Outcome of tendon transfer for radial nerve paralysis: Comparison of three methods

Abstract

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.

Irreparable Radial Nerve Palsy Due to Delayed Diagnostic Management of a Giant Lipoma at the Proximal Forearm Resulting in a Triple Tendon Transfer Procedure: Case report and Brief Review of Literature

“…The essential consideration is the avoidance of radial deviation of the wrist by centralizing the insertion of the ECRL [ 62 ]. The Merle d'Aubigne and Lance procedure is reported to be an excellent and reliable method; two retrospective studies revealed that 73,2 - 88,4% of treated patients were able to return in their original occupations 4 months after surgery [ 63 , 64 ]. However, this procedure is also not free of any problems.…”

“…This is an important wrist movement, which is necessary for activities such as hammering and throwing [ 58 ]. Additionally, the ability to simultaneously extend the wrist and long fingers II-V cannot be achieved in most of patients treated by triple transfer procedures, whereas the majority of patients are able to move their fingers separately [ 63 , 64 ].…”

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

“…The overall result was rated as perfect, good, fair, or poor according to the Moussavi et al [10] classification. The assessment criteria are shown in Table 1.…”

Plastic Surgery for the Oncological Patient

“…Various transfers of tendons have been described for this condition, one of the most common types of reconstruction utilizes the pronator teres muscle for wrist extension, the palmaris longus muscle for thumb extension and abduction and the flexor carpi ulnaris muscle to regain finger extension. These transfers yield good functional results with relatively little donor-site morbidity ( 25 , 26 ). Although the muscles that can be used vary greatly between patients and their individual patterns of functional loss, the principle of replacing lost muscle function by the transfer of still working muscles remains valid and can be applied for various conditions.…”