Background: Ulnar nerve palsy has a negative impact on
basic daily activities. The ulnar nerve lesions seem to be far
worse than the median and radial nerves. Tendon transfer
offers the sole solution in neglected cases of ulnar nerve
injuries by providing active-controlled motion. Tendon transfers
are performed to eradicate claw deformity and restore hand
grip.
Objective: To evaluate the effectiveness of the Zancolli
Lasso procedure (ZLP) vs. Brand technique "Extensor Carpi
Radialis Longus Transfer" in treating hand clawing.
Patients and Methods: Twenty patients who suffered from
isolated ulnar nerve palsy, regardless the level of injury, with
hand clawing after one year or more from the initial injury
time with no clinical signs of nerve recovery participated in
this prospective study. Ten patients were operated on using
the Zancolli Lasso procedure (group A), and ten patients used
Extensor Carpi Radialis longus tendon transfer (group B).
Prior to and following surgery, patients underwent both
subjective and objective evaluations.
Results: Group A showed significantly shorter operative
time, while Group B showed better Hand Assessment Tool
(HAT) score and hand grip measurements. Both groups showed
significant differences in the variable PIP and DIP joint range
of motion.
Conclusion: ZLP is an easier surgical choice for claw
deformity correction with shorter operative time, while ECRL
bestows better handgrip improvement and patient-reported
outcomes. Thus, ECRL is favored in manual workers, whereas
ZLP is favored in patients with medical comorbidities whenever
a shorter operative time is recommended.