Chapter 29 - Tendon transfers for Peripheral Nerve Injuries in the Upper Extremities Flashcards
three principles of tendon transfer
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
muscle power
cross sectional diameter of the muscle belly
in phase tendon transfers
- wrist extension, finger flexion, thumb adduction
- wrist flexion, finger extension, thumb abduction
order of muscle innervation of the radial nerve
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
High radial nerve palsy
loss of wrist, finger extension, loss of grip strength, loss of thumb extension
low radial nerve palsy
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
tendon transfer for high radial nerve palsy
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
high median nerve injury
results in the loss of finger opposition, finger flexor dysfunction, and thumb flexor dysfunction
(FCU and FDP to ring and small are spared)
goal of tendon transfers for high median nerve palsy
restore index finger and thumb flexion and opposition
high median nerve palsy results in a loss of:
- FPL - thumb IP flexion
- Flexor digitorum profundus to the index and long - loss of IF, LF DIP flexion
- complete loss of FDS - loss of PIP flexion to ALL digits
- Opponens pollicis and APB - Thumb opposition
low median nerve palsy results in a loss of:
thumb opposition, sensation to the median nerve distribution EXCEPT palm (palmar cutaneous nerve distribution)
Tendon transfers for High median nerve injury - restore FPL
Brachioradialis
Tendon transfers for High median nerve injury - FDP
side to side suturing of the IF FDP to the LF, RF, SF
difference in clawing between high ulnar nerve palsy and low ulnar nerve palsy
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
define hugh ulnar nerve injury
loss of fcu, fdp to ring and small, intrinsic function