Presentation and Management Outcome of High Radial Nerve Palsy with Tendon Transfers

Document Type : RESEARCH PAPER

Author

Consultant Plastic surgeon and Head of Plastic Surgery Department, National Institute of Rehabilitation Medicine (NIRM), Islamabad, Pakistan

Abstract

Background: This randomized clinical trial was carried out to document the clinical presentation of isolated high
radial nerve palsy (high RNP) and compare the outcome of triple tendon transfers.
Methods: The study included patients of all genders and ages who presented with isolated high RNP. Half of them
were randomly assigned to the flexor carpi radialis set (FCR-set) of tendon transfers (group A) and a half to the
flexor carpi ulnaris (FCU-set) of tendon transfers (group B).
Results: Out of 44 patients, 38 were males, and 6 were females. The age ranged from 7 years to 55 years.
26(59.09%) patients had primary RNP in association with fractures of the humerus. The postoperative mean
disability of arm, shoulder, and hand score (Quick DASH-11 score) for the patients in the FCR-set of transfers was
34.54%% versus 41.81% for the FCU-set of transfers. 11 patients (25%) developed radial deviation deformity.
Conclusion: RNP was predominantly found among males of the young age group, and the majority of the cases
resulted from preventable causes. The triple tendon transfers among patients of the two groups robustly restored
the lost extension of the wrist and digits in a matching way. The patients also subjectively reported remarkable
improvement in terms of the favorable Quick-DASH-11 scores. Radial deviation deformity occurred among half of
the patients who underwent the FCU set of tendon transfers.
Level of evidence: II

Keywords


1. Laulan J. High radial nerve palsy. Hand Surg Rehabil.
2019; 38(1):2–13.
2. Davis TRC. Principles of tendon transfers of
median, radial, and ulnar nerves. In: Wolfe SW,
Pederson WC, Hotchkiss RN, Kozin SH, Cohen MS,
editors. Green’s textbook 7th ed. Philadelphia:
Elsevier; 2017. P.1023-1079.
3. Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis
PV. Radial nerve palsy associated with fractures of the
shaft of the humerus: a systematic review. J Bone Joint
Surg Br. 2005; 87(12): 1647–52.
4. Sammer DM, Chung KC. Tendon transfers part 1:
Principles of transfer and transfers for radial nerve
palsy. Plast Reconstr Surg. 2009; 123(5): 169e–177e.
5. Schwab TR, Stillhard PF, Schibli S, Furrer M, Sommer
C. Radial nerve palsy in humeral shaft fractures with
internal fixation: analysis of management and outcome.
Eur J Trauma Emerg Surg. 2018; 44(2):235-43.
6. Carlan D, Pratt J, Patterson MM, Weiland AJ, Boyer MI,
Gelberman RH. The radial nerve in the brachium: an
anatomic study in human cadavers. J Hand Surg Am.
2007; 32(8): 1177–82.
7. Shoji K, Heng M, Harris MB, Appleton PT, Vrahas MS,
Weaver MJ. Time from injury to surgical fixation of
diaphyseal humerus fractures is not associated with
an increased risk of iatrogenic radial nerve palsy. J
Orthop Trauma. 2017; 31(9): 491–6.
8. Beaton DE, Wright JG, Katz JN, Group UEC.
Development of the QuickDASH: comparison of three
item-reduction approaches. J Bone Joint Surg Am.
2005; 87(5):1038-1046.
9. Ebrahimzadeh MH, Moradi A, Vahedi E, Kachooei AR,
Birjandinejad A. Validity and reliability of the Persian
version of shortened disabilities of the arm, shoulder
and hand questionnaire (quick-DASH). Int J Prev Med
2015; 6:59.
10. Moussavi AA, Saied A, Karbalaeikhani A. Outcome of
tendon transfer for radial nerve paralysis: Comparison of
three methods. Indian J Orthop. 2011; 45(6): 558–562.
11. Vaishnani HV, Jasani JH, Gandotra A, Shah GV. A
study on range of movement (radial deviation, ulnar
deviation, flexion and extension) of wrist joint. Int J
Health Sci Res. 2016; 6(5):94-100.
12. Claessen FM, Peters RM, Verbeek DO, Helfet DL, Ring D.
Factors associated with radial nerve palsy after operative
treatment of diaphyseal humeral shaft fractures. J
Shoulder Elbow Surg. 2015; 24(11): e307–11.
13. Bumbasirevic M, Palibrk T, Lesic A, Atkinson H. Radial
nerve palsy. EFORT Open Rev. 2017; 1(8): 286–94.
14. Reichert P, Wnukiewicz W, Witkowski J, Bochenska A,
Mizia S, Gosk J, et al. Causes of secondary nerve palsy
and results of treatment. Med Sci Monit. 2016; 22:
554–62.
15. Trigo L, Sarasquete J, Noguera L, Proubasta I, Lamas C.
Radial nerve injury following elbow external fixator:
report of three cases and literature review. Arch
Orthop Trauma Surg. 2017; 137(7): 953–7.
16. Karabeg R. Assessment of the forearm tendon transfer
with irreparable radial nerve injuries caused by war
projectiles. Med Arch. 2019; 73(6): 415-420.
17. Taha A, Taha J. Results of suture of the radial, median,
and ulnar nerves after missile injury below the axilla.
J Trauma. 1998; 45(2): 335–9.
18. Murovic JA. Upper-extremity peripheral nerve
injuries: a Louisiana State University Health Sciences
Center literature review with comparison of the
operative outcomes of 1837 Louisiana State University
Health Sciences Center median, radial and ulnar nerve
lesions. Neurosurgery. 2009; 65(4): A11-A17.
19. Nalbantoglu U, Ozkan T, Turkmen M. Results of tendon
transfer in irreparable radial nerve palsy. Acta Orthop
Traumatol Turc. 2008; 42(5):350-357.
20. Richford J, Abdullah S, Norhafizah M, Juliana I,
Rashdeen F, Razana A. Outcome of tendon transfers
for radial nerve palsy in a Malaysian tertiary centre.
Malaysian Orthop J. 2018; 12 (1): 1-6.
21. Martí􀆴nez-Villén, G, Muñoz-Marí􀆴n, J, Pérez-Barrero
P. Are tendon transfers justified in very old hand
radial palsies? J Plast Recon Aesthetic Surg. 2012;
65(10):e293-e296.
22. Boyes JH. Tendon transfers for radial palsy. Bull Hosp
Joint Dis. 1960; 21:97–105.
23. Brand PW. Clinical Mechanics of the hand. St Louis: CV
Mosby; 1985.
24. Altintas AA, Altintas MA, Gazyakan E, Gohla T,
Germann G, Sauerbier M. Long term results and the
disabilities of the arm, shoulder, and hand score
analysis after modified brooks and d’Aubigne tendon
transfer for radial nerve palsy. J Hand Surg Am. 2009;
34(3):474–478.
25. Tsuge K. Tendon transfers for radial nerve palsy. Aust
N Z J Surg. 1980; 50(3):267–272.
26. Ropars M, Dreano T, Siret P, Belot N, Langlais F.
Long-term results of tendon transfers in radial and
posterior interosseous nerve paralysis. J Hand Surg
Br. 2006; 31(5):502–506.
27. Dabas V, Suri T, Surapuraju PK, Sural S, Dhal A.
Functional restoration after early tendon transfer in
high radial nerve paralysis. J Hand Surg Eur. 2011;
36(2): 135-40.
Volume 9, Issue 5
September and October 2021
Pages 578-584
  • Receive Date: 16 September 2020
  • Revise Date: 04 December 2020
  • Accept Date: 30 November 2020