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Hand Tendon Transfers Workup

  • Author: Steffen Baumeister, MD; Chief Editor: Joseph A Molnar, MD, PhD, FACS  more...
 
Updated: Jul 30, 2015
 

Laboratory Studies

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  • The workup of candidates for tendon transfers consists mostly of the physical examination to determine available muscles for transfer and function to be restored.
  • The only laboratory studies needed are those that ensure the safety of the patient during surgery.
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Imaging Studies

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  • Plain radiographs of joints that are stiff may be necessary to ensure that obtaining a supple joint is possible. Severe arthritic conditions in joints involved with the function to be restored represent a relative contraindication to proceeding with the procedure.
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Other Tests

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  • When loss of function is secondary to neurologic or peripheral nerve injury, nerve conduction studies and electromyography (EMG) can help differentiate permanent injury from recovering injury. EMG denervation patterns are evident early, to be followed by evidence of reinnervation.
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Contributor Information and Disclosures
Author

Steffen Baumeister, MD Consulting Staff, Department of Plastic Surgery, Breast Center, Behandlungszentrum Vogtareuth, Bavaria, Germany

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jorge I de la Torre, MD, FACS Professor of Surgery and Physical Medicine and Rehabilitation, Chief, Division of Plastic Surgery, Residency Program Director, University of Alabama at Birmingham School of Medicine; Director, Center for Advanced Surgical Aesthetics

Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Society for Reconstructive Microsurgery, Association for Academic Surgery, Medical Association of the State of Alabama

Disclosure: Nothing to disclose.

Chief Editor

Joseph A Molnar, MD, PhD, FACS Medical Director, Wound Care Center, Associate Director of Burn Unit, Professor, Department of Plastic and Reconstructive Surgery and Regenerative Medicine, Wake Forest University School of Medicine

Joseph A Molnar, MD, PhD, FACS is a member of the following medical societies: American Medical Association, American Society for Parenteral and Enteral Nutrition, American Society of Plastic Surgeons, North Carolina Medical Society, Undersea and Hyperbaric Medical Society, Peripheral Nerve Society, Wound Healing Society, American Burn Association, American College of Surgeons

Disclosure: Received grant/research funds from Clinical Cell Culture for co-investigator; Received honoraria from Integra Life Sciences for speaking and teaching; Received honoraria from Healogics for board membership; Received honoraria from Anika Therapeutics for consulting; Received honoraria from Food Matters for consulting.

Additional Contributors

Anthony E Sudekum, MD Consulting Staff, Department of Plastic Surgery, St John's Mercy Health Center of St Louis

Anthony E Sudekum, MD is a member of the following medical societies: American College of Surgeons, American Society for Surgery of the Hand, Missouri State Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Philip E Higgs, MD, to the development and writing of this article.

References
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Assist devices used in upper limb paralysis.
Natural tenodesis is demonstrated by flexing and extending the wrist with the hand relaxed. The effect shows extension of the fingers when the wrist is flexed and flexion of the fingers when the wrist is extended. If the tendons are not intact, this effect is lost.
Tendons ruptured secondary to rheumatoid arthritis. Repair by transfer of long extensor digitorum communis (EDC) to the ring EDC and the index EDC to the little EDC. The fourth dorsal compartment has been opened to allow inspection of the compartment and repair of any problem causing the ruptures.
Ulnar clawing produced by loss of intrinsics to the little and ring fingers, characterized by hyperextension of the metacarpophalangeal joints and flexion of the interphalangeal joints.
Zancolli-type lasso of A-1 pulley by the superficialis.
Extensor indicis proprius transfer to the extensor pollicis longus.
Side-by-side adjustments of the profundus or extensor tendons for extrinsic balance.
Split flexor pollicis longus transfer for stabilization of the interphalangeal joint.
The neuromuscular stimulator is useful for intraoperative evaluation of tendon excursion and transfer function.
Pulvertaft weave used to connect tendon grafts.
Test excursion and transfer function using a neuromuscular stimulator.
Opponensplasty using the extensor indicis proprius for treatment of low median nerve palsy.
Flexor reconstruction in brachial plexus injury using a brachioradialis to flexor digitorum profundus transfer and a pronator teres to flexor pollicis longus transfer along with extensor tenodesis for release.
Flexor reconstruction in a tetraplegic patient using a extensor carpi radialis longus to flexor digitorum profundus transfer and a pronator teres to flexor pollicis longus transfer along with a split flexor pollicis longus transfer to stabilize the interphalangeal joint.
Table 1. Recommended Transfers for a High Median Nerve Palsy
DonorRecipient
BrachioradialisFlexor pollicis longus
Extensor carpi radialis longusFlexor digitorum profundus
EIP opponensplasty
Table 2. Tendon Transfers for an Anterior Interosseous Nerve Palsy
DonorRecipient
BrachioradialisFlexor pollicis longus
Extensor carpi radialis longusFlexor digitorum profundus
Table 3. Tendon Transfers for a High Ulnar Nerve Palsy
DonorRecipient
BrachioradialisFlexor digitorum profundus
Flexor digitorum superficialisAdductor pollicis
Flexor digitorum superficialis lasso ring and little
Table 4. Tendon Transfers for a High Radial Nerve Palsy
DonorRecipient
Pronator teresExtensor carpi radialis brevis
Flexor carpi ulnarisExtensor digitorum communis
Palmaris longusExtensor pollicis longus (rerouted)
Table 5. Tendon Transfers for a Low Radial Nerve Palsy or Posterior Interosseous Nerve Palsy
DonorRecipient
BrachioradialisExtensor pollicis longus
Flexor carpi ulnarisExtensor digitorum communis
Table 6. Muscles Available for Transfer
Name:Date:
FunctionNeededActiveMuscles Available
Elbow flexion  Brachialis
   Biceps
   Brachioradialis
Elbow extension  Triceps
Forearm pronation  Pronator teres
   Pronator quadratus
Forearm supination  Supinator
Wrist flexion  Flexor carpi radialis
   Flexor carpi ulnaris
   Palmaris longus
Wrist extension  Extensor carpi radialis longus
   Extensor carpi radialis brevis
   Extensor carpi ulnaris
Finger flexion  Flexor digitorum profundus
   Flexor digitorum superficialis
Finger extension  Extensor digitorum communis
   Extensor indicis proprius
   Abductor digiti minimi
Thumb flexion  Flexor pollicis longus
Thumb extension  Extensor pollicis longus
Thumb opposition  Abductor pollicis brevis
Thumb adduction  Abductor pollicis
Name and other procedures:
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