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