the paralysed hand COPY Flashcards

1
Q

Before contemplating tendon transfer what criteria have to be met?

A
  1. The jont must be passively mobile
  2. the gain in function must be greater than the potential loss
  3. Motor must be sufficient power ( generally grade 1 will be lost)

Ideally there should be

  1. one motor per joint to be moved
  2. a stright line of oull
  3. synergistic transfers
  4. sensiblity
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2
Q

What is lost in radial nerve palsy at the wrist/hand?

What tendon transfer can aid this?

A
  • Loss: wrist and MCP extension
  • transfer
    • Pronator teres (PT) to ECRB ( less radial deviation than ERCL)
    • Palmaris longus to EPL or FDS IV to EPL
    • FCR ( or FCU) to EDC
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3
Q

What is lost in low ulnar nerve palsy at the wrist/hand?

What tendon transfer can aid this?

A
  • loss: intrinsics
  • transfer
    • to prevent clawing
      • FDS tendodesis
      • MCPJ capulsodesis
      • FDS to lateral band
      • ERCL plus graft to lateral band
    • for thumb adduction
      • ERCB plus graft
      • EIP thru 2nd MC space
    • ​for first dorsal interossei
      • ​often not needed- flex all fingers to create post for pinch
      • ERCL to DIO
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4
Q

What is lost in high ulna nerve palsy at the wrist/hand?

What tendon transfer can aid this?

A
  • loss of intrinsics/dorsal interossei/ thumb adduction and FCU and FDP
  • suture FDPs together
  • FCR to FCU ( remaining radial flexors PL and APL)
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5
Q

What is lost in low median nerve palsy at the wrist/hand?

What tendon transfer can aid this?

A
  • loss thumb opposition
  • transfer
  • PL to APB
  • EIP to APB
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6
Q

What is lost in high median nerve palsy at the wrist/hand?

What tendon transfer can aid this?

A
  • Loss of abductor pollcis brevis, PT, finger and thumb flexors ( except ulna FDP)
  • Transfer
    • EIP to APB
    • suture FDPs together
    • re- reoute biceps ot ECU to radius for pronation
    • ECRL to FPL
    • BR + graft to FPL
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