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Tendon transfer for median nerve palsy.

W P Cooney1

  • 1Mayo Medical School, Mayo Clinic, Rochester, Minnesota.

Hand Clinics
|May 1, 1988
PubMed
Summary

Tendon transfers effectively restore thumb opposition and finger flexion after nerve injuries. Optimal results depend on surgical principles and matching donor tendons to recipient needs for successful functional recovery.

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Area of Science:

  • Orthopedic Surgery
  • Hand Surgery
  • Reconstructive Surgery

Background:

  • Tendon transfers are crucial for restoring function after nerve palsy.
  • Successful outcomes require adherence to specific surgical principles.
  • Selecting appropriate donor tendons is vital for optimal results.

Purpose of the Study:

  • To review and recommend optimal tendon transfers for median nerve palsy.
  • To guide the selection of donor tendons based on functional requirements.
  • To evaluate the success of tendon transfers in restoring thumb and finger function.

Main Methods:

  • Review of existing literature and clinical studies on tendon transfers.
  • Analysis of biomechanical properties of potential donor tendons (e.g., FDS, ECR, ECRL, EIP, EDQ, ADQ, PL, BR, FDP).
  • Matching donor tendon characteristics (force, motion, excursion) to the functional deficits of median nerve palsy.

Main Results:

  • For low median nerve palsy, FDS of long/ring fingers or wrist extensors (ECR/ECRL) are recommended for opposition and strength.
  • For thumb mobility only, the EIP is ideal; EDQ and ADQ also have sufficient excursion.
  • For high median nerve palsy, brachioradialis or ECRL transfers for thumb flexion and FDP index finger transfers are effective.

Conclusions:

  • Tendon transfers for median nerve palsy are generally successful when principles of direction, pulley location, and insertion are met.
  • Careful consideration of donor tendon properties ensures functional restoration.
  • Tendon transfers are muscle balance operations requiring assessment of both restored and potentially lost function.

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