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Functional deficits in the hand arise most commonly as sequelae of radial, median, or ulnar nerve injury, but can also be secondary to brachial plexus injury, spinal cord injury, specific muscle or tendon injury, or as a result of polio. Additionally, non-displaced distal radius fractures treated non-operatively can lead to attritional rupture of the extensor pollicis longus. Tendon transfers are used to address functional deficits created by these conditions. This activity describes the indications, contraindications, complications, and technique of hand tendon transfers. Objectives: Identify the types of nerve injuries that can occur in the hand and wrist that may require tendon transfers. Describe the indications for hand tendon transfers. Recall the contraindications of hand tendon transfers. Summarize the importance of improving care coordination among the interprofessional team to enhance the delivery of care for patients undergoing hand tendon transfers. Access free multiple choice questions on this topic.

Functional deficits in the hand arise most commonly as sequelae of radial, median, or ulnar nerve injury, but can also be secondary to brachial plexus injury, spinal cord injury, specific muscle or tendon injury, or as a result of polio. Additionally, non-displaced distal radius fractures treated non-operatively can lead to attritional rupture of the extensor pollicis longus. Tendon transfers are used to address functional deficits created by these conditions. Much of what we know today about tendon transfers was learned in treating paralyzed limbs associated with polio and injured soldiers during World Wars I and II.

Donor tendons are attached to recipient tendons most commonly using the Pulvertaft weave. Utilizing this method, the donor tendon is woven back and forth through the substance of the recipient's tendon with each pass 90 degrees perpendicular to the previous pass and fixed to the tendon using a mattress suture of 2-0 or 3-0 ticron or fiberwire depending on surgeon preference and the size of the tendon. A minimum of three passes should be used for appropriate strength. Complications are related mainly to an improper initial graft tensioning and repair site rupture or loosening as a result of slit propagation or knot failure. Alternative repair techniques (spiral linking and loop-tendon suture) can be used based on surgeon preference to help improve the biomechanical strength of the repair site with the tradeoff of increased bulk of the repair. [7][9]

Functional deficits in the hand arise most commonly as sequelae of radial, median, or ulnar nerve injury, but can also be secondary to brachial plexus injury, spinal cord injury, specific muscle or tendon injury, or as a result of polio. Additionally, non-displaced distal radius fractures treated non-operatively can lead to attritional rupture of the extensor pollicis longus. Tendon transfers are used to address functional deficits created by these conditions.