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Tendon Transfers for Radial Nerve Palsy: Finger Extension Deficit

- See: tendon excursion

- Discussion:
    - FCR to EDC transfer;
            - this transfer is also well suited for finger extension;
            - advantages:
                   - uses same incision as for the pronator and brachioradialis transfer;
                   - less donor site morbidity than w/ FCU transfer;
            - proper tension should allow for a tenodesis effect, so that the MP joints will have full
                   extension when the wrist is placed in mild extension;
                   - alternatively, holding the wrist in 20 deg of extension, should keep the MP joints at 0 deg flexion;
            - typically this transfer is performed prior to transfers of the pronator teres
            - technique:
                   - FCR is transfered thru the interosseous membrane (which maximizes length and provides optimal direction of pull);
                   - EDC tendons are transected at the myotendinous junction;
                   - sequentially attach the tendons of the EDC to the FCR, starting w/ the little finger and ending w/ the index finger;
                          - after all of the tendons have been anchored into place, the fingers should maintain a normal cascade,
                                 and further, the normal tenodesis effect of the wrist and fingers should have been restored;
    - FDS to EDC (Boyes transfer)
            - this technique is often used when there is pre-existing wrist fusion;
            - tendon is passed thru the interosseous membrane proximal to the pronator quadratus muscle;
                  - to avoid median neuropathy, the ring finger FDS tendon is brought along the ulnar side of the median nerve,
                          whereas the long finger FDS tendon is brought around the radial side of the nerve;
            - modified technique: tendon is passed subcutaneously around the radial and ulnar sides of the forearm;
            - disadvantages:
                   - ulnar nerve compression from impingement of the transferred tendon;
            - references:
                   - Tendon transfers for radial palsy. JH Boyes. Bull Hosp Joint Dis. 1960;21:97-105.
                   - Ulnar nerve compression following flexor digitorum superficialis tendon transfers around the ulnar border of the forearm to restore digital extension: Case report.
    - FCU transfer to EDC:
            - may be used for both low and high radial nerve palsy;
            - disadvantages
                   - FCU muscle fibers are short (3 cm of excursion) which is not optimal for finger extension (5 cm of excursion);
                   - in addition, transfer of FCU leaves no ulnar stabilizing unit of the wrist;
            - technique involves harvesting the tendon off its insetion into the pisiform;
            - the proximal portion of the tendon is mobilized, and then FCU is mobilized dorsally thru the
                   interosseous space and subcutaneously to reach the EDC;
            - the FCU is woven into the EDC only after the PT has been transfered to to the ECRB

Early transfer for radial nerve transection.

Tendon transfers for radial nerve palsy.

Apparent weakness of median and ulnar motors in radial nerve palsy.

Splinting for radial nerve palsy

An improved splint for radial (musculospiral) nerve paralysis.

Analysis of Tsuge's Procedure for the Treatment of Radial Nerve Paralysis.