Median to radial nerve transfers for restoration of wrist, finger, and thumb extension

Radial nerve injury results in loss of wrist, finger, and thumb extension. Traditionally, radial nerve palsies that fail to recover spontaneously have been reconstructed with tendon transfers or nerve grafts. Nerve transfers are a novel approach to the surgical management of Sunderland grade IV and V radial nerve injuries. We describe our technique for median to radial nerve transfers. In this procedure, the flexor digitorum superficialis nerve is transferred to the extensor carpi radialis brevis nerve for wrist extension, and the flexor carpi radialis nerve is transferred to the posterior interosseous nerve for finger and thumb extension. Our experience with these nerve transfers has demonstrated excellent outcomes up to 10 months after injury. Indeed, unlike tendon transfers, median to radial nerve transfers have the potential to restore normal radial nerve function, including independent finger motion. Tension-free nerve coaptation and postoperative motor re-education are critical factors to achieving these successful outcomes.