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Tendon Transfers in the Upper Limb, An Issue of Hand Clinics, E-Book

Tendon Transfers in the Upper Limb, An Issue of Hand Clinics, E-Book

Glenn Gaston

(2016)

Abstract

This issue of Hand Clinics will include articles on tendon transfers in the upper limb such as: Principles of Tendon Transfers, Biomechanics of tendon transfers, Restoration of Shoulder Function, Restoration of Elbow Flexion, Radial Nerve Tendon Transfers, High Median Nerve Tendon Transfers, Low Median Nerve Transfers (Opponensplasty), Ulnar Nerve Tendon Tendon Transfers for Grasp (Intrinsics), and many more!


Table of Contents

Section Title Page Action Price
Front Cover Cover
Tendon Transfers in theUpper Limb i
Copyright ii
Contributors iii
CONSULTING EDITOR iii
EDITOR iii
AUTHORS iii
Contents vii
Preface: An Update on Upper Extremity Tendon Transfers vii
Principles of Tendon Transfer vii
Biomechanics of Tendon Transfers vii
Restoration of Shoulder Function vii
Restoration of Elbow Flexion vii
Radial Nerve Tendon Transfers viii
High Median Nerve Injuries viii
Low Median Nerve Transfers (Opponensplasty) viii
A Comprehensive Guide on Restoring Grasp Using Tendon Transfer Procedures for Ulnar Nerve Palsy viii
Ulnar Nerve Tendon Transfers for Pinch viii
Tendon Transfers for Combined Peripheral Nerve Injuries ix
Tendon Transfers for Tetraplegia ix
Free Flap Functional Muscle Transfers ix
Tendon Transfers in the Rheumatoid Hand for Reconstruction ix
Tendon Transfers for the Hypoplastic Thumb x
Cerebral Palsy Tendon Transfers: Flexor Carpi Ulnaris to Extensor Carpi Radialis Brevis and Extensor Pollicis Longus Rerout ... x
HAND CLINICS xi
FORTHCOMING ISSUES xi
November 2016 xi
February 2017 xi
May 2017 xi
RECENT ISSUES xi
May 2016 xi
February 2016 xi
November 2015 xi
Preface:\rAn Update on Upper Extremity Tendon Transfers xiii
Principles of Tendon Transfer 283
Key points 283
INTRODUCTION 283
GENERAL PRINCIPLES OF TENDON TRANSFER 284
Preoperative Assessment 284
Tissue Equilibrium 284
Mobile, Intercalary Joints 284
Donor Muscle Properties 285
Adequate strength 285
Excursion 286
Expendable Donor 286
One Tendon, One Function 287
Straight Line of Pull 287
Synergism 287
Surgical Technique 287
Rehabilitation 288
REFERENCES 288
Biomechanics of Tendon Transfers 291
Key points 291
INTRODUCTION 291
BIOMECHANICS FUNDAMENTALS 291
Balance and Synergy 291
Muscle Mechanics 292
Tension 292
Excursion 294
Planning 294
MUSCLE CHANGES FOLLOWING TRANSFER 294
Tension Capacity 296
Excursion 296
Tensioning 298
BIOMECHANICAL CHALLENGES 299
One Muscle Controlling Multiple Joints in Parallel 299
One Muscle Controlling Multiple Joints in Series 299
COAPTATION TECHNIQUES 300
SUMMARY 301
REFERENCES 301
Restoration of Shoulder Function 303
Key points 303
INTRODUCTION 303
Preoperative Planning 305
SURGICAL TECHNIQUE 305
Preparation and Patient Positioning 305
Surgical Approach and Procedure 305
Immediate Postoperative Care 307
REHABILITATION AND RECOVERY 307
CLINICAL RESULTS IN THE LITERATURE 308
SUMMARY 309
REFERENCES 309
Restoration of Elbow Flexion 311
Key points 311
INTRODUCTION 311
TRANSFER OPTIONS 312
Pectoralis Major Transfers 312
Introduction 312
Anatomy 312
Indications 312
Contraindications 312
Review of pectoralis transfer options 312
Tendon transfer 312
Unipolar transfer 312
Bipolar transfer 312
Results 312
Steindler Flexorplasty 313
Introduction 313
Anatomy 313
Indications 313
Contraindications 313
Surgical technique evolution 314
Surgical technique 314
Results 315
Latissimus Transfer 315
Indications 316
Contraindications 316
Surgical technique 316
Results 317
Triceps to Biceps 317
Indications 317
Contraindications 317
Surgical technique 318
Triceps to biceps transfer 318
Isolated long head of triceps to biceps transfer 318
Results 319
SUMMARY 320
REFERENCES 320
Radial Nerve Tendon Transfers 323
Key points 323
INTRODUCTION 323
Nature of the Problem 323
Effect on prehension 324
Relevant anatomy and patient assessment 324
SURGICAL TECHNIQUE 325
Preoperative Planning 325
How good is the patient’s wrist motion? 326
How important is flexor carpi ulnaris function to the patient? 326
Does the patient have a palmaris longus? 326
How important is independent thumb extension or abduction to the patient? 326
Making the choice of tendon transfers 326
Surgical Approach 326
SURGICAL PROCEDURE 328
Step One: Dissection of the Donor Tendons 328
Step Two: Preparation of the Recipient Tendons 328
Step Three: Routing the Donor Tendons to the Recipient Tendons 328
Ensure that the transfers are not compressing the cutaneous nerves 328
Paths that the donor tendons may take 330
Step Four: Weaving the Donor Tendon to the Recipient Tendon 330
Location of weaves 330
Type of weaves 330
Step Five: Tensioning the Transfer 330
The Blix curve and optimal muscle tension 330
Order of tensioning 330
Wrist transfer first 331
Wrist transfer last 332
Immediate Postoperative Care 332
Rehabilitation and Recovery 332
Rehabilitation program 332
Scar management 334
Clinical Results and Literature Review 334
Case series and outcomes 334
Complications 334
Donor deficit 334
SUMMARY 334
ACKNOWLEDGMENTS 337
REFERENCES 337
High Median Nerve Injuries 339
Key points 339
INTRODUCTION 339
NATURE OF THE PROBLEM 339
ANATOMY 339
SURGICAL TECHNIQUE 340
Preoperative Planning 340
Preparation and Patient Positioning 342
SURGICAL APPROACH 342
SURGICAL PROCEDURE 343
IMMEDIATE POSTOPERATIVE CARE 346
CLINICAL RESULTS 346
SUMMARY 347
REFERENCES 347
Low Median Nerve Transfers (Opponensplasty) 349
Key points 349
DEFINING OPPOSITION 349
ANATOMY AND BIOMECHANICS 350
ETIOLOGY 351
PHYSICAL EXAMINATION 352
SURGICAL PROCEDURES 352
Extensor Indicis Proprius 352
Flexor Digitorum Superficialis 354
Palmaris Longus (Camitz) 355
Abductor Digiti Minimi 357
Others 357
SUMMARY 358
REFERENCES 358
A Comprehensive Guide on Restoring Grasp Using Tendon Transfer Procedures for Ulnar Nerve Palsy 361
Key points 361
INTRODUCTION 361
Biomechanics of Grasp 361
Pathophysiology of Deficit 362
SURGICAL TECHNIQUE 363
Simple Claw Hand Reconstructions 363
Metacarpophalangeal Capsulodesis 363
Flexor Digitorum Superficialis Lasso 363
Complex Claw Hand Reconstructions 364
Stiles-Bunnell Flexor Digitorum Superficialis Transfer 365
Wrist Extensor-to-Intrinsic Transfer 365
Flexor Digitorum Profundus Side-to-Side Transfer for High Ulnar Nerve 366
REHABILITATION AND RECOVERY 367
CLINICAL RESULTS IN THE LITERATURE 367
SUMMARY 367
ACKNOWLEDGMENTS 367
REFERENCES 367
Ulnar Nerve Tendon Transfers for Pinch 369
Key points 369
INTRODUCTION 369
Anatomy 369
Etiology of Ulnar Nerve Neuropathy 370
Pathoanatomy 370
Treatment 371
SURGICAL TECHNIQUES 371
Restoration of Thumb Adduction 371
SURGICAL TECHNIQUE 372
Extensor Carpi Radialis Brevis to Adductor Pollicis Muscle Tendon Transfer 372
Flexor Digitorum Superficialis III or IV to Adductor Pollicis Muscle Tendon Transfer 373
Restoration of Index Finger Abduction 373
SURGICAL TECHNIQUE 374
Abductor Pollicis Longus to First Dorsal Interosseous Muscle Tendon Transfer 374
Thumb Metacarpal Phalangeal and Interphalangeal Joint Stabilization 374
SURGICAL TECHNIQUE 375
Split Flexor Pollicis Longus to Extensor Pollicis Longus Transfer 375
SUMMARY 375
REFERENCES 375
Tendon Transfers for Combined Peripheral Nerve Injuries 377
Key points 377
INTRODUCTION 377
LOW MEDIAN-ULNAR NERVE PALSY 379
Key Pinch 379
Thumb Opposition 380
Clawing and Synchronized Flexion 380
HIGH MEDIAN-ULNAR NERVE PALSY 381
Thumb Function 382
Simple Grip and Clawing 382
HIGH ULNAR-RADIAL NERVE PALSY 383
Wrist Extension 383
Thumb and Finger Extension 383
Thumb Adduction 384
Finger Flexion 384
HIGH MEDIAN-RADIAL NERVE PALSY 384
Thumb Opposition 385
Thumb and Finger Extension 385
Thumb and Finger Flexion 386
REHABILITATION AND RECOVERY 386
CLINICAL RESULTS IN THE LITERATURE 386
SUMMARY 386
ACKNOWLEDGMENTS 386
REFERENCES 386
Tendon Transfers for Tetraplegia 389
Key points 389
CERVICAL SPINE INJURY AND CLASSIFICATION 389
PATIENT EVALUATION 390
TREATMENT PRINCIPLES 391
SURGICAL MANAGEMENT 391
ELBOW EXTENSION RECONSTRUCTION 391
HAND RECONSTRUCTION 392
HAND INTRINSIC BALANCING 394
LONG-TERM OUTCOMES 394
SUMMARY 395
REFERENCES 395
Free Flap Functional Muscle Transfers 397
Key points 397
INTRODUCTION 397
PATIENT SELECTION 397
HIERARCHY OF FUNCTIONAL RESTORATION 398
RECIPIENT SITE 398
DONOR MOTOR NERVES 398
DONOR MUSCLE 399
SURGICAL TECHNIQUE FOR GRACILIS MUSCLE HARVEST 400
SURGICAL TECHNIQUE FOR FREE FUNCTIONAL MUSCLE TRANSFER FOR ELBOW FLEXION 400
SURGICAL TECHNIQUE FOR FREE FUNCTIONAL MUSCLE TRANSFER FOR DIGIT FLEXION 402
REPORTED OUTCOMES 403
SUMMARY 403
REFERENCES 403
Tendon Transfers in the Rheumatoid Hand for Reconstruction 407
Key points 407
INTRODUCTION 407
DIAGNOSIS 408
TENDON GRAFTING VERSUS TENDON TRANSFER 408
EXTENSOR TENDON RUPTURES 409
Extensor Pollicis Longus Ruptures 409
PROCEDURE: EXTENSOR INDICIS PROPRIUS TO EXTENSOR POLLICIS LONGUS TENDON TRANSFER 410
Preoperative Planning and Patient Positioning 410
Postoperative Management 411
Isolated Tendon Ruptures 411
PROCEDURE: END-TO-SIDE TENDON TRANSFER 411
Multiple Tendon Ruptures 412
PROCEDURE: MIDDLE AND RING FLEXOR DIGITORUM SUPERFICIALIS TO INDEX THROUGH SMALL EXTENSOR DIGITORUM COMMUNIS TENDON TRANSFER 413
FLEXOR TENDONS 414
SUMMARY 415
REFERENCES 415
Tendon Transfers for the Hypoplastic Thumb 417
Key points 417
BACKGROUND 417
SURGICAL TECHNIQUES 418
Huber Opposition Transfer 418
Flexor Digitorum Superficialis Opposition Transfer 419
General Technical Considerations 420
OUTCOMES 420
REFERENCES 421
Cerebral Palsy Tendon Transfers 423
Key points 423
INTRODUCTION: NATURE OF THE PROBLEM 423
PREOPERATIVE PLANNING—FLEXOR CARPI ULNARIS TO EXTENSOR CARPI RADIALIS BREVIS TENDON TRANSFER 424
Patient Selection 424
Type of Cerebral Palsy 424
Age 424
Cognition and Motivation 424
Preoperative Function (Strength, Voluntary Control, Phasic Contraction) 425
Sensibility 425
PREOPERATIVE PLANNING—EXTENSOR POLLICIS LONGUS REROUTING AND THENAR RELEASE 425
Patient Selection 425
Age 425
SURGICAL TECHNIQUE—FLEXOR CARPI ULNARIS TO EXTENSOR CARPI RADIALIS BREVIS TENDON TRANSFER 426
Preparation and Patient Positioning 426
Surgical Approach 426
Surgical Procedure 426
Immediate Postoperative Care 427
REHABILITATION AND RECOVERY 427
SURGICAL TECHNIQUE—EXTENSOR POLLICIS LONGUS RE-REROUTING AND ABDUCTOR POLLICUS LONGUS RELEASE 427
Surgical Approach 427
Surgical Procedure 427
REHABILITATION AND RECOVERY—EXTENSOR POLLICIS LONGUS REROUTING AND THENAR RELEASE 428
CLINICAL RESULTS 428
Flexor Carpi Ulnaris to Extensor Carpi Radialis Brevis Transfer 428
Extensor Pollicis Longus Rerouting and Thenar Release 429
SUMMARY 429
REFERENCES 429
Index 431