This document discusses radial nerve palsy and tendon transfer surgery. It begins with an overview of the radial nerve's innervation and muscle involvement. Next, it covers clinical findings, diagnosis, and indications for tendon transfer surgery. Technical considerations are provided for common tendon transfer procedures like pronator teres to extensor carpi radialis brevis. Post-operative care and a 12 week rehabilitation plan are also outlined.

1. Radial nerve palsy
Tendon transfer

2. Radial Nerve
Introduction
• Arise from Posterior Cord of plexus brachialis
• Innervation
• Tricep brachii muscle of the arm
• Posterior compartement of the forearm (extensor)
• Wirst joint
• Dorsal skin forearm and hand

3. Cont
• Muscle Innervation
• Triceps
• Anconeus
• ECRL
• ECRB
• Brachioradialis

4. Cont
• Deep Innervation
• Extensor digitorum
• Supinator muscle
• Ext. Digiti Minimi
• Ext. Carpi ulnaris
• Abductor pollicis longus
• Extensor pollicis longus
• Extensor pollicis brevis
• Ext. Indicis Propious
• Superficial Innervation
• Posterior cutaneous nerve
• Superficial brach radial
nerve
• Dorsal digital brach

5. Diagnosis
Clinical Finding
Motoric
• Forearm Supinate
• Brachioradialis + Supinator muscle (-
)
• Forearm extention (-), Injury in the
Axilla Region
• Extend wrist (-)
• ECRL + ECRB (-)
• Extend the finger (-)
• Grip strenght (-)
Sensoric
• Sens. Posterior forearm (-)
• Lateral 3 and 1/2 ring finger
(-)
• Dorsum of hand

6. Diagnostic
• EMG
• Show the impuls transmision (diff. Nerve inj. VS muscle Inj)
• Also Follow up management (after therapy)
• USG
• MRI

7. Indication
Tendon Transfer
• NO POTENTIAL IMPROVEMENT
• Physically irreparable
• Root Avulsion
• Nerve Injury (donot recover after direct nerve repair/graft/transfer)
• Present so Late

8. Technical consideration
Pronator teres + Extensor Carpi Radialis Brevis
• Dividing pronator ters tendon from distal attachment
• Harvest the long strip of periosteum in continuity, have long enough harvest
• Inserted end to end or end to side to ECRB
• Insertion to the ECRB and ECRL, cause to much radial deviation, shud be
avoided

9. Felxor Carpi Radialis + Extensor Digitrum Communis
• FCR digunakan untuk memberikan kekuatan untuk otot EDC melakukan
ektensi metacarpophalangeal joint
• Untuk kombinasi otot yang bisa digunakan yaitu, FCR atau FCU + EDC
• Harvest dari FCR harus dilakukan seproksimal mungkin dengan Felxor
retinaculum untuk mencegah terjadinya bow-stringing

10. Palmaris longus + Extensor Pollicis Longus
• PL digunakan untuk memberi kekuatan pada EPL (Thumb)
• EPL harus dipisahkan seproksimal mungkin dengan musculotendinous
junction
• EPL akan di transpose ke arah radial melalui Lister's tubercle
• Provide some radial abduction of the thumb

12. Post operative care & Rehabilitation
Post operative position
• Elbow shud be flexed 90, forearm pronated, wrist extened 30
• Thumb shud be abducted + extended
• Metacarpophalengeal joint extended
• Interphalangeal joint left free

13. Rehabilitation
• Splint bisa di ganti setelah 1-2 minggu pasca operasi untuk evaluasi Luka operasi, dan refit
the splint
• Selama 4 minggu pasca operasi, penting untuk mempertahankan ROM Shoulder +
Interphalange joint
• Pada minggu ke 4 dapat dimulai untuk mobilisasi single joint
• Elbow flexion and extension, will be performed with wirst and finger extended, and
forearm pronated
• Wirst flexion and extension, will be performed with finger extend and elbow flexed
• Finger metacarpophalangeal flexion and extension, will be performed with elbow
flexed and finger interphalangeal joint extened

14. Rehabilitation
• Minggu ke 6 pasca operasi, fokus pergerakan aktif pada otot2 yang telah
dilakukan tendon transfer
• Minggu ke 8 pasca operasi, fokus rehabilitasi untuk kekuatan otot2 yang telah
dilakukan tendon transfer dan can weaned off the splint.
• Minggu ke 12, Full activity