Tendon transfers at sharp injures to the nerves and the muscles in the upper forearm

Authors

  • I. B. Tretyak Romodanov Institute of Neurosurgery of NAMS of Ukraine
  • A. A. Gatskiy Romodanov Institute of Neurosurgery of NAMS of Ukraine
  • I. V. Kovalenko Romodanov Institute of Neurosurgery of NAMS of Ukraine
  • A. I. Tretyakova Romodanov Institute of Neurosurgery of NAMS of Ukraine

DOI:

https://doi.org/10.11603/2414-4533.2018.3.9436

Keywords:

injury, forearm, tendons, muscles, tendon transfer, median nerve, ulnar nerve, autologous nerve grafting

Abstract

The aim of the work: to evaluate the functional influence of the tendon transfers on recovery of the principal hand grips and pinches at simultaneous lesions of the nerves and musculo-tendineous apparatus in the upper forearm.

Materials and Methods. The study presents a retrospective analysis of the surgical reconstruction of the nerves and musculo-tendineous apparatus in the upper forearm in 9 patients (6 men and 3 women) with mean age of 36.4 years. 4 patients enrolled into the study showed single median nerve lesion, 4 patients showed median and ulnar nerve lesions, 1 patients showed median and superficial radial nerve lesions. Mean post injury term was 5 months. Surgical reconstruction of the nerves included: autologous nerve grafting (6 cases), neurolysis (2 cases), suture of the nerve (1 case). In five cases tendon transfers were aimed to restore independent function of the flexor pollicis longus, in six cases – to restore independent function of the profound flexors of the index and middle finger. Outcomes’ evaluation included the quantification of the muscles’ strength on MRC Scale, sensitivity recovery on Seddon’s Scale, recovery of 4 principal hand grips and pinches, Brief Michigan Hand Questionnaire (BMHQ).

Results and Discussion. Four patients with single nerve injury to the median nerve received mean sensation value 3.75 on Seddon’s Scale. Four patients with the injury to the median and ulnar nerve received mean sensation value 3 and 2 on Seddon’s Scale respectively. Ineffective recovery to the thenar muscles of the hand in 2 patients required Bunnel tendon transfer in much later terms in order to restore proper thumb opposition. Four patients with the injury to the ulnar nerve showed poor recover of the intrinsic muscles of the hand. In five cases tendon transfers allowed us to restore independent functioning of the flexor pollicis longus, in six cases – independent functioning of profound index and middle finger flexors. All nine patients showed recovery of the transversal and diagonal volar grips, as well as pulp pinch. Four patients showed no recovery of the lateral pinch due to poor functioning of the intrinsic muscles of the hand (ulnar nerve). Mean MBHQ value was 70.12 points (from 43.75 up to 89.6).

Conclusions. Tendon transfers are able to restore effective and independent functioning of the thumb, index and middle finger flexors, effective recovery of the transversal and diagonal volar grips, as well as pulp pinch; loss of lateral pinch was determined by poor recovery of the intrinsic muscles of the hand, hence poor regeneration of the ulnar nerve at its proximal lesion.

References

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Shaw, A.D., Milne, A.A., Christie, J., Jenkins, A.M., Murie, J.A., & Ruckley, C.V. (1995). Vascular trauma of the upper limb and associated nerve injuries. Injury, 26 (8), 515-518;

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Ruijs, A.C., Jaquet, J.B., Kalmijn, S., Giele, H., & Hovius, S.E. (2005). Median and ulnar nerve injuries: a meta-analysis of predictors of motor and sensory recovery after modern microsurgical nerve repair. Plast. Reconstr. Surg., 116 (2), 484-494;

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Chekofsky, K.M., Spero, C.R., & Scott, W.N. (1980). A method of repair of late quadriceps rupture. Clinical Orthopaedics and Related Research [Internet]. Ovid Technologies (Wolters Kluwer Health), (147), 190-191. Available from: http://dx.doi.org/10.1097/00003086-198003000-00033;

Oliva, F., Via, A.G., Kiritsi, O., Foti, C., & Maffulli, N. (2014). Surgical repair of muscle laceration:biomechanical properties at 6 years follow-up. Muscles Ligaments Tendons, 24 (3), 313-317;

Kragh, J.F., Svoboda, S.J., Wenke, J.C., Ward, J.A., & Walters, T.J. (2005). Suturing of lacerations of skeletal muscle. The Journal of Bone and Joint Surgery British volume [Internet]. British Editorial Society of Bone & Joint Surgery, 87-B (9), 1303-1305. – Retrieved from: http://dx.doi.org/10.1302/0301-620x.87b9.15728;

Kragh, J.F., Svoboda, S.J., Wenke, J.C., Ward, J.A., & Walters, T.J. (2005). Epimysium and perimysium in suturing in skeletal muscle lacerations. The Journal of Trauma: Injury, Infection, and Critical Care [Internet]. Ovid Technologies (Wolters Kluwer Health), 59 (1), 209-212. – Retrieved from: http://dx.doi.org/10.1097/01.ta.0000171530.11588.70;

Beasley, R.W. (Ed.). (2003). 20 Tendon Transfers. Beasley’s Surgery of the Hand [Internet]. Georg Thieme Verlag. – Retrieved from: http://dx.doi.org/10.1055/b-0034-52157;

Sunderland, S. (1951). A classification of peripheral nerve injuries producing loss of function. Brain, 74 (4), 491-516. doi:10.1093/brain/74.4.491;

Sollerman, C., & Ejeskär, A. (1995). Sollerman hand function test: A standardised method and its use in tetraplegic patients. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, 29 (2), 167-176. doi:10.3109/02844319509034334;

Waljee, J.F., Kim, H.M., Burns, P.B., & Chung, K.C. (2011). Development of a Brief, 12-Item Version of the Michigan Hand Questionnaire. Plastic and Reconstructive Surgery, 128 (1), 208-220. doi:10.1097/prs.0b013e318218fc51.АРА

Robinson, L.R. (2000). Traumatic injury to peripheral nerves. Muscle Nerve.

Shaw, A.D., Milne, A.A., Christie, J., Jenkins, A.M., Murie, J.A., Ruckley, C.V. (1995). Vascular trauma of the upper limb and associated nerve injuries. Injury.

Hull, J.B. (1996). Management of gunshot fractures of the extremities. The Journal of Trauma: Injury, Infection, and Critical Care [Internet]. Ovid Technologies (Wolters Kluwer Health). – Retrieved from: http://dx.doi.org/10.1097/00005373-199603001-00043

Ruijs, A.C., Jaquet, J.B., Kalmijn, S., Giele, H., & Hovius, S.E. (2005). Median and ulnar nerve injuries: a meta-analysis of predictors of motor and sensory recovery after modern microsurgical nerve repair. Plast. Reconstr. Surg.

Garrett, W.E., Seaber, A.V., Boswick, J., Urbaniak, J.R., Goldner, J.L. (1984). Recovery of skeletal muscle after laceration and repair. The Journal of Hand Surgery [Internet]. http://dx.doi.org/10.1016/s0363-5023(84)80014-3;

Orava, S., Sorasto, A., Aalto, K., & Kvist, H. (1984). Total rupture of pectoralis major muscle in athletes. International Journal of Sports Medicine [Internet]. Georg Thieme Verlag KG. – Retrieved from: http://dx.doi.org/10.1055/s-2008-1025919;

Chekofsky, K.M., Spero, C.R., & Scott, W.N. (1980). A method of repair of late quadriceps rupture. Clinical Orthopaedics and Related Research [Internet]. Ovid Technologies (Wolters Kluwer Health). (147), 190-191. Available from: http://dx.doi.org/10.1097/00003086-198003000-00033;

Oliva, F., Via, A.G., Kiritsi, O., Foti, C., & Maffulli, N. (2014). Surgical repair of muscle laceration:biomechanical properties at 6 years follow-up. Muscles Ligaments Tendons, 24 (3), 313-317;

Kragh, J.F., Svoboda, S.J., Wenke, J.C., Ward, J.A., & Walters, T.J. (2005). Suturing of lacerations of skeletal muscle. The Journal of Bone and Joint Surgery British volume [Internet]. British Editorial Society of Bone & Joint Surgery, 87-B (9), 1303-1305. – Retrieved from: http://dx.doi.org/10.1302/0301-620x.87b9.15728;

Kragh, J.F., Svoboda, S.J., Wenke, J.C., Ward, J.A., & Walters, T.J. (2005). Epimysium and perimysium in suturing in skeletal muscle lacerations. The Journal of Trauma: Injury, Infection, and Critical Care [Internet]. Ovid Technologies (Wolters Kluwer Health), 59 (1), 209-212. – Retrieved from: http://dx.doi.org/10.1097/01.ta.0000171530.11588.70;

Beasley, R.W. (Ed.). 20 Tendon Transfers. Beasley’s Surgery of the Hand [Internet]. Georg Thieme Verlag. – Retrieved from: http://dx.doi.org/10.1055/b-0034-52157;

Sunderland, S. (1951). A classification of peripheral nerve injuries producing loss of function. Brain, 74 (4), 491-516. doi:10.1093/brain/74.4.491;

Sollerman, C., & Ejeskär, A. (1995). Sollerman hand function test: A standardised method and its use in tetraplegic patients. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, 29 (2), 167-176. doi:10.3109/02844319509034334;

Waljee, J.F., Kim, H.M., Burns, P.B., & Chung, K.C. (2011). Development of a Brief, 12-Item Version of the Michigan Hand Questionnaire. Plastic and Reconstructive Surgery, 128 (1), 208-220. doi:10.1097/prs.0b013e318218fc51.

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Published

2018-10-16

How to Cite

Tretyak, I. B., Gatskiy, A. A., Kovalenko, I. V., & Tretyakova, A. I. (2018). Tendon transfers at sharp injures to the nerves and the muscles in the upper forearm. Hospital Surgery. Journal Named by L.Ya. Kovalchuk, (3), 18–27. https://doi.org/10.11603/2414-4533.2018.3.9436

Issue

No. 3 (2018)

Section

ORIGINAL INVESTIGATIONS

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