Chapter 29 - Tendon transfers for Peripheral Nerve Injuries in the Upper Extremities

Question 1

three principles of tendon transfer

Answer 1

power of the donor and recipient muscle must be equivalent
excursion of the recipient and donor muscles should be similar
muscle phases must be synergistic

Question 2

muscle power

Answer 2

cross sectional diameter of the muscle belly

Question 3

in phase tendon transfers

Answer 3

• wrist extension, finger flexion, thumb adduction
• wrist flexion, finger extension, thumb abduction

Question 4

order of muscle innervation of the radial nerve

Answer 4

brachioradialis, ecrl, ecrb, supinator, ecu, edc, edm, apl, epl, epb, eip

EPL is LAST (aka most proximal) nerve they can test bc of variability more proximal

Question 5

High radial nerve palsy

Answer 5

loss of wrist, finger extension, loss of grip strength, loss of thumb extension

Question 6

low radial nerve palsy

Answer 6

only involves PIN muscles - functionally results in radial deviation of the wrist (bc of unopposed ecrl with loss of ecu) with loss of finger and thumb extension

Question 7

tendon transfer for high radial nerve palsy

Answer 7

brand transfer - transfer of fcr to edc, with transfer of the pronator teres to ecrb, and the transfer of palmaris longus to epl

spares fcu funciton

Question 8

high median nerve injury

Answer 8

results in the loss of finger opposition, finger flexor dysfunction, and thumb flexor dysfunction

(FCU and FDP to ring and small are spared)

Question 9

goal of tendon transfers for high median nerve palsy

Answer 9

restore index finger and thumb flexion and opposition

Question 10

high median nerve palsy results in a loss of:

Answer 10

1. FPL - thumb IP flexion
2. Flexor digitorum profundus to the index and long - loss of IF, LF DIP flexion
3. complete loss of FDS - loss of PIP flexion to ALL digits
4. Opponens pollicis and APB - Thumb opposition

Question 11

low median nerve palsy results in a loss of:

Answer 11

thumb opposition, sensation to the median nerve distribution EXCEPT palm (palmar cutaneous nerve distribution)

Question 12

Tendon transfers for High median nerve injury - restore FPL

Answer 12

Brachioradialis

Question 13

Tendon transfers for High median nerve injury - FDP

Answer 13

side to side suturing of the IF FDP to the LF, RF, SF

Question 14

difference in clawing between high ulnar nerve palsy and low ulnar nerve palsy

Answer 14

clawing NOT as severe in high as it is in low

because in low - innervation to FDP to ring/small are preserved resulting in unopposed flexiion of these digits 2/2 intrinsic paralysis

Question 15

define hugh ulnar nerve injury

Answer 15

loss of fcu, fdp to ring and small, intrinsic function

Question 16

wartenburg sign

Answer 16

abducted position of the small finger 2/2 loss of intrinsic function and unopposed pull of the edm (radial nerve)

Question 17

froment sign

Answer 17

thumb IP flexion during lateral pinch through recruitment of the fpl (Median nerve) as a result of loss of APL

Question 18

low ulnar nerve palsy

Answer 18

FDP to ring and small is INTACT causing clawing