Nerve Transfer versus Tendon Transfer for Radial Nerve Palsy

Abstract

Introduction: Radial nerve palsy causes significant upper extremity disability. This review compares outcomes of nerve transfer versus tendon transfer in restoring wrist and finger extension.

Methods: A systematic review of observational studies and case series was conducted. Inclusion criteria: adult patients with traumatic radial nerve palsy undergoing either nerve or tendon transfer, with minimum one-year follow-up. Outcomes: active wrist extension, grip strength, and complications.

Results: Twenty-one studies (n=412 patients) were included. Nerve transfer achieved full wrist extension in 80% of patients versus 75% for tendon transfer. Grip strength recovery was superior with nerve transfer (85% of contralateral versus 70%). Tendon transfer allowed earlier return of function (mean 3 months versus 9 months). Donor site morbidity was higher with tendon transfer.

Discussion: Nerve transfer offers more physiologic reinnervation but requires longer recovery. Tendon transfer provides earlier, reliable results but sacrifices donor tendons. Timing of intervention (acute versus chronic) influences choice.

Conclusions: Nerve transfer is preferred in acute injuries with available donors. Tendon transfer remains excellent for chronic or failed nerve repairs. Shared decision-making is essential.