Training of muscle excursion after tendon transfer.
In tendon transfer (TT) surgery there is usually a discrepancy in excursion between the muscle(s) to be replaced and the transferred muscle(s). For example, in patients with radial palsy the pronator terres (PT) muscle is frequently used to replace the wrist extensors. However, the excursion of the PT is less than the extensor of the wrist and therefore needs to double its length to allow for full wrist movement. Questions arise about whether or not the PT will increase its fiber length after transfer for wrist extension and how therapy can positively influence usable excursion of the transferred muscle-tendon unit. Most classifications of results accept the flexion of the wrist will remain limited after TT of the PT. This article presents a patient with TT of the PT who accomplished a wrist total active range of motion (TAM) of 125 degrees (wrist extension 0-60 degrees, flexion 0-65 degrees). Based on this observation, the authors assume that the PT muscle has indeed increased its excursion after TT. The authors conclude that limited wrist excursion should not be accepted too soon, but therapists have to familiarize themselves with methods for "excursion training" and possibly change the existing methods of evaluating the results of TT of the PT.
Schreuders
T A
TA
Department of Rehabilitation, University Hospital Rotterdam-Dijkzigt, The Netherlands.
Stam
H J
HJ
Hovius
S E
SE
D000328:Adult; D006225:Hand / Q000502:physiology*; D018737:Hand Strength; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery; D008297:Male; D018482:Muscle, Skeletal / Q000502:physiology*; D010243:Paralysis / Q000601:surgery; D026741:Physical Therapy Modalities / Q000379:methods*; D011182:Postoperative Care; D011826:Radial Nerve; D016059:Range of Motion, Articular; D013165:Splints; D013709:Tendon Transfer