Attention to the principles of tendon transfer is more important than ever if there is to be a successful outcome. Hammert, mdb, introduction tendon transfers provide a substitute, either temporary or permanent, when function is lost due to peripheral nerve injuries or injuries to the musculotendinous unit itself or when function is imbalanced due to spasticity from neurologic injury in. Any muscle loses at least 1 grade of strength with transfer. Technical tips on tendon selection, tensioning, and placement are provided. Mahan, dpm 1988 9 tendon grafts and implants steven v. Given the complexity of drop foot and its impact on gait biomechanics, these authors offer a primer on the diagnostic workup, and share their thoughts on the potential merits of tendon transfer procedures. No matter the type of palsy, the transfer surgery follows the same technical principles. Tendon transfer center for nerve injury and paralysis.
Describe the anatomy and function of the radial nerve in the forearm and hand. List and understand the principles and biomechanics of tendon transfers. Tendons are transferred at the distal attachment from lesser to more important functions so that the overall function is improved. Corey, dpm 1988 7 current surgical procedures for lengthening of the triceps surae and its components michael s. Principles of tendon transfers for persons with tetraplegia. Tendon transfers to help you avoid reverse shoulder. While the latissimus dorsi tendon transfer has historically been. In the upper extremity, tendon transfers are most commonly used to restore function following injury to the radial, median, and ulnar nerves. Tendon transfers for chronic ulcerations in diabetics. Their job is to allow the body to move and to transfer weight. Tendon transfers commonly are used to restore arm and hand function after injury to the main motor nerves or after spinal cord injury. Year chapter article title author the podiatry institute. A crossed intrinsic tendon transfer cannot be done in a patient who has a subluxed or arthritic mcp joint. Principles and techniques marc bernbach, dpm 1988 3 clawtoe deformitites and contractures of the forefoot james l.
Lower trapezius transfer with achilles tendon augmentation. The principles of tendon transfer require preoperative assessment of the quality of the tissue through which the transfer is to pass and of the suppleness of the joints concerned. If a muscle is used for the tendon transfer, how will that affect my childs arm. Tendon transfers are undertaken to restore muscle function and can be used for any kind of nerve injury. An isolated tendon transfer cannot restore all of the power requirements lost in a low ulnar nerve palsy. Pdf the basics and science of tendon transfers eric. Aug 06, 2018 doctors perform tendon repair surgery to fix a tendon injury. The principles of mtu transfer established for hand surgery can be adopted to optimize the dynamic excursion of the temporalis tendon transfer procedure for facial reanimation. Adults referred to the rics tendon transfer clinic between 19982007. Basic principles the basic principles essential to all successful tendon transfers have been summarized by the author. Tendon transfer is a surgical procedure by which a tendon and its muscle muscletendon unit is moved from one location to another. Describe the history of tendon transfer procedures. Jun 21, 2015 tendon transfers may reconstruct loss of function through injury, disease or congenital absence.
Transfer should not cause loss of an essential muscle function. Surgeons perform tendon transfers by releasing one end of a tendon from bone or soft tissue and reconnecting it to another bone or tendon. Purposeful active movement is dependent on many factors, but primarily on the ability of a myocyte to contract and thereby reduce its length. The basic principles of tendon transfer surgery around the shoulder mirror those of tendon transfers of the hand and wrist.
The muscletendon unit is transferred in order to substitute the lost function movement and stability when repairs of failed muscle is impossible. While adhering to the principles of early ambulation, the postoperative protocol included a posterior splint and nonweight bearing for 1012 days. Muscle tendon unit mtu transfer is a common procedure performed to restore hand function after peripheral nerve or spinal cord injury. Mar 31, 2016 principles and prerequisites of tendon transfer 1 supple joints prior to transfer, 2 soft tissue equilibrium, 3 donor of adequate excursion, 4 donor of adequate strength, 5 expendable donor, 6 straight line of pull, 7 synergy, and 8 single function per transfer. Clinical examination is to determine the condition of the mcp joint and the intrinsic tendons. The staging and timing of multiple procedures must also be carefully thought out, and only those tendon transfer procedures that can be rehabilitated together should be performed at the same time. Tendon repair, tendon graft and rehabilitation principles. However, there are usually nearby muscles that can do the same job as. Applications have included haglunds deformity correction, kidner procedure and peroneus brevis tendon transfer. Genesis birth palsy cerebral palsy polio world war goal principles of tendon transfer focus on radial nerve transfers specific transfers for. Request pdf principles of tendon transfers tendon transfers are carried out to restore functional deficits by rerouting the remaining intact muscles. Your childs arm may be weaker from the tendon transfer.
Tendon transfers may reconstruct loss of function through injury, disease or congenital absence. Tendons are tough, stretchy tissues that join muscles to bone. Tendon transfer techniques are useful for restoring hand function in patients with incomplete injuries or those who have partial recovery of function following nerve grafting or nerve transfer procedures. A single fds tendon transfer can improve integration of the mcp joint and ip joint flexion, key pinch of the thumb, and the flattened metacarpal arch. All joints on which the transfer is to work should have full prom. Muscles are transferred from lesser to more important functions so that the overall system is functionally improved. The principles used to choose the length at which the transferred.
Fdl transfer spring ligament repairreconstruction calcaneal osteotomies adjunctive procedures achilles tendon repair open, mini open, percutaneous delayed achilles tendon reconstruction fhl transfers, vy lengthening, etc. Principles of tendon transfer danielle wilbur, mda, warren c. Apr 20, 2018 general principles of tendon transfers certain key elements play crucial roles in tendon transfer operations. Tendon transfers are used to restore function after an injury or medical condition has compromised function in the hand. Serratus anterior muscle deficit is another cause of scapular winging and decreases the efficacy of an edenlange procedure, but it can be overcome with a simultaneous pectoralis major transfer. Often, the two ends of the tendon are very damaged and cannot be sewn back together. Muscle excursion should be matched, taking into account 23 cm tenodesis action with wrist motion usually. In the setting of shoulder paralysis, the integrity of the ipsilateral lower trapezius may be compromised. As an example, a tendon transfer is commonly used to treat a radial nerve injury that limits mobility in the wrist and fingers. Instead of moving the nerve supply from one muscle to another muscle as is done. Drop foot and foot drop are interchangeable terms that illustrate an abnormal neuromuscular disorder, which affects the patients capacity to lift up the foot at. Castellano, dpm 1988 4 idopathic and neurologic cavus foot deformities alan s.
A tendon transfer is a surgery that moves a working muscle and tendon to replace a nonworking muscle and tendon. The basic steps and principles of tendon transfers in the treatment of patients with nerve injuries or palsies is presented. Surgeons traditionally use passive tension to determine the length at which a muscle should be attached during tendon transfer. Proliferation phase fibroblast, collagen producing process granulation tissue form in the defect extrinsic healing. Principles of muscle tendon surgery and tendon transfers stephen j. Principles of tendon transfers linkedin slideshare. Tendon transfers involve redistribution, not the creation, of power units. Key insights on tendon transfers for drop foot podiatry. Second, the transfer should not create a deformity if significant return of function occurs following a nerve repair. Lower trapezius tendon transfer with achilles tendon allograft augmentation may be used to treat patients with lack of active external rotation following shoulder paralysis or massive irreparable posterosuperior rotator cuff tears. Chapter52 293 tendonreefing orshortening hoffa described a simplistic method for shortening a tendon. Loss of function in the hand can occur because of several types of problems including paralysis from nerve injury, tendon loss, and muscle loss. Principles principles of tendon transfers indications.
The tendon of a functioning muscle is detached from its insertion and reattached to another tendon or bone to replace the function of a. The tendon of a functioning muscle is detached from its insertion and reattached to another tendon or bone to replace the function of a paralysed muscle or injured tendon. First, the transfer should not significantly decrease the remaining function of the hand. They are 1 supple joints prior to transfer, 2 soft tissue equilibrium, 3 donor of adequate excursion, 4 donor of adequate strength, 5 expendable donor, 6 straight line of pull, 7 synergy, and 8 single function per transfer. Transfers are highly attractive in the context of hand surgery because of the possibility of restoring the patients ability to grip. These patients need implant arthroplasty because a soft tissue procedure will not be able to hold a subluxed mcp joint in position. Principles and biomechanics of muscle tendon unit transfer. A surgeon will take some expendable tendons from the front of the forearm, which are innervated by a different nerve and normally produce flexion, and connect them to tendons on the back of the forearm to enable the. Tendon transfers for radial, median, and ulnar nerve palsy.
Principles of muscletendon surgery and tendon transfers. In all cases, it is appropriate to evaluate the underlying pathology, abnormal muscle balance and treat the underlying condition. By performing an indepth analysis of each case and by following strict technical principles, tendon transfer surgery leads to reproducible results. Tendon transfer should pass through healthy tissue no inflammation, scar, or edema to minimize adhesions after acute injury, allow time to pass before transfer if necessary, excise scar and replace with flap 3. Key insights on tendon transfers for drop foot podiatry today. Technical principles choice of motor direction of transfer tension of transfer distal insertion institut. Radial nerve median nerve ulnar nerve not included. Describe the indications, benefits, and drawbacks for various tendon transfer procedures performed for radial nerve palsy. The role of tendon transfers for irreparable rotator cuff. The principles of successful tendon transfer procedures have been identified and refined over the last century.
Pe1447 shoulder release and external rotation tendon. Tendon transfers are carried out to restore functional deficits by rerouting the remaining intact muscles. For example, a tendon appropriately inserted proximal to the wrist and in the fingers will cause flexion of the fingers if the wrist is extended. I the donor muscle should be expendable, ii the donor must have similar excursion and strength as loss of one grade in strength can be expected, iii one muscle one function, and iv the.
The goal is to improve the balance of a neurologically impaired hand. The principles are simple and should be adhered to wherever possible to ensure reliable outcomes. The muscle tendon unit is transferred in order to substitute the lost function movement and stability when repairs of failed muscle is impossible. A tendon transfer is a surgical process in which the insertion of a tendon is moved, but the origin remains in the same location. When it is decided to perform a tendon transfer, there are certain basic principles that should be used as a guide. Tendon transfer is a surgical procedure by which a tendon and its muscle muscle tendon unit is moved from one location to another. Certain key elements play crucial roles in tendon transfer operations. Principles of muscletendon surgery and tendon transfers stephen j. Tendon transfer involves redistribution of muscle power, not recreation.
For example, after a broken wrist, the tendon to the thumb epl tendon that allows you to make a thumbsup can break. Therefore, local tissues need to be thoroughly evaluated and deemed absent from inflammation, edema, and scar. An understanding of the general principles of tendon transfer is important to maximize the outcome. Options for transfer include latissimus dorsi and lower trapezius transfers for posteriorsuperior rcts and pectoralis major and latissimus dorsi transfer for anteriorsuperior rcts.
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