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.

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.

Transfer of the Distal Terminal Motor Branch of the Extensor Carpi Radialis Brevis to the Nerve of the Flexor Pollicis Longus

Neurosurgery ◽  
2011 ◽  
Vol 70 (4) ◽  
pp. 1011-1016 ◽  
Author(s):  
Jayme Augusto Bertelli ◽  
Vera Lúcia Mendes Lehm ◽  
Cristiano Paulo Tacca ◽  
Elisa Cristiana Winkelmann Duarte ◽  
Marcos Flávio Ghizoni ◽  
...  
Keyword(s):  
Tendon Graft ◽  
Flexor Digitorum Profundus ◽  
Orthopedic Procedures ◽  
Flexor Pollicis Longus ◽  
Motor Branch ◽  
Nerve Transfers ◽  
Finger Flexion ◽  
Distal Branch ◽  
Flexor Digitorum ◽  
Extensor Carpi Radialis

Abstract BACKGROUND: In tetraplegics, thumb and finger motion traditionally has been reconstructed via orthopedic procedures. Although rarely used, nerve transfers are a viable method for reconstruction in tetraplegia. OBJECTIVE: To investigate the anatomic feasibility of transferring the distal branch of the extensor carpi radialis brevis (ECRB) to the flexor pollicis longus (FPL) nerve and to report our first clinical case. METHODS: We studied the motor branch of the ECRB and FPL in 14 cadaveric upper limbs. Subsequently, a 24-year-old tetraplegic man with preserved motion in his shoulder, elbow, wrist, and finger extension, but paralysis of thumb and finger flexion underwent surgery. Seven months after trauma, we transferred the brachialis muscle with a tendon graft to the flexor digitorum profundus. The distal nerve of the ECRB was transferred to the FPL nerve. RESULTS: The branch to the ECRB entered the muscle in its anterior and proximal third. After sending out a first collateral, the nerve runs for 2.4 cm alongside the muscle and bifurcates intramuscularly. A main branch from the anterior interosseous nerve, which entered the muscle 3 cm from its origin on the radius, innervated the FPL. The ECRB and FPL nerves had similar diameters (∼1 mm) and numbers of myelinated fibers (∼180). In our patient, 14 months after surgery, pinching and grasping were restored and measured 2 and 8 kg strength, respectively. CONCLUSION: Transfer of the ECRB distal branch to the FPL is a viable option to reconstruct thumb flexion.

CLINICAL RESULTS OF EARLY ACTIVE MOBILISATION AFTER FLEXOR TENDON REPAIR

Hand Surgery ◽  
2008 ◽  
Vol 13 (01) ◽  
pp. 45-50 ◽  
Author(s):  
C. H. Yen ◽  
W. L. Chan ◽  
J. W. C. Wong ◽  
K. H. Mak
Keyword(s):  
Grip Strength ◽  
Tendon Repair ◽  
Clinical Results ◽  
Flexor Digitorum Profundus ◽  
Pinch Strength ◽  
Paired Samples ◽  
Full Flexion ◽  
Zone Ii ◽  
Flexor Digitorum

Between 2005 and 2006, ten patients with flexor digitorum profundus zone II injuries were included. The mean age was 41 (19–84) years. One thumb, two index, four middle, one ring and two little fingers were injured. Repair method comprised four-strand core suture and 6-0 circumferential sutures. Post-operative rehabilitation included immediate active extension, progressive passive full flexion and active hold in dorsal block splint. Follow-up was four (three to seven) months. Grip strength, pinch strength, ROM was 90% (70%–90%), 90% (60%–110%) and 90% (80%–100%) of normal digit, respectively. Mayo wrist scores were five excellent, two good and three fair. All patients were satisfied. Compared with another group of ten patients with the same suture method and Kleinert splintage, grip strength, pinch strength and ROM were 50%, 40% and 40% of normal side, respectively. All differences between these two groups were statistically significant (p < 0.01) by paired samples T-test. There was no re-rupture.

Transfer of Extensor Carpi Radialis Longus or Brevis for Opponensplasty

1999 ◽  
Vol 24 (1) ◽  
pp. 50-53 ◽  
Author(s):  
G. H. BAEK ◽  
J. M. JUNG ◽  
W. J. YOO ◽  
M. S. CHUNG
Keyword(s):  
Tendon Transfer ◽  
Ring Finger ◽  
The Other ◽  
Flexor Digitorum Superficialis ◽  
Flexor Muscles ◽  
Flexor Digitorum ◽  
Extensor Carpi Radialis

For the restoration of thumb opposition many types of tendon transfer techniques have been described. The flexor digitorum superficialis (FDS) of the ring finger is commonly selected as a motor. On occasion, however, the quality of the flexor muscles of the fingers or wrist is not good enough for tendon transfer and another available muscle must be selected. In this situation, we have preferred to use an extensor carpi radialis longus (ECRL) or brevis (ECRB) transfer to restore opposition of the thumb. Follow-up examination, at an average 5 years and 10 months after operation, showed that the results of ten of 11 transfers were excellent and the other was good.

Appendicular Lean Mass, Grip Strength, and the Development of Hospital-Associated Activities of Daily Living Disability among Older Adults in the Health ABC Study

2021 ◽  
Author(s):  
James S Andrews ◽  
Laura S Gold ◽  
May J Reed ◽  
Jose M Garcia ◽  
Robyn L McClelland ◽  
...  
Keyword(s):  
Older Adults ◽  
Grip Strength ◽  
Lean Mass ◽  
Daily Living ◽  
Adult Survivors ◽  
Regression Analyses ◽  
Appendicular Lean Mass ◽  
Adl Disability ◽  
Separate Regression

Abstract Background Half of all physical disability, including activity of daily living (ADL) disability, among older adults occurs in the setting of hospitalization. This study examines whether appendicular lean mass (ALM) and grip strength, which are commonly included in various definitions of sarcopenia, are associated with development of hospital-associated ADL disability in older adults in the Health ABC Study. Methods Individuals hospitalized during the first 5 years of follow-up (n=1,724) were analyzed. ALM to body mass index (BMI) ratio (ALMBMI), by dual energy x-ray absorptiometry (DXA), and grip strength, by hand-held dynamometery, were assessed annually. Development of new ADL disability was assessed at the time of the next annual assessment after hospitalization. Separate regression analyses modeled the association of pre-hospitalization ALMBMI or grip strength with death before the next scheduled annual assessment. Next, among those who survived to the next annual assessment, separate regression analyses modeled the association of ALMBMI or grip strength with development of ADL disability. Results Each standard deviation decrement in pre-hospitalization grip strength was associated with an adjusted 1.80 odds of new ADL disability at follow-up (95% CI: 1.18, 2.74). Low, compared to not low, grip strength (per FNIH definition) was associated with an adjusted 2.36 odds of ADL disability at follow-up (95% CI: 1.12, 4.97). ALM measures were not associated with development of hospital-associated ADL disability. ALM and grip strength measures were not associated with death. Conclusions Pre-hospitalization lower grip strength may be an important risk factor for ADL disability among older adult survivors of hospitalization.

scholarly journals MRI Study on the Distance between the Distal Radius and the Flexor and Extensor Tendons: Is There Any Room for Error/Hardware?

2019 ◽  
Vol 08 (06) ◽  
pp. 470-476
Author(s):  
Minke Bergsma ◽  
Jemara Board ◽  
Job N. Doornberg ◽  
Inger Sierevelt ◽  
Mark Rickman ◽  
...  
Keyword(s):  
Distal Radius ◽  
Magnetic Resonance Images ◽  
Dorsal Side ◽  
Flexor Digitorum Profundus ◽  
Dorsal Cortex ◽  
Level Of Evidence ◽  
Extensor Pollicis Longus ◽  
Extensor Tendons ◽  
Flexor Digitorum ◽  
Extensor Carpi Radialis

Abstract Purpose This study aims to quantify the distances between the cortex of the distal radius and flexor and extensor tendons. Methods We analyzed 50 magnetic resonance images (MRI) of intact wrist without pathology. The distances between the volar cortex and the flexor pollicis longs (FPL), index flexor digitorum profunduns (FDPi), flexor digitorum profundus (FDP), and flexor digitorum superficialis (FDS) were measured at the level of the watershed line and 3- and 6-mm proximal to this level. The distances between the dorsal cortex and the extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), extensor pollicis longus (EPL), extensor indicis proprius (EIP), and the extensor digitorum communis (EDC) were measured at the level of Lister's tubercle and 5-mm distal to this level. Analysis was descriptive. Results At the watershed line, the FPL, FDPi, FDP, and FDS were located at an average of 3.1, 2.4, 3.6, and 5.1 mm, respectively, volar to the volar cortex. The distances of the FDP and FDS increased at 3-mm proximal to the watershed line and increased for all four tendons at 6-mm proximal to the watershed line. Dorsally, at Listers' tubercle the ECRL, ECRB, EPL, EIP, and EDC were identified at an average of 0.7, 0.5, 0.5, 2.6, and 3.2 mm, respectively, dorsal to the dorsal cortex of the distal radius. At 5-mm more distal, these tendons were located on average 1.2, 1.0, 0.7, 1.9, and 1.8 mm, respectively, dorsal to the dorsal cortex. Conclusion On the volar side, on average there is enough room for a volar plate when staying proximal to the watershed line. On the dorsal side, there is virtually no room for protruding screws as physical anatomical space is limited to a maximum of 0.7 mm from cortex to the closest tendon (the FDP), with screw increments being 2 mm. Level of Evidence This is a Level II Study.

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.

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