1. Tendon Transfers for Radial Nerve Palsy Mr Andrew Mahon Consultant Orthopaedic and Hand Surgeon University Hospital of North Durham

2. Principles of Tendon Transfers (1) Correction of contracture Adequate strength Amplitude: 30 / 50 / 70 Straight line of pull One tendon one function

3. Principles of Tendon Transfers (2) Synergism Expendable donor Tissue equilibrium

4. Timing Internal Splint Expected time / degree of recovery

5. Shopping List What do you need? What do you have? What can you use?

6. Jones Transfers 1916 PT to ECRL and ECRB FCU to EDC III-V FCR to EIP, EDC II, and EPL

7. Jones Transfers 1921 PT to ECRL and ECRB FCU to EDC III-V FCR to EIP, EDC II, EPL, EPB, and APL

8. Radial Nerve Transfers (1) FCR Transfer (Starr, Brand, Tsuge and Adachi ) PT to ECRB FCR to EDC PL to rerouted EPL

9. Radial Nerve Transfers (2) Superficialis Transfer (Boyes ; Chuinard et al ) PT to ECRL and ECRB FDS III to EDC FDS IV to EIP and EPL FCR to APL and EPB

10. Radial Nerve Transfers (3) FCU Transfer PT to ECRB FCU to EDC PL to reroute EPL

11. FCR combination Maintain power of wrist ulnar deviation FCR tendon longer and thinner than FCU –Easier to harvest

12. FCR Combination Pronator Teres to ECRB Strip of periosteum

13. FCR Combination FCR to EDC

14. FCR Combination Palmaris longus to rerouted EPL

15. Tendon Transfers in General Know principles What is deficit? Will it recover? – When? What substitutes are available?