This 2013 JAAOS review by Seiler et al defines the eight operative principles governing tendon transfer selection. It then applies them systematically to reconstruction after radial, median, and ulnar nerve palsy — covering donor selection, excursion matching, transfer tensioning, and postoperative rehabilitation for each nerve territory.
When you evaluate a patient with peripheral nerve palsy for tendon transfer, two questions come before anything else: Is the donor strong enough (4/5 or 5/5), and does it have enough excursion for the task?
For a patient with low median nerve injury, do not assume opponensplasty is needed — examine the thumb. Jensen's data show 86% of these patients retain enough opposition to not need reconstruction, because innervation variability often preserves thenar function.
For radial nerve palsy, give the nerve 3 months if it is intact. If EMG remains abnormal at 3 months, spontaneous recovery is unlikely and transfer planning should begin. FCR-to-EDC is preferred over FCU-to-EDC because it preserves the dart thrower's motion and power grip.
For ulnar claw correction, counsel patients preoperatively that both Zancolli lasso and Stiles-Bunnell transfers risk swan neck deformity by removing FDS influence on the PIP joint. The one level I trial in this article supports allowing immediate active motion after claw correction. Earlier pain relief with no compromise in final outcome.
This 2013 JAAOS review by Seiler et al defines the eight operative principles governing tendon transfer selection. It then applies them systematically to reconstruction after radial, median, and ulnar nerve palsy — covering donor selection, excursion matching, transfer tensioning, and postoperative rehabilitation for each nerve territory.
When you evaluate a patient with peripheral nerve palsy for tendon transfer, two questions come before anything else: Is the donor strong enough (4/5 or 5/5), and does it have enough excursion for the task?
For a patient with low median nerve injury, do not assume opponensplasty is needed — examine the thumb. Jensen's data show 86% of these patients retain enough opposition to not need reconstruction, because innervation variability often preserves thenar function.
For radial nerve palsy, give the nerve 3 months if it is intact. If EMG remains abnormal at 3 months, spontaneous recovery is unlikely and transfer planning should begin. FCR-to-EDC is preferred over FCU-to-EDC because it preserves the dart thrower's motion and power grip.
For ulnar claw correction, counsel patients preoperatively that both Zancolli lasso and Stiles-Bunnell transfers risk swan neck deformity by removing FDS influence on the PIP joint. The one level I trial in this article supports allowing immediate active motion after claw correction. Earlier pain relief with no compromise in final outcome.