From the Research
A Left BR to FPL tendon transfer with EPL re-route and tenodesis is a recommended procedure for restoring thumb function in patients with specific nerve or tendon injuries, as it can significantly improve morbidity, mortality, and quality of life outcomes. This procedure involves transferring the brachioradialis (BR) tendon to the flexor pollicis longus (FPL) tendon to restore thumb flexion, while simultaneously re-routing the extensor pollicis longus (EPL) tendon and performing a tenodesis to balance thumb movement.
Key Points
- The surgery is commonly performed for patients with median nerve injuries, anterior interosseous nerve palsy, or traumatic tendon disruptions affecting thumb function 1.
- Recovery typically requires 4-6 weeks of immobilization in a thumb spica cast, followed by 6-12 weeks of hand therapy focusing on progressive strengthening and coordination exercises.
- Patients should expect some initial weakness and may need to learn new motor patterns to activate the transferred tendon.
- Potential complications include adhesions, tendon rupture, or inadequate tension in the transfer.
- Success depends on proper patient selection, meticulous surgical technique, and dedicated post-operative rehabilitation to retrain the brain to use the transferred muscle for its new function 2.
Considerations
- The most recent and highest quality study, published in 2025, supports the use of BR tendon transfer with palmaris longus tendon graft for thumb avulsion, demonstrating good outcomes with active interphalangeal flexion of 70°, grip strength of 45 kg, key pinch strength of 15 kg, and two-point discrimination threshold of 4 mm 2.
- Another study published in 2020 found that early tendon transfer has a unique role in the management of median nerve palsy hand and suggests that this procedure should be considered in both high and low lesions 1.
- The principles of tendon transfer, including normal tissue equilibrium, movable joints, and a scar-free bed, are essential for optimal results 3.
Recommendations
- Proper patient selection, meticulous surgical technique, and dedicated post-operative rehabilitation are crucial for the success of the Left BR to FPL tendon transfer with EPL re-route and tenodesis procedure.
- Patients should be closely monitored for potential complications and undergo regular follow-up appointments to ensure optimal outcomes.
- The procedure should be performed by an experienced surgeon with expertise in hand surgery and tendon transfers.