Functional Long-Term Outcome of Tendon Transfer for Late Radial Nerve Injury

Abstract

Introduction : Radial nerve palsy leads to an inability to extend the wrist ,fingers, and thumb, which consequently causes decreased grip strength. Immediate and early presentations have multiple management modalities, including primary repair with or without internal splintage, as well as the option of nerve transfer. In contrast, for injuries with late presentation, tendon transfer remains the only effective management tool.

Objective : This article assesses the outcome of tendon transfer in cases of radial nervepalsy with late presentation.

Materials  and  Methods : This was a study performed in the department of burns,plastic, and maxillofacial surgery on patients who presented with late post traumaticradial nerve palsy between March 2018 and March 2022. Restoration of wrist extension was achieved using transfer of the pronator teres to the extensor carpi radialis brevis. For finger extension, the flexor carpi radialis was transferred to the extensor digitorumcommunis, and the palmaris longus was transferred to the extensor pollicis long us to facilitate thumb extension.

Analysis : Patients were followed up regularly every 4 weeks. Postoperatively, patients were scored for functional recovery using range of motion (ROM) assessment and grip strength as criteria, along with overall patient satisfaction with the results. The outcomes were evaluated using the Modified Mayo Wrist Score scale.

Results : A total of 22 patients were studied, of which 15 had excellent results, 5 had good results, and 2 had fair results. Grip strength increased postoperatively, as did the ROM of the wrist and metacarpophalangeal joints.

Conclusion : Tendon transfers remain the gold standard for managing late radial nervepalsy and are most commonly used in the upper extremity. The results are predictable and fairly consistent. Return to activity after surgery can be expected within 6 to12 weeks, depending on the patient’s tolerance.