Tendon Transfers for Peripheral Nerve Palsies

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Key points

  • Upper extremity peripheral nerve injuries may lead to incomplete recovery and persistent functional impairment.

  • Tendon transfers offer the potential for restoration of function.

  • The three most common ulnar nerve palsy-related deficits corrected by tendon transfers include claw hand, weak power grip, and weak pinch.

  • Opponensplasty can restore function of the thumb after median nerve palsy.

  • The loss of wrist, finger, and thumb extension after radial nerve palsy is reliably treated with tendon

Ulnar nerve palsy

Three main functional deficits predominate in low ulnar palsy: ulnar claw, difficulties with grip, and weakened pinch (Table 1). We do not routinely correct the small finger abduction deformity (ie, Wartenberg sign), although techniques exist to address this rare complaint.4, 5 High ulnar palsy rarely leads to a claw deformity because the paralyzed flexor digitorum profundus muscle (FDP)ring and FDPsmall do not pull the digits into flexion (Fig. 1). We consider early tendon transfer for

Low median nerve palsy

Low median nerve palsy results in the loss of thumb opposition, because the median nerve innervates the thenar muscles and contributes 70% to 74% of thumb abduction strength.24 Median nerve injuries tend to have better outcomes with primary repair than other peripheral nerve injuries.1 For example, Jensen25 found that 55% recovered opposition following neurorrhaphy alone, with opponensplasty indicated in only 14% of patients.

High median nerve palsy

In addition to the loss of opposition, high median nerve palsy leads to loss of extrinsic finger flexion. High median nerve palsy has been shown to cause a 36% decrease in pinch strength and a 43% decrease in grip strength. Pronation is also weakened to 65% the unaffected side.37 These injuries are rare, representing approximately 0.1% of all upper extremity peripheral nerve injuries.38 Because of the poor recovery of function with high median nerve injuries, early tendon transfer should be

Radial nerve palsy

Radial nerve palsy results in an inability to extend the wrist, extend the fingers at the MCPJs, and radially abduct the thumb. Grip strength is substantially weakened in radial nerve palsy because of an inability to stabilize the wrist to transmit the power of the flexors, and an early tendon transfer to restore wrist extension should be considered. Bevin39 found only 66% of patients with a high radial nerve injury and primary nerve repair without tendon transfers achieved results good enough

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References (51)

  • C. Hamlin et al.

    Restoration of power pinch

    J Hand Surg Am

    (1980)
  • R.J. Smith

    Extensor carpi radialis brevis tendon transfer for thumb adduction: a study of power pinch

    J Hand Surg Am

    (1983)
  • J.R. Boatright et al.

    The effects of low median nerve block on thumb abduction strength

    J Hand Surg Am

    (1997)
  • E.G. Jensen

    Restoration of opposition of the thumb

    Hand

    (1978)
  • G.A. Anderson et al.

    Extensor indicis proprius opponensplasty

    J Hand Surg Br

    (1991)
  • A.L. Terrono et al.

    Camitz palmaris longus abductorplasty for severe thenar atrophy secondary to carpal tunnel syndrome

    J Hand Surg Am

    (1993)
  • W.P. Cooney et al.

    Opposition of the thumb: an anatomic and biomechanical study of tendon transfers

    J Hand Surg Am

    (1984)
  • G.A. Anderson et al.

    Opponensplasty by extensor indicis and flexor digitorum superficialis tendon transfer

    J Hand Surg Br

    (1992)
  • J.A. Bertelli et al.

    Reappraisal of clinical deficits following high median nerve injuries

    J Hand Surg Am

    (2016)
  • A.G. Bevin

    Early tendon transfer for radial nerve transection

    Hand

    (1976)
  • D.C. Riordan

    Radial nerve paralysis

    Orthop Clin North Am

    (1974)
  • M. Ropars et al.

    Long-term results of tendon transfers in radial and posterior interosseous nerve paralysis

    J Hand Surg Br

    (2006)
  • K.B. Raskin et al.

    Flexor carpi ulnaris transfer for radial nerve palsy: functional testing of long-term results

    J Hand Surg Am

    (1995)
  • R.W. Beasley

    Tendon transfers for radial nerve palsy

    Orthop Clin North Am

    (1970)
  • A.C. Ruijs et al.

    Median and ulnar nerve injuries: a meta-analysis of predictors of motor and sensory recovery after modern microsurgical nerve repair

    Plast Reconstr Surg

    (2005)
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    Disclosure Statement: The authors have no financial interest in commercial ventures related to this article.

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