Skip to main content
SpringerLink
Log in

Surgical rehabilitation of a tetraplegic hand: comparison of various methods of reconstructing an absent pinch and hook

  • Published:
HAND

Abstract

Background

Since complete functional restoration after spinal cord injury may not always be possible, the major focus in such cases has to be on rehabilitation. We performed surgery in such patients to reconstruct important absent hand functions viz. pinch and hook using various methods described in literature and compared their outcome.

Methods

A total of 29 procedures were performed in ten patients (18 upper limbs) with tetraparesis consequent to cervical spine injury distal to C6 level who had at least grade 3 power of elbow extension but had not documented any significant improvement in hand function, at least 6 months post injury. Key pinch was reconstructed in 14 upper limbs using brachioradialis (BR) to flexor pollicis longus (FPL) transfer in 11 and pronator teres (PT) to FPL transfer in three limbs. Hook was reconstructed in 15 upper limbs: PT to flexor digitorum profundus (FDP) (n = 7), BR to FDP (n = 2), and FDP tenodesis (n = 6). The gains achieved were measured at intervals of 4 weeks, 3 months, and 6 months postoperatively and at a final possible follow-up of every patient, the average follow-up being 32 months. The functional outcome was assessed by the modified Lamb and Chan score.

Results

For key pinch reconstruction, both BR and PT turned to be equally efficacious donors, while for hook reconstruction, PT and BR transfer to FDP turned out to be superior to FDP tenodesis. The functional outcome as assessed by the modified Lamb and Chan score revealed good to fair outcome in 70 % of patients while poor in 30 %. Complications resulted from stretching of transfer, rupture of tenodesis, and maltensioning.

Conclusion

Surgery can routinely be offered to suitable tetraplegics with deficient hand function in whom no useful recovery of any function is expected with at least 6 months elapsed post injury. Single-staged bilateral procedures enable maximal possible rehabilitation in minimal possible duration.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Alvin A, Freehafer MD, Emmerick Vonhaam MD, Virginia Allen OTR. Tendon transfers to improve grasp after injuries of cervical spinal cord. J Bone Joint Surg. 1974;56:951–9.

    Google Scholar 

  2. Calandruccio JH, Jobe MT. Paralytic hand. In: Canale ST, Beaty JH, editors. Campbell’s operative orthopaedics. 11th ed. Mosby Elsevier. 2008.p.4125-72.

  3. Curtin CM, Hayward RA, Myra Kim H, et al. Physicians perceptions of upper extremity reconstruction for the person with tetraplegia. J Hand Surg [Am]. 2005;30A:87–93.

    Article  Google Scholar 

  4. Ejeskar A, Dahllof A. Results of reconstructive surgery in the upper limb of tetraplegic patients. Paraplegia. 1988;26:204–8.

    Google Scholar 

  5. Forner-Cordero I, Mudarra-Garcia J, Fornder-Valero JV, Vilar-De-La-Pena R. The role of upper limb surgery in tetraplegia. Spinal Cord. 2003;41:90–6.

    Article  CAS  PubMed  Google Scholar 

  6. Freehafer AA. Tendon transfers in patients with cervical spinal cord injury. J Hand Surg. 1991;16:804–9.

    Article  CAS  Google Scholar 

  7. Gansel J, Waters R, Geliman H. Transfer of the pronator teres tendon to the tendons of the flexor digitorum profundus in tetraplegia. J Bone Joint Surg Am. 1990;72:427–32.

    CAS  PubMed  Google Scholar 

  8. Hamou C, Shah NR, DiPonio L, et al. Pinch and elbow extension restoration in people with tetraplegia: a systematic review of the literature. J Hand Surg [Am]. 2009;34:692–9.

    Article  Google Scholar 

  9. House JH, Gwathmey FW, Lundsgaard DK. Restoration of strong grasp and lateral pinch in tetraplegia due to cervical spinal cord injury. J Hand Surg [Am]. 1976;1:152–9.

    Article  CAS  Google Scholar 

  10. House JH, Shannon MA. Restoration fo strong grasp and lateral pinch in tetraplegi: a comparison of two methods of thumb control in each patient. J Hand Surg. 1985;10–A:22–9.

  11. James MA. Reconstruction of the upper extremity in tetraplegia. In: Chapman MJ, Szabo RM, Marder R, Kelly G. Vince, Mann RA, Lane JM, et al. editors. Chapman’s orthopaedic surgery. 3rd ed. Lippincott Williams & Wilkins. 2001.p.1855-70.

  12. Kelly CM, Freehafer AA, Peckham PH, Stroh K. Postoperative results of opponensplasty and flexor tendon transfer in patients with spinal cord injuries. J Hand Surg [Am]. 1985;10:890–4.

    Article  CAS  Google Scholar 

  13. Lamb DW, Chan KM. Surgical reconstruction of the upper limb in traumatic tetraplegia. A review of 41 patients. J Bone Joint Surg. 1983;65B:291–8.

    Google Scholar 

  14. Lipscomb PR, Elkins EC, Henderson ED. Tendon transfers to restore function of hands in tetraplegia especially after fracture-dislocation of the sixth cervical vertebra on the seventh. J Bone Joint Surg Am. 1958;40:1071–80.

    PubMed  Google Scholar 

  15. Lo IKY, Turner R, Connolly S, et al. The outcome of tendon transfers for C6-spared quadriplegics. J Hand Surg Br Eur. 1998;23:156–61.

    Article  CAS  Google Scholar 

  16. Meiners T, Abel R, Lindel K, et al. Improvements in activities of daily living following functional hand surgery for treatment of lesions to the cervical spinal cord: self-assessment by patients. Spinal Cord. 2003;40:574–80.

    Article  Google Scholar 

  17. Mohammed KD, Rothwell AG, Sinclair SW, Willems SM, Bean AR. Upper limb surgery for tetraplegia. J Bone Joint Surg (Br). 1992;74:873–9.

    CAS  Google Scholar 

  18. Robinson MA, Barton GJ, Lees A, et al. Analysis of tetraplegic reaching in their 3D workspace following posterior deltoid-triceps tendon transfer. Spinal Cord. 2010;48:619–27.

    Article  CAS  PubMed  Google Scholar 

  19. Rothwell AG, Anne Sinnott KA, Mohammed KA, et al. Upper limb surgery for tetraplegia: a 10-year re-review of hand function. J Hand Surg [Am]. 2003;28:489–97.

    Article  Google Scholar 

  20. Snoek GJ, Ijzerman MJ, Hermens HJ, et al. Survey of the needs of patient with spinal cord injury: impact and priority for improvement in hand function in tetraplegics. Spinal Cord. 2004;42:526–32.

    Article  CAS  PubMed  Google Scholar 

  21. Vanden Berghe A, Van Laere M, Hellings S et al. Reconstruction of the upper extremity in tetraplegia: functional assessment, surgical procedures and rehabilitation. Paraplegia. 1991;29:103–12.

    Google Scholar 

  22. Vastamaki M. Short-term versus long-term comparative results after reconstructive upper-limb surgery in tetraplegic patients. J Hand Surg [Am]. 2006;31:1490–4.

    Article  Google Scholar 

  23. Wagner JP, Curtin CM, Gater DR, et al. Perceptions of people with tetraplegia regarding surgery to improve upper-extremity function. J Hand Surg [Am]. 2007;32A:483–90.

    Article  Google Scholar 

Download references

Conflict of Interest

Mukul Mohindra declares no conflict of interest.

Sukhbir Singh Sangwan declares no conflict of interest.

Zile Singh Kundu declares no conflict of interest.

Paritosh Gogna declares no conflict of interest.

Anurag Tiwari declares no conflict of interest.

Ankit Thora declares no conflict of interest.

Statement of Human and Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.

Statement of Informed Consent

The study was performed after taking informed consent from all patients.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Maulana Azad Medical College and Associated Hospitals, New Delhi, India

    Mukul Mohindra & Anurag Tiwari

  2. Department of Orthopaedics, Paraplegia and Rehabilitation, Pt BD Sharma PGIMS, Rohtak, Haryana, India, 124001

    Sukhbir Singh Sangwan, Zile Singh Kundu & Paritosh Gogna

  3. Department of Orthopaedics, Maulana Azad Medical College and Associated Hospitals, New Delhi, India

    Ankit Thora

  4. 630/18 Kundan Puri, Civil Lines, Ludhiana, 141001, Punjab, India

    Mukul Mohindra

Authors
  1. Mukul Mohindra
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sukhbir Singh Sangwan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zile Singh Kundu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paritosh Gogna
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anurag Tiwari
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ankit Thora
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mukul Mohindra.

About this article

Cite this article

Mohindra, M., Sangwan, S.S., Kundu, Z.S. et al. Surgical rehabilitation of a tetraplegic hand: comparison of various methods of reconstructing an absent pinch and hook. HAND 9, 179–186 (2014). https://doi.org/10.1007/s11552-014-9615-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11552-014-9615-0

Keywords

Search

Navigation