Multiple tendon transfers for C8 / T1 loss from spinal infarct: Camitz transfer for opposition; ECRL to FDP for finger flexion; Brachioradialis to FPL for thumb flexion
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CPD/CME Points: 2
Tendon transfers are useful for the restoration of important functional losses. An expendable donor muscle is used for reconstruction of a more useful function. Brand defined the criteria for successful transfer. Each case is unique and the functional deficits should be carefully assessed as well as the strength of potential donors. Patients should be involved in the planning process with pre-operative consultations with the hand therapy team to define the aims of surgery and understand the post-operative rehabilitation requirements.
This case is a rare situation where a localised spinal cord stroke has damaged the anterior horn cells and caused a permanent loss of the motor outflow at C8 and T1 unilaterally . This lower motor neurone lesion is not amenable to nerve transfer surgery due to the time elapsed since motor loss. The hand remains supple but functionally useless and the patient wishes to restore some function, but understands that normal function is not possible. The case illustrates the assessment process, the techniques involved in tendon transfer surgery that can be applied to other situations and the rehabilitation following surgery.
Author: Dominic Power FRCS Orth, Consultant Hand and Peripheral Nerve Surgeon
Institution: Peripheral Nerve Injury Service, Birmingham Hand Centre, Queen Elizabeth Hospital, UK