An objective functional evaluation of the flexor carpi ulnaris set of triple tendon transfer in radial nerve palsy

Latheef, Latheesh; Bhardwaj, Praveen; Sankaran, Ajeesh; Sabapathy, S Raja

doi:10.1177/1753193416651574

Cited by 6 publications

(7 citation statements)

References 14 publications

(22 reference statements)

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“…For restoration of the hand function in radial nerve palsy, the triple-tendon transfer of pronator teres (PT) to extensor carpi radialis brevis (ECRB), flexor carpi ulnaris (FCU)/flexor carpi radialis to extensor digitorum communis (EDC), and palmaris longus (PL) to rerouted extensor pollicis longus (EPL) has been recommended. Our results with this set of triple-tendon transfers are satisfactory as described in the study by Latheef et al 1 Rerouting of EPL volarly and transfer to the PL was described by Scuderi 2 to achieve a combined extension and abduction, describing excellent results. Over the years, this has become the standard transfer for thumb extension.…”

Section: Introductionsupporting

confidence: 68%

Evaluation of Extensor Pollicis Brevis as a Recipient of Tendon Transfer for Thumb Extension

Bhardwaj

Muddappa

Dadi

et al. 2019

Indian J Plast Surg

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Introduction Rerouting of the extensor pollicis longus (EPL) is the standard part of tendon transfer surgery for thumb extension. It is done to overcome the ulnar vector of the EPL action. Extensor pollicis brevis (EPB), however, produces better thumb abduction and extension by virtue of its radial vector. The described anatomical variation of EPB extending the thumb interphalangeal joint (IPJ), therefore, gives the “best combination” of movements by a single-thumb extensor tendon. Materials and Methods We performed this transfer in six patients in whom the EPB was found to be extending the IPJ while checked intraoperatively. Three of these six patients were cases of radial nerve palsy and the other three presented with brachial plexus palsy. The outcome was assessed by measuring palmar and radial abduction of the thumb, Kapandji’s score, and Bincaz’s scale. Results We found satisfactory results in all the six patients. In our series, patients had an average radial extension of the thumb of 29.2 degrees and an average palmar abduction of the thumb of 65.7 degrees. On evaluation with the Bincaz score; one patient had excellent result, three patients had good results, and two patients had fair results. Conclusion In situations where EPL rerouting is not possible (as in cases where the donor tendon needs to reach the thumb from the ulnar side, for example, flexor carpi ulnaris), transfer to the EPB, provided it is extending the thumb IPJ, would produce better extension and abduction of the thumb than the transfer to the EPL.

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Section: Introductionsupporting

confidence: 68%

Evaluation of Extensor Pollicis Brevis as a Recipient of Tendon Transfer for Thumb Extension

Bhardwaj

Muddappa

Dadi

et al. 2019

Indian J Plast Surg

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“…4 Conversely, consistent outcomes have been demonstrated with tendon transfers for radial nerve palsy. [6][7][8] However, as the paradigm shift in the management of nerve injuries now includes nerve transfers, the new debate is between tendon transfers and nerve transfers for the management of proximal radial nerve injuries. 4,14,25 Nerve transfers to restore radial nerve function were first described in 1948.…”

Section: Discussionmentioning

confidence: 99%

“…Tendon transfers have been used for over a century to restore function after radial nerve injury or paralysis 1 with good results. [6][7][8] The donor muscle/tendon unit must be expendable, must have appropriate strength and excursion, must be synergistic, must have a straight line of pull, and should reconstruct only 1 function. 9 The patient should have supple passive range of motion.…”

Section: Introductionmentioning

confidence: 99%

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

Patterson

Russo

El-Haj

et al. 2021

Hand (New York, N,Y.)

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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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“…This method results in a flat tension direction and more efficient transfer. If the radial nerve has already been repaired and it is anticipated that the extensor carpi radialis brevis will recover in the future, the pronator teres tendon should be transferred using the end-to-end method, suturing the tendon adjacent to the intact extensor carpi radialis brevis tendon [27–29]. When this application is performed early, the nerves will function as an internal splint to correct the wrist while healing.…”

Section: Discussionmentioning

confidence: 99%

“…The combined extension movement of the thumb and index finger must be simultaneous. This movement facilitates correct manipulation and allows for unique motion [14, 29]. Transfer of the palmaris longus to obtain motion may result in an extension of the joints between the fingers as well as thumb abduction in the radial direction.…”

Section: Discussionmentioning

confidence: 99%

Surgical restoration of drop-hand syndrome with tendon transfer in patients injured in the Syrian civil war

Uçak

2019

Military Med Res

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BackgroundThe radial nerve is one of the most common war-related injury sites due to penetrating cutting tool injuries or gunshot wounds, resulting in drop-hand syndrome. The aim of this study was to evaluate the outcomes of tendon transfer in patients with drop-hand syndrome who had been injured in the Syrian Civil War.MethodsThis level-II, prospective, comparative study included 13 civilians injured in the Syrian Civil War 2015 and 2017. The palmaris longus tendon was used for transfer to the extensor pollicis longus for thumb extension. The pronator teres was transferred to the extensor carpi radialis brevis for wrist extension. The flexor carpi radialis was transferred to the extensor digiti communis for 2nd, 3rd, 4th, and 5th finger extension. All outcomes of thumb abduction and extension, wrist extension, wrist flexion, and finger extension were assessed.ResultsThere was a high level of radial nerve injury in all patients included in the study. The time from injury to treatment ranged from 1.5 months to 9 months. The mechanism of injury most commonly observed was a gunshot wound, which was observed in 8 patients (61.5%), followed by a penetrating cutting tool injury (n = 3; 23.1%) and humerus fracture (n = 2; 15.4%).ConclusionsIn radial nerve injuries, successful results can be achieved with tendon transfer. All patients regained thumb abduction of up to approximately 60°. All the patients were able to bend the wrist, grip, and extend the fingers while in wrist flexion, neutral wrist and wrist extension positions. Although the reason for the radial injury varied, the postoperative outcomes were good for all patients, and the rehabilitation period progressed successfully in patients who underwent tendon transfer repair within 90 days of injury.

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An objective functional evaluation of the flexor carpi ulnaris set of triple tendon transfer in radial nerve palsy

Abstract: 3.

Cited by 6 publications

References 14 publications

Evaluation of Extensor Pollicis Brevis as a Recipient of Tendon Transfer for Thumb Extension

Evaluation of Extensor Pollicis Brevis as a Recipient of Tendon Transfer for Thumb Extension

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

Surgical restoration of drop-hand syndrome with tendon transfer in patients injured in the Syrian civil war

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