Tendon transfers for radial nerve palsy with extensor carpi ulnaris revival: Technique and results - 13/02/20

Doi : 10.1016/j.otsr.2019.11.026

Marion Besnard, Emilie Marteau, Jacky Laulan ⁎ , Guillaume Bacle
Services d’orthopédie 1 et 2, unité de chirurgie de la main, CRHU de Tours, 37044 Tours cedex, France

^⁎Corresponding author.

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Abstract

Background

Nerve repair is the gold standard for treatment of radial palsy. In case of failure or contraindication, palliative techniques using tendon transfers provide good results. However, wrist extension frequently shows radial deviation, impairing grip strength.

Hypothesis

Associating extensor carpi ulnaris (ECU) revival avoids radial deviation.

Study design

Single-center retrospective study.

Material and Methods

The inclusion criterion was radial nerve palsy treated by tendon transfers involving revival of the ECU. Nine patients, with a mean age of 33 years [15–60] were included. Four palsies were trauma-induced, 3 tumor-induced and 2 idiopathic. The mean time to treatment was 32 months [4.6–120].

Results

Mean follow-up was 51 months [3–160.7]. Eight patients could be assessed. Wrist extension was balanced in 6 cases, in ulnar deviation in 1 and in radial deviation in the other. Wrist motion was 54° [30°–80°] in extension, 46° [20°–70°] in flexion, with an active motion in the frontal plane of 21° [0°–35°]. Finger extension was possible with the wrist in extension in 6 cases. Thumb abduction was subnormal in 3 cases, incomplete but functional in 4 and barely functional in 1. Fist closure was always complete. Mean QuickDASH score was 41/100 [14–63].

Conclusion

This technique is reliable and reproducible, giving good functional results and avoiding the radial deviation of the wrist in extension observed with traditional techniques.