Activity Gains After Reconstructions of Elbow Extension in Patients With Tetraplegia

Wangdell, Johanna; Fridén, Jan

doi:10.1016/j.jhsa.2012.01.026

Cited by 26 publications

(10 citation statements)

References 21 publications

(17 reference statements)

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“…Clinical application of this suturing approach to restore arm and hand function in tetraplegia confirmed its success in clinical outcome studies (Fridén and Reinholdt, 2008, Wangdell and Friden, 2012). Although, the feasibility of this type of suturing has been clearly demonstrated for the posterior deltoid tendon-triceps combination (Wangdell and Friden, 2012) and flexor digitorum superficialis-flexor digitorum profundus combination (Brown et al, 2010), other donor-recipient combinations can be envisioned that could provide more diverse options for surgical restoration. Unfortunately, these other combinations are sometimes not advised since there is often a mismatch between donor and recipient tendons in the form of size, shape or both.…”

Section: Introductionmentioning

confidence: 54%

The mechanical strength of side-to-side tendon repair with mismatched tendon size and shape

Fridén

Tirrell

Bhola

et al. 2014

J Hand Surg Eur Vol

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Summary Certain combinations are advised against in tendon transfers due to size or shape mismatches between donor and recipient tendons. In this study, ultimate load, stiffness and Young’s modulus were measured in two tendon-to-tendon attachments with intentionally mismatched donor and recipient tendons - pronator teres (PT)-to-extensor carpi radialis brevis (ECRB) and flexor carpi ulnaris (FCU)-to-extensor digitorum communis (EDC). FCU-EDC attachments failed at higher loads than PT-to-ECRB attachments but they had similar modulus and stiffness values. Ultimate tensile strength of the tendon attachments exceeded the maximum predicted contraction force of any of the affected muscles, with safety factors of 4x and 2x for the FCU-to-EDC and PT-to-ECRB constructs, respectively. This implies that size and shape mismatch should not be a contraindication to tendon attachment in transfers. Further, these safety factors strongly suggest that no postoperative immobilization of these attachments is necessary.

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Section: Introductionmentioning

confidence: 54%

The mechanical strength of side-to-side tendon repair with mismatched tendon size and shape

Fridén

Tirrell

Bhola

et al. 2014

J Hand Surg Eur Vol

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“…This also illustrates that the motor level, which partly determine the surgical procedures, may be of importance for the answers given to the questionnaire. Recently, it was confirmed by Wangdell and Friden 33 that triceps activation in itself improves performance and satisfaction. …”

mentioning

confidence: 90%

Satisfaction with upper extremity surgery in individuals with tetraplegia

Gregersen

Lybæk

Johannesen

et al. 2014

The Journal of Spinal Cord Medicine

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Objective: To supplement the scant information available regarding the satisfaction of patients with tetraplegia following upper extremity reconstructive surgery for such individuals with spinal cord injury (SCI). Study design: Retrospective study with questionnaire follow-up. Setting: The Danish Spinal Cord Injury Centers. Material and methods: In the initial review period, 119 upper extremity surgeries were performed on patients with tetraplegia (n = 49). Seven died and the remaining 42 were invited to complete a follow-up questionnaire with a five-level scale ranging from strongly agree to strongly disagree regarding satisfaction. Forty patients completed the questionnaire. Results: Median time from first surgery was 13 years (2-36). Sixty-five percent of the sample had a C5-C6 SCI, with 64% experiencing complete injury. Initially, 76% of the sample expressed general satisfaction with life, but only 28% of the sample reported that hand appearance improved after surgery. Interestingly, those having surgery from 1991 to 2008 reported significantly greater satisfaction (P < 0.001) and were significantly more satisfied with activities of daily living (ADL) (P < 0.001) than those having surgery between the years 1973 and 1990. In particular, gain of independence was obtained with pinch/specific hand surgery compared to triceps activation. Accordingly, the pinch/specific hand surgery group was significantly more satisfied than the triceps group on the ADL (P = 0.027), and the independence questions (P < 0.001). Conclusion: Overall satisfaction with upper extremity surgery is high. It can have a positive impact on life in general, ability to perform ADL, as well as supplying an increased level of independence.

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“…Elbow extension is important for overhead activities, weight transfer, wheelchair propulsion and to enable more control of the hand. 41) …”

Section: What Kind Of Tendon Transfer Surgery Can Be Done?mentioning

confidence: 99%

Upper Limb Reconstruction in Tetraplegic Patients: A Primer for Spinal Cord Injury Specialists

Liew

Shim

Gong

2020

Korean J Neurotrauma

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Cervical spinal cord injury (SCI) often causes debilitating loss of function of the upper limb. Upper extremity reconstruction surgery can restore some of the upper limb function in tetraplegic patients with SCI. The procedures are typically muscle-tendon unit transfer surgeries, which redistribute the remaining functional muscles to restore active elbow extension, key grip, and finger grasping. In addition to the tendon transfer surgeries, nerve transfers have emerged recently and are showing promising results. However, despite more than half of the tetraplegic patients can benefit from upper limb surgery, only a few of them receive the procedures. This missed opportunity may be due to the lack of communication between SCI specialists and hand surgeons, or the lack of awareness of such options among the specialists and patients. In this review, we provide a basic overview of upper limb reconstruction in tetraplegic patients with target audience of SCI specialists for their better understanding of the basic concept of surgery and information for patient consultation before referring to hand surgeons.

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Activity Gains After Reconstructions of Elbow Extension in Patients With Tetraplegia

Cited by 26 publications

References 21 publications

The mechanical strength of side-to-side tendon repair with mismatched tendon size and shape

The mechanical strength of side-to-side tendon repair with mismatched tendon size and shape

Satisfaction with upper extremity surgery in individuals with tetraplegia

Upper Limb Reconstruction in Tetraplegic Patients: A Primer for Spinal Cord Injury Specialists

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