Chapter 29 - Tendon transfers for Peripheral Nerve Injuries in the Upper Extremities Flashcards

1
Q

three principles of tendon transfer

A

power of the donor and recipient muscle must be equivalent
excursion of the recipient and donor muscles should be similar
muscle phases must be synergistic

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2
Q

muscle power

A

cross sectional diameter of the muscle belly

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3
Q

in phase tendon transfers

A
  • wrist extension, finger flexion, thumb adduction
  • wrist flexion, finger extension, thumb abduction
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4
Q

order of muscle innervation of the radial nerve

A

brachioradialis, ecrl, ecrb, supinator, ecu, edc, edm, apl, epl, epb, eip

EPL is LAST (aka most proximal) nerve they can test bc of variability more proximal

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5
Q

High radial nerve palsy

A

loss of wrist, finger extension, loss of grip strength, loss of thumb extension

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6
Q

low radial nerve palsy

A

only involves PIN muscles - functionally results in radial deviation of the wrist (bc of unopposed ecrl with loss of ecu) with loss of finger and thumb extension

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7
Q

tendon transfer for high radial nerve palsy

A

brand transfer - transfer of fcr to edc, with transfer of the pronator teres to ecrb, and the transfer of palmaris longus to epl

spares fcu funciton

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8
Q

high median nerve injury

A

results in the loss of finger opposition, finger flexor dysfunction, and thumb flexor dysfunction

(FCU and FDP to ring and small are spared)

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9
Q

goal of tendon transfers for high median nerve palsy

A

restore index finger and thumb flexion and opposition

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10
Q

high median nerve palsy results in a loss of:

A
  1. FPL - thumb IP flexion
  2. Flexor digitorum profundus to the index and long - loss of IF, LF DIP flexion
  3. complete loss of FDS - loss of PIP flexion to ALL digits
  4. Opponens pollicis and APB - Thumb opposition
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11
Q

low median nerve palsy results in a loss of:

A

thumb opposition, sensation to the median nerve distribution EXCEPT palm (palmar cutaneous nerve distribution)

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12
Q

Tendon transfers for High median nerve injury - restore FPL

A

Brachioradialis

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13
Q

Tendon transfers for High median nerve injury - FDP

A

side to side suturing of the IF FDP to the LF, RF, SF

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14
Q

difference in clawing between high ulnar nerve palsy and low ulnar nerve palsy

A

clawing NOT as severe in high as it is in low

because in low - innervation to FDP to ring/small are preserved resulting in unopposed flexiion of these digits 2/2 intrinsic paralysis

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15
Q

define hugh ulnar nerve injury

A

loss of fcu, fdp to ring and small, intrinsic function

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16
Q

wartenburg sign

A

abducted position of the small finger 2/2 loss of intrinsic function and unopposed pull of the edm (radial nerve)

17
Q

froment sign

A

thumb IP flexion during lateral pinch through recruitment of the fpl (Median nerve) as a result of loss of APL

18
Q

low ulnar nerve palsy

A

FDP to ring and small is INTACT causing clawing