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PubMed1983

Extensor carpi radialis brevis tendon transfer for thumb adduction--a study of power pinch.

Eighteen patients with disability due to weak pinch were treated with extensor carpi radialis brevis (ECRB) adductor-plasty. Weakness was due to loss of function of the adductor pollicis because of ulnar nerve injury, peripheral neuropathy, local muscle avulsion, partial amputation, or aplasia. At operation, a tendon graft was passed distally through the interspace between the second and third metacarpals, deep to the adductor pollicis, and then sutured to the tendon of the adductor pollicis. Proximally, the graft was tunneled subcutaneously at the dorsum of the wrist and sutured to the detached ECRB. Tendon length was adjusted so that the radial side of the thumb was in the plane of the palm with the wrist straight. For patients with weak thumb abduction due to combined median and ulnar nerve palsy, the graft was made slightly longer. Of the 18 patients operated upon, eight had tendon transfers for abduction of the index finger performed simultaneously with thumb adductor-aplasty. In those patients treated for weakness due to adductor paralysis or avulsion, the mean tip-to-side pinch in the injured hand was 25% that of the normal hand. Postoperatively, mean pinch force was doubled. No patient had difficulty in phase conversion. Two patients had limited thumb abduction postoperatively. Both had thenar paralysis. No patient lost wrist function as a result of the operation.

Adolescent↗
PubMed1997

Subtalar arthrodesis versus flexor digitorum longus tendon transfer for severe flatfoot deformity: an in vitro biomechanical analysis.

We defined the mechanical behavior of the foot after an operation for treatment of the flatfoot deformity, subtalar arthrodesis, and compared results with those from flexor digitorum longus tendon transfer. Twelve fresh-frozen human foot specimens were used. Supporting elements were sectioned to create a flatfoot deformity. To simulate midstance phase of gait, loads were applied axially to the plantar foot and to five tendons. Reduction of deformity in metatarsal-talar, calcaneal-talar, and talar-tibial positions was achieved and was significantly greater after subtalar arthrodesis operation than after flexor digitorum longus transfer.

Adult↗
PubMed1989

Tendon transfers for treatment of the paralyzed hand following brachial plexus injury.

The correction of functional deficits of the hand after a brachial plexus lesion is difficult; treatment should be provided by a well-knit team of surgeons and therapists. The patient should be fully aware of the limitations of surgical treatment before surgery, and should be entrusted to the care of a physical therapist during the critical period of nerve regeneration after initial surgical treatment to ensure optimal results. This article presents therapeutic possibilities and discusses specific problems of tendon transfers in brachial plexus palsy.

Brachial Plexus↗
PubMedDate not supplied

Skeletal muscle architecture: implications for muscle function and surgical tendon transfer.

Skeletal muscles have mechanical properties that are well-described by the length-tension relationship (for isometric contractions) and the force-velocity relationship (for isotonic contractions). These two intrinsic properties are scaled for a given muscle based on its architectural properties. Muscle active force-generating range is determined by muscle fiber length, while maximum muscle force is determined by physiologic cross-sectional area. These and other architectural properties should be matched between muscles when planning surgical tendon transfers in order to closely match donor and recipient muscles. Finally, the fiber length/moment arm ratio of a muscle-joint combination must be considered when describing strength because strength is a manifestation of both muscle and joint properties and not either alone. Unfortunately, detailed description of normal musculoskeletal design or optimal transfer strategy cannot be made until more basic science studies of the musculoskeletal system are conducted.

Finger Injuries↗
PubMed2000

[Tendon transfers in postoperative hallux varus. Apropos of 12 cases].

PURPOSE OF THE STUDY: Iatrogenic hallux varus deformity after bunion surgery is a post-operative condition in which the great toe is oriented in medial deviation in relation to the first metatarsal head. This overcorrection can be a disabling complication with poor cosmetic appearance. A review of the surgical literature showed a reported hallux varus incidence range of 2 p. 100 to 13 p. 100. Various surgical interventions to treat hallux varus are described in the literature and we present here our experience in operative management of acquired hallux varus based on the results of surgical repair with the Johnson (extensor hallucis longus tendon) EHLT transfer procedure and the Hawkins (abductor hallucis tendon) procedure in 12 patients. MATERIAL AND METHODS: All of the patients suffered from painful iatrogenic hallux varus and conservative treatment was unsuccessful in all cases. The mean duration of follow-up was 42 months (range 8-96). The average age was 37 years (range: 17 to 58). The index procedure in eleven patients was a Mc Bride bunionectomy and in one case a Petersen procedure. On physical examination, a claw deformity of the hallux characterized by extension of the metatarsophalangeal joint and flexion of the interphalangeal joint was noted in all feet. Eight transfers of the abductor hallucis tendon and four complete transfers of the extensor hallucis longus tendon with interphalangeal joint fusion were done. At the time of the final follow-up, patients were interviewed and graded using a standardized questionnaire based on pain, metatarso-phalangeal range of motion, alignment of the hallux, footwear requirements, walking capabilities and first ray rest. RESULTS: Eleven patients reported satisfactory results and one patient a fair result. Overcorrection was a potential complication and in this retrospective study, one bunion deformity recurred but was asymptomatic. On radiographic evaluation the hallux abductus angle was improved by a mean 26.6 degrees and the average first intermetatarsal angle was 7 degrees (range: 3 degrees to 12 degrees ). A narrowing of the metatarso-phalangeal joint was observed in four cases (2 Johnson and 2 Hawkins). DISCUSSION: The addition of a tendon transfer to the medial soft tissue release is recommanded in most cases of hallux varus in active patients without osteoarthritis of the metatarso-phalangeal joint. Our experience with the EHLT transfer or the abductor hallucis tendon transfer demonstrated excellent correction of the hallux varus deformity; however metatarso-phalangeal joint stiffness was frequently observed. As originally described by Johnson et Spiegl, the entire extensor hallucis longus tendon was used in conjunction with an interphalangeal joint arthrodesis in the presence of a fixed and painful deformity of the hallux interphalangeal joint. If no fixed claw deformity was present an abductor hallucis tendon transfer was preferred. Onset of degenerative disease involving the metatarso-phalangeal joint in four cases may jeopardize long term survival of these surgical results.

Adolescent↗
PubMedDate not supplied

Latissimus dorsi tendon transfer: a comparative analysis of primary and salvage reconstruction of massive, irreparable rotator cuff tears.

On the basis of a modified Constant scoring system, we compared outcomes for 16 patients who underwent latissimus dorsi transfer as a salvage reconstruction for a failed prior rotator cuff repair with outcomes for 6 patients who underwent a primary reconstruction for an irreparable cuff defect. There was a statistically significant difference in Constant score between groups, which measured 55% for the salvage group compared with 70% for the primary group (P <.05). Poor tendon quality, stage 4 muscle fatty degeneration, and detachment of the deltoid insertion each had a statistically significant effect on the Constant score (P <.05). Late rupture of the tendon transfer occurred in 44% of patients in the salvage group compared with 17% in the primary group at a mean of 19 months postoperatively. Rupture had a statistically significant effect on the Constant score, which declined by a mean of 14% (P <.05). We conclude that salvage reconstruction of failed prior rotator cuff repairs yields more limited gains in satisfaction and function than primary latissimus dorsi transfer.

Adult↗
PubMed2002

The polyester patch: a new technique to promote early motion exercises in extensor tendon transfers.

The polyester patch made from Bard-DeBakey Woven Fabric (C.R. Bard, Inc., Haeverhill, MA, U.S.A.) was used as the core of the interlacing suture. This new technique was applied mainly to extensor tendon transfers on the dorsum of the hand. The end-to-end interlacing suture technique with polyester patch was applied to seven patients with rupture of the extensor pollicis longus tendon, and the end-to-side transfer with a patch was applied to three patients with ruptures of the finger extensor tendon. Evaluation was performed using % total amount of motion. All seven patients who received the end-to-end interlacing suture with a patch were evaluated as good. Of the three patients who received the end-to-side transfer with a patch, two cases had a good result, and one case had a fair result. With this technique, active motion exercise may be started immediately after surgery without cast immobilization.

Journal Article↗
PubMed2002

Posterior tibial tendon transfer and tendo-Achilles lengthening for equinovarus foot deformity due to severe crush injury.

Surgical correction was performed on nine patients who had equinovarus deformity caused by severe crush injury of the leg sustained in an earthquake. The operative procedure used involved the transfer of the posterior tibial tendon to the dorsum of the foot by passing it through the interosseous membrane using a modified procedure as published in 1978. This procedure was combined with percutaneous Achilles tendon lengthening and tenotomy of toe flexors when needed. The average follow-up time after the operation was 21 months. The treatment improved the heel-toe steppage gait in all patients and all were able to walk in standard shoes. There were no complications in the postoperative period. Recurrence of varus deformity was not seen in any of the patients. They had active dorsiflexion of the foot, with a median active dorsiflexion of 5 degrees (0 to 10 degrees) and median active plantarflexion of 16.1 degrees (10 to 25 degrees) compared to the median active dorsiflexion and plantarflexion on the uninvolved side. The total range-of-motion was 21.1 degrees (10 to 35 degrees).

Achilles Tendon↗
PubMed1999

The supination effect of tendon transfer of the flexor carpi ulnaris to the extensor carpi radialis brevis or longus: a cadaveric study.

Flexor carpi ulnaris (FCU) transfer to the extensor carpi radialis brevis (ECRB) and/or the extensor carpi radialis longus (ECRL) has been commonly used to provide wrist extension. The ability of this wrist extension transfer to also provide forearm supination has been inferred but not formally investigated. This laboratory study investigated the forearm supination effect of FCU transfer to the ECRB and to the ECRL in a cadaveric model. Two vectors of pull were investigated: freeing either the distal one third or the distal two thirds of the FCU ulnar origin. Five fresh-frozen, above-elbow, non-matched cadaveric specimens placed in a mounting device that allowed the arm to rotate about its ulnar axis starting from a full pronated position were measured for resultant supination after tendon transfer and loading. This study showed that the transfer of the FCU into either the ECRB or the ECRL resulted in no significant difference in maximum supination. The vector of origin, however, did significantly affect the maximum supination obtained. Releasing the distal two thirds of the FCU ulnar origin resulted in a mean supination that was significantly greater than the mean supination achieved with releasing the distal one third of the FCU ulnar origin. We concluded that in the cadaveric model, transfer of the FCU into either the ECRB or ECRL provided similar resultant supination and that freeing the distal two thirds of the FCU ulnar origin provided significantly more supination than freeing only the distal one third. For the hand surgeon treating wrist flexion in combination with forearm pronation deformity, transfer of the FCU into the ECRB and/or the ECRL can be used to concomitantly provide wrist extension and forearm supination.

Cadaver↗
PubMed2004

Use of the ICF conceptual framework to interpret hand function outcomes following tendon transfer surgery for tetraplegia.

STUDY DESIGN: Clinical commentary OBJECTIVE AND SETTING: This paper is a clinical commentary based on the Round Table discussion on Assessment and Outcomes at the 7th International Conference on Tetraplegia: Surgery and Rehabilitation, Bologna, Italy 6-8 June, 2001. It refers specifically to the 10-year re-review undertaken in 2001 at the Spinal Unit, Burwood Hospital, Christchurch, New Zealand. SUBJECTS: In all, 24 tetraplegic persons at a minimum of 12 years and up to 18 years following bilateral forearm tendon transfer surgery. METHOD: The data were interpreted using the International Classification of Functioning, Disability, and Health (ICF) conceptual framework as the basis of interdisciplinary understanding of the participation dimension. RESULTS: The results of the study outlined confirm that outcome measurement at more than one level of functioning is desirable to determine the functional effects beyond grip strength levels and activities of daily living, to consider the dimension of participation. CONCLUSIONS: Use of the ICF as a theoretical framework for interpretation of the results enhanced the clinical applicability of the outcome measures used in the 10-year re-review undertaken in New Zealand in 2001.

Activities of Daily Living↗
PubMed2006

Flexor hallucis longus tendon transfer for hallux claw toe deformity and vertical instability of the metatarsophalangeal joint.

BACKGROUND: Historically, operative treatment of hallux claw toe deformity has been the Jones procedure or one of its modifications. Review of the literature confirms its ability to maintain alignment and achieve patient satisfaction; however, several complications have been reported. Many of these are related to altered biomechanics across the metatarsophalangeal (MTP) joint. A similar approach to this clinical problem involves restoration of the flexion moment across the MTP joint without an interphalangeal (IP) joint arthrodesis. METHODS: We conducted a retrospective review of 10 patients who had a flexor hallucis longus (FHL) tendon transfer to the proximal phalanx of the great toe for hallux claw toe deformity, as well as for symptomatic vertical instability. Four patients had a positive drawer test indicating vertical instability without static deformity. Two patients with vertical instability were found to have a dynamic deformity. Mean followup was 24 (SD 15.2) months. RESULTS: All deformities were corrected and alignment was maintained at the time of followup. Pain under the first metatarsal head was reliably improved in symptomatic patients (p < 0.05). Patient satisfaction also was assessed. All six patients treated for hallux claw deformity were satisfied with their outcomes. Two of the four patients treated for vertical instability were satisfied. The other two patients expressed dissatisfaction because of persistent pain that occurred during strenuous exercise. Their symptoms during routine activity were improved, however. CONCLUSION: Based on initial results, the FHL transfer to the proximal phalanx appears to be a viable treatment option for hallux claw deformity in terms of deformity correction, pain relief, and patient satisfaction. Further evaluation is warranted regarding the indication of vertical instability.

Adolescent↗
PubMed1999

Restoration of wrist extension by tendon transfer in cases of obstetrical brachial plexus palsy.

Sequelae from obstetrical brachial plexus palsy are sometimes severe even after early microsurgical repair. Tendon transfer may improve hand function but to date, there is no large series that has been published on the results. Fifty-six children with obstetrical brachial plexus palsies were operated on for lack of wrist extension. A functional assessment scale was developed. Postoperatively, 42.5% of patients achieved an active wrist extension, 32.5% a static wrist extension. The extent of paralysis seems to influence the results. Some tendon transfert seems to give better results. The age at the time of transfert has no influence on the out come.

Birth Injuries↗
PubMed1983

Tendon transfers in hand surgery.

The need for skilled surgeons, trained in the proper techniques of hand surgery, to reconstruct paralytic hands has been emphasized. The most useful techniques for radial nerve paralysis have been found to be transfer of the pronator teres to the extensor carpi radialis brevis, of the flexor carpi ulnaris into the extensor digitorum communis, and of the palmaris longus into a rerouted extensor pollicis longus. For treatment of clawhand, the Bunnell sublimis transplantation is recommended for mild deformities in patients without normally hyperextensible joints and for patients who need a powerful flexor force on the proximal phalanges for strong gripping of tools, such as those used by mechanics and carpenters. The modified Fowler extensor transplant is also recommended for cases detected early and can be used for more advanced cases. The recent Brand procedure, which uses the extensor carpi radialis longus and a four-tailed tendon graft to the palmar side through the carpal tunnel and lumbrical canal, is also recommended, but further experience is needed for full evaluation of this procedure. Of the static methods of overcoming clawed hands, the Zancolli procedure of advancing the palmar plate proximally provides good results, although it probably should be reserved for those patients in whom no active tendon transfer can be provided. Long-term experience has shown that this capsulodesis seems to gradually stretch out and allow some recurrence of the hyperextension of the proximal joint. The Fowler tenodesis, which has an advantage over the Riordan method, is a semiactive tenodesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Hand Deformities, Acquired↗