26497 Transfer of tendon to restore intrinsic function; ring and small finger

Name of the Procedure:

Transfer of tendon to restore intrinsic function; ring and small finger (Common names: Tendon Transfer Surgery for Ring and Little Finger Function)

Summary

Tendon transfer surgery is designed to restore the movement and function of the ring and small fingers by redirecting healthy tendons to replace damaged or non-functional ones.

Purpose

This procedure addresses loss of intrinsic function in the ring and small fingers, often due to injury, nerve damage, or deformities. The goal is to improve grip strength, dexterity, and overall hand functionality.

Indications

• Loss of intrinsic function due to ulnar nerve paralysis
• Claw deformity of the ring and small fingers
• Conditions such as Charcot-Marie-Tooth disease
• Trauma or injury leading to tendon or nerve damage

Preparation

• Fasting for at least 8 hours prior to surgery, if general anesthesia is used
• Adjusting or temporarily stopping specific medications as advised by the physician
• Undergoing pre-operative tests such as blood work, imaging studies (X-rays or MRI), and nerve conduction studies

Procedure Description

1. The patient is given anesthesia (general or regional anesthesia depending on the case).
2. An incision is made in the area of the hand where the tendon transfer will occur.
3. A healthy tendon is identified, often one of the flexor tendons.
4. The tendon is carefully detached from its original insertion point and re-routed to the non-functional finger.
5. The transferred tendon is then secured to its new over/under the pathway and insertion point using surgical sutures.
6. The incision is closed with stitches, and a splint or cast is applied to maintain the proper positioning.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The surgery is usually performed in a hospital or outpatient surgical center.

Personnel

• Orthopedic or hand surgeon
• Surgical nurses
• Anesthesiologist or nurse anesthetist
• Operative and postoperative care team

Risks and Complications

• Infection at the incision site
• Nerve damage leading to numbness or weakness
• Tendon rejection or failure to integrate properly
• Prolonged stiffness or pain
• Scarring or adhesions affecting finger movement

Benefits

• Improved finger movement and hand functionality
• Enhanced ability to perform daily tasks
• Increased grip strength and dexterity
• Potential for a significant improvement in quality of life

Recovery

• Immobilization of the hand in a splint or cast for approximately 4 to 6 weeks
• Gradual initiation of physical therapy to restore strength and mobility
• Pain management with prescribed medications and ice application
• Avoiding strenuous activities until cleared by the surgeon
• Follow-up appointments to monitor progress

Alternatives

• Non-surgical treatments, such as occupational therapy or splinting
• Other surgical options like nerve grafts or joint fusion
• Pros of alternatives include less invasive options with lower immediate risk; cons include potentially less effective improvement in function

Patient Experience

• During the procedure, the patient will be under anesthesia and won’t feel pain.
• Postoperatively, mild to moderate pain may be managed with medication.
• Patients may experience swelling and limited movement during the initial recovery period.
• Gradual return of finger function with persistent therapy and rehabilitation.