Following high radial nerve paralysis
- the wrist needs an extensor (photo credit)
- the fingers and thumb need extensors
- the carpometacarpal joint of the thumb needs an extensor to replace the abductor pollicis longus
Burkhalter also advocated early tendon transfer because he believed the transfer acts both as a substitute during regrowth of the nerve or when lesions are irreparable and also as a helper during reinnervation. In a recent article, Kruft et al. reported that irreversible radial nerve paralysis should be treated with early tendon transfer. They reported 43 patients who underwent tendon transfer, with 38 patients ultimately returning to their original jobs. The authors qualified their results by stating that tendon transfers “never fully replace an intact radial nerve for the purpose of controlling the hand.” Elton and Omer observed that patients with radial nerve paralysis treated by tendon transfer often experienced extensor tightness, which prevented simultaneous flexion of the wrist and fingers. Barton described this as a “rather unnatural movement, seldom needed in ordinary life.” Many authors have thought that the greatest functional loss after radial nerve palsy was not the loss of finger extension, but instead the loss of power grip, which cannot be easily recreated with standard tendon transfers.
Current Approach to Radial Nerve Paralysis; Plastic & Reconstructive Surgery. 110(4):1099-1113, September 15, 2002; Lowe, James B. III, M.D.; Sen, Subhro K. M.D.; Mackinnon, Susan E. M.D.
Tendon Transfers for Radial Nerve Palsy-- Wheeless' Online Textbook of Orthopaedics
Atlas of Hand Surgery By Sigurd Pechlaner--Google eBook (very nice pictures of the transfers)
The Hand: Fundamentals of Therapy By Judith Boscheinen-Morrin, W. Bruce Conolly--Google eBook
Radial Nerve Entrapment by Mark Stern, MD--eMedicine article