The Birmingham Hand Centre Tendon transfers for nerve injuries for nerve injuries Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust Principles •Use available muscle units •Ensure criteria are met Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust •Patient – compliance, understanding •Stable skeleton •Mobile joints •Soft and supple soft tissues Recipient factors Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust •Expendability •Strength •Excursion •Synergism •Intact Innervations Donor factors Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust •Integrity – one tendon for one tendon •Line of pull •Route – s/c , inter osseous •Fixation •Tension •Timing Surgical factors Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust Low median Nerve Palsy( opponensplasty ) Absent – ABP,OP,FPB and lumbricals I and II Absent function – opposition, thumb abbduction Available – all others COMMON Transfers – EIP, FDS(IV), ADM,PL Alternative transfers -ECU to EPB,EDM,FPL,EPL, ECRL Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust High median Nerve Palsy Absent – ABP,OP,FPB and lumbricals I and II, FDS, FPL, index FDP, PL, FCR, PT & PQ Absent function – opposition, thumb abduction, thumb and index flexion and forearm pronation Available – Radial and ulnar innervated muscles COMMON Transfers – EIP, BR – FPL, Alternative transfers -ECU to EPB,EDM,EPL, ECRL Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust High Radial Nerve Palsy Absent – BR,Supinator,ECRL,ECRB,ECU,EDC,EIP,EDM, EPL,EPB,APL Absent function – wrist extension, finger extension,, thumb extension and radial abduction Available – median and ulnar innervated muscles COMMON Transfers – PT-ECRB, FCU,FCR,FDS(IV) -EDC, PL,FCU,FCR,FDS-EPL Alternative transfers – BR,FCU,FCR – ECRB Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust Low Radial Nerve Palsy Absent –ECU,EDC,EIP,EDM, EPL,EPB,APL Absent function –finger extension,, thumb extension and radial abduction Available – median and ulnar innervated muscles COMMON Transfers – PL-EPL, FDS(IV) -EDC, Alternative transfers – FDS – EPL, FDS -EDC Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust BEST COMBINATIONS OF TENDON TRANSFERS FOR RADIAL NERVE PALSY FCR Transfer (Starr, 76 Brand, 15 Tsuge and Adachi 84) PT to ECRB FCR to EDC PL to rerouted EPL Superficialis Transfer (Boyes 11; Chuinard et al 24) PT to ECRL and ECRB FDS III to EDC FDS IV to EIP and EPL FCR to APL and EPB FCU Transfer PT to ECRB FCU to EDC PL to reroute EPL Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust JONES TRANSFERS 1916 35 PT to ECRL and ECRB FCU to EDC III-V FCR to EIP, EDC II, and EPL 1921 37 PT to ECRL and ECRB FCU to EDC III-V FCR to EIP, EDC II, EPL, EPB, and APL Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust Low Ulnar Nerve Palsy Absent –FAO ulnar, all interossei, ulnar 2 lumbricals, AP and ulnar FPB Absent function –finger MP flexion of 4 & 5, abd and adduction of fingers, key pinch, muscles COMMON Transfers – FDS Lasso, ECRL + graft, EIP,EDM,FDS EIP Adductor plasty Alternative transfers – FDS ring – AP, Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust High Ulnar Nerve Palsy Absent –FAO ulnar, all interossei, ulnar 2 lumbricals, AP and ulnar FPB, FDP to ting and little, FCU Absent function –finger MP flexion of 4 & 5, abd and adduction of fingers, key pinch, absent flexion of DIP of 4 &5 Available – median and radial innervated muscles COMMON Transfers – FDS Lasso, ECRL + graft, EIP,EDM,FDS EIP Adductor plasty Alternative transfers – FDS ring – AP, Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust Radial Nerve palsy tendon transfer Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust BR-FPL, ECRL-FDP(II) Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust Capsulodesis -anticlaw Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust PL Graft for static claw correction Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust Dynamic Correction Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust the EPB to the insertion of the first dorsal interosseous to improve index abduction. Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust ECRB extended with a free tendon graft, through the interspace between the third and fourth metacarpals across the palm volar to the adductor pollicis muscle and dorsal to the finger flexor tendons and neurovascular structures Tendon transfers for nerve injuries Tendon transfers for nerve injuries The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust The Birmingham Hand Centre THANK YOU