TECHNIQUESManagement of Hand Palsies in Isolated C7 to T1 or C8, T1 Root AvulsionsGoubier, Jean-Noel PhD; Teboul, Frédéric MDAuthor Information Centre International de Chirurgie de la Mainclinique du parc Monceau, Paris, France Address correspondence and reprint requests to Jean-Noel Goubier, PhD, Centre International de Chirurgie de la Main, clinique du parc Monceau, 21 rue de Chazelles, 75017 Paris, France. E-mail: [email protected]. Techniques in Hand & Upper Extremity Surgery: September 2008 - Volume 12 - Issue 3 - p 156-160 doi: 10.1097/BTH.0b013e318172d72b Buy Metrics Abstract Thirteen patients were operated on for hand palsies in cases of C7 to T1 or C8, T1 root avulsions. Finger flexion and intrinsic function were paralyzed in all patients. Finger extension was paralyzed in 12 patients. Wrist flexion and extension were present in all patients. Tendon transfers were performed to restore the different functions. The extensor carpi radialis longus was transferred to the flexor digitorum profundus. The brachioradialis tendon was transferred to the flexor pollicis longus tendon for thumb flexion, with a tendon translocation procedure in 6 patients. Intrinsic function was reanimated with passive capsulorrhaphy techniques or other equivalent techniques in 9 patients. Extensor tenodesis was performed to restore hand opening with active wrist flexion in all patients. Moreover, sensory neurotization was performed to restore sensation on the ulnar side of the hand. All patients recovered finger flexion with an average pulp-to-palm distance of 2 cm. Finger extension occurred in 30 degrees wrist flexion. The average Kapandji score was 3. Key pinch was present in all patients. The average grip strength was 8 kg; the average key pinch was 5 kg. All patients recovered a protective sensation with a mean time of 19.5 months. Injury with C7 to T1 or C8, T1 root avulsions is a rare entity. Motor nerve surgery is not possible in these cases. However, surgery remains a challenge and may greatly improve these patients. Therefore, we propose a new tendon transfer and sensory neurotization protocol. © 2008 Lippincott Williams & Wilkins, Inc.