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At least 145 records · Page 8Linked to original sources
PubMed2003

Tendon transfers for thumb opposition: a biomechanical study of pulley location and two insertion sites.

PURPOSE: The purpose of this biomechanical study was to test 5 proximal tendon pulley sites or routes of tendon transfer and 2 distal tendon insertion sites that are used commonly for performing a thumb opposition transfer. METHODS: Five fresh-frozen cadaver arms were used to test (1) an around flexor carpi ulnaris (FCU) pulley, (2) an FCU loop pulley, (3) a Guyon's canal pulley, (4) a junction of the distal edge of the transverse carpal ligament and the ulnar border of the palmar aponeurosis (Royle-Thompson pulley), and (5) a palmar thenar subcutaneous transfer (Camitz). Two tendon insertion sites were tested: a palmar radial insertion into the abductor pollicis brevis and a dorsal ulnar insertion into the thumb proximal phalanx. RESULTS: The Guyon's canal and Royle-Thompson pulleys produced the greatest amount of approximation of the thumb pulp to the fifth metacarpal head. The around the FCU pulley, FCU loop pulley, and Camitz transfer produced the greatest palmar abduction. The Guyon's canal and Royle-Thompson pulleys were the most mechanically efficient pulleys, producing the least amount of transmitted force. The palmar radial insertion site produced better thumb opposition, metacarpophalangeal joint abduction, metacarpophalangeal joint flexion, and approximation of the thumb pulp to the fifth metacarpal head. CONCLUSIONS: We conclude that the choice of the proximal pulley used may depend on the needs of the transfer, and a palmar radial thumb insertion is more effective than the dorsal ulnar insertion.

Biomechanical Phenomena↗
PubMedDate not supplied

The modified McBride bunionectomy utilizing the adductor tendon transfer.

A modification of the McBride bunionectomy utilizing the adductor tendon transfer is described. It includes transposition of the adductor hallucis tendon into the medial capsular flap via a pulley suture, and derotation of the sesamoidal apparatus. This is accomplished by torque placed on the medial capsular flap. It is transferred to the medial sesamoid through the tibial sesamoid ligament and then to the fibular sesamoid by the intersesamoidal ligament. The contracted fibular sesamoid ligament is sacrificed. The procedure helps to maintain reduction of an increased intermetatarsal angle, with hypermobile first ray. Another advantage is the ability to perform a concomitant metatarsal neck osteotomy, when necessary. This was not possible in the original McBride bunionectomy in which the adductor tendon was transposed to the head of the first metatarsal through a drill hole. Short-term results have been encouraging.

Adult↗
PubMed1987

Tendon transfer in partially anaesthetic hands.

Stereognosis and sensory localisation were studied in hands of patients with partial anaesthesia due to peripheral nerve injury both before and after tendon transfer to impart movement to the anaesthetic part. One patient showed a marked improvement in stereognosis and localisation, but in general little was gained in terms of improved sensation. Function was improved more in the dominant than in the non-dominant hand. Earlier tendon transfer in cases of peripheral nerve injury might decrease cortical exclusion.

Adult↗
PubMed2006

Latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears. Factors affecting outcome.

BACKGROUND: The purpose of this study was to evaluate the clinical results of latissimus dorsi tendon transfer in patients with an irreparable posterosuperior rotator cuff tear to help determine which patient and anatomic factors affect clinical outcome. METHODS: Fourteen patients with a latissimus dorsi tendon transfer were clinically evaluated with use of the PENN (University of Pennsylvania) shoulder score as well as with quantitative measurement of isometric muscle strength and the range of motion of both shoulders at a minimum of twenty-four months postoperatively. The anatomic results were evaluated with postoperative magnetic resonance imaging and electromyography. RESULTS: Nine patients were satisfied with the outcome, had significant clinical improvement, and reported that they would have the operation again under similar circumstances. The other five patients were dissatisfied with the result and had significantly worse PENN scores, active elevation, and objective measures of strength. Eight of the nine patients with a good clinical result were male, and four of the five with a poor result were female. Patients with a good clinical result had had significantly better preoperative function in active forward flexion and active external rotation compared with the patients with a poor result. The magnetic resonance imaging demonstrated healing of the tendon to the greater tuberosity in twelve patients and equivocal healing in two. There was no significant atrophy of any of the transferred muscles. Electromyography demonstrated clear activity in the transferred latissimus muscle during humeral adduction in all fourteen patients, some electrical activity with active forward elevation in only one patient, and some electrical activity with active external rotation in six of the nine patients with a good clinical result. None of the patients with a poor clinical result demonstrated electrical activity of the transferred muscle with active forward flexion or external rotation. CONCLUSIONS: Synchronous in-phase contraction of the transferred latissimus dorsi is a variable finding following the surgical treatment of irreparable posterosuperior rotator cuff tears, but when it is present it is associated with a better clinical result. Preoperative shoulder function and general strength influence the clinical result. Female patients with poor shoulder function and generalized muscle weakness prior to surgery have a greater likelihood of having a poor clinical result.

Adult↗
PubMed1983

Split posterior tibial-tendon transfer in spastic cerebral palsy.

Sixteen split posterior tibial-tendon transfers, usually with heel-cord lengthening, were performed on sixteen children with spastic cerebral palsy and equinovarus deformities. The patients were followed for a minimum of two years postoperatively. All of the varus deformities were corrected, although two patients required an osteotomy of the calcaneus because of fixed varus deformity. There were no recurrences of the varus deformities, nor were any valgus or calcaneal deformities produced, and the equinus element of the gait was eliminated.

Cerebral Palsy↗
PubMed2005

Biomechanical properties of the brachioradialis muscle: Implications for surgical tendon transfer.

PURPOSE: To understand the mechanical properties of the brachioradialis (BR) muscle and to use this information to simulate a BR-to-flexor pollicis longus (FPL) tendon transfer for restoration of lateral pinch. METHODS: The BR mechanical properties were measured intraoperatively. Passive elastic properties were measured by elongating BR muscles at constant velocity while they were attached directly to a dual-mode servomotor. Sarcomere length was measured intraoperatively and in situ by laser diffraction with the elbow fully extended. Then both the mechanical and structural properties were programmed into a surgical simulator to test the hand surgeon's decision making when tensioning muscles in a simulated BR-to-FPL tendon transfer. RESULTS: Passive mechanical BR properties were highly nonlinear. Under slack conditions sarcomere length (mean +/- standard deviation) was 2.81 +/- 0.10 microm (n = 4), corresponding to an active force of 93% maximum. Sarcomere length of the BR measured in situ with the elbow fully extended and the forearm in neutral rotation was 3.90 +/- 0.27 microm (n = 8), corresponding to an active force of only 23% maximum. Surgeons, who tensioned the BR for transfer into the FPL using only tactile feedback from the surgical simulator, attached the muscle at a passive tension of 5.87 +/- 0.97 N, which corresponded to a sarcomere length of 3.84 microm and an active muscle force of 27% maximum. Passive BR tension when both tactile and visual information were provided to the surgeon was significantly lower (2.42 +/- 0.72 N), corresponding to a sarcomere length of 3.56 mum and a much higher active muscle force of 45% maximum. CONCLUSIONS: When these data were used to model pretransfer and posttransfer function dramatic differences in predicted function were obtained depending on the tensioning protocol chosen. This emphasizes the point that the decision-making process used during muscle tensioning has a profound effect on the functional outcome of the transfer.

Adult↗
PubMedDate not supplied

Magnetic resonance imaging and clinical findings before and after tendon transfers about the shoulder in children with residual brachial plexus birth palsy.

The purpose of this study was to assess the magnetic resonance imaging (MRI) and clinical outcome after tendon transfers about the shoulder in children with residual brachial plexus birth palsy. Twenty-three children with an average age at surgery of 5.3 +/- 1.7 years underwent transfer of the latissimus dorsi and teres major to the posterior rotator cuff with or without concomitant musculotendinous lengthenings. Preoperative MRI revealed glenoid retroversion measuring -25.3 +/- 14.3 degrees and only 29.5 +/- 15.5% percent of humeral head anterior to the middle of the glenoid. Clinical evaluation showed significant improvements in external rotation and abduction. Postoperative MRI 1 year after surgery revealed no change in glenoid retroversion (-24.5 +/- 14.2) or percent of humeral head anterior to the middle of the glenoid (28.4 +/- 14.9%). These results demonstrate that tendon transfers improve overall shoulder motion but do not reduce humeral head subluxation or enhance glenohumeral joint realignment.

Birth Injuries↗
PubMedDate not supplied

Restoration of glenohumeral motion in Erb's palsy by tendon transfers.

BACKGROUND: Children with erb's palsy have significant functional disability, mainly related to the shoulder. The objective of this study was to analyze the functional outcome of tendon transfers performed for restoration of shoulder motion in patients with Erb's palsy. METHODS: This descriptive case series was conducted at Aga Khan University Hospital from May 1999 to December 2003. Ten patients who had functional deficit of shoulder elevation were operated by a single surgeon. The surgical procedure; modified Sever L'Episcopo procedure was uniform in all cases. The data was collected through patient interviewing and medical records maintained through Health Information Management System (HIMS). Mallet class was recorded preoperatively and postoperatively. RESULTS: Ten patients; seven females (70%) and three males (30%), with average age of 75 months at operation were included in this series. Right shoulder was affected in seven cases (70%) while left in three cases (30%). Preoperative mallet class for global abduction improved from 3 to 4; for global external rotation from 2 to 4 and for ability to bring the hand to mouth and neck from 1 to 3. Post operatively mallet class improved in all aspects to 4 and 5; statistically significant on paired t-test with p value of less than 0.005. There was a significant improvement in abduction, forward flexion and external rotation as compared to -preoperative values; statistically significant on paired t-test with p value of less than 0.005. CONCLUSION: Tendon transfer improves the functional status of shoulder in late cases of Erb's Palsy with significant improvement in mallet class, cosmesis and patient satisfaction. A motivated patient, compliance and aggressive rehabilitation are important outcome parameters.

Birth Injuries↗
PubMed1988

Tendon transfers for brachial plexus injury.

Brachial plexus injuries result in severe functional deficits in the upper limb. The authors review a group of 74 patients with brachial plexus injuries who underwent 160 tendon transfer operations, as well as 94 additional procedures, in an attempt to augment lost function. Following evaluation of functional recovery, 58 percent of the patients were rated Good, 34 percent Improved, and 8 percent Unimproved. The authors conclude that significant benefit can be obtained by peripheral reconstruction and tendon transfers in patients with brachial plexus injuries.

Arm Injuries↗
PubMed1997

Rupture of the posterior tibial tendon. Evaluation of injury of the spring ligament and clinical assessment of tendon transfer and ligament repair.

Eighteen of twenty-two patients who were having a tendon transfer to treat rupture of the posterior tibial tendon had evidence of injury to the spring ligament. The injury consisted of a longitudinal tear in the ligament in seven patients, a lax ligament without a gross tear in seven, and a complete rupture of the ligament in four. The ruptured posterior tibial tendon was treated with transfer of the flexor digitorum longus in twenty of the twenty-two patients. A variety of methods were used to repair the ligament. It is essential to determine the status of the spring ligament when patients are managed for rupture of the posterior tibial tendon. Patients who have a torn or lax spring ligament in addition to the ruptured posterior tibial tendon may have more severe abnormalities of the hindfoot than those who have only a ruptured tendon.

Adult↗
PubMed1983

Restoration of thumb-index pinch by a double tendon transfer following ulnar nerve paralysis.

Repair of ulnar nerve lesions by suture or grafts often gives good results, but in some cases there persists a long-term isolated paralysis of the muscles of the first web space. There is certain to be a resulting loss of function from loss of the thumb-index pinch which can be corrected by tendon transfers. In 11 cases the authors have used two tendon transfers: the short extensor of the thumb to re-establish the function of the first dorsal interosseous muscle, and the extensor indicis proprius to improve adduction. In every case there was notable improvement in the function of the hand.

Adolescent↗
PubMed1990

Tendon transfer for radial nerve palsy.

Fifty patients (42 males and 8 females) with radial nerve paralysis were treated by tendon transfer. The age range was 20-50 years, and the follow-up period was 2-12 years. The right hand was affected in 39 cases; the left hand in 11. Forty-three of the 50 cases had high radial nerve palsy and 7 had low radial nerve palsy. Irreparable damage to the radial nerve associated with severe humeral shaft fracture was encountered in 38 cases; a penetrating stab wound was the cause in 7 cases; and 5 cases were found as a result of full recovery from brachial plexus palsy. The pronator teres was transferred to the extensor carpi radialis longus and brevis in 43 patients, the flexor carpi ulnaris to the extensor digitorum communis in 40 patients, and the flexor digitorum superficialis of the fourth finger to the extensor digitorum communis in 10 patients. The palmaris longus was transferred to the extensor pollicis longus in all 50 cases. The results of the surgery were excellent in 12 cases, good in 31, and fair in 7. Five cases had mild radial deviation of the hand without disturbance of hand function.

Adult↗
PubMed1995

The functional results of ulnar nerve repair. Defining the indications for tendon transfer.

The subjective, objective and functional outcome following repair of isolated ulnar nerve injuries was assessed in 50 patients, 1 to 7 years after repair. We tried to identify those patients who may benefit from early tendon transfer. This study confirmed a satisfactory functional result in sedentary workers, but not in manual labourers. Intrinsic muscle power, grip strength, key pinch and sensation continued to improve following repair of high injuries for at least 2 years, and of low injuries for at least 3 years. Early tendon transfers are only recommended in manual workers who complain of poor grip or key pinch.

Adolescent↗
PubMed1982

Early tendon transfers in the rehabilitation of median, radial, and ulnar palsies.

Early tendon transfers car restore a balanced simplification of motor performance and provide an essential component for re-education of sensation. Recommended transfers include the extensor indicis proprius to restore thumb opposition in low median palsy, the pronator teres to restore wrist extension in radial palsy, and the multi-tailed single flexor digitorum superficialis to restore thumb-index pinch and prevent ring-little finger clawing in low ulnar palsy.

Humans↗
PubMedDate not supplied

Split tibialis posterior tendon transfer with concomitant distal tibial derotational osteotomy in children with cerebral palsy.

Fifteen lower extremities with a spastic equinovarus foot deformity associated with internal tibial torsion were identified. Each lower extremity underwent a split tibialis posterior tendon transfer combined with a distal tibial derotational osteotomy. The medical record of each patient was reviewed retrospectively. We paid particular attention to clinic visits, gait analyses, and surgical procedures performed. These patients were followed up for an average of 4 years and 5 months after surgery. Twenty-seven percent had an excellent result, 13% developed a rigid equinovarus deformity, and 40% developed a severe planovalgus deformity. Eight of the 15 lower extremities required further corrective surgery because their resultant deformities limited their ambulation, was painful, or both. The combination of a split tibialis posterior tendon transfer with a distal tibial derotational osteotomy increases the difficulty of balancing the muscle forces across the spastic equinovarus foot, increasing the likelihood that overcorrection and a planovalgus deformity will develop.

Cerebral Palsy↗
PubMed2006

Biomechanic comparison of 3 tendon transfers for supination of the forearm.

PURPOSE: Flexion-pronation of the hand and the forearm is a common deformity when the upper extremity is affected by cerebral palsy. Solutions used to improve the pronation deformity and increase supination include transfer of the flexor carpi ulnaris to the extensor carpi radialis brevis, pronator teres rerouting, and brachioradialis rerouting. The purpose of this study was to compare the biomechanic efficacy of these 3 tendon transfers in simulated supination in cadaveric forearms. METHODS: Ten fresh-frozen adult cadaveric above-elbow upper extremities were used. In each specimen the 3 tendon transfers were performed sequentially in random order and were loaded in increments of 4 N (1 lb) to a maximum of 36 N (8 lb). Measurements were recorded from the starting point of 90 degrees of pronation. Statistical analysis of the data included the Student t test with the Bonferoni correction. RESULTS: For all transfers, supination increased in a nonlinear manner as the load was increased in a nonlinear manner. For the flexor carpi ulnaris transfer, the forearm reached its neutral position at a load of 9 N (2 lb). The forearm continued to rotate to up to 84 degrees of supination with 36 N (8 lb) of load. With the brachioradialis transfer, the forearm reached its neutral position at 13 N (3 lb) of load and continued to rotate to up to 33 degrees of supination with 36 N of load. With the pronator teres transfer, the forearm never reached the neutral position. Under a maximum load of 36 N, only 55 degrees of rotation from full pronation was obtained. CONCLUSIONS: Transfer of the flexor carpi ulnaris to the extensor carpi radialis brevis proved to be the most effective transfer for producing supination in cadavers. The brachioradialis transfer was second best. The pronator teres rerouting was the least effective transfer in effecting simulated supination in this experiment.

Adult↗
PubMed1979

Prevention of extensor lag after indicis proprius tendon transfer.

An experiment on fresh cadaver hands showed that a longitudinal incision of the hood did not affect index extension when traction was made on the common extensor tendon, but that excision of a portion of the hood containing the indicis proprius caused an extensor lag. The lag was eliminated by repair of the hood, providing that the closure was not too tight to prevent normal excursion of the hood. These findings were correlated with findings in patients who had undergone indicis proprius tendon transfer. Extensor lag after indicis proprius transfer is not caused by removal of the force of the tendon per se, but by factors which cause either disruption of normal hood function or tethering of its normal excursion.

Cadaver↗
PubMedDate not supplied

Stabilizing suspension procedure involving multiple tendon transfers in a patient with multiple sclerosis.

Patients afflicted with multiple sclerosis develop weaknesses of the lower extremity resulting in drop foot, making ambulation very difficult. A review of the literature by the authors failed to reveal any cases or manuscripts discussing the podiatric management of patients with this disease. This manuscript offers a review of the disease, common principles regarding tendon transfers, a case report, and unique surgical approach consisting of a stabilizing suspension procedure involving multiple tendon transfers. At 1 year following correction, the patient was pleased with the results and ambulatory status.

Adult↗