We are waiting for a second opinion on the timing of a tendon transfer for my husband. He injured his thumb last spring and it's still not recovered. How do surgeons decide when to wait and when to proceed?
The timing of tendon transplants is a matter of considerable debate. Early transfers (done within the first weeks after injury) create what is called an internal splint. An internal splint works much like and external splint (one that is strapped on around the arm). Whether an internal or external spling, the effect is to hold the arm in place so the tendons and ligaments don't get overstretched or the joints contracted (so tight it can't move fully).
Nerve recovery may be spontaneous as a result of the normal, natural healing process. Or it can be helped along by surgery to repair damage to the nerve. Until it's clear what's going on, tendon transfers can be delayed -- sometimes by weeks to months (up to 18 months).
When it's clear that the nerve to an individual muscle isn't going to recover, then surgery is done to transfer a tendon to take over the function of the muscle no longer innervated by the damaged nerve. The surgeon can't take any tendon. It must be one powerful enough to accomplish the task needed. The donor tendon must also move like the tendon it is replacing in order to provide the function needed.
Understanding the anatomy (location of nerves and the muscles they supply) and what to expect in recovery is essential. This knowledge aids in making the decision about timing of tendon transfers as well.
And although the surgeon's role is very important, it is important to recognize the value and benefit of a multidisciplinary (team) approach. That team is made up of the patient, parents (if the patient is a child), nurses, therapists, and electrodiagnosticians (nerve testing). Everyone's contribution to the patient's care is a valued part of patient care, recovery, and rehabilitation.
Joshua A. Ratner, MD, et al. Update on Tendon Transfers for Peripheral Nerve Injuries. In The Journal of Hand Surgery. August 2010. Vol. 35-A. No. 8. Pp. 1371-1381.
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