Tendon transfer is an operation to reroute a functioning tendon from its normal attachment to a new position, replacing the function of a damaged or paralysed tendon or muscle. It restores lost movements in the hand.
One or more incisions are made in the forearm and/or hand. A functioning expendable tendon (the donor) is detached from its insertion, rerouted through the tissues, and attached to the insertion of the non-functioning tendon (the recipient). The tension is carefully set. Common transfers include PT-to-ECRB for wrist extension, FDS-to-EDC for finger extension, and opponensplasty for thumb opposition. The operation takes one to three hours.
Tendon transfer is recommended for irreversible nerve injuries (radial, ulnar, or median nerve palsy), tendon ruptures that cannot be directly repaired, and conditions such as rheumatoid tendon ruptures or spinal cord injury.
Splinting and adaptive devices can compensate for some lost functions. Nerve repair or grafting may restore function if performed early enough. Tendon transfer is typically performed when nerve recovery is not expected.
Detailed assessment of available donor tendons and recipient needs. The donor tendon must be expendable, have adequate strength, and have appropriate excursion (range of pull). Pre-operative hand therapy.
Restoration of lost movement. Outcomes depend on the specific transfer, patient compliance with rehabilitation, and the underlying condition. Most well-selected transfers provide useful functional improvement.
The transferred tendon may not be as strong as the original muscle.
Retraining the brain to use the transferred tendon for a new function takes dedicated practice.
Scar tissue may limit tendon glide.
The transferred tendon may pull out, rupture, or not function adequately.
Some loss of the original function of the donor tendon.
Wound infection.
Joint stiffness from prolonged splinting.
General or regional anaesthesia.
Protective splinting for four to six weeks. Hand therapy begins immediately and is critical — retraining the brain to use the transferred tendon takes weeks of practice. Active use from six weeks. Full rehabilitation three to six months.
Regular reviews with hand therapy over three to six months.
Through repetitive practice, the brain creates new neural pathways. Initially, you activate the transferred tendon by thinking about its original function. Gradually, the movement becomes automatic.