Clinical and Radiographic Evaluation of Surgical Reconstruction of Finger Flexion in Tetraplegia

Ejeskär, Arvid; Dahlgren, Annika; Fridén, Jan

doi:10.1016/j.jhsa.2005.01.008

Cited by 13 publications

(4 citation statements)

References 14 publications

(15 reference statements)

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“…These functional benefits have been largely demonstrated with different assessment methods, varying from dynamometry to functional evaluation in activities of daily life. 8,10,11,13,30,34 Here, we further analyse the mechanism of this improvement.…”

Section: Importance and Function Of An Active Elbow Extensormentioning

confidence: 96%

How do C6/C7 tetraplegic patients grasp balls of different sizes and weights? Impact of surgical musculo-tendinous transfers

et al. 2007

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Study design: Prospective control cohort study. Objectives: To develop a new test to analyse qualitatively grasping strategies in C6/C7 tetraplegic patients, and to quantify the effect of musculo-tendinous transfers. Setting: France. Methods: Twelve C6/C7 tetraplegic adults (17 arms; 31.377.9 years) and 17 healthy subjects (30.979.4 years) completed the study. We assessed participants' ability to grasp, move and release standardized balls of variable sizes and weights. Outcome measures: Failures, movement duration (MD), grip patterns, forearm orientation during transport. Results: In patients as well as in controls, the number of digits involved in prehension increased proportionally to the size and weight of the ball. C6 non-operated tetraplegic patients failed 38.2% of the tasks. They frequently used supine transport (51.4% of successful tasks). MD was longer, with a large distribution of values. The presence of active elbow extension poorly influenced the amount of failure nor grip configuration, but significantly reduced MD and supine transport (34%). Patients who were evaluated after hand surgery showed a trend towards improved MD and more frequent completion (failure 30%), especially for middle-sized and middle-weighted balls. Grip patterns were deeply modified, and all transports were made in pronation. Conclusion: The 'Tetra Ball Test' evidences the characteristics of grasping in tetraplegic patients and those influenced by surgery. It may be useful in understanding effects of surgical procedures. This preliminary study must be completed to evaluate the quantitative responsiveness and reproducibility of this test and to develop instrumented electronic balls to optimise it.

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Section: Importance and Function Of An Active Elbow Extensormentioning

confidence: 96%

How do C6/C7 tetraplegic patients grasp balls of different sizes and weights? Impact of surgical musculo-tendinous transfers

et al. 2007

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“…While no difference has previously been shown between the 2 procedures in terms of grip strength or activities of daily living, 10,13 these technical differences have functional implications. For example, because MCP joint flexion is mechanically linked to PIP jointextension in the House procedure, this creates a more open hand during grasp, which we would expect to allow opening around larger objects, such as gripping the drive ring of the manual wheelchair.…”

Section: Discussionmentioning

confidence: 72%

Intrinsic Hand Muscle Function, Part 2: Kinematic Comparison of 2 Reconstructive Procedures

Muzykewicz¹,

Arnet²,

Lieber³

et al. 2013

The Journal of Hand Surgery

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Purpose Reconstruction of grasp is a high priority for tetraplegic patients. Restoration of finger flexion by surgical activation of flexor digitorum profundus can result in roll-up finger flexion, interphalangeal (IP) joint before metacarpophalangeal (MCP) joint flexion, which can be improved by restoring intrinsic function. This study compares grasp kinematics between 2 intrinsic balancing procedures—Zancolli-llasso and House. Methods The intrinsic muscles of 12 cadaver hands were reconstructed by either the Zancolli-lasso or the House procedure (n=6 each) and tested by deforming FDP with a motor to simulate hand closure. Results were compared to 5 control hands. All 17 hands were studied by video analysis. Kinematics were characterized by the order of MCP joint and IP joint flexion. Optimal grasp was defined as the maximal fingertip-to-palm distance during the arc of finger closure. Results Kinematics differed between the 2 procedures. The Zancolli-lasso reconstructed hands flexed first in the IP joints, and then in MCP joints, resembling an unreconstructed intrinsic-minus hand while the House reconstructed hands flexed first in MCP joints and then in the IP jointss, resembling an intrinsic-activated hand. Maximal fingertip-to-palm distance did not differ significantly between the 2 procedures, and both showed improvement over unreconstructed controls. Discussion Both intrinsic balancing techniques improved grasp. Only the House procedure restored hand kinematics approximating those of an intrinsic-activated hand. Improvement in fingertip-to-palm distance in Zancolli-lasso hands resulted primarily from the initial resting MCP joint flexion of 40°. We therefore advocate the more physiologic House procedure for restoration of intrinsic function in tetraplegic patients. Clinical Relevance This study provides a rationale for advocacy of 1 reconstructive procedure over another.

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“…The trend towards complex solutions of grip function (i.e. both extension and flexion) systematically occurs only in later works 5,8,14,15 . Current development unambiguously proceeds with a quantitative increase of active muscle transfers, considered transfer of paralyzed muscles and balancing creation???…”

Section: Discussionmentioning

confidence: 98%

Possible restorations of the upper extremity motion in tetraplegic patients - 5-year clinical experience

Čižmář¹,

Zálešák²,

Pilný³

et al. 2006

BIOMED PAP

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Aim:The aim of the work is to objectify the functional effectiveness of these operations and their influence on the quality of life of handicapped patients.Method: The authors evaluate the results of reconstructive surgery restoring hand grip in a group of 15 tetraplegic patients (3 women and 12 men) with complete spinal cord lesion of C5-C7 segments. The average age of patients in the group is 33 (22-50) years old. The reconstructions were performed using tendon transfer and tenodesis in the forearm and hand area. The effectiveness of the transfer was assessed objectively with regard to muscle strength by measuring the restored "thumb-index finger" grip and "into fist" grip. The range of motion achieved was also evaluated. Transfer effectiveness was evaluated on the basis of subjective patients' evaluation. An ADL (activities of daily living) questionnaire by Mohammed's (1992) took into account the effect of the surgery in a whole range of common daily activities.Results: An extended range of daily activities was evident mainly in the fields of: communication, eating and drinking and operations associated with increase in general selfcare of the patient. There was no deterioration of condition in any of the activities.Conclusions: Up to 80 % of tetraplegic patients are suitable candidates for transfers and, to a certain extent, it is possible to improve the upper limb function. In a partial function restoration of the upper limbs there is immense potential for improvement in the quality of life of these patients.

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Clinical and Radiographic Evaluation of Surgical Reconstruction of Finger Flexion in Tetraplegia

Cited by 13 publications

References 14 publications

How do C6/C7 tetraplegic patients grasp balls of different sizes and weights? Impact of surgical musculo-tendinous transfers

How do C6/C7 tetraplegic patients grasp balls of different sizes and weights? Impact of surgical musculo-tendinous transfers

Intrinsic Hand Muscle Function, Part 2: Kinematic Comparison of 2 Reconstructive Procedures

Possible restorations of the upper extremity motion in tetraplegic patients - 5-year clinical experience

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