Presentation and Management Outcome of High Radial Nerve Palsy with Tendon Transfers

Background: This randomized clinical trial was carried out to document the clinical presentation of isolated high radial nerve palsy (high RNP) and compare the outcome of triple tendon transfers. Methods: The study included patients of all genders and ages who presented with isolated high RNP. Half of them were randomly assigned to the flexor carpi radialis set (FCR-set) of tendon transfers ( group A) and a half to the flexor carpi ulnaris (FCU-set) of tendon transfers (group B). Results: Out of 44 patients, 38 were males, and 6 were females. The age ranged from 7 years to 55 years. 26(59.09%) patients had primary RNP in association with fractures of the humerus. The postoperative mean disability of arm, shoulder, and hand score (Quick DASH-11 score) for the patients in the FCR-set of transfers was 34.54%% versus 41.81% for the FCU-set of transfers. 11 patients (25%) developed radial deviation deformity. Conclusion: RNP was predominantly found among males of the young age group, and the majority of the cases resulted from preventable causes. The triple tendon transfers among patients of the two groups robustly restored the lost extension of the wrist and digits in a matching way. The patients also subjectively reported remarkable improvement in terms of the favorable Quick-DASH-11 scores. Radial deviation deformity occurred among half of the patients who underwent the FCU set of tendon transfers.