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Tendon transfers involve separating a tendon from muscle and reattaching it in a new location. This procedure lets a healthy muscle help a weak or hurt muscle perform normally.
Tendons can be moved from one part of the wrist to another to change the wrist position during rest or activity. This surgery is often performed while a child is in middle school. By this age, the child and health-care provider can work together to find the best tendon for the transfer.
Most commonly, the flexor carpi ulnaris (FCU) tendon is a problem. It can cause the wrist to be flexed down and toward the pinky side. Doctors can separate the tendon from its normal placement and reroute it to the back of the wrist. There, it’s attached to a muscle that extends the wrist (extensor carpi radialis brevis) or one that extends the fingers (extensor digitorum communis). Choosing which tendon to transfer is a decision made by your health-care provider, based on the child’s ability to open the hand/fingers when the wrist is held in slight extension. This surgery helps to stabilize the wrist.
One other possible transfer involves the muscle that turns the forearm “palm down” (pronator teres). The transfer can help open the thumb or assist further in wrist extension. A rearrangement could allow the forearm to turn “palm-up” better. There are other possible transfers that can be done as well, and your health-care provider will work with you to choose what’s right for your child.
Most of these surgeries require the arm to be placed in a cast (usually below the elbow) for four to five weeks. These surgeries can be done at the same time as leg surgeries and the patient can usually go home the same day. Most kids stay home from school for three to four days after the surgery so they can ice the forearm/wrist and keep the arm elevated to control swelling.
Your child should have a well-fitting wrist brace ready to wear after the cast is removed. This can help steady the wrist and prevent soreness after cast removal. If you don’t have one ready, Norton Children’s will provide one at the post-op visit.
After surgery, the brace must be worn at least 20 hours a day. After some time to heal, it can be worn mostly at night – at least 10 hours a day. Your health-care provider will work with you to let you know how much time the brace should be worn.
The child will need occupational therapy after cast removal three times per week for two months, then twice weekly for two months, then weekly.
This should be set up so that it can begin the day the cast is removed, at the latest. It is the parent’s responsibility to make occupational therapy appointments.