Tendon transfers are performed to improve compromised motor function when repair of an injured nerve, muscle, or tendon is impossible or has failed. The force and excursion of a muscle tendon unit are important when considering a tendon transfer to restore motor function, The cross-sectional area of a muscle is most closely associated with the force of that muscle. Ideally, tendon transfers should be synergistic. Patients with a high radial nerve palsy will generally have the pronator teres, flexor carpi ulnaris, and palmaris longus muscle tendon units as available donors for tendon transfers/The Jones transfer, which was described in 1921, has been a classic combination of transfers for restoration of functional loss due to a high radial nerve palsy. These transfers include a pronator teres transfer to the extensor carpi radialis longus and extensor carpi radialis brevis tendons; the flexor carpi radialis tendon to the extensor pollicis longus, the extensor pollicis brevis, abductor pollicis longus, and extensor digitorum communis to the index finger; and the flexor carpi ulnaris tendon to the extensor digitorum communis tendon. A low median nerve palsy can result in loss of thumb opposition. To restore thumb opposition, the transfer needs to duplicate, as closely as possible, the function of the opponens pollicis muscle. The flexor digitorum sublimis tendon to the ring finger has been used to restore thumb opposition using either a tendon loop of the flexor carpi ulnaris as a pulley at the wrist crease or a window cut in the volar carpal ligament as a pulley. This will result in a line of pull directed from the pisiform toward the thumb MCP joint, which is the same as the abductor pollicis brevis. Low ulnar nerve palsies will result in compromise of fine tip and key pinch. Key pinch can be strengthened by a number of transfers, including the extensor carpi radialis longus prolonged with a tendon graft to the adductor pollicis.
KeywordsTendon Transfer Adductor Pollicis Flexor Digitorum Profundus Pronator Teres Spastic Hemiplegia
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