Median (FCR/FDS) to Radial (PIN/ECRB) Nerve Transfers with PT to ECRB Tendon Transfer

Radial nerve palsy is a debilitating nerve injury that results in lost of wrist and finger extension, which classically presents as wrist drop. The two reconstructive options for managing this injury are tendon transfers and nerve transfers, each with their advantages and disadvantages. Nerve transfers are able to provide independent finger extension, however there is an associated prolonged recovery period in comparison to tendon transfers for radial nerve palsy. Electing the appropriate surgical management depends on the patient’s demands and needs. Nerve transfers for radial nerve palsy includes two transfers: (1) FCR to PIN and (2) FDS to ECRB. The tendon transfer for wrist extension can be elected for an early outcome and includes the transfer of the pronator teres to ECRB tendon. In this case, the patient presented three months following a severe MVC and suffered a radial nerve transection associated with a humeral facture. Due to the patient’s needs, the median to radial nerve transfers were elected with the pronator teres to ECRB tendon transfer. To restore radial nerve sensation, an end-to-side nerve transfer was additionally performed and included the radial sensory nerve end-to-side into the sensory component of the median nerve.

Standard 140820

Extended 140820

POSITION

Supine.

INCISION

Over the proximal forearm and extended distally to accommodate PT to ECRB tendon transfer.

REFERENCES

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