Procedures · Hand & Upper Extremity Surgery

Tendon Transfer

Medically reviewed by Dr. Khalid Almutairi, Consultant Plastic Surgeon — updated 2026-08-13

In selected cases of paralysis or muscle loss, a muscle and tendon that work well can be redirected to perform a movement that was lost through injury to another nerve or muscle. That is the idea of tendon transfer: the body itself lends a movement from a place that can partly spare it, to bring back a more important function.

Care is led by Dr. Khalid Almutairi, a consultant plastic and reconstructive surgeon, fellowship trained in hand surgery and microsurgery in Canada and the USA.

When is tendon transfer considered?

Transfer is discussed when an important movement has been lost and is unlikely to return through nerve reconstruction alone — or after the time for it has passed. Situations where it may be suitable include:

• Radial nerve palsy: loss of wrist and finger extension after nerve injury.
• Median or ulnar nerve palsy: loss of fine functions such as thumb opposition or finger balance.
• Brachial plexus injury: as part of a wider reconstructive plan.
• Foot drop: restoring lift of the foot after established peroneal nerve paralysis.
• Tendon rupture in the rheumatoid hand: replacing a worn tendon that cannot be repaired directly.
• Irreparable muscle or tendon loss after trauma.

How is the donor muscle chosen?

The success of a transfer rests on careful selection of the donor muscle, measured against clear criteria:

• It must work with reliable strength — a transfer redirects a muscle's force; it does not increase it.
• Its original role must be spareable without significant functional loss, because other muscles can cover its work.
• Its excursion — the distance it can pull — must be sufficient for the required movement.
• Its tendon must be re-routable along an effective line of pull toward the new function.

Tendon transfer or nerve transfer?

They are different tools, not interchangeable ones. A nerve transfer reactivates the original muscle itself, provided that muscle can still be reinnervated, and needs months for the regenerating nerve to arrive. A tendon transfer gives earlier movement and does not depend on nerve regeneration, but it redirects a different muscle. The choice — and sometimes the combination — depends on the time since injury, its level, the condition of the muscles, and the patient's functional priorities.

After surgery: retraining the brain

After a period of protection in a splint, rehabilitation begins — and its essence is retraining the brain. The transferred muscle spent its life performing one movement and must now learn to produce another. This is achieved with graded exercises under a hand therapist, and coordination improves progressively over months of use.

Realistic expectations

A transfer aims to restore useful movement that returns independence in the activities that matter, not to make the hand or foot exactly as it was before the injury. The result varies with the case, the available donor muscle, and adherence to rehabilitation; realistic goals are discussed with each patient before any decision.

Limitations and risks

Specific risks include adhesion of the transferred tendon restricting its glide, stretching or weakening of tension over time, and imbalance — an over- or under-correction — in addition to general risks such as infection and scar tenderness. A later surgical adjustment is needed in some cases, and all of this is discussed before surgery.

Will I lose the movement the donor muscle used to perform?

The donor is chosen so that other muscles cover its original role, so an important function is not usually lost. The doctor explains the gain-and-cost calculation for your specific case.

When does the result appear?

The new movement begins after the protection period, and control and coordination improve gradually with rehabilitation over months. Individual instructions and the therapist's programme are the reference.

Is transfer still useful years after the injury?

Yes, in many cases. Unlike nerve repair, tendon transfer does not depend on the nerve-regeneration window — but supple joints and a suitable donor muscle are required, and this is assessed by examination.

Medical-information notice

This is general information and does not replace consultation and examination, nor does it mean the procedure suits every case; individual assessment determines the appropriate option.