Tendon transfers in reconstructive hand surgery

188 Pages·2005·4.847 MB·English

by  Fridň, Jan

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Tendon Transfers in
Reconstructive Hand Surgery
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Tendon Transfers in
Reconstructive Hand Surgery
Jan Fridén MD, PhD
Professor of Hand Surgery
Sahlgrenska University Hospital
Göteborg
Sweden
Published in association with
Federation of European Societies
for Surgery of the Hand
CRC Press
Taylor & Francis Group
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Version Date: 20130325
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Freiden Prelims 25/5/05 2:05 pm Page v
Contents
Preface vii
Acknowledgements ix
About the authors xi
List of contributors xiii
1. Muscle architectural and biomechanical considerations 1
in tendon transfer
Richard L Lieber
2. Historical aspects of tendon transfers 21
Michael J Botte, Lorenzo L Pacelli
3. Basic principles in tendon transfer surgery 29
Michael J Botte , Lorenzo L Pacelli
4. Musculotendinous unit transfers after nerve injury 51
Rolfe Birch, Thomas Carlstedt
5. Tenodeses in reconstructive hand surgery 69
Caroline Leclercq
6. Patient’s perspective 85
Claes Hultling
7. Reconstruction of elbow extension in tetraplegia 91
Jan Fridén
8. Reconstruction of grip function in tetraplegia 103
Arvid Ejeskär
9. Tendon transfers in the congenital hand 121
Steven ER Hovius, Sarah L Versnel, J Michiel Zuidam
v
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vi TENDON TRANSFERS IN RECONSTRUCTIVE HAND SURGERY
10. Tendon transfers in cerebral palsy 133
Ann Nachemson
11. Tendon transfers in rheumatoid arthritis 149
Lorenzo L Pacelli, Michael J Botte
Appendix: Testing of upper extremity muscle functions 169
Index 179
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Preface
Instructional courses traditionally cover impor- directly involved in the rehabilitation as well as
tant and difficult clinical problems. An addi- carefully instructing occupational therapists
tional motivation for assembling the pre-eminent and physiotherapists in postoperative patient
experts in this field to present an instructional care. It is, after all, only the responsible surgeon
course is to update the knowledge base within a who knows the details of the surgical procedure
field that experiences new developments. The performed. This is where experience becomes
topic of ‘Tendon Transfers in Reconstructive so important. We are all aware that there are no
Hand Surgery’ is indeed one of these fields, and short-cuts in our endeavor for perfection in the
there is no doubt that the contributors to this highly demanding and exquisite field of recon-
volume are the world’s authorities. structive hand surgery.
Surgical tendon transfers involve the careful The experts play an important role in
assessment of lost motor function, or more developing our field of expertise by critically
often, a combination of lost functions. The analyzing current treatment strategies as well
assessments themselves are quite challenging. as initiating and executing studies in a scientif-
They include intriguing functional measure- ically sound manner. The content of this book
ments, and very often true control comparisons spans from advanced biomechanical modeling
are not possible as the neuromuscular injury or and predictions to practical guidelines on how
disease itself is bilateral. The surgeries them- to perform the actual surgical procedures. It is
selves are also technically challenging, as there my hope that this instructional course will
are many complicated real-time decisions to be provide new surgeons with the tools to plan
made. During surgery there are several techni- and execute sound tendon transfer procedures.
cal details that need to be addressed. For exam- Perhaps more important, I hope that the
ple, selection of donor muscles, routing of course will infuse the field with new and
donor muscles, tissue preparation and challenging ideas that will ultimately improve
optimization, tensioning of muscle–tendon the care of our patients. The faculty of con-
units, balancing joints and suturing attach- tributors to this book is impressive to say the
ments. Postoperatively, the surgeon needs to be least.
Jan Fridén MD PhD
Professor of Hand Surgery
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Acknowledgements
I am indebted to many who have contributed hard to make this compendium a modern, evi-
to this endeavor. All of the information in this dence-based, science-based and important sup-
book resulted from clinical and experimental plement to the hand surgery literature. I thank
research as well as personal experience from Maria Knall for help in preparing manuscripts
many years of reconstructive hand surgery. I in final form and Björn Fridén for expert image
would like to thank the authors for working so processing assistance.
ix
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About the authors
Dr Richard L Lieber has an impressive track neonatal plexus injury. He has not only devel-
record of more than 25 years of world-class sci- oped the surgical techniques required in this area
ence in the field of muscle mechanics and bio- but has also provided new and invaluable guide-
physics. His authoritative chapter ‘Muscle lines for injury examination and classification.
architectural and biomechanical considerations He has defined and refined the prognostic fac-
in tendon transfer’ is exactly the kind of infor- tors that are important for effective communica-
mation that surgeons who aspire to obtain and tion with patients, parents and care-givers. We
maintain technical skill in this field need to are all proud of Dr Birch’s willingness to share
process and incorporate into their decision- with younger colleagues his vast knowledge in
making during reconstructive hand surgery. Dr this challenging field of reconstructive surgery.
Lieber provides a reader-friendly catalog of the Dr Caroline Leclercq has long experience of
facts on tendon and muscle mechanics neces- surgical rehabilitation of the upper limbs after
sary for understanding the underlying anatomi- traumatic nerve injury and tetraplegia. She is a
cal and biomechanical basis for tendon transfer leader in her field of expertise and has published
surgery. several important articles regarding surgical
Dr Michael J Botte is a hand surgeon with approaches and functional assessments in
unique expertise in upper-extremity anatomy. reconstructive hand surgery. Her chapter ‘Ten-
Dr Botte has participated in much of the semi- odeses in reconstructive hand surgery’ is indeed
nal work in muscle anatomy that forms the basis authoritative and insightful. Dr Leclercq pro-
for upper-extremity surgery. His clinical expert- vides the reader with a catalog of established
ise and surgical experience make him uniquely and newer strategies on how to use tenodeses
qualified to write his chapters, entitled ‘Histori- both independently as well as integrated in the
cal aspects of tendon transfers’ and ‘Basic princi- active tendon transfer augmentation.
ples in tendon transfer surgery’. Dr Botte is a Dr Thomas Carlstedt has a unique skill
prolific writer and lecturer in the field of upper- ranging from high-class experimental studies of
extremity surgery, with special emphasis on neu- nerve repair and regeneration to advanced clin-
romuscular disorders such as stroke, head injury, ical practice in plexus brachialis and peripheral
spinal cord injury and peripheral nerve injury. nerve surgery and microsurgery. His training
Dr Rolfe Birch is a world-renowned author- and interest in basic science together with his
ity in the field of surgical reconstruction of endless quest for perfection in reconstructive
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xii TENDON TRANSFERS IN RECONSTRUCTIVE HAND SURGERY
upper-extremity surgery makes Dr Carlstedt the stand and, if necessary, incorporate new infor-
perfect role-model of a high-profile academic mation into his practice that will benefit the
surgeon. Dr Carlstedt has advanced surgical treatment of his patients.
techniques beyond levels not even imaginable Dr Steven Hovius has devoted his clinical
just 10 years ago. and academic skills to the treatment of congen-
In his chapter ‘Patient’s perspective’, Dr ital malformations. His strong scientific back-
Claes Hultling gives not only his own personal ground has provided him with the necessary
perspective of treating patients with tetraplegia tools to investigate intriguing clinical problems
but also his personal experience of being para- using sophisticated techniques. In his basic sci-
lyzed himself after a traumatic cervical spinal ence studies, Dr Hovius has investigated the
cord injury. His insights into every corner of the mechanical function of peripheral nerves, pre-
patient’s daily life as well as his vast knowledge vention of neural adhesions and many other
of challenges and successes at all levels of reha- aspects of neuromuscular control and optimiza-
bilitation certainly are eye-opening. Dr tion. In addition to these basic studies, Dr Hov-
Hultling’s strong belief in a holistic perspective ius has applied advanced techniques to map the
applied to treatment and care, together with his effects of surgical correction of congenital
seemingly never-ending enthusiasm and strong deformities and he has outlined strategies for
leadership, are unique assets that all surgeons assessment and classification of congenital hand
and surgeons under training can learn and ben- abnormalities.
efit from tremendously. Dr Ann Nachemson has developed an inter-
Dr Jan Fridén provides a unique perspective nationally acclaimed treatment program for
as one of the few practicing hand surgeons with spasticity in children with cerebral palsy. In her
a PhD in Muscle Anatomy. This state-of-the art chapter ‘Tendon transfers in cerebral palsy’ she
perspective on muscle structure and function summarizes and discusses the current strategies
permits Dr Fridén the opportunity to develop for reconstructions. Detailed descriptions of the
new surgical methods, define surgical goals pre- generally accepted surgical techniques, the pros
cisely and test current concepts in tendon trans- and cons in the choice of procedure as well as
fer surgery. As Editor of this volume, Dr Fridén the personal preference of an experienced sur-
has provided an invaluable service to the aca- geon, make this chapter a ‘must read’ for any-
demic community in recruiting the world’s one interested in the field of reconstructive sur-
foremost experts to provide their unique gery in spasticity.
insights into this important topic. Dr Lorenzo L Pacelli has provided a valuable
Dr Arvid Ejeskär has devoted the past resource to the hand surgery community with
20–25 years to the surgical treatment of his chapter entitled ‘Tendon transfers in
tetraplegic patients. Dr Ejeskär was trained rheumatoid arthritis’. Dr Pacelli is currently
under the strong guidance of the late Professor active in research involving rheumatoid patients
Erik Moberg and has not only adopted that includes several research projects concern-
Moberg’s level of surgical skill but also devel- ing joint replacement and tendon transfer. His
oped and perfected methods for assessment and fellowship training with Dr David Green in San
surgical treatment of tetraplegic patients. Dr Antonio has provided him with an almost ency-
Ejeskär has a reputation for never compromis- clopedic knowledge in the area. As one of the
ing, in order to make the function of the youngest contributors to this volume, Dr
tetraplegic patient as good as possible. Dr Pacelli’s level of excellence bodes well for the
Ejeskär’s eyes and ears are alwaysopen to under- future of this exciting field.
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List of contributors
Rolfe Birch MChir FRCS Jan Fridén MD PhD
Peripheral Nerve Injury Unit Department of Hand Surgery
Royal National Orthopaedic Hospital Sahlgrenska University Hospital
Brockley Hill, Stanmore SE-413 45 Göteborg
Middlesex, HA7 4AP Sweden
UK
Steven ER Hovius MD PhD
Michael J Botte MD Research Unit Afdeling Plastische en
Hand and Microvascular Reconstructive Reconstructieve Chirurgie
Surgery Section Erasmus MC Rotterdam, Faculteit, kamer Ee
Division of Orthopaedic Surgery 15.91
Scripps Clinic Dr Molewaterplein 50
La Jolla, CA 92037 3015 GE Rotterdam
USA The Netherlands
Thomas Carlstedt MD PhD Claes Hultling MD PhD
Peripheral Nerve Injury Unit Spinalis
Royal National Orthopaedic Hospital Karolinska University Hospital
Brockley Hill, Stanmore SE-169 89 Stockholm
Middlesex, HA7 4AP Sweden
UK
Caroline Leclercq MD
Arvid Ejeskär MD PhD Institut de la Main
Department of Hand Surgery 6 Square Jouvenet
Sahlgrenska University Hospital 75016 Paris
SE-413 45 Göteborg France
Sweden
xiii