ABSTRACT

In the severely paralyzed hand there may be very few, if any, motors available for transfer. In such cases there are very few alternatives. A selective arthrodesis may be helpful on occasion. A more effective way to restore some function may be to use some of the paralyzed tendons to create or reinforce a tenodesis. A tenodesis is the automatic movement of a joint produced by another, usually more proximal joint. The most common example of tenodesis is easily demonstrated at the wrist level: when one actively extends the wrist, it produces an automatic flexion of the fingers and thumb, and creates an automatic pinch between the thumb pulp and the lateral border of the index finger (lateral or ‘key’ pinch). Conversely, when one actively flexes the wrist, it produces an automatic extension of the finger and thumb joints. Patients with paralyzed hands who retain some active movements of the wrist learn very quickly to activate their fingers through wrist motion, and usually develop a functional pinch, even though weak. In the absence of surgery, it is commonly their only means of acquiring an object using one hand.