Single Tendon Transfer of the Flexor Carpi Ulnaris for High Radial Nerve Injury

Sankaran, Ajeesh; Thora, Ankit; Arora, Sumit; Dhal, Anil

doi:10.1177/230949901502300318

Cited by 7 publications

(6 citation statements)

References 8 publications

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“…Several different tendons may be transferred to the extensor pollicis longus. In the literature, the most frequently transferred tendons are the palmaris longus or flexor digitorum superficialis of the ring finger [12, 13, 20]. Similarly, the palmaris longus tendon was transferred to the extender pollicis longus for thumb extension in the current study.…”

Section: Discussionmentioning

confidence: 83%

“…This is because once a nerve repair application has failed, better results can be obtained via tendon transfer in patients with radial nerve palsy. In particular, if there is a low level of improvement in radial nerve injuries within a one-year period, tendon transfer should be recommended for the treatment of such injuries [14, 19, 20]. Although many surgeons prefer different tendon transfer approaches to obtain the best treatment outcomes, including restoration of the thumb, finger extension, and wrist extension, there are points of disagreement on the best tendon transfer approach in patients with radial nerve palsy [21, 22].…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 83%

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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“…Single-FCU tendon transfers have also been described for high-radial nerve palsies and no rerouting is possible if they are chosen. 11 12 In addition, the subcutaneous rerouting of the EPL tendon causes a bowstringing on the volar aspect of the wrist which may not be cosmetically acceptable.…”

Section: Discussionmentioning

confidence: 99%

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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“…Many ways of transfers have been described focusing on this three lost movements (Seiler et al, 2013). Some authors promote simple transfers of FCU to cover fingers and thumb extension and keep wrist in neutral positions along with fingers motion (Sankaran et al, 2015). Other option to consider is to make wrist fusion (described later) to provide full wrist stability (very reliable, especially in manual workers) and then transfer wrist flexors (FCR to EPL and FCU to EDC, EDMI and EIP).…”

Section: Radial Nerve Palsymentioning

confidence: 99%

Secondary and salvage procedures in nerve injuries

Czarnecki¹

2017

IRONS

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Single Tendon Transfer of the Flexor Carpi Ulnaris for High Radial Nerve Injury

Abstract: Single tendon transfer of the FCU is a viable option to restore hand function and strength following high radial nerve injuries.

Cited by 7 publications

References 8 publications

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

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

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

Secondary and salvage procedures in nerve injuries

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