Tendon Transfers for Ulnar and Combined Palsy

April 25th, 2007

If the ulnar nerve is cut, chronically injured, or repaired after being severed--but with incomplete recovery--numbness in the small and ring finger, clumsiness in the hand, grip and pinch weakness, claw deformity,flattening of the palm, and asynchronous digital flexion may result.If the median nerve is injured as well, the thumb may be unable to be drawn out of the plane of the palm--making grip and pinch nearly impossible.

The fundamental goals of tendon transfer surgery for Ulnar nerve palsy and Combined palsy include improving pinch and grip strength, and correcting deformity.

Over the past 14 years I have had the priviledge of performing reconstructive surgery for ulnar nerve palsy and combined palsy of the medial and ulnar nerves in over 30 patients. This experience, and my commitment to scrutinize postoperative outcomes, has afforded me a unique opportunity to assess functional return and levels of patient satisfaction, and constantly improve surgical techniques and selection thereof.

Though the hand will never work normally, surgery is very effective at correcting claw deformity, restoring synchronous finger flexion,improving the position of the thumb, and improving prehensile pinch strength between thumb and index finger. When there is an element of median nerve palsy, the tendon transfer to the thumb can be altered a bit to improve the ability to position the thumb in space, in preparation for grip.

Surgery takes about 2 hours and can be performed as an outpatient. Tendon grafts are usually required, but donor tendons from either arm or feet are available--without residual loss of function. After surgery a cast is worn for 4 weeks, followed by a removable splint for 4 weeks. Strengthening begins at 8 weeks, and full recovery may take as long as 6-8 months.

In these types of nerve palsy cases, it is very likely that you will be satisfied with the functuional benefit, but it takes some time to get better. That having been said, in my experience, tendon transfer surgery is worth it in the final analysis!

Related Photos:

preoperative claw deformity as compared to the unaffected hand

APL slip transfer to 1st DI via tendon graft--restores abduction strength to index finger during pinch

EIP tendon is harvested for opponens transfer

EIP tendon is delivered to the radial side of the thumb--this will allow the thumb to move out of the plane of the palm in preparation for grasp

4-tailed graft is prepared in order to restore synchronous finger flexion, correct claw deformity, and improve grip strength

4-tailed graft is passed deep to the transverse metacarpal ligament, into each finger for attachment

Befor lateral profile of the hand deformity

Correction of hand deformity after transfers are performed

Related Videos:

Outcome 6 months after tendon transfers for low median and ulnar nerve palsy secondary to nerve lacerations at the level of the wrist
Note asynchronous finger flexion, characterized by the finger initiating flexion from the tip as opposed to the MP joint--resulting in the fingers folding in on themselves