Post Operative Physiotherapy for Pronator Teres Tendon Transfer
Original Editor - Tanvi Korba
Top Contributors - Tanvi Korba and Kim Jackson
Introduction[edit | edit source]
Proximal radial nerve injuries are seen mainly in patients with humeral shaft fractures[1]. Tendon and nerve transfers are utilized if the Functional recovery is not observed after primary nerve repair. This surgical option is available for reconstruction of the wrist, thumb, and finger extension. The motor branch of the flexor digitorum superficialis (FDS) is used for the motor branch of the extensor carpi radialis brevis (ECRB). It is mainly used for a synergistic effect. The FDS function gets affected if the only branch of the FDS nerve is cut off. In such case scenarios, pronator teres (PT) nerve transfer to the extensor carpi radialis longus (ECRL) nerve is preferred to achieve and restore wrist extension[2]. For wrist extension reconstruction, the ECRB muscle is preferred over the ECRL due to ECRB muscle’s central location. That provides better-balanced radio-ulnar deviation during wrist extension[3][4][5]. Outcomes of tendon transfer are considered favorable when patients achieve good wrist extension, finger extension, thumb extension, and hand grip[6].
Procedure[edit | edit source]
This video describes the following tendon transfer: (1) pronator teres (PT) to extensor carpi radialis brevis (ECRB), (2) flexor carpi radialis (FCR) to extensor digitorum communis (EDC), and (3) palmaris longus (PL) to extensor pollicis longus (EPL).
Indications of Surgery[edit | edit source]
Indication[7] for tendon transfers in high radial nerve injury are:
- Unlikely nerve recovery
- No recovery following nerve repair surgery
- Failure to achieve recovery after a period of non-surgical management
Pre-operative Evaluation[8][edit | edit source]
A team approach can effectively address pre-operative issues and enhance post-operative success. The ideal team would consist of a hand surgeon, physician assistant or nurse practitioner, hand therapist (Occupational or Physical therapist), electro-diagnostician, social worker, the client, and his/ her family.
- Neural recovery status: no change or plateaued recovery observed over the past few months with the help of assessment techniques and electrodiagnostic tests such as electromyography or nerve conduction studies
- Musculoskeletal assessment: Active and Passive range of motion available in the involved joint, active range during functional tasks
- Strength of the muscles: Manual muscle testing or hand-held dynamometry, Grip, and pinch dynamometers
- Assessment of function/ dexterity to document pre-operative performance
- Testing for sensibility: Semmes–Weinstein monofilaments or the Weinstein Enhanced Sensibility Test to assess touch pressure threshold, Discrimination assessment with static/ moving two-point discrimination
- Patient-related factors such as compliance, motivation, finances, previous and current interests/ abilities (including other psychosocial issues)
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References[edit | edit source]
- ↑ Ekholm R, Ponzer S, Törnkvist H, Adami J, Tidermark J. The Holstein-Lewis humeral shaft fracture: aspects of radial nerve injury, primary treatment, and outcome. Journal of orthopaedic trauma. 2008 Nov 1;22(10):693-7.
- ↑ García-López A, Navarro R, Martinez F, Rojas A. Nerve transfers from branches to the flexor carpi radialis and pronator teres to reconstruct the radial nerve. The Journal of Hand Surgery. 2014 Jan 1;39(1):50-6.
- ↑ Sammer DM, Chung KC. Tendon transfers part I: principles of transfer and transfers for radial nerve palsy. Plastic and reconstructive surgery. 2009 May;123(5):169e.
- ↑ Moussavi AA, Saied A, Karbalaeikhani A. Outcome of tendon transfer for radial nerve paralysis: Comparison of three methods. Indian journal of orthopaedics. 2011 Dec;45:558-62.
- ↑ Bertelli JA, Tacca CP, Duarte EC, Ghizoni MF, Duarte H. Transfer of the pronator quadratus motor branch for wrist extension reconstruction in brachial plexus palsy. Plastic and reconstructive surgery. 2012 Dec 1;130(6):1269-78.
- ↑ Ishida O, Ikuta Y. Analysis of Tsuge's procedure for the treatment of radial nerve paralysis. Hand surgery. 2003 Jul;8(01):17-20.
- ↑ Tsuge K. Tendon transfers for radial nerve palsy. Australian and New Zealand Journal of Surgery. 1980 Jun;50(3):267-72.
- ↑ Hunter JM, Mackin EJ, Callahan AD, Skirven TM, Schneider LH, Osterman AL. Rehabilitation of the hand and upper extremity. InRehabilitation of the hand and upper extremity 2002 (pp. 1096-1096).
