Tendon Transfers Flashcards
indications for tendon transfer (4)
considered as a restorative option when there is no further recover or nerve regeneration (3-4 months)
- nerve injuries
- CP
- SCI
- brachial plexus birth palsy
key component of tendon transfer
patient must be motivated and have a good understanding of the process
goal of tendon transfer
to improve functional outcomes and independence
prerequisites for tendon transfer (7)
- analysis of client’s needs
- bony stability
- edema/inflammation subsided
- adequate soft tissue bed
- mobile joints
- expendable donor muscles
- functional sensation in affected extremity
considerations in selecting a donor tendon (4)
- must have the strength to overcome the strength and passive tension of the antagonist muscle
- needs to lie in appropriate direction of the desired action
- travels a straight rout and performs a single function
- potential excursion of the muscle once it is freed from all connective tissue attachments
tendon transfer pre-op othosis: radial nerve palsy
support the wrist and MP joints in extension
tendon transfer pre-op orthosis: median nerve palsy
support and position the thumb in opposition and ABduction for fine motor tasks
tendon transfer pre-op orthosis: ulnar nerve palsy
MP joints positioned in flexion to prevent clawing and to substitute for lack of intrinsic function
evaluation for pre-op treatment of tendon transfer (9)
- assess ability to follow protocol
- history
- examine the extremity
- sensory status
- AROM/PROM
- functional use
- compensatory movements
- self-reporting outcome measure
- MMT
treatment prior to tendon transfer (4)
- might provide orthosis to tight joints
- strengthening the donor muscle
- ROM
- patient education
common tendon transfers: median nerve palsy (3)
- palmaris longus - palmar ABduction
- FDS (ring) - opposition
- ADM to APB for opposition
common tendon transfers: radial nerve palsy (4)
- PT to ECRB for wrist extension
- FDS (middle) to EDC for MP extension and FDS (ring) to EPL and EIP
- FCR to EDC for MP extension and PL for thumb extension
- FCU to EDC for MP extension and FCR to APL and EPB for thumb radial ABduction
common tendon transfers: ulnar nerve palsy (6)
- ECRB with graft to intrinsics via lateral bands
- FDS (middle) inserted onto proximal phalanx
- FDS (ring and middle) split into slips an inserted into lateral band of each finger or lateral part of P1
- FDS passed through pulley and sutured back onto itself to improve MP flexion
- BR extended w/ free graft and passed between MC 3-4 to insert on adductor tubercle of thumb
- ECRB to ADP at 1st MC to restore power pinch
questions for physician: tendon transfers (8)
- ask for op report
- which muscles were transferred to which insertion sites
- were pulleys created to alter the course of pull
- quality of transferred tendon
- were grafts needed
- type of suturing technique
- how long should tendons be immobilized
- how was the tension of transferred muscles determined
tendon transfer treatment guidelines : early phase (4)
weeks 1 to 4
- encourage movement of uninvolved digits/joints
- monitor/treat edema
- monitor cast for good fit
- patient education on protocol
tendon transfer treatment guidelines : intermediate phase (6)
weeks 4 to 6
- cast removed/make orthosis
- scar management
- modalities
- begin AROM of isolated joints (gentle AROM/AAROM short sessions several x/day)
- avoid composite motion and overstretching transferred muscle
- add facilitation techniques
facilitation techniques for tendon transfers (8)
- place and hold
- using both hands simultaneously
- using the donor muscle action
- resistance to the donor muscle (original action)
- verbal cues
- visual and functional cues
- mirror training
- NMES
tendon transfer precautions (4)
- no PROM against the transferred muscle
- no resistance to desired muscle
- no composite motion that puts tension on the transferred muscle
- do not overwork the transferred muscle
tendon transfer treatment guidelines : late phase (5)
weeks 6 to 12
- begin adding strengthening
- work for good quality movement
- gradually discontinue use of orthosis
- encourage use of hand into ADLs
- add PROM in opposite direction of transfer
tendon transfer orthosis median nerve - opposition
cast 3-4 weeks
long opponens orthosis with thumb in wide ABduction
wear 24/7, only remove for exercise
tendon transfer orthosis radial nerve
cast of at 4 weeks
long arm orthosis with elbow 90 deg flexion, pronation, wrist 30-40 deg extension, MP 0 deg extension, IP free (for EPL IP in full extension)
as ROM control improves decrease daytime wear
12 weeks: night wear only
tendon transfer orthosis ulnar nerve
cast 3-4 weeks forearm based dorsal or volar orthosis with MP flexion 4 weeks: gentle AROM one joint at a time 8 weeks: gentle strengthening 12-14 weeks: full activity
Wide Awake tendon transfer surgeries
patient is awake with nerve block and physician can ask for movements to check quality of repair
