- 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, et al);
-
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.
Restoration of strong opposition after median-nerve or brachial plexus paralysis.
Abductor digiti quinti opponensplasty.
