Mateusz Gładysz FESSH prep

FESSH prep Compressive neuropathies chronic ulnar palsy — tendon transfers and capsulodesis

Tendon transfers and reconstructive procedures for chronic ulnar palsy

Last reviewed v1.0

FESSH-015Compressive neuropathies●●● advanced

Regarding tendon transfers and reconstructive procedures for chronic ulnar palsy, which of the following statements are true?

  1. 1.In chronic ulnar palsy, a negative Bouvier test indicates complex clawing and must be distinguished from loss of passive joint mobility.

  2. 2.The Zancolli lasso procedure is a static tenodesis used to correct claw deformity.

  3. 3.Transfer of the extensor indicis proprius to the adductor pollicis is the standard operation for restoring thumb adduction in low ulnar nerve palsy.

  4. 4.Flexor digitorum superficialis can be used as the motor donor to restore intrinsic function — for example, the Stiles–Bunnell transfer (FDS slips routed through the lumbrical canals to the radial lateral bands) or the Zancolli lasso (FDS looped through the A1 pulley).

  5. 5.Side-to-side tenodesis between the ulnar and median FDP tendons is principally used to correct claw deformity in low ulnar palsy.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-015
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. In chronic ulnar palsy, a negative Bouvier test indicates complex clawing and must be distinguished from loss of passive joint mobility.

    True

    Bouvier testing assesses whether blocking MCP hyperextension restores active IP extension. Failure indicates complex clawing. Passive range must be assessed separately: a supple complex claw may be treated with a tendon transfer that provides IP extension, including lateral-band insertion, whereas fixed contracture requires restoration of passive mobility before tendon transfer.

    • Sammer DM, Chung KC. Tendon transfers: Part II. Transfers for ulnar nerve palsy and median nerve palsy. Plastic and reconstructive surgery. 2009;124(3):212e-221e. PMID 19730287
    • Sammer DM, Chung KC. Tendon transfers: part I. Principles of transfer and transfers for radial nerve palsy. Plastic and reconstructive surgery. 2009;123(5):169e-177e. PMID 19407608

  2. 2. The Zancolli lasso procedure is a static tenodesis used to correct claw deformity.

    False

    The Zancolli lasso uses an active flexor digitorum superficialis slip looped through the A1 (or A2) pulley and sutured to itself; it is a dynamic transfer that produces active MCP flexion. Zancolli's earlier 1957 capsulodesis is the corresponding static operation.

    • Zancolli EA. Claw-hand caused by paralysis of the intrinsic muscles: a simple surgical procedure for its correction. J Bone Joint Surg Am. 1957;39-A(5):1076-1080. PMID 13475406
    • Gupta V, Consul A, Swamy MKS. Zancolli lasso procedure for correction of paralytic claw hands. J Orthop Surg (Hong Kong). 2015;23(1):15-18. PMID 25920636

  3. 3. Transfer of the extensor indicis proprius to the adductor pollicis is the standard operation for restoring thumb adduction in low ulnar nerve palsy.

    False

    Standard donors for adductor pollicis reconstruction are extensor carpi radialis brevis with tendon graft (Smith), ring or middle finger flexor digitorum superficialis routed across the palm (Hamlin–Littler), or brachioradialis with graft (Boyes). Extensor indicis proprius has been described as a donor but is regarded as weak with an unfavourable vector; its established roles are opponensplasty (Burkhalter) and reconstruction of a ruptured extensor pollicis longus.

    • Smith RJ. Extensor carpi radialis brevis tendon transfer for thumb adduction—a study of power pinch. J Hand Surg Am. 1983;8(1):4-15. PMID 6827050
    • Hamlin C, Littler JW. Restoration of power pinch. J Hand Surg Am. 1980;5(4):396-401. PMID 7419885

  4. 4. Flexor digitorum superficialis can be used as the motor donor to restore intrinsic function — for example, the Stiles–Bunnell transfer (FDS slips routed through the lumbrical canals to the radial lateral bands) or the Zancolli lasso (FDS looped through the A1 pulley).

    True

    FDS-based transfers are workhorses for ulnar claw correction. Stiles–Bunnell-type procedures route FDS slips volar to the deep transverse intermetacarpal ligament onto the radial lateral bands to extend the IP joints; the Zancolli lasso loops FDS around a flexor pulley to flex the MCP joint. Harvest of FDS from a donor digit risks PIP swan-neck deformity if a distal slip is not preserved.

    • Brand PW. Tendon transfers for median and ulnar nerve paralysis. Orthop Clin North Am. 1970;1(2):447-54. PMID 5521866
    • Sapienza A, Green S. Correction of the claw hand. Hand Clin. 2012;28(1):53-66. PMID 22117924

  5. 5. Side-to-side tenodesis between the ulnar and median FDP tendons is principally used to correct claw deformity in low ulnar palsy.

    False

    Side-to-side FDP tenodesis is a procedure for high ulnar palsy: it restores synchronous DIP flexion of the ring and little fingers, not MCP flexion or claw correction. Claw correction in low ulnar palsy is addressed by Stiles–Bunnell, Brand, or Zancolli-type procedures.