Tendon Repairs/Reconstruction

What is a low median nerve injury transfer called?

Opponensplasty

What is a high median nerve injury transfer called?

Brachioradialis to flexor pollicis longus

What are the 4 types of opponensplasty?

1. Flexor digitorum superficialis → abductor pollicis brevis

2. Palmaris longus → abductor pollicis brevis

3. Extensor indicis proprius → around pinky to abductor pollicis brevis

4. Abductor digiti minimi → abductor pollicis brevis

How should the wrist be placed in an orthosis for low median nerve transfers?

Wrist in neutral to 20-30 degrees of flexion (extensor indices to abductor pollicis brevis is wrist in 30 degrees of flexion)

What is a Duchenne’s sign for ulnar nerve injury?

Hyperextension of the MCP joints

What is the Jeanne’s sign for ulnar nerve injury?

Hyperextension of the thumb MCP joint

What is the Wartenberg’s sign for ulnar nerve palsy?

Excessive abduction of the pinky

What is the static Zancolli lasso procedure for low ulnar nerve transfers?

Take the flexor digitorum superficialis is looped around the base of the affected finger and attached back to itself

Prevents excessive extension (claw deformity)

What is the dynamic brand transfer for low ulnar nerve transfers?

Take the ECRB/ECRL → lumbricals to help with MCP flexion (tenodesis)

What are the stiles bunnel transfer for low ulnar nerve injuries?

Flexor digitorum superficialis is split and attached to the pinky and ring fingers to help with flexion (tenodesis)

What is the smith-hastings transfer for low ulnar nerve injuries?

ECRB → adductor pollicis to restore key pinch

What is the littler procedure for low ulnar nerve injuries?

Take the FDS → adductor pollicis to restore key pinch

What is the high ulnar nerve injury tendon transfer?

ECRL →FDP to improve DIP flexion

What happens with a high radial nerve injury?

Affects more muscles like the triceps that leads to wrist/hand drop

What happens with a low radial nerve injury?

Causes wrist drop and involves the posterior interosseous nerve, but the ECRL remains intact

What are the 3 radial nerve tendon transfers?

1. Pronator teres → ECRB to improve wrist extension

2. FCU → extensor digitorum to improve MCP extension

3. Palmaris longus → extensor pollicis longus to improve thumb extension

What is an example of safe zone 1 for tendon repairs?

Picking up an apple

What is an example of safe zone 5 for tendon repairs?

Opening an easy drawer

What is an example of safe zone 10 for tendon repairs?

Yellow resistance band

What is an example of safe zone 20 for tendon repairs?

Pulling on a stuck drawer

What is an example of safe zone 40 for tendon repairs?

Max pressure

What is primary grafting tendon reconstruction?

Remove the injured tendon and replace with a pulley system

What is the 2-stage tendon reconstruction?

Stage 1. Silicone rod is inserted to create the space and fake sheath

Stage 2. Input a tendon graft after 3 months of rod placement

What is mallet finger?

When the DIP tendon is injured and cannot extend

What are the 2 phases of treatment for mallet finger?

Phase 1. weeks 1-8 keep DIP joint in full extension

Phase 2. weeks 8+ wean from splint and begin AROM (monitor for extension lag)

What is swan neck deformity?

PIP is in hyperextension and DIP is in flexion

What is the 2 phases of treatment for swan-neck deformity?

Phase 1. weeks 0-6 of PIP in orthosis at 30° flexion and DIP at 0° days 3-14 can start AROM allowing full flexion of PIP but limits extension to 30°

Phase 2. weeks 6-10 adjust orthosis to allow increased extension and can begin strengthening for flexion

What is Boutonniere deformity?

When the PIP is flexed but the DIP is extended

What is extensor tenolysis?

Surgical incision to remove scar tissue binding the tendon to surrounding tissues