Restoration of Intrinsic functions of fingers

Clawing

1.Stiles and Forrester - Brown

FDS - detach , split and transfer to dorsum of fingers to extensors

 No f/u


2. Bunnel

FDS - detach , split

   one slip to each of extensor aponeurosis by way of lumbricals

   effective when intrinsic only weak but not paralyzed ,


3. Fowler's modification

   FDS - splitted into 4 slips

    passed through volar side of deep transverse metacarpal ligaments , attached to radial side of extensor aponeurosis of each finger

effective if wrist is flexed.



4.Brand

ECRL / ECRB passed through volar side of forearm , to carpal tunnel and extended by 4 tailed grafts

Plantaris / Palmaris Longus ) and through lumbrical canal to extensor aponeurosis.


5. Riordan

FCR passed through dorsum of wrist, extended with 4 tailed graft , each tail passed volar to deep

transverse metacarpal ligament and attached to radial side of extensor aponeurosis .



6.Zancoli Arthrodesis

 capsulodesis , joint supple , no muscles for transfer .


7. Tenodesing

Riordan Technique

 -ECRB and ECU cut at M3/D3 portion on forearm , extended one slip of each with grafts and one

   slip left intact

-each slip altogether 4 extended into extensor aponeurosis passing volar to deep transverse

metacarpal ligament .







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