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Tendon Transfer Principles
- greatest force of contraction exerted when muscle is at resting length
- amplitude proportional to length of muscle
- work capacity = (force) x (amplitude)
- should transfer motor grade 5
- appropriate tensioning
- can adjust with pulley or tenodesis effect
- 3 cm excursion - wrist flexors, wrist extensors
- 5 cm excursion - EDC, FPL, EPL
- 7 cm excursion - FDS, FDP
- elbow flexion (musculocutaneous n.)
- shoulder stabilization (suprascapular n.)
- brachiothoracic pinch (pectoral n.)
- sensation C6-7 (lateral cord)
- wrist extension and finger flexion (lateral and posterior cords)
- determine what function is missing
- determine what muscle-tendon units are available
- evaluate the options for transfer
- donor must be expendable and of similar excursion and power
- one tendon transfer performs one function
- synergistic transfers rehabilitate more easily
- it is optimal to have a straight line of pull
- one grade of motor strength is lost following transfer
- correlates with C8-T1 avulsion
- often appears 2-3 days following injury
- indication of root avulsion
- PIN syndrome
- loss of radial nerve proper function (triceps, brachioradialis, ECRL plus muscles innervated by PIN)
- loss of thumb opposition (APB function)
- loss of thumb opposition
- loss of thumb, index finger, and middle finger flexion
- loss of power pinch
- abduction of the small finger ( Wartenberg sign )
- results from imbalance between intrinsic and extrinsic muscles
- primary distinguishing deficit
- clawing less pronounced because extrinsic flexors are not functioning
- better than standard EMG/NCS
- decreased passive range of motion
- total or near-total brachial plexus injury
- high energy injury
- partial upper-level brachial plexus palsy
- low energy injury
- protect for 3-4 weeks then begin ROM
- continue with protective splint for 3-6 weeks
- synergistic transfers are easier to rehabilitate (synergistic actions occur together in normal function, e.g., finger flexion and wrist extension)
- necessitate aggressive therapy and possible secondary tenolysis
- leading prognostic factor
- worse after age 30
- distal is better than proximal
- - Tendon Transfer Principles
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