Flexor to Extensor Tendon Transfers in the Hand

1995 ◽  
Vol 20 (1) ◽  
pp. 26-28 ◽  
Author(s):  
W. J. DUNNET ◽  
P. L. HOUSDEN ◽  
R. BIRCH
Keyword(s):  
Brachial Plexus ◽  
Radial Nerve ◽  
Tendon Transfer ◽  
Extensor Tendon ◽  
Contralateral Side ◽  
Vascular Injuries ◽  
Wrist Extension ◽  
Power Grip ◽  
Tendon Transfers

We reviewed 49 cases of flexor to extensor tendon transfer following injury to the radial nerve (22) or brachial plexus (27). Post-operative follow-up averaged 5.6 years (0.5–12.5). Function was improved in 84% (41) of patients. 16% (8) reported no improvement; of these, four (50%) had associated vascular injuries. In those with improvement, impaired coordination and dexterity were reported by 79% (15 of 19) of the plexus injuries and in 64% (14 of 22) of the radial nerve palsies. Premature fatigue was noted by 89% (17 of 19) of plexus injuries and in 82% (18 of 22) of radial nerve palsies. The power of wrist extension averaged 22% of the contralateral side (8% to 80%), power of digital extension was 31% (5% to 130%), and power grip was reduced to 40% (5% to 86%).

Radial Nerve Palsy: Nerve Transfer Versus Tendon Transfer to Restore Function

Hand ◽  
2021 ◽  
pp. 155894472098812
Author(s):  
J. Megan M. Patterson ◽  
Stephanie A. Russo ◽  
Madi El-Haj ◽  
Christine B. Novak ◽  
Susan E. Mackinnon
Keyword(s):  
Radial Nerve ◽  
Tendon Transfer ◽  
Nerve Palsy ◽  
Nerve Transfer ◽  
Pinch Strength ◽  
Radial Nerve Palsy ◽  
Nerve Injuries ◽  
Tendon Transfers ◽  
Nerve Transfers ◽  
Transfer Group

Background: Radial nerve injuries cause profound disability, and a variety of reconstruction options exist. This study aimed to compare outcomes of tendon transfers versus nerve transfers for the management of isolated radial nerve injuries. Methods: A retrospective chart review of 30 patients with isolated radial nerve injuries treated with tendon transfers and 16 patients managed with nerve transfers was performed. Fifteen of the 16 patients treated with nerve transfer had concomitant pronator teres to extensor carpi radialis brevis tendon transfer for wrist extension. Preoperative and postoperative strength data, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and quality-of-life (QOL) scores were compared before and after surgery and compared between groups. Results: For the nerve transfer group, patients were significantly younger, time from injury to surgery was significantly shorter, and follow-up time was significantly longer. Both groups demonstrated significant improvements in grip and pinch strength after surgery. Postoperative grip strength was significantly higher in the nerve transfer group. Postoperative pinch strength did not differ between groups. Similarly, both groups showed an improvement in DASH and QOL scores after surgery with no significant differences between the 2 groups. Conclusions: The nerve transfer group demonstrated greater grip strength, but both groups had improved pain, function, and satisfaction postoperatively. Patients who present early and can tolerate longer time to functional recovery would be optimal candidates for nerve transfers. Both tendon transfers and nerve transfers are good options for patients with radial nerve palsy.

scholarly journals Surgical restoration of drop-hand syndrome with tendon transfer in patients injured in the Syrian civil war

2019 ◽  
Vol 6 (1) ◽  
Author(s):  
Murat Ucak
Keyword(s):  
Civil War ◽  
Radial Nerve ◽  
Tendon Transfer ◽  
Cutting Tool ◽  
Gunshot Wounds ◽  
Wrist Flexion ◽  
Wrist Extension ◽  
Extensor Pollicis Longus ◽  
Finger Extension ◽  
Syrian Civil War

Abstract Background The radial nerve is one of the most common war-related injury sites due to penetrating cutting tool injuries or gunshot wounds, resulting in drop-hand syndrome. The aim of this study was to evaluate the outcomes of tendon transfer in patients with drop-hand syndrome who had been injured in the Syrian Civil War. Methods This level-II, prospective, comparative study included 13 civilians injured in the Syrian Civil War 2015 and 2017. The palmaris longus tendon was used for transfer to the extensor pollicis longus for thumb extension. The pronator teres was transferred to the extensor carpi radialis brevis for wrist extension. The flexor carpi radialis was transferred to the extensor digiti communis for 2nd, 3rd, 4th, and 5th finger extension. All outcomes of thumb abduction and extension, wrist extension, wrist flexion, and finger extension were assessed. Results There was a high level of radial nerve injury in all patients included in the study. The time from injury to treatment ranged from 1.5 months to 9 months. The mechanism of injury most commonly observed was a gunshot wound, which was observed in 8 patients (61.5%), followed by a penetrating cutting tool injury (n = 3; 23.1%) and humerus fracture (n = 2; 15.4%). Conclusions In radial nerve injuries, successful results can be achieved with tendon transfer. All patients regained thumb abduction of up to approximately 60°. All the patients were able to bend the wrist, grip, and extend the fingers while in wrist flexion, neutral wrist and wrist extension positions. Although the reason for the radial injury varied, the postoperative outcomes were good for all patients, and the rehabilitation period progressed successfully in patients who underwent tendon transfer repair within 90 days of injury.

Wrist extension strength required for power grip: a study using a radial nerve block model

2011 ◽  
Vol 37 (5) ◽  
pp. 432-435 ◽  
Author(s):  
T. Suzuki ◽  
T. Kunishi ◽  
J. Kakizaki ◽  
N. Iwakura ◽  
J. Takahashi ◽  
...  
Keyword(s):  
Nerve Block ◽  
Strong Correlation ◽  
Radial Nerve ◽  
Recovery Process ◽  
Wrist Flexion ◽  
Nerve Blocks ◽  
Wrist Extension ◽  
Power Grip ◽  
The Mean ◽  
Healthy Males

The aim of this study was to investigate the correlation of wrist extension strength (WES) and grip strength (GS) using a radial nerve block, and to determine the WES required to prevent the “wrist flexion phenomenon” (antagonistic WES) when making a fist. We tested 14 arms in seven healthy males. WES and GS were measured before blocking as standard WES and standard GS. All participants then had radial nerve blocks with mepivacaine hydrochloride. During the recovery process from radial nerve blockade, WES and GS were recorded every 5 minutes. There was a very strong correlation between WES and GS ( p < 0.0001). The mean antagonistic WES was 51% of standard WES, and the mean GS, recorded at the same time, was 66% of standard GS.

Operative Management of Foot and Ankle Equinovarus Associated with Focal Dystonia

1998 ◽  
Vol 19 (4) ◽  
pp. 229-231 ◽  
Author(s):  
Thomas J. Moore ◽  
William Evans ◽  
Douglas Murray
Keyword(s):  
Tendon Transfer ◽  
Operative Management ◽  
Clinical Results ◽  
Focal Dystonia ◽  
Functional Improvement ◽  
Foot And Ankle ◽  
Tendon Transfers ◽  
Anterior Tibial ◽  
Clinically Significant

Six surgical procedures, consisting of tendon transfers and releases, were performed in five patients with idiopathic focal dystonia involving the lower extremity. All patients were female. Surgical management was performed to correct clinically significant foot abnormalities. The goal of each procedure was functional improvement and obtaining a plantigrade foot. The SPLATT (split anterior tibial tendon transfer) procedure was performed in each foot with a flexible equinovarus foot abnormality. Follow up at a mean of 27.2 months (range, 8–40 months) yielded satisfactory clinical results without significant complications. Clinical equinovarus has not recurred after this procedure. All patients remain brace-free ambulators.

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.

scholarly journals Irreparable Radial Nerve Palsy Due to Delayed Diagnostic Management of a Giant Lipoma at the Proximal Forearm Resulting in a Triple Tendon Transfer Procedure: Case report and Brief Review of Literature

2017 ◽  
Vol 11 (1) ◽  
pp. 794-803 ◽  
Author(s):  
Ingo Schmidt
Keyword(s):  
Functional Recovery ◽  
Radial Nerve ◽  
Tendon Transfer ◽  
Nerve Palsy ◽  
Radial Nerve Palsy ◽  
Patient Reported ◽  
Diagnostic Management ◽  
Giant Lipoma ◽  
Proximal Forearm

Background: Non-traumatic radial nerve palsy (RNP) caused by local tumors is a rare and uncommon entity. Methods: A 62-year-old female presented with a left non-traumatic RNP, initially starting with weakness only. It was caused by a benign giant lipoma at the proximal forearm that was misdiagnosed over a period of 2 years. The slowly growth of the tumor led to an irreparable overstretching-related partial nerve disruption. For functional recovery of the patient, a triple tendon transfer procedure had to be performed. Results: Four months after surgery, the patient was completely able to perform her activities of daily living again. At the 10-months follow-up, strength of wrist extension, thumb's extension and abduction, and long fingers II-V extension had all improved to grade 4 in Medical Research Council scale (0-5). In order to restore motion, the patient reported that she would undergo the same triple tendon transfer procedure a second time where necessary. Due to the initially misdiagnosed tumor, there was an overall delayed duration of time for functional recovery of the patient. Conclusion: The triple tendon transfer procedure offers a useful and reliable method to restore functionality for patients sustaining irreparable RNP. However, it must be noted critically with our patient that this procedure probably would have been avoided. Initially, there was weakness only by entrapment of the radial nerve. RNP caused by local tumors are uncommon but known from the literature, and so it should be considered generally in differential diagnosis of non-traumatic RNP.

scholarly journals Use of the Facial Artery for Free Functioning Muscle Transfers: An Alternative Pedicle for Salvage in Brachial Plexus Lesions with Vascular Injuries

2020 ◽  
Vol 53 (01) ◽  
pp. 105-111
Author(s):  
Anil Bhatia ◽  
Kaustubh Prabhune ◽  
Alex De Carvalho
Keyword(s):  
Brachial Plexus ◽  
Elbow Flexion ◽  
Facial Artery ◽  
Salvage Procedure ◽  
Vascular Injuries ◽  
Nerve Reconstruction ◽  
Nerve Grafts ◽  
Muscle Transfers ◽  
Functional Muscle Transfer

AbstractFree functional muscle transfer (FFMT) is a salvage procedure recommended in cases of brachial plexus injury with late presentations or failures of primary nerve reconstruction. The workhorse for most authors is the gracilis, and the most common indication is the restoration of elbow flexion. For successful revascularization of the muscle, donor vessels must be in proximity of the site of the muscle fixation and allow direct coaptation to a donor nerve, ideally without the use of nerve grafts. A major problem occurs when patients have sustained concomitant vascular injuries to the subclavian and/or axillary arteries and had previous surgical dissections in the area where the most common vascular pedicles are located. The authors report the use of the rerouted facial vessels as donors in these complex cases. The surgical technique is presented, along with three cases where the procedure was used. The flaps survived in all the patients and grade > 3/5 muscle contraction was observed in the two patients who had adequate follow-up. Conclusion: the use of the facial vessels as donor vessels is an option to revascularize a FFMT in the setting of severe vascular injury to the subclavian and axillary arteries.

scholarly journals Pronator Quadratus to Extensor Carpi Radialis Brevis Nerve Transfer in C5–C7 or C5–C8 Brachial Plexus Injuries for Independent Wrist Extension

2020 ◽  
Vol 53 (01) ◽  
pp. 036-041
Author(s):  
Anil Bhatia ◽  
Mahmoud Salama
Keyword(s):  
Brachial Plexus ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Shoulder Abduction ◽  
Wrist Extension ◽  
Pronator Quadratus ◽  
Motor Branch ◽  
Nerve Surgery ◽  
Extensor Carpi Radialis

Abstract Background Patients with lesions affecting C7 and C8 roots (in addition to C56) demonstrate loss of independent wrist dorsiflexion in addition to loss of shoulder abduction and elbow flexion. Traditionally, this deficit has been addressed using tendon transfers after useful function at the shoulder and elbow has been restored by primary nerve surgery. Confidence with nerve transfer techniques has prompted attempts to replace this method by incorporating procedures for wrist dorsiflexion in the primary operation itself. Aim The objective of this study was to report the results of pronator quadratus motor branch transfers to the extensor carpi radialis brevis motor branch to reconstruct wrist extension in C5–C8 root lesions of the brachial plexus. Patients and Methods Twenty-three patients, average age 30 years, with C5–8 root injuries underwent operations an average of 4.7 months after their accident. Extrinsic extension of the fingers and thumb was weak or absent in two cases while the remaining 18 patients could open their hand actively. The patients lacked independent wrist extension when they were examined with the fingers flexed as the compensatory action of the extrinsic finger extensors was removed. The average follow-up was 21 months postoperative with the minimal follow-up period was at least 12 months. Results Successful reinnervations of the extensor carpi radialis brevis (ECRB) were demonstrated in all patients. In 17 patients, wrist extension scored M4, and in 3 patients it scored M3. Conclusions The pronator quadratus (PQ) to ECRB nerve transfer in C5–C7 or C5–C8 brachial plexus injuries for independent wrist extension reconstruction gives consistently good results with minimal donor morbidity.

Single Versus Double Tendon Transfer to Improve Shoulder External Rotation During the Treatment of Brachial Plexus Birth Palsy

Hand ◽  
2020 ◽  
pp. 155894472091121
Author(s):  
Joshua M. Abzug ◽  
Elie Miller ◽  
Alexandria L. Case ◽  
Danielle A. Hogarth ◽  
Dan A. Zlotolow ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Internal Rotation ◽  
Tendon Transfer ◽  
External Rotation ◽  
Significant Loss ◽  
Tendon Transfers ◽  
Brachial Plexus Birth Palsy ◽  
Shoulder External Rotation ◽  
Birth Palsy ◽  
Single Versus

Background: Tendon transfers are commonly performed in patients with brachial plexus birth palsy (BPBP) to improve function. Transferring 2 tendons in patients with C5-7 injury has the potential complication of loss of midline function. The purpose of this study was to investigate whether a single tendon transfer (1TT) as opposed to the traditional double tendon transfer (2TT) resulted in any differences in functional outcomes in patients with C5-7 BPBP. Methods: A retrospective review of all patients with C5-7 BPBP who underwent tendon transfers to improve shoulder external rotation over a 5-year period was performed at 2 institutions. Outcomes were assessed using the modified Mallet (MM) classification scores. Results: Twenty-two C5-7 patients had complete records of preoperative and postoperative MM scores, including 11 sex-matched patients in both the 1TT and 2TT groups. When comparing preoperative and postoperative MM categories, there were significant improvements in both the 1TT and 2TT groups for global abduction ( P < .05 and P < .01, respectively) and external rotation ( P < .00001 for both). Modified Mallet (MM) hand to neck scores were significantly improved in the 2TT group ( P < .05) but not in the 1TT group ( P = .053). Internal rotation scores significantly decreased in both groups ( P < .001). Both groups demonstrated significant increases in total scores from the preoperative MM scores ( P < .01). Conclusion: The 1TT and 2TT procedures result in substantial gains in upper extremity functions for patients with C5-7 BPBP as measured by the MM score, specifically within the global abduction and external rotation subcategories. However, a significant loss occurs in internal rotation for both groups.

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