Complex Hand Injuries/Trauma/Tendon Transfers Flashcards
What are the stages of wound healing?
Inflammatory: 3-5 days
Fibroplasia: 5-28 days
Maturation: 28 days to 2 years
which muscle commonly used as a donor for wrist extension after radial nerve palsy?
pronator teres
donor muscle used for wrist extension in patients with cerebral palsy
in CP, wrist is typically postured in pronation and wrist flexion due to increased flexor tone.
FCU can be transferred to EDC or ECRB
which transfers are part of the “superficialis transfer” (“Boyes transfer”) for radial nerve palsy?
FCR or FCU to EDC
PT to ECRB
FDS of MF to EDC
FDS of RF to EPL
FCR to APL/EPB
*the wrist flexors have less amplitude of excursion than finger extensors, so active extension of the fingers can only be achieved with wrist is in volar flexion, relying on tendodesis
what sequence of repair is followed in a replantation?
- bony fixation
- extensor tendon repair
- flexor tendon repair
- nerve repair
- arterial anastomoses
- venous anastomoses
- skin coverage
after repair of a completely transected nerve, how long should you wait to perform stretching and nerve gliding exercises?
3 weeks
what is Jeanne’s sign?
seen in a low ulnar nerve palsy
hyperextension of the thumb MCP with key pinch or gross grip due to loss of adductor pollicis, which helps thumb adduct, flex at the MP, and extend at the IP
what constitues a low median nerve injury?
an injury at the wrist
this wouild include a majority of the thenar muscles
loss of OP and APB render thumb in an adducted position
lumbricals to IF and MF are also impacted
what constitutes a high median nerve lesion?
at or near the elbow
loss of FDP to IF/MF and FDS to all fingers robs the hand of grasp
active pronation also lost due to pronator teres and pronator quadratus
what constitutes a low radial nerve lesion?
injury to PIN and occurs distal to the elbow
wrist extension preserved b/c ECRL innervated more proximally, as is brachioradialis
what constituates a high radial nerve lesion?
injury is proximal to the elbow
wrist, finger, and thumb extension lost as well as thumb abduction
what constitues a low ulnar nerve palsy?
injury at the level of the wrist
loss of all hypothenars, palmar and dorsal interossei, and lumbricals to RF and SF, resulting in clawing
what constitutes high ulnar nerve lesion?
at or near the elbow
in addition to all muscles from a low ulnar nerve lesion, also lose FDP to RF and SF, which makes clawing much less severe
loss of FCU as well
what are common radial nerve tendon transfers?
- PT to ECRB
- FCU to EDC
- FCR to EDC
- middle finger FDS to EDC
- PL to EPL
- ring finger FDS to EPL
- middle finger FDS to EIP
- ring finger FDS to EDM
what are common median nerve tendon transfers?
- RF FDS transferred via constructed pulley at the pisiform, across the palm, & inserted to dorsal ulnar thumb metacarpal for opposition
- EIP to APB
- neurovascular pedicle of ADM to APB
- ECRL to APB
- PL to APB
- BR to FPL
- ECRL to FPL
- RF/SF FDP tenodesis to IF/MF FDP
- ECRL to a synchronized FDP