Nerve Transfer Versus Tendon Transfer for Isolated Radial Nerve Palsy

Reconstructive options for high radial nerve injuries include tendon transfer (TT) and nerve transfer (NT), each with distinct advantages and limitations. This prospective, randomized clinical trial compared the outcomes of TT and NT in 21 patients with isolated radial nerve injuries.

Patients were randomly assigned to the NT group (11 patients) or the TT group (10 patients). Nerve transfer involved transferring the distal anterior interosseous nerve to the extensor carpi radialis brevis motor branch and the flexor carpi radialis motor branch to the posterior interosseous nerve. Tendon transfer used the Boyes tendon transfer technique.

At an average follow-up of 20 months for NT and 15 months for TT, NT resulted in significantly better wrist flexion (51° vs 27°), wrist extension (54° vs 34°), metacarpophalangeal hyperextension (15° vs 8°), and thumb radial abduction (44° vs 37°). Nerve transfer also resulted in significantly higher muscle power grades for finger and thumb extension, with higher proportions of patients achieving grades M4+ and M5. Both groups showed significant improvements in Disabilities of the Arm, Shoulder, and Hand scores and grip strength, but with no significant differences between both groups. Tendon transfer offered faster functional recovery (4.30 ± 1.49 months) compared with NT (5.72 ± 1.34 months).

Nerve transfer provided better long-term muscle strength and range of motion, while TT allowed quicker rehabilitation. The choice between NT and TT should consider individual patient factors, balancing early functional recovery with long-term outcomes. Further studies with larger cohorts are recommended to validate these results and refine treatment guidelines.