Seventeen patients with 28 flexor tendon injuries were examined after tendon repair. The current most frequently used evaluation systems, including grip and pinch strength, were compared with functional outcome as assessed by a questionnaire, evaluating Disabilities of Arm, Shoulder and Hand (DASH). Good correlation was found between Total Active Motion (TAM) and the Original Strickland test (kappa = 0.85), however with reduced categories. Only limited correlation was found between the DASH-score and TAM (r = -0.33) as well as between the DASH-score and pinch strength (r = -0.35). We suggest reporting the average Range of Motion (ROM) of the complete finger as a percentage of the contralateral finger, instead of reporting the classified result, and to include assessment of pinch strength. It would be very useful to have an accurate functional outcome assessment, but DASH proves to be insufficiently sensitive.
Wrist flexion deformity in cerebral palsy is treated with flexor carpi ulnaris to extensor carpi radialis brevis transfer. The aim of the study was to assess the outcome of this procedure and analyse the determining factors for patient satisfaction. Fifteen patients were reviewed after a mean follow-up of 23 months. The functional and cosmetic outcome and patient satisfaction were evaluated using patient rated scales. There was a strong and significant correlation between the cosmetic outcome and patient satisfaction, but there was no significant correlation between functional improvement and patient satisfaction. When analysing the cosmetic outcome in relation to the time since surgery, there was a decrease in the patient rated improvement over time. It seems that patient satisfaction is mainly determined by the cosmetic result, but the improvement, or the perception of it, tends to diminish over time. Fourteen out of 15 patients felt that the procedure was worthwhile and eight of them felt that the result was good or excellent.
Nerve transfer surgery, also referred to neurotization, developed in the mid 1800s with the use of animal models, and was later applied in the treatment of brachial plexus injuries. Neurotization is based on the concept that following a proximal nerve lesion with a poor prognosis, expendable motor or sensory nerves can be re-directed in proximity of a specific target, whether a muscle or skin territory, in order to obtain faster re-innervation. Thanks to the contribution of several authors including Oberlin, MacKinnon and many others, the field of nerve transfer surgery has expanded in treatment of not only the brachial plexus, but also the arm, forearm and hand. This article reviews the recent literature regarding current concepts in nerve transfer surgery, including similarities to and differences from tendon transfer surgery. Moreover, indications and surgical techniques are illustrated for different types of nerve injury affecting the extrinsic and intrinsic musculature of the hand as well as sensory function.
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