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The “Double Wrist Flexor” Tendon Transfer for Radial Nerve Palsy

AbstractIn isolated high radial nerve palsy, it is traditionally taught that one should not use both wrist flexors for tendon transfers. Over the last 17 years, the author has encountered 4 unusual cases of high radial nerve palsy with concurrent direct injury to the pronator teres, flexor digitorum superficialis, and the palmaris longus in the proximal forearm. In these cases, the author used both wrist flexors, namely, the flexor carpi radialis to restore wrist extension and the flexor carpi ulnaris to restore finger/thumb extension as well as thumb radial abduction. Despite the major loss of wrist flexion, all patients had a good overall function as per the modified Bincaz scale. It was concluded that this “double wrist flexor” transfer remains to be an acceptable option for high radial nerve palsy when the pronator teres, flexor digitorum superficialis, and the palmaris longus tendons are not available.