Tendon Transfer Revision
Transcript of Tendon Transfer Revision
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Tendon TransfersMr Adam Watts
Consultant Hand and Upper Limb
Surgeon, Wrightington
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Principles of Tendon Transfer
Supple - address contracture
Satisfactory bed
Sensibility
Strength - of donor must be adequate
Size (or amplitude) of motion
Straight line of pull
Single tendon, single function
Synergism
Sacrifice (is the donor expendable)
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Assessment and Treatment
What is missing?
What function needs to be restored?
What is available?
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Low Median Nerve Palsy
What is Missing?APB
OppP
FPB
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Low Median Nerve Palsy
What function needs to be restored?
Thumb Opposition
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Low Median Nerve Palsy
Transfer Options:
FDS opponensplasty
EIP opponensplasty
ADM (Huber) transfer
Palmaris longus (Camitz) transfer
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High Median Nerve Palsy
What additional loss is there?PT
FCR
FDS all digits
FDP to index and middleFPL
PQ
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High Median Nerve Palsy
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What function needs to be restored?Opposition
Flexion of index finger and thumb
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High Median Nerve Palsy
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Transfer Options?only BR, ECRL and ECU available
ECU may be needed for opponensplasty
therefore:BR to FPL
ECRL to index FDP
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Low Ulnar Nerve Palsy
What is missing?
Intrinsic muscles
Hypothenar muscles may be spared depending on level
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Low Ulnar Nerve Palsy
What function needs to be restored?
Thumb power pinch
Roll-up function - correction of clawing
Little finger adduction
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Low Ulnar Nerve Palsy
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Transfer optionsThumb key pinch -
ECRB between 3rd and 4th MC to adductor tubercle with free graft
Clawing -
ECRL with 4 tail graft to A2 pulley
or Zancolli lasso - FDS around A1 to itself
Little finger adduction and Metacarpal arch
EDM tendon split and ulnar half passed palmar to deep transverseligament and attach to radial collateral ligament
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High Ulnar Nerve Palsy
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What additional loss is there?
FDP ring and little finger
FCU
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High Ulnar Nerve Palsy
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What additional functional loss is there?
Active finger flexion
restoration may result in clawing so low nerve lesion transfersmay be required
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High Ulnar Nerve Palsy
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Transfer options
Side to Side Ring and Little FDP to Middle FDP
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Radial Nerve Palsy
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What is missing?
?BR and ECRL may be intact depending on level
ECRB
EDC
ECU
EDM
APLEPL
EPB
EIP
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Radial Nerve Palsy
What function do we need to restore?
Wrist Extension
Finger Extension
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Radial Nerve Palsy
Transfer Options
FCR or FCU transferPT to ECRB
FCR or FCU to EDCPL to rerouted EPL
Superficialis transferPT to ECRL and ECRB
FDS III to EDC
FDS IV to EIP and EPL
FCR to APL and EPB
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