TENDON TRANSFER FOR ULNAR NERVE PALSY ppt

Ulnar nerve injury

1. TENDON TRANSFER FOR ULNAR NERVE PALSY MYO KO KO YEAR 3

2. 2 INTRODUCTION Paralysis of the extremity produces major functional impairment. The ability to perform activities of daily life can be severely compromised, especially in bilateral paralysis. When muscle-tendon units remain functional in an extremity, consider sacrificing one function to restore another by transferring the working unit to a new location. Restoring something as simple as a pinch grip can create major improvement in the function of the extremity.

3. HISTORY Tendon transfers have been used in upper extremity reconstruction for well over a century. Early on, the technique was used for reconstruction following obstetric brachial plexus palsy or paralysis secondary to polio. The middle part of the 20th century the development of transfers for multiple peripheral nerve paralyses, including median, ulnar, and radial nerve palsies

4. HISTORY In the latter part of the century, microvascular techniques were developed that added free muscle transfers as a possible tool for paralysis reconstruction. tendon transfer remains a primary tool in upper extremity paralysis management.

5. DEFINITION Tendon transfer surgery is a type of surgery that is performed in order to improve lost extremities function. A functioning tendon is shifted from its original attachment to a new one to restore the action that has been lost.

6. Fundamental Principles of Tendon Transfers Correction of Contracture Adequate Strength Amplitude of Motion Straight Line of Pull One Tendon - One Function Synergism Expendable Donor Tissue Equilibrium

7. ANATOMY

8. 12 ulnar nerve palsy

9. Motor High Low hypothenar Intrinsic Thenar and 1 st web (Abd digiti minimi)

10. Ulna nerve palsy is a more devastating injury than radial nerve palsy Key pinch is lost because of absent adductor pollics and first dorsal interosseous muscle function Clawing as a result of paralysis of the interosseous muscles in the presence of functioning extrinsic finger flexors . Claw hand prevents the patient from cupping the hand around objects. Difficult to grasp objects. Unlike radial nerve palsy, the sensory deficit in ulnar nerve palsy is clinically disabling.

11. Clinical examination Clawing, with hyperextension at MP joint and flexion at IP joints, is the characteristic resting posture of the ring and little finger ( Duchenne sign)

12. Bouvier maneuver is used to test the integrity of the central slip and the lateral bands of the extensor expansion

13. abduct the middle finger from side to side ( Pitres-Testut sign) Another sign of loss of ulnar nerve function is the inability to cross the middle finger dorsally over the index finger, or the index over the middle finger (a test of the first palmar interosseous and second dorsal interosseous muscles).

14. Froment sign, marked thumb IP joint flexion when pinching sheets of paper between the thumb and index finger, indicates paralysis of the AD and first dorsal interosseous muscles with replacement of their pinch function by FPL. The Wartenberg sign is the inability to adduct the extended little finger to touch the extended ring finger.

15. Restoration of Function in Ulnar Nerve Palsy Low” ulnar nerve palsy are to improve thumb pinch, correct finger clawing, and restore the normal pattern of finger flexion. “High” ulnar nerve surgery also can be performed to restore ring and little finger distal IP joint flexion Attempts to restore sensibility to the ring and little fingers are possible, but not normally performed and the loss of sensation in ulnar nerve palsy is not as devastating as in median nerve palsy.

16. Restoration of Function in Ulnar Nerve Palsy Correction of the claw deformity Restoration of Thumb-Index Key Pinch Restoration of the transverse metacarpal arch

17. The Ulnar Claw Hand and Its Management Aim Flexion of MCB joint Extension of IPJs

18. The Ulnar Claw Hand and Its Management Surgical Techniques for Correction of the Ulnar Claw Hand static and dynamic procedures Static Techniques. These prevent hyperextension of the finger MP joints by either shortening their palmar capsules or creating “checkrein” ligaments/ tenodeses static procedure is contraindicated if Bouvier maneuver (+)

19. The Ulnar Claw Hand and Its Management Surgical Techniques for Correction of the Ulnar Claw Hand

20. Palmar Capsulodesis of the MP Joint  ( Zancolli ) Omer modified Zancolli's technique Palmar Capsulodesis of the MP Joint  ( Zancolli ) Omer modified Zancolli's technique Riordan Static Tenodesis . Parkes Static Tenodesis . Fowler's Wrist Tenodesis Technique

21. Dynamic Tendon Transfers Superficialis Tendon Transfer Techniques and Modifica-tions . Modified Stiles- Bunnell procedure. Modifications of the superficialis transfer. Dynamic Tendon Transfers Superficialis Tendon Transfer Techniques and Modifica-tions . Modified Stiles- Bunnell procedure Modifications of the superficialis transfer Extensor Indicis Proprius and Extensor Digiti Minimi Transfers Transfers Using Wrist Flexor and Extensor Muscles Dorsal route transfer of ECRB/ECRL Flexor route transfer of ECRL

22. Restoration of Thumb–Index Key Pinch and Tip Pinch

23. Restoration of Thumb–Index Key Pinch and Tip Pinch Dynamic Procedures to Restore Thumb Adduction ECRB as Motor (Smith) Dynamic Procedures to Restore Thumb Adduction ECRB as Motor (Smith) Extensor Indicis as a Motor (Brown) Combination of EIP and EDC (Little) Tendon Transfers for Pinch Index Abduction Techniques Accessory Slip of APL Transfer EIP Transfer to First Dorsal Interosseous . Th Palmaris Longus to the First Dorsal Interosseous .

24. Other Techniques for Restoring Index Finger Abduction

25. Restoration of the Transverse Metacarpal Arch Bunnell's “Tendon T” Operation. EDM Transfer ( Ranney ). Palande's Modification of Brand's Flexor Route Transfer of ECRL.

26. Correction of Little Finger Abduction Deformity Split EDM Transfer

27. High Ulnar Nerve Palsy Restoration of Ring and Little Finger Flexion and Strength Little and Ring Finger FDP Suture to the Middle Finger FDP

28. Restoration of Sensibility Digital Nerve Transfer. Transfer of two or three tendons cannot be expected to restore the fine function of the many intrinsic muscles whose function is lost with a complete ulnar nerve lesion aim of surgery for ulnar nerve palsy is to improve rather than restore normal function

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