tendon transfers - elbowdoc.co.uk · low ulnar nerve palsy 12 transfer options thumb key pinch -...

Tendon Transfers

Mr Adam WattsConsultant Hand and Upper Limb

Surgeon, Wrightington

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Principles of Tendon Transfer

Supple - address contractureSatisfactory bedSensibility

Strength - of donor must be adequateSize (or amplitude) of motionStraight line of pullSingle tendon, single functionSynergismSacrifice (is the donor expendable)

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Assessment and Treatment

What is missing?

What function needs to be restored?

What is available?

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Low Median Nerve Palsy

What is Missing?APBOppPFPB

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Low Median Nerve Palsy

What function needs to be restored?

Thumb Opposition

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Low Median Nerve Palsy

Transfer Options:

FDS opponensplasty

EIP opponensplasty

ADM (Huber) transfer

Palmaris longus (Camitz) transfer

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High Median Nerve Palsy

What additional loss is there?PTFCRFDS all digitsFDP to index and middleFPLPQ

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High Median Nerve Palsy

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What function needs to be restored?OppositionFlexion of index finger and thumb

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High Median Nerve Palsy

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Transfer Options?only BR, ECRL and ECU availableECU may be needed for opponensplasty

therefore:BR to FPLECRL to index FDP

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Low Ulnar Nerve Palsy

What is missing?

Intrinsic muscles

Hypothenar muscles may be spared depending on level

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Low Ulnar Nerve Palsy

What function needs to be restored?

Thumb power pinch

Roll-up function - correction of clawing

Little finger adduction

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Low Ulnar Nerve Palsy

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Transfer optionsThumb key pinch -

ECRB between 3rd and 4th MC to adductor tubercle with free graft

Clawing - ECRL with 4 tail graft to A2 pulleyor Zancolli lasso - FDS around A1 to itself

Little finger adduction and Metacarpal archEDM tendon split and ulnar half passed palmar to deep transverse ligament and attach to radial collateral ligament

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High Ulnar Nerve Palsy

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What additional loss is there?

FDP ring and little finger

FCU

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High Ulnar Nerve Palsy

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What additional functional loss is there?

Active finger flexion

restoration may result in clawing so low nerve lesion transfers may be required

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High Ulnar Nerve Palsy

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Transfer options

Side to Side Ring and Little FDP to Middle FDP

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Radial Nerve Palsy

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What is missing?

?BR and ECRL may be intact depending on level

ECRBEDCECUEDMAPLEPLEPBEIP

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Radial Nerve Palsy

What function do we need to restore?

Wrist Extension

Finger Extension

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Radial Nerve Palsy

Transfer Options

FCR or FCU transferPT to ECRBFCR or FCU to EDCPL to rerouted EPL

Superficialis transferPT to ECRL and ECRBFDS III to EDCFDS IV to EIP and EPLFCR to APL and EPB

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