Radial Nerve Palsy - Rob Lee 20/10/2005

High Radial Nerve Palsy

The mostproximal muscles, the brachialis (BR) and ECRL, reinnervate by 4 to 6 monthsfollowed by the ECU and EDC

The lastmuscle reinnervated is the EPL because it is located farthest from the point ofinjury.

Limitedtendon transfers in the early period following radial nerve repair have beenadvocated as serving as an internal splint (PT to ECRB).

In cases inwhich damage to the radial nerve is deemed irreparable or unlikely to succeed(gaps larger than 4 cm), a full set of transfers can be performed early.

Afterexploration and repair, a recovery period of 6 months is allowed before repairis deemed unsuccessful and tendon transfers are performed.

Goals ofTendon Transfers

Improve wrist extension (important for a strong grip/grasp)
Provide finger extension and thumb extension (important forrelease)
Stabilize the thumb base (improves pinch)

Reconstruction Of Wrist Extension
(PT universally used)
PT to ECRB Smith2, Omer4 and Tsuge5
PT to ECRB and ECRL Boyes6, Dunn7, Zachary8 and Tajima3
PT to ECRB and centralized ECRL Brand 9 and Tubiana 10

Universally, the PT is used for the donor to obtain wristextension.
The most widely used transfer involves rerouting of the PTto the ECRB.
The most common variation on this procedure is insertiononto both the ECRL and ECRB.

Transfers Author(s)
FCR to EDC Starr11, Brand9 and Tsuge5
FDS to EDC/EIP/EPL Boyes 6 and Tajima3
FCU to EDC Jones 12 Scuderi 13 and Omer14
Reconstruction Of The Digital Extensors

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