- See:
-
Entrapment of Median nerve
at the Elbow and Forearm:
-
Combined Injuries of the Median and Ulnar Nerves:
-
Median Nerve
-
Nerve Repair
- Deficit:
- loss of pronation of forearm, wrist flexors, index & long finger flexion;
- loss of thumb flexion:
-
long term contractures:
- adduction contractures can be prevented w/ oppenens splint;
- fixed supination deformity may develop despite bracing (due to the deforming
forces of the EPL and adductor;
- Prerequisites for Tendon Transfer:
- absence of web space contracture and supination contracture of thumb;
- tendon transfer for the extrinsic muscles innervated by
median nerve may
be delayed, anticipating return of long flexor f(x)
- Accessory Transfers in High Median Nerve Lesions:
-
FPL is reenforced by
Brachioradialis ;
-
FDP of index & long fingers are reinforced by transfer of
ECRL ;
-
FDP of ring and small fingers are anchored to
FDP of index and
middle fingers using side to side repair;
-
opponensplasty:
- w/ median nerve injury several inches above the wrist, consider early transfer;
- treatment options:
-
EIP transfered to
APB (Burkhalter);
-
opponens &
APB
are reinfored by paralyzed
FDS around distal
end of
FCU -
ECU used as a motor;
- paralyzed
FDS of ring finger is isolated at wrist and at base of digit &
delivered at at wrist;
- distal
FCU tendon is detached & anchored to
ECU tendon, thereby
forming indirect dynamic pulley;
- paralyzed
FDS is then passed thru this pulley & into proximal
phalanx of thumb, similar to a routine
opponens transfer;
- proximal end of FCU is sutured to paralyzed
FDS;
- accessory procedures include either arthrodesis of the MP joint or the distal IP
joint of the thumb, depending of the stability;
Early Tendon Transfers in Upper Extremity Peripheral Nerve Injury.
WE Burkhalter.
COOR No 104, Oct 1974.
Restoration of strong opposition after median-nerve or brachial
plexus paralysis.
Abductor digiti quinti opponensplasty.
