Who Was the First in History to Treat Radial Nerve Palsy by Tendon Transfer?

Abstract

Sir: The first learning objective of the well-written article by Sammer and Chung, entitled “Tendon Transfer: Part 1. Principles of Transfer and Transfer for Radial Nerve Palsy,” is “to be able to describe the history of tendon transfer procedures.”1 The authors provide some sketchy information on the early history of tendon transfers in general and mention several important contributors to the development of this surgical principle to treat radial nerve palsy. Unfortunately, the authors omitted crediting the first surgeon in history to perform a tendon transfer for this indication. Therefore, some additional historical remarks seem necessary. The idea of using the tendon of a dispensable healthy muscle to function in place of one that has become paralyzed was first conceived by Carl Nicoladoni (1847–1902) in the early 1880s.2 Nicoladoni's concept was further popularized in the 1890s by the Polish surgeon Tomasz Drobnik (1858–1901).2 Boyes, in his classic article entitled “Tendon Transfers for Radial Palsy,”3 mentioned Drobnik as the first in history, in 1894, to use this method to treat radial nerve palsy. Unfortunately, Boyes provides no reference to Drobnik's operation, but the account can be found in Drobnik's most influential article on tendon transference, entitled “Ueber die Behandlung der Kinderlähmung mit Funktionsheilung und Funktionsübertragung der Muskeln,” published in 1896.4 In the article, Drobnik describes a case of a 4½-year-old girl who suffered a postpolio paralysis of all extensors of the hand and wrist, except the extensor carpi radialis longus and extensor carpi radialis brevis. On February 27, 1894, Drobnik transferred the extensor carpi radialis longus to the extensor digitorum, but the result was not satisfactory. Therefore, he performed another operation in which he transferred part of the extensor carpi radialis brevis to the extensor pollicis longus. The result was acceptable to Drobnik, as the girl was able to extend her thumb fully and the index and middle finger 67 percent. The fourth and fifth digits showed only 50 percent extension.4 Soon after Drobnik's report, several other surgeons published their attempts to treat radial nerve palsy with tendon transfer.3 However, if someone asks us who the first in history was to treat radial nerve palsy with tendon transfers, the answer should be Drobnik, in 1894. Steven F. S. Korteweg, M.D. Robert C. van de Graaf, M.D. Paul M. N. Werker, M.D., Ph.D. Department of Plastic Surgery University Medical Center Groningen Groningen, The Netherlands