Reconstruction after nerve injury

Mapping Intimacies ◽

10.1093/med/9780199550647.003.006009 ◽

2011 ◽

Author(s):

T.E.J. Hems

Keyword(s):

Nerve Injury ◽

Tendon Transfer ◽

Nerve Palsy ◽

Common Type ◽

Radial Nerve Palsy ◽

Reconstructive Procedures ◽

Tendon Transfers ◽

Ulnar Nerve Palsy ◽

Intrinsic Paralysis ◽

Median Nerve Injury

♦ Late reconstructive procedures may improve function if there is persisting paralysis after nerve injury♦ Transfer of a functioning musculotendinous unit to the tendon of the paralysed muscle is the most common type of procedure♦ Passive mobility must be maintained in affected joints before tendon transfer can be performed♦ The transferred muscle should be expendable, have normal power, and have properties appropriate to the function it is required to restore♦ Tendon transfers can provide reliable improvement in function after isolated radial nerve palsy♦ A number of procedures have been described for reconstruction of thumb opposition but impaired sensation after median nerve injury may limit gain in function♦ Tendon transfers are possible to improve clawing of fingers and lateral pinch of the thumb after ulnar nerve palsy or other cases of intrinsic paralysis.

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

Hand ◽

10.1177/1558944720988126 ◽

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.

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Tendon Transfers in Upper Extremity Reconstruction

Operative Plastic Surgery ◽

10.1093/med/9780190499075.003.0101 ◽

2019 ◽

pp. 1015-1018

Author(s):

Vincent G. Laurence ◽

Gregory Rafijah

Keyword(s):

Peripheral Nerve ◽

Upper Extremity ◽

Nerve Injury ◽

Radial Nerve ◽

Nerve Palsy ◽

Radial Nerve Palsy ◽

Tendon Transfers ◽

History Of ◽

Extremity Reconstruction ◽

Radial Nerve Injury

Tendon transfers, first performed more than 100 years ago, remain one of the most powerful tools in the hand surgeon’s repertoire for addressing chronic peripheral nerve palsies. Dozens of transfers have been described in the intervening years, but three sets of transfers to provide wrist, finger, and thumb extension after a high radial nerve injury remain among the most commonly performed. This chapter briefly discusses the history of tendon transfers; outlines the general principles, indications, and timing of transfers; and provides a detailed, step-by-step description of the authors’ preferred set of transfers (the FCR set) for a high radial nerve palsy.

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Comprehensive Analysis of Zachary’s Modification of Jones Tendon Transfer in Isolated High Radial Nerve Palsy

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/48164.14789 ◽

2021 ◽

Author(s):

Neeraj Kant Agrawal ◽

Mahendra Kumar Gupta

Keyword(s):

Radial Nerve ◽

Tendon Transfer ◽

Nerve Palsy ◽

Professional Competence ◽

Radial Nerve Palsy ◽

Neutral Position ◽

Wrist Flexion ◽

Tendon Transfers ◽

Metacarpophalangeal Joints ◽

Clinical Records

Introduction: The radial nerve is the most frequently injured nerve caused by fractures of the humeral shaft. It results in loss of hand function which can considerably impair the person’s ability to perform normal activities of daily living as well as professional competence. Primary nerve repair provides best results but is often not possible because of badly traumatised nerve or late presentation. In such cases, tendon transfers are considered best to restore lost functions. Among the various transfers described for radial nerve palsy, Jones tendon transfer was popular and often practiced but the procedure had a major shortcoming of using both the wrist flexors. The Zachary’s modification is postulated as more advantageous as it preserves one wrist flexor. Aim: The study is intended to critically analyse modified Jones tendon transfer and discuss its implications with other standard methods of tendon transfer. The results of the study were evaluated extensively with emphasis on surgical details and finer technical skills. Materials and Methods: In this retrospective cohort study carried out in the Department of Plastic Surgery in eastern Uttar Pradesh, the clinical records from January 2017-December 2019, were studied to isolate the patients with high radial nerve palsy. A total of 26 patients were found to fulfil the inclusion criteria and their records were comprehensively analysed. Modified Jones tendon transfer was used. Postoperative results were evaluated using Bincaz score. Results: Amongst the data of total 26 patients studied 80.77% patient’s, radial nerve was injured due to fracture of the humerus.With metacarpophalangeal joints extended, wrist extension was 48.6°±9.64°, the minimum being 20°. Wrist flexion was 54.8°±10.25°. The position of metacarpophalangeal joints was vital to get rid of the tenodesis effect. Neutral position of the metacarpophalangeal joints has been defined at 0° without hyperextension. The study demonstrated deficit of 18°±6.78° short of the neutral position. Thumb extension and subsequent opening of first web space was more limited and we obtained 37.6°±7.51° with incomplete thumb extension in four patients. Abduction of the thumb at carpometacarpal joint and interphalangeal joint extension returned to normal range. Seventeen patients rated the results as excellent using postoperative evaluation by Bincaz score. Conclusion: Flexor Carpi Ulnaris (FCU) based tendon transfers returned encouraging results in high radial nerve palsy. Technical superiority in performing modified Jones tendon transfer was essential to obtain good results in patients with isolated high radial nerve palsy.

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