Tendon Transfers



10.1055/b-0034-97740

Tendon Transfers

John R. Barbour & Ida K. Fox
A 47-year-old man sustained a deep penetrating stab wound to the right arm 1 year ago. The hand is at rest, and the patient is unable to actively flex thumb interphalangeal and index or long finger distal interphalangeal joints.


Description




  • Findings consistent with incomplete median nerve palsy




    • Intact flexion at proximal interphalangeal joints.



    • Loss of distal interphalangeal joint flexion of index and long finger and interphalangeal joint of thumb.



    • Loss of thumb palmar abduction.



    • Flexion present in right ring and small fingers.



Work-up



History




  • Age, gender, handedness, and occupation of the patient.



  • Timing and mechanism of injury




    • Trauma: Associated injuries, underlying fractures, dislocations, neurovascular insult.



    • Infection: Nature of infection (bacterial, fungal, other), operative management to date (incision and drainage), antimicrobial medications, local versus systemic signs and symptoms.



    • Tumor ablation: Tumor pathology, margins, planned radiation and chemotherapy.



  • Previous injury or surgery to the hand in question.



  • Manual demands of daily living and overall lifestyle.



  • Past medical and surgical history.



  • Social history including smoking status and substance abuse.



Physical examination




  • Location and type of original injury.



  • Functional deficit.




    • Motor function (discern neurologic function based on motor examination findings).



    • Sensory function.



  • Vascular status of hand (intact palmar arch).



Pertinent imaging or diagnostic studies




  • Standard radiography (three views of the hand).



  • Computed tomography if further detail required regarding bony structures (especially carpal bones).



Consultations




  • Physical/occupational therapy




    • If joints are not sufficiently supple, they must be loosened, preferably by hand therapy.



    • If hand therapy fails, surgical release of the joints may be required before tendon transfer.

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Jun 18, 2020 | Posted by in General Surgery | Comments Off on Tendon Transfers
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