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

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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Median to Radial Nerve Transfer to Restore Wrist and Finger Extension: Technical Nuances

Operative Neurosurgery ◽

10.1227/01.neu.0000354364.13224.c8 ◽

2010 ◽

Vol 66 (suppl_1) ◽

pp. ons-75-ons-83 ◽

Cited By ~ 11

Author(s):

Justin M. Brown ◽

Thomas H.H. Tung ◽

Susan E. Mackinnon

Keyword(s):

Radial Nerve ◽

Nerve Palsy ◽

Nerve Transfer ◽

Radial Nerve Palsy ◽

Tendon Transfers ◽

Line Drawings ◽

Nerve Transfers ◽

Finger Extension ◽

Reconstructive Option ◽

Distal Nerve

Abstract Background: Traditional methods for restoring finger and wrist extension following radial nerve palsy include interposition nerve grafting or tendon transfers. We have described the utilization of distal nerve transfers for the restoration of radial nerve function in the forearm. Objective: We review the neuroanatomy of the forearm and outline the steps required for the implementation of this transfer. Methods And Results: We use a step-by-step procedural outline and detailed photographs, line drawings, and video to describe the procedure. Conclusion: This approach is technically feasible and is a reconstructive option for patients with this nerve deficit.

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Systematic Review of Tendon Transfer Versus Nerve Transfer for the Restoration of Wrist Extension in Isolated Traumatic Radial Nerve Palsy

JAAOS Global Research and Reviews ◽

10.5435/jaaosglobal-d-18-00001 ◽

2018 ◽

Vol 2 (4) ◽

pp. e001

Author(s):

Jocelyn Compton ◽

Jessell Owens ◽

Molly Day ◽

Lindsey Caldwell

Keyword(s):

Systematic Review ◽

Radial Nerve ◽

Tendon Transfer ◽

Nerve Palsy ◽

Nerve Transfer ◽

Radial Nerve Palsy ◽

Wrist Extension

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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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