What are the common tendon transfers for upper limb nerve palsies?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: June 2, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

From the Research

Tendon transfers for upper limb nerve palsies are highly individualized and depend on the specific nerve injury, with the goal of restoring critical hand functions like grasp, pinch, and release. The most common tendon transfers for upper limb nerve palsies include:

  • For radial nerve palsy:
    • Pronator teres to extensor carpi radialis brevis for wrist extension 1
    • Flexor carpi radialis or flexor carpi ulnaris to extensor digitorum communis for finger extension 1, 2
    • Palmaris longus or flexor digitorum superficialis to extensor pollicis longus for thumb extension 1
  • For median nerve palsy:
    • Extensor carpi radialis longus to flexor pollicis longus for thumb opposition 3
    • Brachioradialis to flexor digitorum profundus for index finger flexion 3
  • For ulnar nerve palsy:
    • Extensor carpi radialis longus to adductor pollicis for thumb adduction 3
    • Flexor digitorum superficialis rerouted to restore intrinsic hand function 3
  • For brachial plexus injuries:
    • Trapezius to deltoid for shoulder abduction 3
    • Latissimus dorsi to biceps for elbow flexion 3 These transfers work by repurposing expendable donor muscles with adequate strength and excursion to replace lost function, with the goal of restoring critical hand functions like grasp, pinch, and release, as supported by the most recent study in 2022 1. Successful outcomes depend on proper donor muscle selection, adequate passive joint motion, and intensive postoperative rehabilitation to retrain the brain for the new muscle function 1, 2, 4, 3, 5.

References

1
Research

Tendon transfer surgery for radial nerve palsy.

Hand surgery & rehabilitation, 2022

3
Research

Tendon transfers after peripheral nerve injuries: my preferred techniques.

The Journal of hand surgery, European volume, 2019

4
Research

Radial Nerve Tendon Transfers.

Hand clinics, 2016

5
Research

Tendon transfers for radial, median, and ulnar nerve palsy.

The Journal of the American Academy of Orthopaedic Surgeons, 2013

Related Questions

What is the best splinting approach for managing radial nerve palsy with wrist drop and medial weakness, considering I've been using a wrist splint contiguous with the middle finger on and off?
Will injectable steroids (e.g. methylprednisolone or dexamethasone) help a patient with a radial nerve injury secondary to an iatrogenic needle injury in the antecubital fossa, presenting with weakness of the middle finger?
What are the rehabilitation options for fine motor control impairment following surgical repair of a partially severed Flexor Carpi Ulnaris (FCU) tendon?
What is the most appropriate next step in management for a patient 21 days after an iatrogenic needle injury to the radial nerve who has no pain, no wound, intact forearm flexors, and persistent wrist‑drop despite full physiotherapy and functional electrical stimulation?
Will I recover from an iatrogenic (caused by medical treatment) radial nerve injury with slight wrist drop and middle finger involvement after receiving a steroid injection?
What antibiotic treatment is recommended for a urinary tract infection with high minimum inhibitory concentration (MIC) and resistance to common antibiotics?
What is the appropriate treatment for a urinary tract infection (UTI) with a high colony count in a urine culture and sensitivity (C&S) test?
Does electro-cautery (electrocautery) dissection reduce seroma formation compared to knife dissection in surgical procedures?
What is the management approach for a patient diagnosed with Pyruvate Dehydrogenase Kinase (PDK) deficiency?
What is the appropriate approach to explaining a diagnosis of Polycystic Kidney Disease (PKD) to a patient?
What treatment is recommended for a patient with estrogen receptor (ER) positive breast cancer?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question