Tendon transfer

Key Principles

Force is proportional to the cross-sectional area.

Amplitude is proportional to length

Work capacity = Length x Cross-sectional area

Requirements

  • Motivated patient
  • Donor site must be expendable
  • Distance
  • Direction
  • Synergy
  • Strength
  • Tension
  • Excursion

Importance of resting length

Blex curve

Tension and Strength

  • 3-5-4 Rule:
    • 3: Wrist Extension & Flexion.
    • 5: EDC, FPL, EPL.
    • 4: FDP, FDS.

Erb’s Palsy Affected Muscles: (Axillary, MC, suprascapular and radial nerves)

  • Deltoid,
  • Supraspinatus,
  • Infraspinatus,
  • Teres Minor.
  • Biceps,
  • Brachialis,
  • Supinator.

Brachial Plexus palsy

Principles of treatment

  1. Stable Shoulder (Supra Scapular Nerve)
  2. Brachio-Thoracic Pinch (PN).
  3. Elbow Flexion (MCN):
  4. Wrist Extension (Lateral & Posterior Cords).
  5. Finger Flexion.
  6. C6 Sensation (Lateral Cord).

Solution

  • Stable Shoulder: GH arthrodesis
  • Elbow flexion: Pect major to biceps
  • Wrist Extension: Pronator Teres (PT) → ECRB.
  • Finger and Thumb Extension: FCR → EDC.
  • Thumb extension: Palmaris Longus (PL) → EPL

Ulnar nerve palsy

  • Index finger abduction: EI to 1st DI
  • Thumb adduction: FDS to Add pollusis
  • Clawing: FDS to lateral band of ulnar digits

Median nerve

  • Low: EI to APB
  • High:

    • +

    • BR to FPL

    • FDP tenodesis

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