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PubMed2006

Long-term results of tendon transfers in radial and posterior interosseous nerve paralysis.

Eighteen cases of tendon transfer for isolated radial or posterior interosseous nerve palsy have been carried out in our unit over a period of 21 years. Fifteen patients were reviewed with a mean follow-up of 9.5 years. Nine had sustained high and six low radial nerve injury. We achieved 11 excellent, two good, one fair and one bad result. The main problems were loss of power of gripping and the occurrence of radial deviation, particularly in patients with flexor carpi ulnaris transfer to the extensor digitorum communis. During this time, our technique has evolved, including changes of the tendons transferred. Our final preference is a modified Tsuge procedure, using the pronator teres to restore extension of the wrist, the flexor carpi radialis for extension of the fingers and the palmaris longus for extension of the thumb. Abduction of the thumb is restored by a tenodesis of the abductor pollicis longus to the brachioradialis. This review justifies the final policy, in particular the preservation of flexor carpi ulnaris to maintain wrist stability and flexion.

Adolescent↗
PubMed1976

Early tendon transfer for radial nerve transection.

A retrospective comparison of twelve patients with radial nerve transection treated by nerce repair, and thirteen similar patients treated by tendon transfer only, showed an average time to recovery of 7.5 months after nerve repair, and eight weeks after transfer. In view of this, a policy of early tendon transfer instead of radial nerve suture is advised. Results are reported in nine patients who had tendon transfers at an average of thirteen days after nerve injury.

Adult↗
PubMed1975

Tendon transfers to improve grasp in patients with cervical spinal cord injury.

Patients with cervical spinal cord injury can gain useful hand function from a good rehabilitation programme and non-operative hand care. Effective prehension can usually be achieved by proper positioning, exercises, and splinting but when grasp is poor, tendon transfers are very effective in furthering the goal of independence. These patients have been reviewed extensively and classified into groups according to remaining neurological function. Group I patients have weak elbow flexion and weak shoulder function or less. No tendon transfers were done. Group II patients have shoulder control, elbow flexion and weak wrist extensors. Some of these patients can be improved by transferring the brachioradialis to the radial wrist extensor. Group III patients have the above and good to normal brachioradialis and two radial wrist extensors. Transferring the brachioradialis to restore opposition and the extensor carpi radialis longus to the flexor digitorum profundi provides strong and effective prehension. Group IV patients have the above plus pronator teres and flexor carpi radialis which can be used for transfer. Opposition and finger flexion can be restored by a variety of transfers. In groups III and IV tendon transfers were done only when automatic grasp was poor or absent. If finger grasp was good and thumb function ineffective only opponens transfers were done in order to achieve key pinch. Group V patients have all muscles functioning but with varying degrees of intrinsic weakness. Opponens transfer is useful for these patients. Indications and contraindications to surgery are given. All the patients have improved function and strength following their tendon transfers. No patient has regretted having had surgery.

Adolescent↗
PubMedDate not supplied

The use of dynamic EMG in predicting the outcome of split posterior tibial tendon transfers in spastic hemiplegia.

The purpose of this study was to assess the outcome of split posterior tibial tendon transfers in patients with spastic cerebral palsy to determine whether the use of preoperative dynamic electromyography was predictive of surgical success. The study is a consecutive case series of 25 children with spastic hemiplegia who underwent unilateral split posterior tibial tendon transfers for varus foot deformities. Three patients were considered failures because of residual varus, which required further surgery. An additional 5 patients had mild residual varus. Preoperative dynamic electromyographic data were evaluated to determine the etiology of postoperative undercorrection. Undercorrection seems to be related to unrecognized anterior tibial muscle overactivity and advanced age at surgery. Overcorrection did not occur. Dropfoot was noted postoperatively in 52% of patients and was related to early cessation of anterior tibial muscle activity in swing. Split posterior tibial tendon transfer is a successful surgery on those patients with increased posterior tibial muscle activity. Undercorrection can be avoided by assessing the activity of the anterior tibial muscle before surgery. These results are expected to assist in surgical decision making for the equinovarus foot in cerebral palsy.

Adolescent↗
PubMedDate not supplied

Application of biomechanics to tendon transfers.

This article has focused on considerations important in the application of biomechanics to tendon transfers and has used an example protocol. Different surgeries require different protocols. What is most important is that specific protocols are used, and that they are both safe and effective. The communication among the therapist, surgeon, and patient is essential with the use of any protocol. As Brand has stated, "A hand is a very personal thing. It is the interface between the patient and his or her world. It is an emblem of strength, beauty, skill, sexuality, and sensibility. When it is damaged it becomes a symbol of the vulnerability of the whole person." For the patient who has damage from nerve palsy, paralysis, or injury resulting in a dysfunctional hand, a tendon transfer procedure may prove to be a viable option to restore balance and function, especially if the biomechanics of deformity and correction are considered.

Biomechanical Phenomena↗
PubMed1985

Our experience in tendon transfers for radial palsy.

Techniques of tendon transfers in the management of sequelae of radial paralysis have progressively been improved. The main modifications have concerned the operative details and the choice of procedures with the necessity of adapting the technique to the needs of the patient. In the case of a manual laborer whose job does not require special dexterity, it seems preferable to reinforce the extension of the wrist by using a flexor digitorum sublimis, especially in dominant hand. If, on the contrary, independence of flexion is required for each finger, the removal of a superficialis flexor tendon must be avoided. If the patient already has a tendency toward radial deviation before the operation, the flexor carpi ulnaris must be left in place. In all other cases, we prefer to transfer the flexor carpi ulnaris to the extensor digitorum communis as described in the technique we developed.

Humans↗
PubMed1995

Split posterior tibial tendon transfer through the interosseus membrane in spastic equinovarus deformity.

The split posterior tibial tendon transfer procedure was first reported by Green for correction of equinovarus hindfoot deformity in patients with cerebral palsy. A modification of the split posterior tibial tendon transfer combined with an Achilles tendon lengthening is described in 17 children (21 procedures) with a minimum follow-up of 3 years. This modified technique is indicated in young children with a continuously spastic posterior tibial tendon to correct a dynamic equinovarus. It restores active dorsiflexion when the anterior tibial and extensor muscles are weak. The anterior half of the split tibialis posterior is transferred through the interosseus membrane to the dorsum of the foot. Excellent or good results and two poor results were noted after a mean follow-up of 29 months. In the patients with an excellent or good result, marked improvement of their equinovarus foot deformity in stance and swing phase of gait was seen. In two patients, the procedure failed because of technical errors.

Achilles Tendon↗
PubMedDate not supplied

Anterior tibial tendon transfer in residual dynamic clubfoot deformity.

Residual forefoot adduction and supination deformities with functional problems and difficulty with shoe wear may occur during the course of management of the congenital clubfoot. Between 1975 and 1988, 55 patients with 71 feet who had residual dynamic clubfoot deformity underwent anterior tibial tendon transfer. There were 42 full anterior tibial tendon transfers (FTs) and 29 split anterior tibial tendon transfers (STs). The average age of the patient at the time of the procedure was 6 years. The age at surgery for FT was 5.3 years compared with 7.1 years in ST. The clinical appearance of the feet improved in both groups, according to Garceau's criteria. The range-of-motion improvement was noted in dorsiflexion and eversion. There was an increase of eversion strength of both groups by 1.5 grades. The radiographic improvement was noted in both forefoot adduction and supination. Although the FT group had a little better statistical data than did the ST group, the ST group had better preservation of inversion function.

Child↗
PubMed2004

Unusual complication of an opposition tendon transfer at the wrist: ulnar nerve compression syndrome.

Restoration of thumb opposition by tendon transfer may be necessary in cases of severe thenar atrophy caused by long-standing carpal tunnel syndrome. Routing the extensor indicis proprius transfer subcutaneously around the ulna to reanimate thumb opposition is an accepted procedure and is considered safe. Ulnar nerve compression leading to palsy is possible, however, as shown in the patient presented. Neurolysis failed to improve the palsy. Rerouting of the transfer deep to the ulnar nerve was necessary to treat the iatrogenic condition. Possible nerve compression should be kept in mind when planning a tendon transfer around the ulnar side of the forearm or carpus and when following up with the patient. Early intervention is necessary to prevent permanent sequelae.

Adult↗
PubMed2000

Long-term results of tendon transfers for radial nerve palsy in patients with limited rehabilitation.

The authors reviewed the long-term functional results of 22 patients who underwent tendon transfer for isolated radial nerve palsy. The average number of postoperative visits was eight (range of postoperative visits, 3-16), and the mean follow-up was 6.3 years. All but 1 patient had improved function after the tendon transfers, and could cope with the activities of daily living. Radial deviation of the wrist at rest was present in 10 of the 15 patients with flexor carpi ulnaris transfer and in 2 of 7 patients with flexor carpi radialis transfer, with a mean of 14.5 deg (range of radial deviation, 5-30 deg). Although a global decrease in wrist power and power grip was noted, 13 of 17 previously employed patients were able to work after transfer; however, only 1 of 7 heavy manual laborers was able to return to his previous employment. Despite the poor clinic attendance, the overall functional results compared favorably with other published series. It appears that tendon transfer for radial nerve palsy is a viable option, even in patients with limited rehabilitation.

Adult↗
PubMedDate not supplied

Stabilization of the subluxed second metatarsophalangeal joint: flexor tendon transfer versus primary repair of the plantar plate.

Surgical treatment of the subluxed second metatarsophalangeal joint (MTPJ) has been a consistently frustrating problem for the foot and ankle surgeon. The plantar plate is the principal stabilizing structure of the second MTPJ and compromise to its integrity has been implicated as the cause of the subluxed second toe. Flexor tendon transfer has been reported as the mainstay of treatment to stabilize the subluxed second MTPJ. Recently, primary repair of the plantar plate has been advocated, yet no research exists comparing it to flexor tendon transfer. Eight freshly frozen lower extremity cadaver specimens were mounted on a custom-fabricated load frame. A vertical dorsally directed force was applied to the base of the proximal phalanx of the second toe via a pneumatic actuator to stimulate the Lachman test. Dorsal displacements of the proximal phalanx were measured with a linear variable distance transducer. This investigation examined the comparative strength of flexor tendon transfer versus primary repair of the plantar plate in stabilizing the second MTPJ. Results showed a significant difference between the transected plantar plate and the intact plantar plate. Displacements for the repair groups were similar to the intact plantar plate group and also significantly different from the transected plantar plate. Primary repair of the plantar plate is a viable alternative to flexor tendon transfer in stabilizing the second MTPJ with the advantage of addressing the pathology anatomically. Clinical studies are needed to substantiate these laboratory findings.

Cadaver↗
PubMedDate not supplied

The cincinnati incision for the split posterior tibial tendon transfer: a technical note.

The split posterior tendon transfer has been effective in correcting equinovarus deformity in children with cerebral palsy. The original report of this procedure described a four incision approach. We have modified the technique by substituting the single transverse, Cincinnati incision, which permits better visual and physical access to the operative field and has no major disadvantages.

Child↗
PubMed2001

A method for evaluating the results of tendon transfers for foot drop.

A system for assessing the results of tibialis posterior tendon transfers in the treatment of foot drop secondary to nerve palsy is proposed. There are seven sections to this scoring system: pain, need for orthosis, ability to wear normal shoes, activity level, muscle power of ankle dorsiflexion, degree of active ankle dorsiflexion, and foot posture. The total score is 100. The results are classified as excellent for scores between 85 and 100, good between 70 and 84, fair between 55 and 69, and poor for scores below 55. The results of 18 patients (mean followup, 64.6 months) who had a tibialis posterior tendon transfer were assessed using this method. Four patients (22.2%) had an excellent result, seven (38.8%) had a good result, two (11.1%) had a fair result, and five (27.7%) had a poor result. The average score was 67.2, suggesting an overall fair result for this operation. In nine patients, there was correlation between the outcome when assessed with this method and with patient rating. In two patients, the outcomes were better when assessed with this method than with patient rating, whereas the reverse was true in seven other patients. Thus, this system may provide a more objective and critical evaluation of tibialis posterior transfers for foot drop.

Adolescent↗
PubMed1977

Preoperative and postoperative dynamic electromyography as an aid in planning tendon transfers in children with cerebral palsy.

Electromyography was used to supplement clinical evaluation in planning tendon transfers in twenty-four children with cerebral palsy. Sixteen flexible deformities of the hind part of the foot, four internally rotated lower limbs, and four flexible deformities of the forearm and wrist were studied. When deforming muscles were active exclusively in one portion of either the gait cycle or a function of an upper extremity, appropriate tendon transfers were performed. When continuous muscle activity was noted, tendon lengthening was utilized. The desired function was obtained in all twenty-four patients six months after operation.

Cerebral Palsy↗
PubMed1984

[Restoration of elbow flexion by tendon transfer in traumatic paralysis of the brachial plexus in adults. Apropos of 44 injured patients].

Forty-four post traumatic paralyses of the brachial plexus were operated on to restore elbow flexion using tendon transfers. On 19 occasions, the plexus had been explored surgically with 10 neurolyses and 9 nerve repairs. Eight patients had a second tendon transfer, the first one having failed. Twenty-two Steindler flexor plasties were performed, the medial epicondyle being transferred upwards by an average of 4.5 cms. Details of treatment are described by which secondary displacement of the transplanted medial epicondyle can be avoided. On 5 occasions the results were poor. Pectoralis minor was transferred 8 times with 5 failures due to the difficulty of appreciating the preoperative strength of the muscle and because of technical problems. The technique should only be used in C5-C6 lesions. On 14 occasions the triceps was transferred with 14 successes. The simultaneous contraction of biceps and triceps was advantageous. The results of all kinds of transfers were much better after C5-C6 paralysis than after C5-C6-C7 lesions. For correction of medial rotation deformity, osteotomy appeared to be safer than tendon transfer.

Adolescent↗
PubMed1983

Flexor superficialis tendon transfers to the thumb--an alternative to the free tendon graft for treatment of chronic injuries within the digital sheath.

Transfer of a flexor digitorum superficialis tendon is an effective procedure in restoring active flexion of the thumb following old lacerations or ruptures of the flexor pollicis longus tendon within the digital sheath when tendon repair or advancement is not possible. The ample length of the transferred tendon and, more importantly, its normal excursion make it the preferred procedure to the alternative tendon graft. The operation is usually carried out as a one-stage procedure, but, if there is severe scarring, it can follow the preliminary insertion of a silicone rod. For 23 patients, the operation was performed in a single stage in 18 and in 5 after insertion of a silicone rod. Postoperative mobility of the interphalangeal joint averaged 53.5 degrees. Mobility of the donor ring finger was complete in all patients.

Adolescent↗