Secondary Repair, Hand
Tendon transfers for wrist and finger
Secondary Surgery - Hand
At the wrist level one of the more frequent deficits that needs to be restored is the wrist extension. The transfers can vary depending of the availability of functioning muscles
but they are generally possible even in more extensive paralysis. Restoration of wrist extension is of paramount importance for the hand
function and must be a priority objective.
The palliative surgery at the hand level for lack of finger function is more difficult to carry out, not for technical problems
but due to the frequent lack of available muscles to be transposed. This happens in total paralysis where lower roots of the
brachial plexus had been avulsed and no possibility of spontaneous recovery can happen. Despite the early microsurgical repair
of these roots, the functional results can be sometimes poor and for this reason transfer to recover finger flexion must be
In severe total paralysis when no muscle are available for transfer
there is the possibility to performe a tenodesis: it consists of fixing
extensor and flexor tendons to the bone (radius) win such away that
during eztension of the wrist (red arrows) the flexor are tightened and
the extensor are relaxed producing in this way a flexion of the fingers.
On the right side we can see that the passive drop of the hand produces
a passive extension of the fingers with an opening of the hand
The ideal age to perform these operations is generally around 4 years, as the completion of functional
recovery takes more time to occur than in the upper part of the arm.
In selected cases in which no function at all is recovered, especially for elbow flexion, there is still
the possibility to transfer with microsurgical techniques a muscle from the thigh. This type of surgery can
restore only a unique limited function.
All these type of secondary surgeries (except the last one) take less time to perform as compared
to primary microsurgical repair of brachial plexus; it is also necessary to immobilize the affected arm in a
cast for a period of 4 to 5 weeks depending of the type of muscular transfer.
Tendon Transfers for wrist and fingers
If there is a lack of wrist and fingers extension after 3 years , there is little hope of
further spontaneous recovery . It is the necessary to reconstruct extension with tendon
transfers . The muscle used depend on the recovery : if the lower roots have not been
paralysed initially , several good muscles can be used : Flexor Carpi Ulnaris , Pronator
Teres , Flexor Superficialis ...
In cases of complete paralysis , the distal muscles are weak and the result of the
transfers are not so good ;
After transfer , the wrist or fingers are immobilized in extension for 5 weeks . After
removal of the splint , the physiotherapy is resumed and a night splint is used for 3 months .