Publication:

Evaluation of split flexor carpi ulnaris tendon transfer for fingers and thumb extension, pronator teres transfer for wrist extension in high radial nerve palsy

Background The radial nerve is the largest terminal branch of the brachial plexus. Loss of radial nerve function creates a significant disability in the hand. The grip is severely impaired following loss of radial nerve function as a result of loss of extension of wrist, metacarpophalangeal joints of fingers and interphalangeal joints of the thumb.

Methods Prospective, quasi experimental study carried out for 3 years at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR). Forty-eight patients of high radial nerve palsy were selected for tendon transfer (split FCU tendon to EDC and EPL) and PT transferred to ECRB.

Results Mean age of the patients was 28.92 years (range 15-45 years), significantly higher in 26-35 years age group. There was preponderance of injury to the dominant right side (58.33%) than the none-dominant left side (41.67%). Motor vehicle accident (66.67%) was the common cause of injury followed by assault (33.33%). Out of 48 patients, 28 patients score 8-9 (excellent), 16 patients score 7 (good), 4 patients scores 5 (fair). So that, total 44 patients achieved satisfactory outcome (91.67%) and 4 patients achieved unsatisfactory outcome (8.33%). All patients can extend their wrist, fingers and thumb. Beyond this, all patients can flex their fingers up to mid palmar crease and thumb can be extended separately-independent of EDC function.

Conclusions Transfer of split FCU tendon to EDC and EPL for fingers and thumb extension in irreparable and neglected long standing high radial nerve palsy results significant functional outcome.