Radial nerve lesions and the possibilities of functional reconstruction using late tendon transfer

Authors:

• Igor Čižmář,
• Edvard Ehler,
• J. Pilný,
• D. Ira,
• P. Višňa,
• P. Dráč

Abstract

Aim: Evaluation of clinical results in patients with irreparable lesion of the radial nerve. Methods: The authors evaluate a group of 16 patients (15 males, 1 female), average age 34 years (17-55), in whom they have performed functional reconstruction of the finger and wrist extension by tendon transfers in irreversible lesion of the radial nerve in the years 2002-2009. The mean time interval between lesion and tendon transfer was 23.6 (8-42) months. Clinical evaluation of muscle strength and range of motion was performed in 14 patients with at a mean time interval of 30.6 (3-81) months. Results: Full function of the transferred muscles with muscle strength of 4-5 degrees was achieved in all patients; thus hand function has been fully restored to the extent of active extension of wrist and fingers. The median of the extension achieved was 42.5° (range 10°-65°) in the wrist, 0° (0°-10°) in the fingers and 50°(45°-70°) in the thumb. The median DASH score value was 26.05 (21.66-38.11). Conclusion: With respect to achievable and excellent functional results after the performance of tendon transfers, the authors - in accord with reported data - would like to appeal for timely indication of these procedures, especially in cases when the time interval between the nerve lesion in the proximal part of the arm and the reconstructive procedure addressing reinervation exceeds 8 months, and particularly if the nerve defect is also larger than 4-5 cm. In these cases, when the use of nerve grafts proves necessary, nerve reconstructions after such a long time interval provide less satisfactory functional results. These reconstructions should also include an assessment of indications for simultaneous tendon transfer, which eliminates possible negative results of nerve regeneration.