The Journal of Bone and Joint Surgery, Vol 72, Issue 3 427-432, Copyright © 1990 by Journal of Bone and Joint Surgery, Inc
Transfer of the pronator teres tendon to the tendons of the flexor digitorum profundus in tetraplegia
J Gansel, R Waters and H Gellman
Regional Spinal Cord Injury Care System of Southern California, Rancho Los Amigos Medical Center, Downey.
In eleven patients who had traumatic tetraplegia, the pronator teres tendon
was transferred to the flexor digitorum profundus tendons to restore active
flexion of the fingers. At the same time, in ten of these patients the
tendon of the brachioradialis was transferred to the tendon of the flexor
pollicis longus, and in the eleventh patient the brachioradialis tendon was
transferred to the tendon of the flexor digitorum superficialis of the
small finger, to restore pinch. The average time between injury and
operation was thirty-four months. The average length of follow-up after
operation was thirty-four months. Ten patients gained functional active
flexion of the fingers, and they reported improved performance of
activities of daily living. When the wrist was in 30 degrees of extension,
the average active grasp strength was twenty-one millimeters of mercury and
the average key-pinch strength was 2.2 kilograms. The average active
flexion of the fingers from the resting position, measured from the tip of
the finger to the distal palmar crease, was 1.5 centimeters. Only one
patient did not gain active flexion of the fingers. Of the entire group,
this patient had the least function of the hand on preoperative evaluation;
retrospectively, he seemed to be a poor candidate for operation, since the
strength of the pronator teres muscle and the sensibility of the hand were
insufficient for useful function. We concluded that, in selected
tetraplegic patients, transfer of the pronator teres tendon to the flexor
digitorum profundus tendons provides useful active flexion of the fingers.
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