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Training of muscle excursion after tendon transfer
T A Schreuders1, H J Stam, S E Hovius
1Department of Rehabilitation, University Hospital Rotterdam-Dijkzigt, The Netherlands.
Summary
Pronator teres tendon transfer (TT) can achieve greater wrist motion than typically expected. Excursion training may enhance outcomes, challenging current assessment methods for wrist function after radial palsy surgery.
Area of Science:
- Orthopedic Surgery
- Rehabilitation Medicine
- Biomechanical Engineering
Background:
- Tendon transfer (TT) surgery often involves matching muscle excursions, but discrepancies are common.
- In radial palsy, pronator teres (PT) is used for wrist extension, though its excursion is typically insufficient for full wrist mobility.
- Existing literature suggests limited wrist flexion post-PT transfer for wrist extension.
Observation:
- A patient with radial palsy underwent pronator teres (PT) tendon transfer (TT) for wrist extension.
- This patient achieved a total active motion (TAM) of 125 degrees, including 60 degrees of wrist extension and 65 degrees of wrist flexion.
- This outcome exceeds the commonly accepted range of motion following such a procedure.
Findings:
- The achieved wrist range of motion suggests that the transferred pronator teres (PT) muscle increased its excursion.
- The authors hypothesize that the PT muscle fibers adapted and lengthened post-transfer to accommodate the increased excursion demand.
- Therapeutic interventions focused on 'excursion training' may play a crucial role in maximizing the functional capacity of the transferred unit.
Implications:
- Limited wrist range of motion after pronator teres (PT) tendon transfer (TT) should not be prematurely accepted.
- Therapists should explore and implement specific 'excursion training' protocols for transferred tendons.
- Current methods for evaluating the success of PT tendon transfers may need revision to account for potential muscle adaptation and enhanced excursion.