Combined Nerve and Tendon Transfer for the Restoration of Hand Function in Individuals With Tetraplegia

2020 ◽  
Author(s):  
Keyword(s):  
Tendon Transfer ◽  
Hand Function

Improvement in Activities of Daily Living Using the Freehand: A System Designed for People with Tetraplegia

2003 ◽  
Vol 66 (3) ◽  
pp. 113-117 ◽  
Author(s):  
Julie Esnouf ◽  
Paul Taylor ◽  
John Hobby
Keyword(s):  
Activities Of Daily Living ◽  
Functional Ability ◽  
Daily Living ◽  
Tendon Transfer ◽  
Hand Function ◽  
International Classification ◽  
Home Work ◽  
Set Up ◽  
Implanted Device ◽  
At Home

The Freehand system is an implanted device for people with C5/6 tetraplegia, international classification 0, 1 and 2. The implant is designed to improve hand function, particularly in those who lack voluntary muscles suitable for tendon transfer. This study investigated how the Freehand system was being used at home, work and leisure. Twelve participants, who were assessed, implanted and trained with the Freehand system, were reviewed against their preoperative goals. Prior to surgery, eight activities of daily living goals that the participant would like to perform with the Freehand system were selected by him or her. Each task was assessed in three sections: the set-up of the task, the performance and the take-down. The amount of assistance for each section was recorded. This was repeated after training had been completed and daily use established. Each participant was also asked to state a preference on how the tasks would be completed, whether with the system or by the method prior to surgery. The results of this study show an improvement in the participants' functional ability in their selected goals when using the Freehand system. The preference for using the Freehand system to complete tasks applied to 84% of the total 96 tasks chosen by the 12 participants in this study.

scholarly journals Implanted Passive Engineering Mechanism Improves Hand Function after Tendon Transfer Surgery: A Cadaver-Based Study

Hand ◽  
2014 ◽  
Vol 10 (1) ◽  
pp. 116-122 ◽  
Author(s):  
Katherine L. Mardula ◽  
Ravi Balasubramanian ◽  
Christopher H. Allan
Keyword(s):  
Tendon Transfer ◽  
Hand Function

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 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. 

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.

scholarly journals Extensive Hand Thermal and Blast Injury From Electronic Cigarette Explosion: A Case Report

Hand ◽  
2017 ◽  
Vol 13 (3) ◽  
pp. NP1-NP5 ◽  
Author(s):  
Ellen S. Satteson ◽  
Nicholas J. Walker ◽  
Christopher J. Tuohy ◽  
Joseph A. Molnar
Keyword(s):  
Tendon Transfer ◽  
Tissue Injury ◽  
Electronic Cigarettes ◽  
Hand Function ◽  
Soft Tissue Injury ◽  
Blast Injury ◽  
Nerve Grafting ◽  
Blast Injuries ◽  
Deep Soft Tissue ◽  
Flap Coverage

Background: As the use of electronic cigarettes rises, more reports of injuries related to device explosion are surfacing. Methods: Presented here is the case of a 35-year-old man sustaining extensive thermal and blast injuries to his hand when the device exploded while he was holding it. He required multiple surgeries involving groin flap coverage, tendon transfer, and nerve grafting to optimize his postinjury function. Results: While much of his hand function has been restored, he has continued deficits in range of motion and sensation as a result of the incident. Conclusions: With increasing numbers of such injuries, hand surgeons must be aware of the blast mechanism involved so as to avoid missing deep soft tissue injury or disruption of deep structures, as demonstrated in this case.

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