Tendon Transfers

Question 1

Surgical priorities for UE function?

Answer 1

1. elbow flexion (musculocutaneous n.)
2. shoulder stabilization (suprascapular n.)
3. brachiothoracic pinch (pectoral n.)
4. sensation C6-7 (lateral cord)
5. wrist extension and finger flexion (lateral and posterior cords)

Question 2

Musculocutaneous nerve palsy, tendon transfer?

Answer 2

• Elbow flexion
  
  • Pec major or lat to biceps
  • Common flexor mass advancement
    
    • Steindler flexorplasty

Question 3

Radial nerve & PIN palsy

Answer 3

• Elbow extension (transfer to triceps)
  
  • deltoid, lats, biceps
• Wrist extension (transfer to ECRB)
  
  • PT
• Finger extension (transfer to EDC)
  
  • FDS, FCR, or FCU
• Thumb extension (transfer to EPL)
  
  • PL or FDS

Question 4

Low median nerve palsy

Answer 4

• Thumb opposition and abduction (transfer to APB or base of 1st prox phalanx)
  
  • FDS (4th) - use FCU as pulley = classic Bunnell opponensplasty

can also use EIP - pulley around ulnar side of wrist

Question 5

High median nerve palsy

Answer 5

• Thumb IP flexion - AIN (transfer to FPL)
  
  • BR
• Index and long finger flexion - (Transfer to FDP)
  
  • Side to side transfer of ring and small finger FDP.

AIN = FPL, FDP, PQ (rest is median proper)

High median both FDS (median) and FDP (AIN) are out.

Question 6

Ulnar nerve palsy

Answer 6

• Thumb adduction (transfer to Adductor pollicis)
  
  • FDS or ECRB
• Finger abduction (index most important) (transfer to 1st dorsal interosseous)
  
  • APL, ECRL, EIP
• Reverse clawing effect (counter weak intrinsic and strong extrinsinc) - (transfer to lateral bands of ulnar digits)
  
  • FDS, ECRL (pass volar to transverse MC lig)