Summary
There have been very few reports about results of tendon transfers carried out in
very old radial palsies affecting the hand. We present two cases of radial palsy operated
52 and 30 years after the original injury, which also had after-effects in pronosupination
due to elbow injuries. In the first patient, with high radial-nerve palsy, we made
a triple transfer of the pronator teres to the extensor carpi radialis brevis, the
flexor carpi ulnaris to the extensor digitorum communis and the palmaris longus to
the extensor pollicis longus. In the second case, which had posterior interosseous
nerve palsy, we transferred the flexor carpi radialis to the extensor digitorum communis,
and the brachiorradialis to the extensor pollicis longus. The surgical findings showed
a ‘gelatinous degeneration’ in some of the receiving tendons, which did not prevent
the sutures from being resistant. The first patient, who had a stiff elbow, with pronosupination
blocked since childhood, showed disuse atrophy of the pronator teres, which conditioned
a late rupture of the tenomuscular junction and required a second surgery for wrist
arthrodesis.
Results after postoperative period of 30 months after surgery in the first patient,
and 14 months after surgery in the second one, showed functional recovery in finger
range of extension, grip and key-pinch strength and a significantly higher QuickDASH
score, restoring the natural aesthetical appearance of the limb. This facilitated
the return to professional and daily activities, re-establishing a fine ability to
grab and release objects.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Plastic, Reconstructive & Aesthetic SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Tendon transfer for old radial nerve paralysis.AMA Arch Surg. 1958; 76: 24-27
- Basic principles in tendon transfer surgery.in: Fridén J. Tendon transfers in reconstructive hand surgery. Taylor & Francis, London and New York2005: 29-49
- Radial nerve palsy.in: Green D.P. Hotchkiss R.N. Pederson W.C. Green’s operative hand surgery. 4th ed. Churchill Livingstone, Philadelphia, Pennsylvania1999: 1481-1496
- Transferts tendineux pour paralysie radiale.Chir Main. 2002; 21: 157-165
- Les transferts palliatifs de réanimation de l’extension du poignet et des doigts. À propos de 14 transferts pour paralysie radiale et dix transferts pour lésion plexique.Chir Main. 2002; 21: 13-22
- The geometry of actin filament-membrane associations can modify adhesive strength of the myotendinous junction.Cell Motil. 1983; 3: 439-447
- Force transmission across muscle cell membranes.J Biomech. 1991; 24: 43-52
- Tendon transfers: an overview.in: Mackin E.J. Callahan A.D. Skirven T.M. Schneider L.H. Osterman A.L. Rehabilitation of the hand and upper extremity. 5th ed. Mosby, Philadelphia2002: 792-798
- Historical aspects of tendon transfers.in: Fridén J. Tendon transfers in reconstructive hand surgery. Taylor & Francis, London and New York2005: 21-28
Article info
Publication history
Published online: July 09, 2012
Accepted:
June 10,
2012
Received:
February 13,
2012
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
