- Discussion:
- there are many surgical options for restoring digital extension in radial nerve palsy;
- as w/ all tendon transfers, consider not only not only synergistic muscle activity, but also amplitude as well as muscle power and tendon excursion;
- if surgery must be delayed, consider a stabilizing wrist orthosis;
- low radial nerve palsy:
- with a low radial nerve injury, there will be loss of EDC, EPL, APL;
- in low nerve palsy, wrist extension is maintained, where as in high palsy, there is loss of wrist extension;
- high radial nerve palsy:
- loss of EDC, EPL, APL, BR, ECRL / ECRB
- hand orthosis:
- need to prevent web space contracture, and hyper-extension at MP joints;
- Technical Considerations:
- tensioning tendon transfers:
- EDC deficit:
- An Analysis of Results After Selective Tendon Transfers Through the Interosseous Membrane to Provide Selective Finger and Thumb
Extension in Chronic Irreparable Radial Nerve Lesions
- EPL deficit:
- brachioradialis transfer:
- can only be used in low palsies in which there is at least 4/5 function of the BR;
- advantage is that this can be performed thru the same incision as the pronator tranfer and the FCR transfer;
- typically this transfer is performed after the FCR to EDC transfer;
- palmaris longus transfer:
- tendon rerouted to EPL;
- EPL is released at the myotendinous junction and its insertion into the thumb can be mobilized radially inorder to promote some abduction
inaddition to thumb extension;
- palmaris longus has also been used to restore thumb abduciton;
- flexor carpi radialis split transfer:
- split transfer allows independent restoration of finger and thumb extension in the absence of palmaris longus;
- if present palmaris longus muscle may also be transferred to restore the function of the abductor pollicis longus;
- ref: Independent function in a split flexor carpi radialis transfer.
- wrist extension deficit: (ECRL / ECRB)
- often one of the major complaints following radial nerve injuries, is lack of power grip due to inability to stabilize the wrist;
- pronator teres transfer to the ECRB has become a standard method for restoring wrist extension;
- the beauty of this transfer is that the pronator teres will continue to function as a pronator;
- generally this transfer is performed at the time of nerve repair;
- make small longitudinal incision over the insertion of the PT tendon on the volar radial aspect of the forearm;
- harvest the insertion along with 2 cm of adjacent periosteum;
- pronator tendon is passed subcutaneously over the brachioradialis tendon until it reaches the ECRB;
- pronator tendon is woven into ECRB w/ enough tension to hold the wrist in mild extension;
- ref: Functional Deficit After Transfer of the Pronator Teres for Acquired Radial Nerve Palsy.
- APL deficit:
- in a low radial nerve palsy, pronator teres can be transfered to the APL, however, in a high radial nerve palsy
the pronator teres is used to restore wrist extension;
Early transfer for radial nerve transection. AG Bevin. Hand. Vol 8. p 134. 1976.
Tendon transfers for radial nerve palsy. R.W. Beasley. Orthop Clinics of North America. Vol 1: p 439. 1970.
Apparent weakness of median and ulnar motors in radial nerve palsy. J. Hand Surg. Vol 11-A. 1986. p 528.
Splinting for radial nerve palsy. JC Colditz. J. Hand Therapy. Vol 1(1) p 18. 1987.
An improved splint for radial (musculospiral) nerve paralysis. FB Thomas. JBJS. Vol 33-B. 1951. p 272.
Analysis of Tsuge's Procedure for the Treatment of Radial Nerve Paralysis.
Independent function in a split flexor carpi radialis transfer.
