽  
Flexor Digitorum ◽  
Tendon Excursion

Although brachioradialis tendon transfer is thought to offer limited tendon excursion and finger motion, we have used it to restore active thumb and digital function in eight patients. Three had Volkmann’s contracture, one avulsion of forearm muscles and four had tetraplegia resulting in inability to perform activities of daily living and loss of pinch or grasp and extrinsic extension. The brachioradialis was transferred to the flexor pollicis longus, to the flexor digitorum profundus or to the common digital extensors. Except for one patient who had unremitting pain, all were pleased with their improved motion, pinch, grip, and independence. Function, however, remained abnormal in all but one.

scholarly journals Brachioradialis to flexor digitorum profundus tendon transfer to restore finger flexion

2018 ◽  
Vol 51 (02) ◽  
pp. 123-130 ◽  
Author(s):  
R. Srikanth ◽  
Koteswara Rao Rayidi ◽  
Subha Kakumanu
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Tendon Transfer ◽  
Hand Function ◽  
Flexor Digitorum Profundus ◽  
Tendon Transfers ◽  
Wrist Extensor ◽  
Nerve Transfers ◽  
Finger Flexion ◽  
Flexor Digitorum

ABSTRACT Introduction: The main deformity following an adult lower brachial plexus injury is the loss of finger flexion. Distal nerve transfers have been used to restore finger and thumb flexion followed by tendon transfers for intrinsic replacement for opening of the fingers. When patients present beyond 6 months, only tendon transfers are applicable. Since the brachioradialis (BR) is always spared in such injuries, it is the ideal muscle to provide finger flexion. Wrist extensor power may not be normal for the use of the radial wrist extensor to serve as donor. BR to FDP transfer provides reasonable flexion range and an acceptable hand function to permit activities of daily living, when associated with ancillary procedures like opponensplasty, PIPJ arthrodesis. Materials and Methods: Eleven patients underwent a BR to FDP tendon transfer between January 2013 and January 2017 of which eight patients came for follow-up. Results: Four of the eight patients got a functionally useful hand to carry out activities of daily living with hook grip, span grasp, key pinch, chuck grip and pulp pinch. These patients also underwent simultaneous or secondary ancillary procedures. Four of the patients need secondary procedures to further improve functionality of the hand inspite of having a flexion range. Conclusion: The BR is an effective donor in providing adequate range and power of finger flexion in lower plexus injuries.

The Outcome of Tendon Transfers for C6-Spared Quadriplegics

1998 ◽  
Vol 23 (2) ◽  
pp. 156-161 ◽  
Author(s):  
I. K. Y. LO ◽  
R. TURNER ◽  
S. CONNOLLY ◽  
G. DELANEY ◽  
J. H. ROTH
Keyword(s):  
Grip Strength ◽  
Daily Living ◽  
Flexor Digitorum Profundus ◽  
Flexor Pollicis Longus ◽  
Tendon Transfers ◽  
Flexor Digitorum ◽  
Extensor Carpi Radialis ◽  
Uniform Group

The purpose of this study was to review retrospectively and evaluate a uniform group of C6-spared quadriplegics who had similar surgical procedures. Eight patients undergoing 12 procedures were reviewed at an average of 3.8 years follow-up. There were three bilateral procedures. All patients had extensor carpi radialis longus to flexor digitorum profundus and brachioradialis to flexor pollicis longus transfers to improve grip strength and key pinch. All patients reported subjective improvements in quality of life, activities of daily living and patient-centred goals. There were six excellent and two good results. Objective improvements included mild improvements in key pinch and grip strength.

LINBURG-COMSTOCK PHENOMENON FOLLOWING FOREARM LACERATION

Hand Surgery ◽  
2012 ◽  
Vol 17 (02) ◽  
pp. 221-224 ◽  
Author(s):  
B. Lin ◽  
S. Sreedharan ◽  
Andrew Y. H. Chin
Keyword(s):  
Index Finger ◽  
Interphalangeal Joint ◽  
Penetrating Injury ◽  
Flexor Digitorum Profundus ◽  
Flexor Pollicis Longus ◽  
Distal Interphalangeal Joint ◽  
Distal Interphalangeal ◽  
The Right ◽  
Flexor Digitorum ◽  
Wide Awake

A 20-year-old man presented with an inability to flex the interphalangeal joint of the right thumb without simultaneous flexion of the distal interphalangeal joint of the index finger following a penetrating injury to the right forearm. With a clinical suspicion of intertendinous adhesions between the flexor pollicis longus and the flexor digitorum profundus to the index finger, surgical exploration under wide-awake anesthesia was performed. Intraoperatively, the intertendinous adhesions were identified and divided completely. Postoperatively, the patient achieved good, independent flexion of the interphalangeal joint of the thumb. This case demonstrates a clinical picture similar to that of Linburg-Comstock syndrome, which occurred following a forearm penetrating injury. We call this the Linburg-Comstock (LC) phenomenon.

Tossed in the Deep End

2010 ◽  
pp. 257-269
Author(s):  
Jeff Chaffee
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Support Staff ◽  
Common Goal ◽  
Output Device ◽  
Speech Output ◽  
Device User ◽  
The Common ◽  
Strategic Rules

The purpose of this chapter is to minimize the shock and stigma of adding device users to a caseload in a school, medical, or rehabilitation setting. To this end, the author gives four strategic rules for adapting the device to the therapy setting as well as four additional strategies for improving carryover into activities of daily living, the classroom, and other settings with caregivers and loved ones. To illustrate each of these strategies, the case of Corey, an adult AAC device user, is presented. His case highlights the need for clinicians and support staff to work together towards the common goal of improving communication through the use of the computerized speech output device.

Sonographic study of repair, gapping and tendon bowstringing after primary flexor digitorum profundus repair in zone 2

2018 ◽  
Vol 43 (5) ◽  
pp. 480-486 ◽  
Author(s):  
Lisa Reissner ◽  
Nadja Zechmann-Mueller ◽  
Holger Jan Klein ◽  
Maurizio Calcagni ◽  
Thomas Giesen
Keyword(s):  
Clinical Outcomes ◽  
Ultrasound Examination ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Level Of Evidence ◽  
Repair Site ◽  
Heterotopic Ossifications ◽  
Finger Motion ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

We report sonographic findings with clinical outcomes after zone 2 flexor digitorum profundus tendon repairs in ten fingers. The tendons underwent a six-strand M-Tang core repair, no circumferential suture, and partial or complete division of the pulleys. Over 12 months after surgery and using ultrasound, we found no gapping at the repair site during finger motion. When the pulleys were divided, there was sonographic evidence of tendon bowstringing, but the bowstringing was minimal. Clinically, we did not find any fingers that displayed tendon bowstringing or had functional loss. With ultrasound examination, the repaired tendons remained enlarged over 12 months. Two patients developed heterotopic ossifications at the repair site without tendon gliding, and these required tenolysis. We conclude that the tendon repair site does not gap when a strong core suture is used in the repair without adding peripheral sutures. There is no notable tendon bowstringing clinically, though the repaired tendons have sonographic evidence of minor bowstringing. Level of evidence: III

Improvement in Activities of Daily Living Using the Freehand: A System Designed for People with Tetraplegia

2003 ◽  
Vol 66 (3) ◽  
pp. 113-117 ◽  
Author(s):  
Julie Esnouf ◽  
Paul Taylor ◽  
John Hobby
Keyword(s):  
Activities Of Daily Living ◽  
Functional Ability ◽  
Daily Living ◽  
Tendon Transfer ◽  
Hand Function ◽  
International Classification ◽  
Home Work ◽  
Set Up ◽  
Implanted Device ◽  
At Home

The Freehand system is an implanted device for people with C5/6 tetraplegia, international classification 0, 1 and 2. The implant is designed to improve hand function, particularly in those who lack voluntary muscles suitable for tendon transfer. This study investigated how the Freehand system was being used at home, work and leisure. Twelve participants, who were assessed, implanted and trained with the Freehand system, were reviewed against their preoperative goals. Prior to surgery, eight activities of daily living goals that the participant would like to perform with the Freehand system were selected by him or her. Each task was assessed in three sections: the set-up of the task, the performance and the take-down. The amount of assistance for each section was recorded. This was repeated after training had been completed and daily use established. Each participant was also asked to state a preference on how the tasks would be completed, whether with the system or by the method prior to surgery. The results of this study show an improvement in the participants' functional ability in their selected goals when using the Freehand system. The preference for using the Freehand system to complete tasks applied to 84% of the total 96 tasks chosen by the 12 participants in this study.

Timely manner application of hand orthoses to patients with amyotrophic lateral sclerosis: A case report

2013 ◽  
Vol 38 (3) ◽  
pp. 239-242 ◽  
Author(s):  
Kazunari Tanaka ◽  
Koji Horaiya ◽  
Junya Akagi ◽  
Nagatoshi Kihoin
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Case Report ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Timely Manner ◽  
Clinical Algorithm ◽  
Hand Muscles ◽  
Finger Motion ◽  
Lateral Sclerosis

Background: In patients with amyotrophic lateral sclerosis, the atrophy of hand muscles often causes impairment of thumb/finger motion and disabilities in their activities of daily living. Hand orthoses are effective for such impairment and disabilities; however, there are some difficulties in their application. Case description and methods: In this case report, we present the timely application of hand orthoses and introduce our clinical algorithm for the application of hand orthoses to patients with amyotrophic lateral sclerosis. Findings and outcomes: Our clinical algorithm was applied to 11 patients. The numbers of applications and the durations of the use of orthoses were as follows: 4, web spacer; 4, short thumb spica; 8, long thumb spica; and 2, cock-up splint; and 2.75, 2.0, 0.63, and 2.0 months, respectively. Conclusions: The clinical algorithm for the application of hand orthoses is helpful in choosing the optimal orthoses and contributes to maximizing patients’ function, independence, and quality of life. Clinical relevance Hand orthoses are useful for improving the activities of daily living of patients with amyotrophic lateral sclerosis. The clinical algorithm might be helpful for many physicians in choosing the optimal orthoses in a timely manner.

Neurotization as an alternative for restoring finger and wrist extension

2001 ◽  
Vol 94 (5) ◽  
pp. 795-798 ◽  
Author(s):  
Mehmet Erkan Üstün ◽  
Tunç Cevat Öğün ◽  
Mustafa Büyükmumcu
Keyword(s):  
Median Nerve ◽  
Motor Nerve ◽  
Flexor Digitorum Profundus ◽  
Posterior Interosseous Nerve ◽  
Flexor Pollicis Longus ◽  
Pronator Quadratus ◽  
Content Type ◽  
Pronator Teres ◽  
Flexor Digitorum ◽  
Fine Print

Object. In cases of irreparable injuries to the radial nerve or in cases in which nerves are repaired with little anticipation of restoration of function, tendon transfers are widely used. In this study, the authors searched for a more natural alternative for selectively restoring function, with the aid of a motor nerve transfer. Methods. Ten arms from five cadavers were used in the study. The posterior interosseous nerve and the median nerve together with their motor branches were exposed in the proximal forearm. The possibility of posterior interosseous nerve neurotization via the median nerve through its motor branches leading to the pronator teres, flexor pollicis longus, flexor digitorum profundus, and pronator quadratus muscles was investigated. The lengths of the nerves from points of divergence and their widths were measured using calipers, and the means with standard deviations of all nerves were calculated. Motor branches to the pronator teres, flexor pollicis longus, and pronator quadratus muscles were found to be suitable for neurotization of the posterior interosseous nerve at different levels and in various combinations. The motor nerve extending to the flexor digitorum profundus muscle was too short to use for transfer. Conclusions. These results offer a suitable alternative to tendon transfer for restoring finger and wrist extension in cases of irreversible radial palsy. The second step would be clinical verification in appropriate cases.

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