STRATEGY and INDICATIONS

Group 2

Active extension of the wrist is possible but weak. It means that ECRL must not be used, and that BR only is available as motor for a transfer.

This muscle must be used to restore prehension, that is to say pinch (FPL) and/or grasp (FDP). Many teams use BR as a motor for the key-grip only. In our experience, if you have a motor for the pinch (BR or ECRL), this motor can efficiently restore both pinch and grasp, and it can be therefore transfered both to FPL and to FDP.

The main pitfall when you restore grasp in group 2 is that opening of the hand is not complete, because you can only restore passive extension of fingers MP, and mainly because excursion of the transfered BR is shorter than excursion of the extended fingers. Compared with the extraordinary benefit of a strong grasp, limitation of finger extension is not a drawback as much important for the patient as Moberg stated when he emphasized the caressing hand. Nevertheless, patient must be extensively informed about this point before any surgery, and it is important he can see patients who have undergone this surgical restoration. In our experience, most of our group 2 patients who underwent restoration of pinch and grasp asked the same operation to be performed on their other hand.

 

       

SITUATION

(see table)

Remaining functions
  • active flexion of the elbow
  • active but weak extension of the wrist
 
Paralysed functions
  • active extension of the elbow
  • active flexion of the wrist
  • all extrinsic and intrinsic functions of the fingers and thumb
 
Muscle available for transfers
  • BR only
 
       
       
       
       

SUGGESTED

SURGICAL PROGRAM

(3 stages)

1st surgical stage  
2nd surgical stage Postoperative immobilization : 4 weeks (elbow in flexion at 90, wrist in extension, fingers MP joints in flexion)
3rd surgical stage Postoperative immobilization : 4 weeks (elbow in flexion at 90, wrist in flexion, fingers MP joints in flexion, thumb in abduction and antepulsion)