the paralysed hand

Question 1

Before contemplating tendon transfer what criteria have to be met?

Answer 1

1. The jont must be passively mobile
2. the gain in function must be greater than the potential loss
3. Motor must be sufficient power ( generally grade 1 will be lost)

Ideally there should be

1. one motor per joint to be moved
2. a stright line of oull
3. synergistic transfers
4. sensiblity

Question 2

What is lost in radial nerve palsy at the wrist/hand?

What tendon transfer can aid this?

Answer 2

• Loss: wrist and MCP extension
• transfer
  
  • Pronator teres (PT) to ECRB ( less radial deviation than ERCL)
  • Palmaris longus to EPL or FDS IV to EPL
  • FCR ( or FCU) to EDC

Question 3

What is lost in low ulnar nerve palsy at the wrist/hand?

What tendon transfer can aid this?

Answer 3

• loss: intrinsics
• transfer
  
  • to prevent clawing
    
    • FDS tendodesis
    • MCPJ capulsodesis
    • FDS to lateral band
    • ERCL plus graft to lateral band
  • for thumb adduction
    
    • ERCB plus graft
    • EIP thru 2nd MC space
  • ​for first dorsal interossei
    
    • ​often not needed- flex all fingers to create post for pinch
    • ERCL to DIO

Question 4

What is lost in high ulna nerve palsy at the wrist/hand?

What tendon transfer can aid this?

Answer 4

• loss of intrinsics/dorsal interossei/ thumb adduction and FCU and FDP
• suture FDPs together
• FCR to FCU ( remaining radial flexors PL and APL)

Question 5

What is lost in low median nerve palsy at the wrist/hand?

What tendon transfer can aid this?

Answer 5

• loss thumb opposition
• transfer
• PL to APB
• EIP to APB

Question 6

What is lost in high median nerve palsy at the wrist/hand?

What tendon transfer can aid this?

Answer 6

• Loss of abductor pollcis brevis, PT, finger and thumb flexors ( except ulna FDP)
• Transfer
  
  • EIP to APB
  • suture FDPs together
  • re- reoute biceps ot ECU to radius for pronation
  • ECRL to FPL
  • BR + graft to FPL