- See:
Nerve Repair:
- Discussion:
- digit flexors are restored by transferring
ECRL to
FDP tendons;
-
FPL is reinforced by
Brachioradialis
and, in certain instances, the
distal joint of the thumb is arthrodesed;
- MP joint of the thumb is arthrodesed if this joint is unstable;
- opposition and abduction of the thumb are secured by transfer of
FDS
around
FCU, which if denervated can be formed into a pulley by use
of
ECU as active motor to
FDS ;
- first dorsal interosseous is reinforced by either
EIP or
EPB, & MP
joint of the thumb is arthrodesed;
- Low Median and Low Ulnar Nerve Lesions:
- loss of palm sensation: correct contractures & fuse IP if required;
- loss of
Intrinsic:
ECRB - tendon graft - intrinsics (Brand)
- thumb opposition:
FDS (ring finger) to
FCU pulley to
EPL
(Riordan)
- thumb adduction:
EIP to
Adductor;
- High Median and High Ulnar Nerve Lesions;
- hand anesthesia: need arthrodesis of thumb MCP (Zancolli)
- loss of flexors and
intrinsic s:
- need capsulodesis of MCP joints,
ECRL
to
FDP , &
BR
to
FPL , &
ECU (with graft) to
EPB ;
- Burkhalter Transfer for Claw Deformity:
Tendon transfers and arthrodeses in combined median and ulnar nerve paralysis.
JW Littler.
JBJS Vol 40-A. 1958. p 1071.
Treatment of interphalangeal hyperflexion and metacarpophalangeal hyperextension of the thumb in combined low median - ulnar nerve palsy.
SA Goloborodko MD.
J. Hand Surg. Vol 23-A. 1998. p 1059-1062.
