How to treat sequelae of upper extremity polio?

Due to many reasons, the treatment of paralysis of the upper extremities is quite difficult. Among the treatment measures, tendon transfer is the method that is considered to be the most effective.

Injury to the nerves in the upper extremities is a common condition, due to causes such as daily-life accidents, traffic accidents, work accidents,... The treatment of upper extremity palsy is quite difficult. , many cases have not been paid enough attention, ignored.
According to many surveys, the nerve sheath anastomosis by conventional techniques gives a good result rate of 65 - 70%; The suture rate of nerve fiber bundles by microsurgery gives a good result rate of 85 - 90%. In addition, there are still patients who are not treated or treated with no results, leaving sequelae of upper limb paralysis, limb deformity, loss of motor function, affecting aesthetics and work of the patient. core.

Tendon transfer is considered the most effective method to treat sequelae of nerve paralysis. Tendon transfer is a technique that moves a functional muscle tendon from its original position to another to replace the function of a paralyzed or damaged muscle. There are many methods of tendon transfer and each method has its own advantages and disadvantages. Some of the methods widely used today are:
Cases of damage to the capsular nerve: The capsular nerve palsy is manifested by atrophy of the deltoid muscle, causing the patient to lose the movement of shoulder extension and arm forward. The patient is indicated for surgery to transfer the trapezius muscle to restore paralysis of the deltoid muscle; Injury to the radial nerve: The radial nerve palsy is manifested as muscle atrophy at the back of the forearm, the patient loses wrist extensor, fingers, loss of extensor or thumb shape, the hand drooping like a stork neck. The Smith Tendon Transfer is used to restore wrist, finger, extensor, and thumb extension; Injury to the musculoskeletal nerve: Patients with neuromuscular palsy present with atrophy of the anterior arm muscles, loss of elbow flexion. The Steindler tendon transfer will help restore elbow flexion for the patient; Injury to the median nerve: Manifestations of patients with median nerve palsy are loss of comparison of the thumb, loss of flexion of the index finger, middle finger, and thumb. It is recommended to treat according to the Burkhalter method to transfer the long supraclavicular tendon to the long flexor of the thumb; sew the deep flexor tendons of fingers 2 and 3 to fingers 4 and 5; perform a restorative tendon transfer to the thumb; Injury to the ulnar nerve: Manifestations of ulnar nerve palsy are atrophy of the interosseous muscles of the hand; loss of extensor 2, 3 of fingers 4, 5; knuckle deformity 1 of the fingers; loss of thumb; deformed monkey hand or cylindrical claw hand. Treatment of tendon transfer according to Zancolli method to correct ulnar claw deformity.

The average hospital stay for upper extremity palsy surgery is about 10 days. The patient is monitored for the condition of the wound and the tip of the finger during this time. The operating arm will be immobilized with a cast brace, and the arm is suspended high. Patients are instructed to exercise after surgery, use antibiotics, pain relievers, reduce swelling and sedatives. If there is a hand infection, the patient is sutured, bandaged, and re-excisional.
When discharged from the hospital, the patient's hand continued to be fixed on the brace for 6 weeks, and was instructed to exercise. After 6 weeks, the patient comes back for a check-up, removes the splint and does physical therapy to restore function.
When indicated to treat the sequelae of upper extremity palsy by tendon transfer, the patient needs to coordinate with all indications of the doctor. If unusual symptoms arise, the patient should immediately notify the doctor for timely intervention and treatment.