Techniques in Hand & Upper Extremity Surgery

The Journal of Hand Surgery, 2010

Indian Journal of Orthopaedics, 2011

Background: Tendon transfer for radial nerve paralysis has a 100 years history and any set of tendons that can be considered to be useful has been utilized for the purpose. The pronator tress is used for restoration of wrist dorsiflexion, while the flexor carpi radialis, flexor carpiulnaris, and flexor digitorum superficialis are variably used in each for fingers and thumb movements. The present study was a retrospective analysis, designed to compare three methods of tendon transfer for radial nerve palsy. Materials and Methods: 41 patients with irreversible radial nerve paralysis, who had underwent three different types of tendon transfers (using different tendons for transfer) between March 2005 and September 2009, included in the study. The pronator teres was transferred for wrist extention. Flexor carpi ulnaris (group 1, n=18), flexor carpi radialis (group 2, n=10) and flexor digitorum superficialis (group 3, n=13) was used to achieve finger extention. Palmaris longus was used to achieve thumb extention and abduction. At the final examination, related ranges of motions were recorded and the patients were asked about their overall satisfaction with the operation, their ability, and time of return to their previous jobs, and in addition, disabilities of the arm, shoulder and hand (DASH) Score was measured and recorded for each patient. Results: The difference between the groups with regard to DASH score, ability, and time of return to job, satisfaction with the operation, and range of motions was not statistically significant (P>0.05). All of the patients had experienced functional improvement and overall satisfaction rate was 95%. No complication directly attributable to the operation was noted, except for proximal interphalangeal joint flexion contracture in three patents. Conclusion: The tendon transfer for irreversible radial nerve palsy is very successful and probably the success is not related to type of tendon used for transfer.

Al-Azhar International Medical Journal (Print), 2020

Background: Radial nerve palsy had disabling effect on hand function, leads to loss of power grip due to lost extension. Many surgical procedure was described to restoring function, tendon transfer is an important option due to bad reputation of nerve repair. The donor site from muscle supplied by the median and ulnar nerves. Aim of work: Evaluation of different methods of tendon transfer for management of wrist and finger drop in radial or PIN palsy. Patient and Methods: 20 patients with radial or PIN palsy. Presented with post traumatic injury, 14cases in the arm with total radial nerve, 6cases in forearm with PIN. Various techniques of tendon transfer were used including FCU transfer, FCR transfer, and FDS transfer to the EDC. In cases with high radial injury, PT to ECRB transfered to restore wrist extension and palmaris for thumb extension. Results: This study included 20patients in three groups, the FCR group including 9patients, the FCU group including 6patients, and the FDS group including 5patients. In FCR group, 6patients(66.6%) were excellent, 2patients(22.2%) were good and 1patient(11.1%) was fair. In FCU group, 3patients(50%) were excellent, 2patients(33.3%) were good and 1patient(16.7%) was fair. In FDS group, 3patients(60%) were excellent, 1patient(20%) was good and 1patient(20%) was fair according to an objective evaluation. Conclusion: The tendon transfer is a very successful treatment for irreversible radial nerve paralysis, many techniques of tendon transfer were prescribed for treatment of wrist and finger drop. The FCR transfer is the best option for restoration of hand extension Because it preserves the important moment of flexion and ulnar deviation of the wrist which is important for power grip in working men and it's transfer is easier, quicker and associated with less intra-operative dissection and less donor site morbidity.

Current Orthopaedics, 1991

Türkiye Fiziksel Tıp ve Rehabilitasyon Dergisi, 2010

um mm ma ar ry y Extended delay in the treatment of radial nerve injuries might lead to permanent loss of motor end-plate function. In such cases tendon transfer is mandatory for regaining hand functions. The postoperative management of tendon transfer is difficult and requires patient cooperation and close follow-up. Two case reports are presented to describe the postoperative course of tendon transfer for radial nerve palsy. Turk J Phys Med Rehab 2010;56:91-3. K Ke ey y W Wo or rd ds s: : Radial nerve injury, tendon transfer, rehabilitation Ö Öz ze et t Radial sinir yaralanmas›n›n tedavisinde gecikme, nöromüsküler bileflke ifllevlerinin kal›c› yitimine yol açabilir. Bu durumda elin ifllevini yeniden kazanmas› için tendon transferi gereklidir. Cerrahi sonras› rehabilitasyon zor bir süreçtir ve yak›n izlem ve hasta kooperasyonu gerektirir. Bu yaz›da radial sinir felci nedeniyle izledi¤imiz iki olgunun sonuçlar› belirtilmifltir. Türk Fiz T›p Rehab Derg 2010;56:91-3. A An na ah ht ta ar r K Ke el li im me el le er r: : Radial sinir yaralanmas›, tendon transferi, rehabilitasyon

Purpose: Objective and subjective evaluation of the results of flexor digitorum superficialis tendon transfer for the restoration of finger extension in irreparable radial nerve lesions. Methods: Restoration of finger extension, thumb extension, was done in 10 patients (seven with radial nerve and three with posterior interossius nerve injury; age range: 5-60 years). We used tendon transfer technique using the flexor digi-torum superficialis (FDS) 3 [to extensor pollicis longus (EPL)] and FDS 4 [to extensor digitorum communis (EDC)] as donors for the reconstruction of fingers and thumb extension (all patients) and pronator teres (PT) for wrist extension. Results: Eight patients (out of 10) yielded 'Excellent to good' results: These patients showed marked improvement to the motor power scoring M4-M5 on the MRC grading system while 2 patients (out of 10) yielded 'Fair' results: Moderate improvement to the motor power scoring M3 on the MRC grading system. Conclusions: The FDS transfer provides thumb extension independent from the fingers and wrist extension, because the FDS control for each finger is independent from the other fingers.

Journal of Hand Surgery (European Volume), 2020

Background: High radial nerve paralysis is a very distressing hand condition among hand trauma patients, several methods have been used to restore the lost function in extension of the wrist and fingers. Objectives: To compare between one of the classic methods used for tendon transfer in high radial nerve paralysis and new method which utilize single tendon instead of triple tendons. Patients and Methods: Thirty patients with old post traumatic irreparable high radial nerve paralysis one year ago allocated into two groups the first one operated by the transfer of flexor carpi ulnaris to extensor digit minimi and extensor digitorum communis and extensor indicis proprius and extensor pollicis longus while the second group operated by triple Jones technique tendon transfer of pronator teres to extensor carpi radialis brevis and flexor carpi ulnaris to extensor digitorum communis and palmaris longus to extensor pollicis longus to restore wrist extension and fingers extension including ...

Plastic and Reconstructive Surgery, 2015

Learning Objectives: After reading this article, the participant should be able to: 1. Identify the prerequisite conditions to perform a tendon or a nerve transfer. 2. Detail some of the current nerve and tendon transfer options in upper extremity peripheral nerve injuries. 3. Understand the advantages and disadvantages of tendon and nerve transfers used in isolation and in combination. 4. Appreciate the controversies that surround the nerve/tendon transfers. 5. Realize the treatment outcomes of peripheral nerve injuries. Summary: Traditional treatment of a Sunderland fourth-or fifth-degree peripheral nerve injury has been direct neurorrhaphy, nerve grafting, or tendon transfers. With increasing knowledge of nerve pathophysiology, additional treatment options such as nerve transfers have become increasingly popular. With an array of choices for treating peripheral nerve injuries, there is debate as to whether tendon transfers and/or nerve transfers should be performed to restore upper extremity function. Often, tendon and nerve transfers are used in combination as opposed to one in isolation to obtain the most normal functioning extremity without unacceptable donor deficits. The authors tend to prefer reconstructive techniques that have proven long-term efficacy to restore function. Nerve transfers are becoming more common practice, with excellent results; however, the authors are wary of using nerve transfers that sacrifice possible secondary tendon reconstruction should the nerve transfer fail.

The Journal of Hand Surgery, 2009

Purpose Radial nerve damage results in substantial functional limitations of the upper extremity. No detailed data exist regarding long-term results, patient satisfaction, and professional and social reintegration after tendon transfer for irreparable damage to the radial nerve. In this retrospective study, we investigated these data through the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Methods Between 1995 and 2006, 77 patients underwent a modified Brooks and d'Aubigne surgical technique for radial nerve palsy in our department. In 19 cases, the flexor carpi radialis muscle was used as a donor instead of the flexor carpi ulnaris muscle. The mean follow-up period was 60 months (range, 24-150 months); motion of the wrist and finger joints and pinch-grip power were compared with the healthy side. We assessed the limitation in pursuing daily activities using the DASH score. Results Wrist extension averaged 73% of the contralateral side, whereas the value for movement of digital extension was 32% and for thumb abduction in the palmar direction it was 80%. The power grip was reduced to 49% and the pinch grip was reduced to 28%. The mean DASH score was 15 Ϯ 9, the symptom score mean was 15 Ϯ 7, and the working score mean was 12 Ϯ 10. The mean total DASH score was 16 Ϯ 10. The proportion of patients who remained employed after surgical treatment was 89%. Conclusions Functional results, adequate patient satisfaction, and sufficient professional and social reintegration can be achieved after modified Brooks and d'Aubigne tendon transfer. Accordingly, the tendon transfer offers an important alternative-possibly the procedure of choice-to microsurgical nerve reconstruction, particularly when early professional and social reintegration is important.