Upper Extremity Tendon Trasfers: Tensioning the Graft


- Tensioning the Graft:
    - as a muscle is tensioned to mid stretch, most of the potential energy generated results from passive tension of elastic recoil;
    - note that the tenodesis effect can effectively increase tendon excursion by 2-3 cm;
    - Mayer's Rule:
          - origin is brought as close as possible to the insertion and the tendon is then sutured w/ no tension;
          - the greatest contraction force is exerted when a muscle is at resting length (on Blix curve);
    - flexor to extensor transfer:
          - it is permissible to error slightly on the side of over-tensioning;
          - w/ slight overtensioning, the patient may have difficulty in achieving full flexion, however, there will be no difficulty in achieving full extension;
                 - in addition, many of these patients will regain full flexion w/ time;
    - extensor to flexor transfer:
          - take care not to over tension the graft;
          - overtensioning will lead to flexion contracture of the digit;


Excursion of prime wrist tendons.

Early Tendon Transfers in Upper Extremity Peripheral Nerve Injury.

Fundamental principles of tendon transfer.  

Relative tension and potential excursion of muscles in the forearm and hand.

The technique and timing of tendon transfers.
     Omer GE. Orthop Clin North Am. 1974;5:243.

Relative tension and potential excursion of muscles in the forearm and hand.

Biomechanics of tendon transfer.
 
Biomechanics of tendon transfers.

Determination of muscle tendon unit properties during tendon transfer.

Relative tension and potential excursion of muscles in the forearm and hand.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, April 11, 2012 11:34 am