scholarly journals Tendon transfer of pronator teres to flexor pollicis longus to restore thumb flexion in incomplete tetraplegia

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Nathan P. Jarrett ◽  
Gregory A. Merrell
Keyword(s):  
Tendon Transfer ◽  
Spinal Cord Injuries ◽  
Hand Function ◽  
Daily Activities ◽  
Neutral Position ◽  
Flexor Pollicis Longus ◽  
Pronator Teres ◽  
Before And After ◽  
The Difference ◽  
Flexor Pollicis Longus Tendon

Background and Hypothesis: Incomplete tetraplegia creates immense barriers to autonomy for individuals with spinal cord injuries. These patients may retain control of some forearm extensors, but use of flexors is largely eliminated, affecting many movements necessary for daily activities. Although tendon transfers using brachioradialis and other muscles to restore hand function are standard practice, pronator teres has not been extensively studied as a donor for flexors. The purpose of this study is to quantify forearm pronation capability pre- and post-tendon transfer of pronator teres to flexor pollicis longus in a cadaver model. We hypothesize that tendon transfer will make thumb flexion possible, while preserving forearm pronation against gravity at a minimum.  Experimental Design: Five cadaver arms were evaluated for pronation capability against gravity before and after tendon transfer. In both stages, the arms were also assessed for the pronation forces produced at the wrist when pulling pronator teres with 25, 50, and 75 N of force. With each force, the arms were tested in full supination and neutral position.  Results: All five arms were capable of pronating against gravity before and after the tendon transfer. Following the transfer, pronation force decreased, but the difference was not statistically significant.  Conclusion and Potential Impact: Pronator teres to flexor pollicis longus tendon transfer produces thumb flexion while retaining the forearm’s ability to pronate. Used in conjunction with well-established donors, such as brachioradialis, pronator teres’ expendability could offer an additional motor unit for restoring hand function in tetraplegic patients. 

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 Comparison of impairment and restitution of hand function in a group of patients with total damage to the extensor pollicis longus and in a group of patients with damage to the flexor pollicis longus tendon after surgical treatment

2016 ◽  
Vol 20 (3) ◽  
pp. 5-12
Author(s):  
Jakub Szczechowicz ◽  
Krzysztof Jamka ◽  
Marek Pieniążek
Keyword(s):  
Surgical Treatment ◽  
Physical Therapy ◽  
Muscle Strength ◽  
Hand Function ◽  
Functional Improvement ◽  
Study Group ◽  
Flexor Pollicis Longus ◽  
Extensor Pollicis Longus ◽  
Flexor Pollicis Longus Tendon ◽  
Total Damage

The thumb constitutes 40% of the whole hand function, and damage to the extensor pollicis longus (EPL) and/or the flexor pollicis longus (FPL) tendons of the thumb results in its significant limitation. The main factors contributing to damage of the EPL and/or FPL tendons are mechanical injuries - cuts and spontaneous ruptures. The aim of the study was to compare values of thumb and whole hand function loss and restoration as a result of the implemented physical therapy in patients with total damage to the EPL tendon with the values obtained by the study group 2 comprised of patients with damage to the FPL tendon. The study involved 25 patients of the Specialized Hand Therapy Center in Krakow. 15 of them had ruptured continuity of the EPL tendon (study group), and 10 suffered damage to the FPL tendons (control group). The study included measurements of active motion of the thumb and wrist and superficial sensation. On the basis of these tests, functional impairment was measured using the methodology according to Swanson. The study included assessment of muscle strength in terms of global and precision grips using a dynamometer. Statistically signifcant functional improvement was noted for the thumb and whole hand as well as muscle strength in both groups. The values of functional loss differed between the two groups. The indicators of functional improvement were greater in patients with damage to the EPL tendon. Functional physical therapy is an important factor determining the return of function in the thumb and whole hand after total damage to the EPL and FPL tendons. Szczechowicz J., Jamka K., Pieniążek M. Comparison of impairment and restitution of hand function in a group of patients with total damage to the extensor pollicis longus and in a group of patients with damage to the flexor pollicis longus tendon after surgical treatment. Med Rehabil 2016; 20(3): 5-12. DOI: 10.5604/01.3001.0009.5009

Electromyographic analysis of brachioradialis to flexor pollicis longus tendon transfer in quadriplegia

1990 ◽  
Vol 15 (2) ◽  
pp. 335-339 ◽  
Author(s):  
Robert L. Waters ◽  
Lis Zin Stark ◽  
Ira Gubernick ◽  
Harris Bellman ◽  
Greg Barnes
Keyword(s):  
Tendon Transfer ◽  
Flexor Pollicis Longus ◽  
Longus Tendon ◽  
Electromyographic Analysis ◽  
Flexor Pollicis Longus Tendon
Sign in / Sign up

Export Citation Format

Share Document