Palsy of elbow extension

Area of Science:

• Orthopedics
• Neurosurgery
• Rehabilitation Medicine

Background:

• Elbow extension palsy can impact daily activities, but gravity often assists when standing.
• Restoring elbow extension is vital for hand positioning and function in cases of trunk paralysis, brachial plexus palsy, and tetraplegia.

Purpose of the Study:

• To review techniques for restoring elbow extension in patients with various paralytic conditions.
• To compare the efficacy and indications of nerve transfers versus tendon transfers for elbow extension restoration.

Main Methods:

• Discussion of nerve transfer techniques targeting triceps reinnervation for early palsy.
• Analysis of secondary tendon transfer options, including posterior deltoid and biceps brachii transfers, for established palsy or when nerve transfers are unsuitable.
• Consideration of pre-operative factors like shoulder stability and elbow contractures.

Main Results:

• Nerve transfers are most effective when performed early before muscle atrophy.
• Tendon transfers, particularly biceps brachii, offer broader indications and are the reference technique for tetraplegics in wheelchairs.
• Specific muscle transfers have distinct requirements and contraindications.

Conclusions:

• Early nerve transfers are preferred for triceps reinnervation.
• Palliative tendon transfers are essential for functional restoration in tetraplegia and when nerve transfers are not viable.
• Restoration of elbow extension must be part of a comprehensive upper limb surgical plan.