Tendon Transfers

Question 1

Nerve Palsy: Axillary

What is/are the typical tendon transfers or alternative treatment?

Answer 1

GH Arthrodesis

Question 2

Nerve Palsy: Musculocutaneous

What is/are the typical tendon transfers or alternative treatment?

Answer 2

Elbow flexion

pectoralis major, latissimus dorsi –> biceps

or

Elbow flexion

common flexor mass –> point more proximal on humerus (Steindler flexorplasty)

Question 3

Nerve Palsy: Radial & PIN

What is/are the typical tendon transfers or alternative treatment?

Answer 3

Elbow extension

deltoid, latissimus dorsi, or biceps –> triceps

Wrist extension

PT –> ECRB

Finger extension

FDS, FCR, or FCU –> EDC

Thumb extension

PL or FDS –> EPL

Question 4

Nerve Palsy: Low Median

What is/are the typical tendon transfers or alternative treatment?

Answer 4

Thumb opposition and abduction

FDS (ring) –> base of thumb proximal phalanx

or –> APB tendon

(use FCU as pulley - classic Bunnell opponensplasty)

EIP –> APB (pulley around ulnar side of wrist)

Question 5

Nerve Palsy: High Median

What is/are the typical tendon transfers or alternative treatment?

Answer 5

Thumb IP flexion

BR –> FPL

Index and long finger flexion

FDP of ring and small finger (ulnar nerve) –> FDP of index and middle (side-to-side transfer)

Thumb Opposition

EIP –> APB (pulley around ulnar side of wrist)

*** Can’t do the FDS Bunnel trasnfer because in a high nerve palsy FDS is OUT

Question 6

Nerve Palsy: Ulnar

What is/are the typical tendon transfers or alternative treatment?

Answer 6

Thumb adduction

FDS or ECRB –> adductor pollicis

Finger abduction (index most important)

APL, ECRL, or EIP –> 1st dorsal interosseous

Reverse clawing effect

FDS, ECRL –> lateral bands of ulnar digits

(must pass volar to transverse metacarpal ligament to flex proximal phalanx)