The role of upper limb surgery in tetraplegia

Abstract

Study design: A retrospective follow-up study. Objectives: To assess the value of surgery on the tetraplegic hand to improve its function. Setting: Spinal unit. Hospital La Fe. Valencia (Spain). Method: We reviewed the functional results obtained in 15 patients (10 males and 5 females) operated on at our hospital between 1988 and 1997. We performed 66 surgical procedures on 20 upper limbs. After a year or more the patients were evaluated by two independent examiners not related with the surgeons, using the questionnaire of Lamb and Chan modi®ed by Mohammed, taking into account the change in the performance of activities of daily living (ADL), the patient's satisfaction, and the ful®lment of their expectations. Results: A good or excellent result was obtained in 71.4% of our patients, 85.7% were satis®ed with the operation and 57.2% said that the surgery did not meet their expectations. The bad results occurred in patients with previous joint rigidity, ocular sensibility, pain, and lack of motivation. Conclusion: Hand surgery improved the function of tetraplegics and should be performed more frequently. The hands should be cared for from the very beginning to keep them supple. The information given to the patients should be realistic. Spinal Cord (2003) 41, 90 ± 96.

Satisfaction with upper extremity surgery in individuals with tetraplegia

“…[1][2][3] Improvement in hand function is comparable to that of bladder and bowel function, which is known to have great impact on the lives of individuals with SCI. 4,5 In Denmark, ∼3000 people currently live with an SCI.…”

Long-term patient satisfaction after reconstructive upper extremity surgery to improve arm–hand function in tetraplegia

“…A possible explanation could be that the information given to them before the surgery was not precise, resulting in higher expectations. Forner-Cordero et al 11 found in their study that 57.2% of the persons expected better results of the surgery. Another possibility could be that there was really no improvement after surgery.…”

“…Some studies report about satisfaction of participants as well, however, this is usually evaluated using only a few, untested questions. [11][12][13] These studies report that the majority of the participants are satisfied with the results of the surgery. Lo et al 12 described the outcome of tendon transfers for eight C6-spared quadriplegics (12 hands 15 The results of their study showed that 87.5% of their population were satisfied with the operation, 42.8% of the participants felt that the operation had fulfilled their expectations, however, 57.2% expected better results.…”

“…10 Results mainly describe functional outcomes such as muscle strength and ADL skills. 11 There are limited data about patient satisfaction, activities and participation after reconstructive surgery in persons with tetraplegia. Some studies report about satisfaction of participants as well, however, this is usually evaluated using only a few, untested questions.…”

Upper limb reconstructive surgery uptake for persons with tetraplegia in New Zealand: a retrospective case review 2001–2005

“…As this was a clinical notes audit on discharge information, it is unknown whether these people were offered the opportunity to be assessed but declined, or were never offered the opportunity. The average length of time between injury and surgery of 20 months is earlier in NZ compared with other countries such as Spain (34 months), 14 France (46.1 months) 15 and within the United States (34-50 months depending on the centre). [16][17][18] There are a number of plausible explanations for these observed differences between NZ and other countries.…”