Nerve reconstruction for hand and wrist

Nerve injury over upper limb causes varied function loss of wrist and hand, such as radial nerve injury may cause wrist and hand extension loss, median nerve injury may cause wrist and hand flexion loss, and ulnar nerve injury may cause intrinsic function loss. By using nerve transfer and tendon transfer, the hand and wrist function could be restored with satisfied outcomes. 

Radial nerve injuries cause significant disability, and it is not an uncommon injury, especially in patient with distal third humerus fracture. Tendon transfer has been used to restore the hand and wrist extension function with many modified procedures. Recently, more surgeons using nerve transfer to treat the radial nerve injury with a comparable outcome. To obtain an optimal outcome, we performed the tendon transfer and nerve transfer simultaneously. The results of simultaneous tendon transfer and nerve transfer showed that patients with radial nerve palsy could regain more than M4 hand and wrist extension recovery with ability to extend the wrist and digits simultaneously. 

Brachial plexus injury also affects hand and wrist function. The rationale underlying nerve transfer in brachial plexus injury is redirecting healthy proximal nerve axons onto paralyzed muscle-nerve units, effectively bypassing the injured zone of brachial plexus injury. Unlike tendon transfers, nerve transfers preserve native musculoskeletal mechanical advantages and don not require prolong limb immobilization. Moreover, nerve transfers leverage regenerating nerves’s potential for collateral axonal sprouting, such that one motor axon can reinnervate up to five recipient motor axons. With this potential expansion reinnervation, a single donor nerve could able to provide good to excellent control and dexterity, without permanent donor site mobility. We used the varied donor branch, such as branches of radial nerve, wrist flexor branches of median nerve, transferring to anterior interosseous nerve and flexor branches of ulnar nerve to restore lower arm type brachial plexus patients hand function with more than M4 hand flexion recovery.   

Paralytic hand and wrist, caused by nerve injury, is not an uncommon disease. With a well-designed nerve transfer with or without tendon transfer, we could treat the patients successfully with satisfactory outcomes.