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

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.