الفهرس 
Anatomical consideration of theOnly 14 pages are availabe for public view
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Abstract
Tendon transfer is a reconstructive technique that restores motion or balance to the limb lost secondary to impaired or absent function of the muscle-tendon units. It is a procedure in which the tendon of insertion of a functioning muscle is divided and reinserted into a bony part or another tendon to supplement or substitute for the action of a nonfunctioning unit. A transferred tendon may be lengthened by a tendon graft but always remains attached to its muscle with blood and nerve supply intact. (1, 2)
The objectives of tendon transfer are to provide active motor power to replace function of a paralyzed muscle, to eliminate the deforming effect of a muscle when its antagonist is paralyzed, and to improve stability by improving muscle balance. (5)
Many different conditions can be treated by tendon transfer. Tendon transfer surgery is necessary when a certain muscle function is lost because of a nerve injury. If a nerve is injured and cannot be repaired, then the nerve no longer sends signals to certain muscles. Those muscles are paralyzed and their muscle function is lost. Also, tendon transfer can be used to attempt to replace that function. Tendon transfer surgery may also be necessary when a muscle has ruptured or been lacerated and cannot be repaired. Common muscle or tendon injuries that are treated with tendon transfer surgery are tendon ruptures due to rheumatoid arthritis or fractures. Also, tendon lacerations that cannot be repaired after injury may be treated with tendon transfer. Tendon transfer surgery may also be needed if a muscle function has been lost due to a disorder of the nervous system. In this situation, the nervous system disease or injury prevents normal nerve signals from being sent to a muscle, and imbalance in hand function occurs. The muscle imbalance or muscle loss due to nervous system disease may be treated with tendon transfer. Common nervous system disorders treated with tendon transfer surgery are cerebral palsy, stroke, traumatic brain injuries, and spinal muscle atrophy. (3, 4)
The most frequently used donor muscles in tendon transfer around the shoulder are the sternal part of the pectoralis major, the pectoralis minor, levator scapulae, rhomboidei, the upper trapezius (clavicular and acromial parts), latissimus dorsi, teres maior, and the anterior part of the middle deltoid. Whether the muscle to be transferred has adequate excursion and sufficient power to carry out the desired motion should be determined before operation. (2)
Complications of tendon transfer surgery are typical of any surgery in the upper extremity. These include the relatively small potential for wound infections, blood loss or hematoma, injury to nerves, or injury to tendons. (9, 10)
Effective postoperative rehabilitation of the shoulder following tendon transfer surgery is considered essential for the patient to return acceptable level of function. The common goals of rehabilitation process include reduction of pain and inflammation, improvement in range of motion and strength, and optimization of proprioception and endurance. This is achieved by immobilization in sling, pendulum exercises, and the progressive active and passive exercises to shoulder girdle. (