Radial nerve damage results in substantial functional limitations of the upper extremity. No detailed data exist regarding long-term results, patient satisfaction, and professional and social reintegration after tendon transfer for irreparable damage to the radial nerve. In this retrospective study, we investigated these data through the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire.
Between 1995 and 2006, 77 patients underwent a modified Brooks and d'Aubigne surgical technique for radial nerve palsy in our department. In 19 cases, the flexor carpi radialis muscle was used as a donor instead of the flexor carpi ulnaris muscle. The mean follow-up period was 60 months (range, 24–150 months); motion of the wrist and finger joints and pinch-grip power were compared with the healthy side. We assessed the limitation in pursuing daily activities using the DASH score.
Wrist extension averaged 73% of the contralateral side, whereas the value for movement of digital extension was 32% and for thumb abduction in the palmar direction it was 80%. The power grip was reduced to 49% and the pinch grip was reduced to 28%. The mean DASH score was 15 ± 9, the symptom score mean was 15 ± 7, and the working score mean was 12 ± 10. The mean total DASH score was 16 ± 10. The proportion of patients who remained employed after surgical treatment was 89%.
Functional results, adequate patient satisfaction, and sufficient professional and social reintegration can be achieved after modified Brooks and d'Aubigne tendon transfer. Accordingly, the tendon transfer offers an important alternative—possibly the procedure of choice—to microsurgical nerve reconstruction, particularly when early professional and social reintegration is important.
Type of study/level of evidence
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- Radial nerve palsy associated with humeral shaft fracture: evaluation with US—initial experience.Radiology. 2001; 219: 811-816
- Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review.J Bone Joint Surg. 2005; 87B: 1647-1652
- Die Chirurgie der Hand (übersetzt von J. Böhler).in: Wien- Bonn-Bern, W. Maudrich1958: 85-97
- Functional results of primary nerve repair.Hand Clin. 2000; 16: 67-72
- Radial nerve palsy.in: Green D. Hotchkiss R. Pederson W. Wolfe S. 5th ed. Operative hand surgery. vol. 2. Churchill Livingstone, New York2005: 1113-1131
- [Improved outcome of nerve injuries in the upper extremity].Nervenarzt. 2006; 77: 922-930
- Principles of tendon transfers.in: Berger R. Weiss A.P.C. Hand surgery. Lippincott Williams & Wilkins, Philadelphia2003: 927-936
- Transposition of the tendon of pronator teres in cerebral palsy.J Bone Joint Surg. 1976; 58B: 220-223
- [Treatment of irreparable injuries of peripheral nerves.].Wiederherstellungschir Traumatol. 1953; 1: 240-262
- Treatment of irreversible lesion of the radial nerve by tendon transfer: indication and long-term results of the Merle d'Aubigne procedure.Plast Reconstr Surg. 1997; 100: 610-618
- Current approach to radial nerve paralysis.Plast Reconstr Surg. 2002; 110: 1099-1113
- Tendon transfers for radial nerve palsy.Aust N Z J Surg. 1980; 50: 267-272
- The modern treatment of peripheral nerve injuries.Med Press. 1952; 228: 549-553
- [Surgical restoration of hand].Rev Prat. 1956; 6: 3561-3564
- Ersatzoperationen bei motorischen und sensiblen Ausfällen der oberen Extremität.Trauma Berufskrankheiten. 2006; 8: 31-37
- Radial nerve palsy.Hand Clin. 1988; 4: 179-185
- Tendon transfers for defective long extensors of the wrist and fingers.Scand J Plast Reconstr Surg. 1969; 3: 71-78
- Neurotization as an alternative for restoring finger and wrist extension.J Neurosurg. 2001; 94: 795-798
- [Functional radial tendon replacement surgery at the Accident Hospital of the occupational association in Hamburg: indications—technique—results].Handchir Mikrochir Plast Chir. 1996; 28: 309-316
- [Palliative tendon transfer for reanimation of the wrist and finger extension lag: report of 14 transfers for radial nerve palsies and ten transfers for brachial plexus lesions].Chir Main. 2002; 21: 13-22
- [Evaluation criteria in follow-up studies of flexor tendon therapy].Handchirurgie. 1976; 8: 65-69
- [Transposition operation in paralysis of extensor muscles of the hand: intermediate-term results].Z Orthop Ihre Grenzgeb. 2001; 139: 403-409
- Tendon transfers for radial nerve palsy: use of superficialis tendons for digital extension.J Hand Surg. 1978; 3: 560-570
- [Clinical experiences with a new Wiedemann method of radial replacement operation].Orthopade. 1997; 26: 684-689
- Analysis of Tsuge's procedure for the treatment of radial nerve paralysis.Hand Surg. 2003; 8: 17-20
- Tendon transfer for triple nerve paralysis of the hand in leprosy.Lepr Rev. 2002; 73: 319-325
- Long-term results of tendon transfers for radial nerve palsy in patients with limited rehabilitation.Ann Plast Surg. 2000; 45: 122-126
- [Development of the techniques of tendon transfers for radial paralysis].Rev Chir Orthop Reparatrice Appar Mot. 1991; 77: 285-292
- Our experience in tendon transfers for radial palsy.Ann Chir Main. 1985; 4: 197-210
- Outcomes assesment in hand surgery.Clin. Plast Surg. 1997; 24: 191-194
- Measuring the success of treatment in patient terms.Med Care. 1995; 33: AS226-AS235
- But was the operation worth it?.J Qual Clin Pract. 1996; 16: 75-85
- Motorische Ersatzoperationen nach irreparabler Radialisläsione.Wehrmedizinische Monatsschrift. 1984; 9: 367-370
- Transfer of a single flexor carpi ulnaris tendon for treatment of radial nerve palsy.J Hand Surg. 2006; 31B: 542-546
- Technik und Ergebnisse der Ersatzoperationen bei irreparabler Radialisparese.Aktuelle Traumatologie. 1985; 3: 93-135
- [Experiences with radial plastic surgery (author's trans.)].Unfallheilkunde. 1976; 79: 507-511
- [Merle d'Aubigne replacement-plasty in irreparable radial paralysis].Zentralbl Chir. 1985; 110: 239-244
- Long-term results of tendon transfers in radial and posterior interosseous nerve paralysis.J Hand Surg. 2006; 31B: 502-506
- [Tendon suture: surgical techniques].Orthopade. 2000; 29: 188-195
- Technik und Ergebnisse von Ersatzoperationen bei irreparablen Radialisschäden.Handchir Mikrochir Plast Chir. 1975; 5: 195-197
- Über Sehnenoperationen bei Radialislähmungen nebst Studien über die Sehnenverpflanzung und Tenodese im allgemeinen.Beitr Kin Chir. 1918; 113: 289-368
Accepted: November 14, 2008
Received: May 4, 2008
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
© 2009 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.