Functional evaluation of early tendon transfer for thumb opposition in median nerve palsy.
Early tendon transfer
Median nerve palsy
Opponensplasty
Journal
Journal of clinical orthopaedics and trauma
ISSN: 0976-5662
Titre abrégé: J Clin Orthop Trauma
Pays: India
ID NLM: 101559469
Informations de publication
Date de publication:
Historique:
received:
14
04
2020
revised:
27
05
2020
accepted:
28
05
2020
entrez:
21
7
2020
pubmed:
21
7
2020
medline:
21
7
2020
Statut:
ppublish
Résumé
There is paucity of literature on early tendon transfer in surgical rehabilitation of hands with median nerve injuries. Since the single most important functional deficit in median nerve palsy is the loss of thumb opposition, we evaluated the results of early tendon transfer in restoration of thumb opposition. This prospective study involved 10 cases of isolated median nerve paralysis (axonotmesis or neurotmesis) that underwent early tendon transfer for restoration of thumb opposition. A pre- and post-operative evaluation in terms of power and precision grip strength and range of opposition of thumb was done. Median nerve exploration was performed in 4 cases and was supplemented by a tendon transfer for thumb opposition. The extensor indicis proprius (EIP) opponensplasty was performed in nine out of ten cases. In one case where the patient had scarring over the EIP tendon, palmaris longus (PL) opponensplasty was performed. The median age at injury was 29 years (range; 8 years-57 years). Minimum period of follow-up was 6 months. Six patients who underwent EIP transfer had excellent opposition while 3 had good opposition. The patient, in whom PL opponensplasty was done, had an excellent opposition. The median time for return to work was 2.75 months.There was significant improvement in the power grip and all three types of precision grip at 6 months follow-up. The percentage deficit in the affected hand compared to the normal hand was significantly reduced. There was no case of tendon pull out in our study, nor did any of our patients have an extensor lag following EIP transfer. Early tendon transfer has a unique role in the management of median nerve palsy hand and we suggest this procedure should be considered in both high and low lesions.
Sections du résumé
BACKGROUND
BACKGROUND
There is paucity of literature on early tendon transfer in surgical rehabilitation of hands with median nerve injuries. Since the single most important functional deficit in median nerve palsy is the loss of thumb opposition, we evaluated the results of early tendon transfer in restoration of thumb opposition.
METHODS
METHODS
This prospective study involved 10 cases of isolated median nerve paralysis (axonotmesis or neurotmesis) that underwent early tendon transfer for restoration of thumb opposition. A pre- and post-operative evaluation in terms of power and precision grip strength and range of opposition of thumb was done. Median nerve exploration was performed in 4 cases and was supplemented by a tendon transfer for thumb opposition. The extensor indicis proprius (EIP) opponensplasty was performed in nine out of ten cases. In one case where the patient had scarring over the EIP tendon, palmaris longus (PL) opponensplasty was performed.
RESULTS
RESULTS
The median age at injury was 29 years (range; 8 years-57 years). Minimum period of follow-up was 6 months. Six patients who underwent EIP transfer had excellent opposition while 3 had good opposition. The patient, in whom PL opponensplasty was done, had an excellent opposition. The median time for return to work was 2.75 months.There was significant improvement in the power grip and all three types of precision grip at 6 months follow-up. The percentage deficit in the affected hand compared to the normal hand was significantly reduced. There was no case of tendon pull out in our study, nor did any of our patients have an extensor lag following EIP transfer.
CONCLUSION
CONCLUSIONS
Early tendon transfer has a unique role in the management of median nerve palsy hand and we suggest this procedure should be considered in both high and low lesions.
Identifiants
pubmed: 32684705
doi: 10.1016/j.jcot.2020.05.036
pii: S0976-5662(20)30223-X
pmc: PMC7355086
doi:
Types de publication
Journal Article
Langues
eng
Pagination
650-656Informations de copyright
© 2020 Delhi Orthopedic Association. All rights reserved.
Déclaration de conflit d'intérêts
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Références
Indian J Lepr. 2002 Oct-Dec;74(4):319-28
pubmed: 12624980
J Bone Joint Surg Am. 1973 Jun;55(4):725-32
pubmed: 4283744
Clin Orthop Relat Res. 1974 Oct;(104):68-79
pubmed: 4369943
J Hand Surg Br. 1992 Dec;17(6):611-4
pubmed: 1484241
J Hand Surg Br. 1991 Aug;16(3):334-8
pubmed: 1960505
Hand Clin. 1988 May;4(2):155-65
pubmed: 3294241
Neurol India. 2009 Jul-Aug;57(4):434-7
pubmed: 19770544
J Hand Surg Am. 2003 Jan;28(1):28-34
pubmed: 12563634
Clin Orthop Relat Res. 1970 Jan-Feb;68:14-21
pubmed: 5414712
Muscle Nerve. 2006 Dec;34(6):785-8
pubmed: 16881066
J Bone Joint Surg Am. 1963 Oct;45:1389-96
pubmed: 14069778
J Plast Reconstr Aesthet Surg. 2013 May;66(5):726-8
pubmed: 22981385
J Rehabil Med. 2004 Nov;36(6):273-8
pubmed: 15841605