Introduction
The muscular cord that connects a muscle to the bone at both ends is known as a tendon. The muscles and tendons work together to move the joints. There are more than forty distinct muscles in the hand and forearm. Many of these muscles have overlapping roles. People may experience muscle dysfunction following an injury. A tendon transfer involves surgery to replace a non-functioning tendon with a working tendon.
What Is Tendon Transfer?
A tendon transfer is the moving or transferring of a functional tendon from one part of the body to another. Tendons are frequently moved to help a foot or ankle that has lost function move more normally. Loss of the ability to lift the foot, often known as "foot drop," is a common issue.
Damage to the nerves or muscles as a result of a stroke, an accident, or other illnesses can cause this. The foot may become bent or twisted as a result of muscle weakness or paralysis, making it painful or difficult to stand, walk, or wear shoes.
A few tendon transfers enable the ankle and foot to flex and extend as well as regain some strength and motion. Others position the foot to make it easier to walk, stand, and wear shoes, but they do not increase the range of motion. Also, by distributing pressure across the foot more evenly, realigning the foot and ankle helps lessen pain. A tendon transfer may, in some circumstances, completely replace the need for a brace.
Who Requires a Tendon Transfer Procedure?
Surgery for tendon transfer can be used to address a wide range of disorders.
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Nerve Injury: When a nerve injury results in the loss of a particular muscle function, tendon transfer surgery is required. A damaged nerve that cannot be healed stops sending messages to particular muscles. These muscles lose their ability to move and are paralyzed. To try to restore that function, surgeons can transfer tendons. Tendon transfer surgery is frequently used to treat injuries to the spinal cord, radial nerve, ulnar nerve, or median nerve.
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Muscle Injury: When a muscle has ruptured or been torn and cannot be healed, tendon transfer surgery may also be required. Tendon ruptures from rheumatoid arthritis or fractures are common muscle or tendon injuries that are treated by tendon transfer surgery. Additionally, tendon transfer surgery may be used to treat irreparable tendon lacerations after injury.
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Neuromuscular Disorder: In cases when a muscle function has been lost as a result of a nervous system problem, tendon transfer surgery may also be required. In this, for instance, an illness or injury to the neurological system prevents the normal nerve signals from reaching a muscle, leading to an imbalance in the function of the hand. Tendon transfers may be used to address muscle imbalance or muscle atrophy brought on by nervous system disorders. Cerebral palsy, stroke, traumatic brain traumas, and spinal muscular atrophy are common nervous system conditions that are treated by tendon transfer surgery.
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Birth Defects: Babies can be born without some muscle functions under specific circumstances. In some cases, tendon transfer surgery may be used to restore the missing muscle functions. Hypoplastic thumbs and brachial plexopathy (a condition of brachial plexus disorder in which the arm or hand has numbness, tingling, discomfort, weakness, or restricted movement) are two common birth defects that can be treated with tendon transfer surgery.
What Occurs During Surgery to Transfer a Tendon?
There are more than forty muscles below the elbow. Different muscles serve various functions. For instance, the thumb is moved by nine different muscles. Each muscle has a beginning (origin), a tendon that tapers down from its muscular belly into a bone (insertion) in a specific location, and when the muscle fires (contracts), it produces a particular motion (action).
The muscle's origin, as well as the muscle's nerve and blood supplies, are all preserved during tendon transfer surgery. The tendon's attachment to the bone is separated and moved to a new location. Different bones and different tendons may be used as the anchoring point. The muscle will function differently based on where it was placed after it has been moved when it fires.
What Is the Procedure for Tendon Transfer?
Patients can be fully aware during the procedure, slightly sedated, or entirely unconscious. The patient and the surgeon will decide what kind of anesthetic is best based on the severity of the injury. One or more skin incisions (cuts) are made by the surgeon. The surgeon locates the tendon of the excess muscle, transfers it, and stitches it into the tendon of the weak muscle. It may be necessary to perform multiple tendon transfers at once. The surgeon uses stitches to seal the skin.
How Is the Recovery After Tendon Transfer?
Following surgery, patients might need to wear a cast or splint to protect the newly transferred tendon while it heals and takes on its new position. Normally, healing takes one to two months. Depending on the situation, the surgeon will decide whether hand therapy is required and when to start the therapy. If hand therapy is prescribed, patients must attend and strictly adhere to the therapist's instructions. The both insufficient and excessive movement might lead to complications.
What Are the Complications of Tendon Transfer?
Early concerns can include:
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Bleeding.
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Infection.
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Damage to adjacent nerves, tendons, or blood vessels is uncommon.
Subsequent hazards include:
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Hand stiffness.
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Muscular weakening in the transferred area.
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Transfer rupture requires additional surgery.
What Options Are Possible for the Tendon Transfer Procedure?
The hand surgeon will be able to advise you on other treatment options. There may be other options, such as healing the damaged tendon or muscle or restoring the damaged nerve. In rare circumstances, tendon grafts can be used to close a gap in an injured tendon by removing a section of an intact tendon while leaving the muscle in place. In some situations, tendon lengthening or bone fusions could be required to rebuild hand function.
Conclusion
Tendons are moved from less critical to more critical roles at the distal connection to enhance overall function. When the muscular function is lost due to nerve injuries or injuries to the muscle or tendon unit, tendon transfers offer a permanent or temporary replacement.
