Nerve Versus Tendon Transfer for Radial Nerve Paralysis Reconstruction

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Reconstructive Surgery

Background:

• Radial nerve lesions can cause significant functional deficits.
• Nerve transfers and tendon transfers are surgical options for restoring function.
• Outcomes of these procedures are not well-compared objectively.

Purpose of the Study:

• To compare the functional outcomes of nerve transfers versus tendon transfers in patients with radial nerve lesions.
• To evaluate wrist, finger, and thumb motion, and grasp strength after each procedure.

Main Methods:

• Nerve transfer group (n=14): Anterior interosseous nerve to extensor carpi radialis brevis (ECRB) and flexor carpi radialis to posterior interosseous nerve (radial nerve lesions <12 months).
• Tendon transfer group (n=13): Pronator teres to ECRB, flexor carpi ulnaris to extensor digitorum communis, palmaris longus to extensor pollicis longus (longstanding paralysis ≥15 months).
• Outcome measures included range of motion (ROM) and grasp strength.

Main Results:

• Nerve transfer group demonstrated superior wrist flexion-extension ROM and grasp strength compared to tendon transfer.
• Tendon transfer group had limitations in wrist flexion (9/13) and radial deviation (5/13).
• Nerve transfer improved first carpometacarpal joint extension (11/14) versus tendon transfer (4/13); both groups had poor extensor pollicis longus recovery.

Conclusions:

• Nerve transfer procedures yield better functional recovery for radial nerve palsy than tendon transfers.
• Further advancements are needed to optimize thumb motion, particularly extensor pollicis longus function, with both surgical techniques.