Flexor Carpi Ulnaris Transfer Research Articles

Outcome of Transfer Flexor Carpi Ulnaris And Plmaris Longus Tendons for Hand Deformity in Persistance Radial Nerve Palsy

Objective; the aim of our study is to evaluate the functional outcome of transfer flexor carpi ulnaris and palmaris longus for patients with persistence radial nerve palsy by minimal tendon transfer technique.
 Methods; The study included 10 patients 8 male and two female, mean age 25 years, range from 20 to 30 years. They underwent transfer of flexor carpi ulnaris (FCU) and palmaris longus (PL) tendon for patient with persistence radial nerve palsy, the duration of outcome of tendon transfer after radial nerve injury evaluated after one year. Clinical evaluation include wrist joint range of movement by Geniometry and compared with the contralateral normal side.
 Results; The average ranges of wrist movements were as the follows: the mean wrist flexion was 52⁰(range 46⁰–56⁰), the mean wrist extension was 34⁰(range 30–38), radial deviation 18⁰(range 16⁰–20⁰) and ulnar deviation 21⁰ (range 18–23). The mean extension of the fingers in wrist extension was 7⁰(range 5⁰–10⁰) and in wrist neutral position was 12⁰(range 9⁰–16⁰). The mean abduction of the thumb was 38⁰(range 35⁰–44⁰). In comparison to the measure of joints in the contralateral normal hand, the final extension of the wrist was less, but extension of the fingers and MCP joints was similar to that of the normal hand. All of the patients in our study were able to extend their fingers with the wrist in the neutral position. Thumb abduction and extension was sufficient to deal with daily activities and, even, heavy jobs in most of the patients. Postoperative follow up of the patients was ranged (12–24) months. After 45 days, 8o% of the patients were able to do the normal non heavy daily work. In 20% of cases recovery was not progressing satisfactorily at 5 weeks. These were referred to physiotherapy for a planned exercise program, which the two patients improved their movements.
 Conclusion; The purpose of this study was to evaluate function of the hand after transfer of the FCU to EDC and PL to EPL, with persistence high nerve injuries. The FCU & PL tendons transfer has some advantages over the other techniques, short duration of operation time, no morbidity, improve range of motion of hand and less surgical scares. It is a viable option to restore hand function and strength following radial nerve injuries.

A new technique of flexor carpi ulnaris transfer in multilevel surgery for upper extremity deformities in spastic cerebral palsy.

Aim To assess treatment outcomes of cerebral palsy (CP) patients who underwent upper limb surgical treatment including new technique of flexor carpi ulnaris (FCU) transfer. Methods The study included an outcome of orthopaedic surgeries in 30 upper limbs of 25 CP patients aged 10 to 24 years (mean age of 15.1 years). In addition to standard orthopaedic assessment, we used the integral scales of the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS). Functional disorders of the upper limb were also evaluated with classifications of Van Heest, House, Gshwind and Tonkin. Results A total of 30 surgical interventions were performed. In seven patients with hemiparesis, surgical treatment was accompanied by simultaneous intervention on the lower limb. Improvement of the functional capabilities and cosmetic appearance was noted in all cases in a follow-up over 12 months, as evidenced by an improvement in the functional class according to Van Heest classification. Conclusion A new technique of FCU transfer to the radius showed to be an effective method to address pronation contracture of the forearm joints and can be used in combination with other elements of surgical intervention for elbow and thumb contractures. The FCU rerouting and transfer to distal radius is a good option in the absence of active supination. Distal release of FCU weakening flexion forces with a simultaneous procedure restoring active wrist extension provides satisfactory outcomes in the treatment of associated flexed wrist contracture.

Mechanical effect of rat flexor carpi ulnaris muscle after tendon transfer: does it generate a wrist extension moment?

The mechanical effect of a muscle following agonist-to-antagonist tendon transfers does not always meet the surgeon's expectations. We tested the hypothesis that after flexor carpi ulnaris (FCU) to extensor carpi radialis (ECR) tendon transfer in the rat, the direction (flexion or extension) of the muscle's joint moment is dependent on joint angle. Five weeks after recovery from surgery (tendon transfer group) and in a control group, wrist angle-moment characteristics of selectively activated FCU muscle were assessed for progressive stages of dissection: 1) with minimally disrupted connective tissues, 2) after distal tenotomy, and 3) after maximal tendon and muscle belly dissection, but leaving blood supply and innervations intact. In addition, force transmission from active FCU onto the distal tendon of passive palmaris longus (PL) muscle (a wrist flexor) was assessed. Excitation of control FCU yielded flexion moments at all wrist angles tested. Tenotomy decreased peak FCU moment substantially (by 93%) but not fully. Only after maximal dissection, FCU wrist moment became negligible. The mechanical effect of transferred FCU was bidirectional: extension moments in flexed wrist positions and flexion moments in extended wrist positions. Tenotomy decreased peak extension moment (by 33%) and increased peak flexion moment of transferred FCU (by 41%). Following subsequent maximal FCU dissection, FCU moments decreased to near zero at all wrist angles tested. We confirmed that, after transfer of FCU towards a wrist extensor insertion, force can be transmitted from active FCU to the distal tendon of passive PL. We conclude that mechanical effects of a muscle after tendon transfer to an antagonistic site can be quite different from those predicted based solely on the sign of the new moment arm at the joint.

Effects of tendon and muscle belly dissection on muscular force transmission following tendon transfer in the rat

The aim of the present study was to quantify to what extent the scar tissue formation following the transfer of flexor carpi ulnaris (FCU) to the distal tendon of extensor carpi radialis (ECR) affects the force transmission from transferred FCU in the rat. Five weeks after recovery from surgery (tendon transfer group) and in a control group, isometric length–force characteristics of FCU were assessed for progressive stages of dissection: (i) with minimally disrupted connective tissues, (ii) after full dissection of FCU distal tendon exclusively, and (iii) after additional partial dissection of FCU muscle belly.Total and passive length–force characteristics of transferred and control FCU changed significantly by progressive stages of dissection. In both groups, tendon dissection decreased passive FCU force exerted at the distal tendon, as well as the slope of the length–force curve. However, force and slope changes were more pronounced for transferred FCU compared to controls. No additional changes occurred after muscle belly dissection. In contrast, total force increased in transferred FCU following both tendon and muscle belly dissection at all lengths studied, while dissection decreased total force of control FCU. In addition, after tendon and muscle belly dissection, we found decreased muscle belly lengths at equal muscle–tendon complex lengths of transferred FCU.We conclude that scar tissue limits the force transmission from transferred FCU muscle via the tendon of insertion to the skeleton, but that some myofascial connectivity of the muscle should be classified as physiological.

Late Deformities Following the Transfer of the Flexor Carpi Ulnaris to the Extensor Carpi Radialis Brevis in Children With Cerebral Palsy

The transfer of flexor carpi ulnaris (FCU) to extensor carpi radialis brevis (ECRB) (the Green transfer) in children with cerebral palsy (CP) is a surgical option frequently used to address the typical wrist flexion deformity that is often present in these patients. We hypothesize that late deformities may occur when these transfers are performed in patients before skeletal maturity. The purpose of this investigation was to determine the frequency of these deformities and the factors that influence their development. We performed 41 FCU to ECRB tendon transfers in children with CP at our institution between 1987 and 2005 and retrospectively reviewed them. A total of 24 patients with 25 transfers had a minimum 2-year follow-up and were included in the study population. We identified patients who developed a late deformity after tendon transfer. We analyzed medical records of these patients to identify factors associated with the development of a deformity. Of the 25 transfers, 12 developed a late deformity between 10 and 105 months postoperatively. The deformities that developed were extension deformities (8), supination deformities (one), and recurrent flexion deformities (3). Of the 12 patients with deformity, 9 required revision surgeries. Of these 12 patients, 9 who were less than 13 years of age at the time of transfer developed a late deformity, compared with 3 who were older than 13 years of age. The FCU to ECRB tendon transfer remains a viable option to address the wrist flexion deformity seen in patients with CP. Care should be taken when performing this tendon transfer in patients less than 13 years of age because they may develop a postoperative deformity, commonly an extension deformity. We believe that these deformities develop when the patient enters a growth spurt and the transferred muscle-tendon unit does not lengthen at the same rate as the involved upper extremity. Therapeutic IV.

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The purpose of this study was to evaluate the results of tendon transfers in patients with irreparable radial nerve palsy. The study included 29 patients (5 females, 24 males; mean age 29 years; range 9 to 51 years) who underwent tendon transfers for radial nerve palsy. Four patients had low- and 25 patients had high-level radial nerve palsy. The mean duration of tendon transfer after injury (paralysis time) was 19.7 months (range 1 day to 180 months). Clinical evaluations included joint range of motion and muscle strengths. Functional evaluation was made using the Tajima criteria. The mean follow-up was 56.9 months (range 5 to 90 months). Muscle strengths were measured as follows: 3 (n=3), 4 (n=10), and 5 (n=12) for the wrist extensor muscle; 3 (n=7), 4 (n=10), and 5 (n=12) for the finger extensor muscle; and 3 (n=6), 4 (n=13), and 5 (n=10) for the thumb extensor muscle. The mean wrist range of motion was 67.4 degrees , extension was 48.3 degrees (10 degrees to 70 degrees ), and flexion was 21.5 degrees (10 degrees to 55 degrees ). The mean metacarpophalangeal joint extension was 1.7 degrees (0 degrees to 12 degrees ), thumb abduction was 45.6 degrees (34 degrees to 56 degrees ), and thumb interphalangeal joint extension was 18 degrees (0 degrees to 30 degrees ). According to the Tajima criteria, the results were excellent in 15 patients (51.7%), good in nine patients (31%), and moderate in five patients (17.2%). Eight patients (27.6%) had radial deviation deformity and four patients (13.8%) had 1-level weaker finger extensor muscle strength compared to the other fingers. The flexor carpi ulnaris (FCU) was used in the transfer of patients who developed radial deviation deformity. Treatment of irreparable radial nerve palsy with tendon transfers yields successful results. Radial deviation deformity mostly occurs in patients receiving FCU transfer for finger extension.

Split Flexor Carpi Ulnaris Transfer: A New Functioning Free Muscle Transfer with Independent Dual Function

Split Flexor Carpi Ulnaris Transfer: A New Functioning Free Muscle Transfer with Independent Dual Function

Split Flexor Carpi Ulnaris Transfer: A New Functioning Free Muscle Transfer with Independent Dual Function

Split Flexor Carpi Ulnaris Transfer: A New Functioning Free Muscle Transfer with Independent Dual Function

Three-dimensional video analysis of forearm rotation before and after combined pronator teres rerouting and flexor carpi ulnaris tendon transfer surgery in patients with cerebral palsy

The effect of combined pronator teres rerouting and flexor carpi ulnaris transfer on forearm rotation was prospectively studied by comparison of pre- and postoperative three-dimensional analysis of forearm range of motion in ten patients with cerebral palsy. One year postoperatively, surgery had improved maximal supination of the forearm in all patients by an average of 63°, but there was also a mean loss of 40° pronation. Forearm range of motion increased by a mean of 23°. The centre of the range of motion on average shifted 52° in the direction of supination. Based on these results of objective forearm range of motion analysis, we conclude that the common combination of pronator teres rerouting and flexor carpi ulnaris transfer in patients with cerebral palsy effectively facilitates active supination but impairs active pronation.

Biomechanical effects of dissecting flexor carpi ulnaris

Our aim was to determine whether the length and function of the flexor carpi ulnaris muscle were affected by separating it from its soft tissue connections. We measured the length of flexor carpi ulnaris before and after its dissection in ten patients with cerebral palsy. After tenotomy, tetanic contraction shortened the muscle by a mean of 8 mm. Subsequent dissection to separate it from all soft tissue connections, resulted in a further mean shortening of 17 mm (p < 0.001). This indicated that the dissected connective tissue had been strong enough to maintain the length of the contracting muscle. Passive extension of the wrist still lengthened the muscle after tenotomy, whereas this excursion significantly decreased after subsequent dissection. We conclude that the connective tissue envelope, which may be dissected during tendon transfer of flexor carpi ulnaris may act as a myofascial pathway for the transmission of force. This may have clinical implications for the outcome after tendon transfer.

Selective release of the flexor origin with transfer of flexor carpi ulnaris in cerebral palsy

Transfer of flexor carpi ulnaris combined with selective release of the flexor pronator origin was undertaken in 35 patients with hemiplegic cerebral palsy for a pronation flexion deformity of the forearm, hand and wrist. The patients were divided into four groups depending on the severity of the deformity, the surgical procedure recommended, potential hand function and prognosis. The procedure reduces the power of wrist and finger flexion by release of the flexor pronator origin, and reinforces the strength of extension and supination of the wrist by transfer of flexor carpi ulnaris. After a mean follow-up of four years the appearance of the hand and forearm improved in all patients. None lost movement and all gained improved mobility of the forearm, wrist and hand. There was no overcorrection.

Long-Term Results of Tendon Transfers for Radial Nerve Paisy in Patients With Limited Rehabilitation

The authors reviewed the long-term functional results of 22 patients who underwent tendon transfer for isolated radial nerve palsy. The average number of postoperative visits was eight (range of postoperative visits, 3-16), and the mean follow-up was 6.3 years. All but 1 patient had improved function after the tendon transfers, and could cope with the activities of daily living. Radial deviation of the wrist at rest was present in 10 of the 15 patients with flexor carpi ulnaris transfer and in 2 of 7 patients with flexor carpi radialis transfer, with a mean of 14.5 deg (range of radial deviation, 5-30 deg). Although a global decrease in wrist power and power grip was noted, 13 of 17 previously employed patients were able to work after transfer; however, only 1 of 7 heavy manual laborers was able to return to his previous employment. Despite the poor clinic attendance, the overall functional results compared favorably with other published series. It appears that tendon transfer for radial nerve palsy is a viable option, even in patients with limited rehabilitation.

The supination effect of tendon transfer of the flexor carpi ulnaris to the extensor carpi radialis brevis or longus: a cadaveric study.

Flexor carpi ulnaris (FCU) transfer to the extensor carpi radialis brevis (ECRB) and/or the extensor carpi radialis longus (ECRL) has been commonly used to provide wrist extension. The ability of this wrist extension transfer to also provide forearm supination has been inferred but not formally investigated. This laboratory study investigated the forearm supination effect of FCU transfer to the ECRB and to the ECRL in a cadaveric model. Two vectors of pull were investigated: freeing either the distal one third or the distal two thirds of the FCU ulnar origin. Five fresh-frozen, above-elbow, non-matched cadaveric specimens placed in a mounting device that allowed the arm to rotate about its ulnar axis starting from a full pronated position were measured for resultant supination after tendon transfer and loading. This study showed that the transfer of the FCU into either the ECRB or the ECRL resulted in no significant difference in maximum supination. The vector of origin, however, did significantly affect the maximum supination obtained. Releasing the distal two thirds of the FCU ulnar origin resulted in a mean supination that was significantly greater than the mean supination achieved with releasing the distal one third of the FCU ulnar origin. We concluded that in the cadaveric model, transfer of the FCU into either the ECRB or ECRL provided similar resultant supination and that freeing the distal two thirds of the FCU ulnar origin provided significantly more supination than freeing only the distal one third. For the hand surgeon treating wrist flexion in combination with forearm pronation deformity, transfer of the FCU into the ECRB and/or the ECRL can be used to concomitantly provide wrist extension and forearm supination.

Long-Term Results of the Steindler Flexorplasty

Seventy-one consecutive patients were treated with a modified Steindler flexorplasty from 1970 to 1987. The mechanisms of injury and etiologies included 45 motor vehicle accidents, 13 birth injuries, and 13 cases of poliomyelitis. Additional operative procedures included shoulder fusion (45 patients), tendon transfer (20 patients), and wrist tenodesis (3). Follow-up averaged 8.2 years. The outcome was excellent in 32%, good in 47%, fair in 13%, and poor in 8%. Postoperatively, the mean arc of active elbow flexion was 114 degrees; the average elbow extension loss, 28 degrees; the mean active pronation, 74 degrees; and supination, 30 degrees. Wire breakage was found in two cases. Additional tendon transfer of flexor carpi ulnaris to extensor carpi radialis brevis improved the outcomes in the patients without active supination. The modified Steindler flexorplasty provided predictable functional improvement in carefully selected patients with paralyzed upper extremities.

Proximal row carpectomy with muscle transfers for spastic paralysis

Fourteen patients with spastic paralysis from various causes (eight with cerebral palsy) who needed minimal two handed activities to assist in self-care and who desired improvement in appearance were treated by proximal row carpectomy. In twelve transfer of flexor carpi ulnaris to extensor carpi radialis brevis was done, and in two the extensors of the wrist were shortened. Various other procedures were done in some patients. Prolonged splinting was carried out. Better extension of the wrist was obtained and supination improved more when the transfer was subcutaneous around the ulnar border than when through the interosseus membrane. Less tendency for the carpus to displace ulnarward was seen when the distal half of the scaphoid was not removed. Strength of grasp and pinch improved, but ability to release objects was diminished due to the more dorsiflexed position of the wrist. Subjective use for two handed activities was improved and the patients were satisfied with the appearance.