Intrinsic balancing in reconstruction of the tetraplegic hand

“…2). 8,10,12 Briefly, incisions were made over the palmar aspect of each MCP joint. Each FDS tendon was identified and cut distal to the A1 pulley.…”

Section: Methodsmentioning

confidence: 99%

“…8-10 We performed these surgeries on cadaveric hands, comparing their effects on grasp to unreconstructed control hands and to each other. Hands were characterized both by their kinematics and their functional capacity.…”

Section: Introductionmentioning

confidence: 99%

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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“…Tendon transfer procedures are commonly used to improve upper extremity function by restoring movements such as elbow extension, wrist extension, and grasp/release. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] In addition, there are procedures to reduce contractures such as the rotational radial osteotomy to correct a forearm supination contracture or a biceps tendon lengthening to reduce elbow flexion contractures. [16][17][18][19][20][21] Tendon transfer procedures have traditionally been most effective for individuals who have sustained injuries at the C5-C7 level, as persons at this level have strong but redundant donor muscles to be used for providing additional function.…”

Section: Introductionmentioning

confidence: 99%

Perceived outcomes and utilization of upper extremity surgical reconstruction in individuals with tetraplegia at model spinal cord injury systems

et al. 2004

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A mailed survey eliciting responses with respect to: (1) utilization of upper extremity reconstructive procedures and (2) the clinicians' perceived outcomes of these procedures. Results: In all, 76% responded positively about the availability and appropriateness of upper extremity surgical reconstruction at their center. Of the respondents, 75% felt that surgery recipients were generally satisfied with their surgeries, 80% felt that the surgery made a positive impact on recipients' lives, 81% felt that recipients showed increased independence, and 70% reported a positive impact on recipients' occupation. In all, 93% felt insurance companies should pay for the procedures. Compared to the satisfaction of surgery recipients using a similar instrument, clinicians anticipated slightly greater improvements in all areas except occupation. Conclusions: There is a positive perception of the benefits of reconstructive surgery for tetraplegia; however, procedures are not routinely offered at all centers. The primary reasons reported for this include the misconception that insurance does not remit payment, that a surgeon is not available, and that surgical candidates are referred to another center.

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Intrinsic balancing in reconstruction of the tetraplegic hand

Cited by 51 publications

References 7 publications

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

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

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

Perceived outcomes and utilization of upper extremity surgical reconstruction in individuals with tetraplegia at model spinal cord injury systems

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