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Nerve Versus Tendon Transfer for Radial Nerve Paralysis Reconstruction.
J Hand Surg Am. 2020 May; 45(5):418-426.JH

Abstract

PURPOSE

With radial nerve lesions, the results of nerve transfers and how they objectively compare with the outcomes of tendon transfers remain unstudied. We compared the results after nerve transfer in patients with less than 12 months since radial nerve injury with the results after tendon transfer in patients not eligible for nerve surgery because of longstanding paralysis (minimum of 15 months).

METHODS

In 14 patients with radial nerve lesions incurred less than 12 months previously, we transferred the anterior interosseous nerve to the nerve of the extensor carpi radialis brevis (ECRB), while the nerve to the flexor carpi radialis was transferred to the posterior interosseous nerve. In 13 patients with lesions of longer duration, we transferred the pronator teres tendon to the ECRB, the flexor carpi ulnaris tendon to the extensor digitorum communis, and the palmaris longus to the rerouted extensor pollicis longus (EPL) tendon. At a final evaluation, we measured passive and active range of motion (ROM) of the wrist, finger, and thumb and grasp strength.

RESULTS

In a comparison of wrist flexion-extension ROM and grasp strength, we observed better recovery in the nerve transfer than in the tendon transfer group. In the tendon transfer group, we observed limitations in wrist flexion in 9 of the 13 patients and permanent radial deviation in 5. Half of the patients in the tendon transfer group needed to flex their wrist to fully extend their fingers, whereas finger extension was possible with the wrist either extended or at neutral in all patients following nerve transfer. After nerve transfer, extension at the first carpometacarpal joint was restored in 11 of the 14 patients, whereas this occurred in just 4 of the 13 patients following tendon transfer. In both groups, we observed a 30° lag in thumb metacarpophalangeal extension, which reflects poor recovery of EPL function.

CONCLUSIONS

Overall, we observed better outcomes in those who underwent nerve transfer versus tendon transfer procedures. However, room still remains for improved thumb motion with both procedures.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Authors+Show Affiliations

Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul), Tubarão; Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, SC, Brazil. Electronic address: drbertelli@gmail.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32093993

Citation

Bertelli, Jayme Augusto. "Nerve Versus Tendon Transfer for Radial Nerve Paralysis Reconstruction." The Journal of Hand Surgery, vol. 45, no. 5, 2020, pp. 418-426.
Bertelli JA. Nerve Versus Tendon Transfer for Radial Nerve Paralysis Reconstruction. J Hand Surg Am. 2020;45(5):418-426.
Bertelli, J. A. (2020). Nerve Versus Tendon Transfer for Radial Nerve Paralysis Reconstruction. The Journal of Hand Surgery, 45(5), 418-426. https://doi.org/10.1016/j.jhsa.2019.12.009
Bertelli JA. Nerve Versus Tendon Transfer for Radial Nerve Paralysis Reconstruction. J Hand Surg Am. 2020;45(5):418-426. PubMed PMID: 32093993.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nerve Versus Tendon Transfer for Radial Nerve Paralysis Reconstruction. A1 - Bertelli,Jayme Augusto, Y1 - 2020/02/21/ PY - 2019/01/29/received PY - 2019/10/23/revised PY - 2019/12/17/accepted PY - 2020/2/26/pubmed PY - 2020/2/26/medline PY - 2020/2/26/entrez KW - Nerve grafting KW - nerve transfer KW - radial nerve paralysis KW - radial nerve repair KW - tendon transfer SP - 418 EP - 426 JF - The Journal of hand surgery JO - J Hand Surg Am VL - 45 IS - 5 N2 - PURPOSE: With radial nerve lesions, the results of nerve transfers and how they objectively compare with the outcomes of tendon transfers remain unstudied. We compared the results after nerve transfer in patients with less than 12 months since radial nerve injury with the results after tendon transfer in patients not eligible for nerve surgery because of longstanding paralysis (minimum of 15 months). METHODS: In 14 patients with radial nerve lesions incurred less than 12 months previously, we transferred the anterior interosseous nerve to the nerve of the extensor carpi radialis brevis (ECRB), while the nerve to the flexor carpi radialis was transferred to the posterior interosseous nerve. In 13 patients with lesions of longer duration, we transferred the pronator teres tendon to the ECRB, the flexor carpi ulnaris tendon to the extensor digitorum communis, and the palmaris longus to the rerouted extensor pollicis longus (EPL) tendon. At a final evaluation, we measured passive and active range of motion (ROM) of the wrist, finger, and thumb and grasp strength. RESULTS: In a comparison of wrist flexion-extension ROM and grasp strength, we observed better recovery in the nerve transfer than in the tendon transfer group. In the tendon transfer group, we observed limitations in wrist flexion in 9 of the 13 patients and permanent radial deviation in 5. Half of the patients in the tendon transfer group needed to flex their wrist to fully extend their fingers, whereas finger extension was possible with the wrist either extended or at neutral in all patients following nerve transfer. After nerve transfer, extension at the first carpometacarpal joint was restored in 11 of the 14 patients, whereas this occurred in just 4 of the 13 patients following tendon transfer. In both groups, we observed a 30° lag in thumb metacarpophalangeal extension, which reflects poor recovery of EPL function. CONCLUSIONS: Overall, we observed better outcomes in those who underwent nerve transfer versus tendon transfer procedures. However, room still remains for improved thumb motion with both procedures. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV. SN - 1531-6564 UR - https://www.unboundmedicine.com/medline/citation/32093993/Nerve_Versus_Tendon_Transfer_for_Radial_Nerve_Paralysis_Reconstruction_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0363-5023(20)30003-4 DB - PRIME DP - Unbound Medicine ER -
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