A comparison of tendon and nerve transfer surgery for reconstruction of upper limb paralysis

Abstract

Paralysis of the upper limb muscles may follow peripheral nerve injury, spinal cord injury, nerve compression, tumour resection, inflammatory neuropathy, spot-infective neuritis or as a result of a degenerative neurological disease. The goals of treatment are to restore important functions without losing important donor muscle function. Caution should be exerted when the underlying process is a progressive one because initially successful reconstruction may be followed by a delayed deterioration. Tendon transfer and nerve transfer surgery are two of the reconstructive techniques available for functional restoration of paralysis. Tendon transfer redirects a muscle-tendon unit for a more critical function losing some muscle power in the process. Nerve transfer uses an expendable donor nerve branch or fascicle from within a nerve trunk to re-innervate the paralysed muscle in its original bed. These procedures may be combined either with functioning free muscle transfers or with arthrodesis procedures to stabilise important joints and free up additional muscle-tendon or nerves for transfer. Hybrid reconstruction with combined tendon transfer and nerve transfer may achieve greater potential gains for an individual than either technique in isolation. We aim to provide the reader with a broad overview of the above techniques to better inform decision-making when faced with a patient with functional deficit of the upper limb.