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Combining nerve and tendon transfers in tetraplegia: a proposal of a new surgical strategy based on literature review

  • Paolo Titolo
  • Federico FusiniEmail author
  • Chiara Arrigoni
  • Gianluca Isoardo
  • Luigi Conforti
  • Stefano Artiaco
  • Davide Ciclamini
  • Monica Sicari
  • Bruno Battiston
General Review • HAND -EXPERIMENTAL
  • 137 Downloads

Abstract

Spinal cord injury (SCI) is very common, most frequently resulting from motor vehicle accidents and falling from a height. Often, SCI occurs at the cervical level, resulting in tetraplegia, which consists of loss of effective arm and/or hand function. For these patients, hand function is considered the most desired function, above bowel, bladder and sexual function. Fortunately, understanding about nerve and tendon transfers is steadily growing, providing new surgical solutions for functional restoration in tetraplegia patients. The primary aim of this systematic review of the literature is to assess all the various ways to improve upper-limb function, using both nerve transfers and classical tendon transfers in patients suffering from tetraplegia. Surgical indications, optimum timing and contraindications were reviewed. In accordance with the International Classification for Surgery of the Hand in Tetraplegia, ten subgroups of tetraplegic patients were analysed and a proposal for treatment combining nerve and tendon transfers formulated for each subgroup, seeking alternatives to classical surgical strategies. We also sought to propose strategies that, in instances of failure, still would allow for the use of some classical surgical approach. Starting with traditional management, we proposed new strategies using tenodesis and tendon transfers in association with nerve surgery. We believe that the suggestions described in the current paper could both improve and complete current surgical strategies and contribute to ensuring that more patients benefit from these options in future.

Keywords

Nerve transfers Tetraplegic hand Tendon transfers Surgical strategy 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare they have no conflict of interest regarding the topic of this publication.

References

  1. 1.
    Kumar N, Osman A, Chowdhury JR (2017) Traumatic spinal cord injuries. J Clin Orthop Trauma 8:116–124.  https://doi.org/10.1016/j.jcot.2017.06.022 CrossRefGoogle Scholar
  2. 2.
    Wolfe SW, Pederson WC, Hotchkiss RN, Kozin SH, Cohen MS (2010) Green’s operative hand surgery: the pediatric hand e-book. Elsevier Health SciencesGoogle Scholar
  3. 3.
    Anderson KD (2004) Targeting recovery: priorities of the spinal cord-injured population. J Neurotrauma 21:1371–1383.  https://doi.org/10.1089/neu.2004.21.1371 CrossRefGoogle Scholar
  4. 4.
    Brown J (2011) Nerve transfers in tetraplegia I: background and technique. Surg Neurol Int 2:121.  https://doi.org/10.4103/2152-7806.84392 CrossRefGoogle Scholar
  5. 5.
    Waters RL, Sie IH, Gellman H, Tognella M (1996) Functional hand surgery following tetraplegia. Arch Phys Med Rehabil 77:86–94CrossRefGoogle Scholar
  6. 6.
    Bednar MS, Woodside JC (2018) Management of upper extremities in tetraplegia. J Am Acad Orthop Surg 26:e333–e341.  https://doi.org/10.5435/JAAOS-D-15-00465 CrossRefGoogle Scholar
  7. 7.
    Limthongthang R, Bachoura A, Songcharoen P, Osterman AL (2013) Adult brachial plexus injury. Orthop Clin North Am 44:591–603.  https://doi.org/10.1016/j.ocl.2013.06.011 CrossRefGoogle Scholar
  8. 8.
    James MA (2007) Use of the Medical Research Council muscle strength grading system in the upper extremity. J Hand Surg 32(2):154–156CrossRefGoogle Scholar
  9. 9.
    Zlotolow DA (2011) The role of the upper extremity surgeon in the management of tetraplegia. J Hand Surg Am 36:929–935.  https://doi.org/10.1016/j.jhsa.2011.03.001 CrossRefGoogle Scholar
  10. 10.
    Gohritz A, Fridén J, Herold C, Aust M, Spies M, Vogt PM (2007) Ersatzoperationen bei Ausfall motorischer Funktionen an der Hand. Unfallchirurg 110:759–776.  https://doi.org/10.1007/s00113-007-1322-7 CrossRefGoogle Scholar
  11. 11.
    Lee SK, Wolfe SW (2012) Nerve transfers for the upper extremity: new horizons in nerve reconstruction. J Am Acad Orthop Surg 20:506–517.  https://doi.org/10.5435/JAAOS-20-08-506 CrossRefGoogle Scholar
  12. 12.
    Fox IK (2016) Nerve transfers in tetraplegia. Hand Clin 32:227–242.  https://doi.org/10.1016/j.hcl.2015.12.013 CrossRefGoogle Scholar
  13. 13.
    Fox IK, Novak CB, Krauss EM, Hoben GM, Zaidman C, Ruvinskaya R, Juknis N, Winter AC, Mackinnon SE (2018) The use of nerve transfers to restore upper extremity function in cervical spinal cord injury. PM&R.  https://doi.org/10.1016/j.pmrj.2018.03.013 Google Scholar
  14. 14.
    Cain S, Gohritz A, Fridén J, van Zyl N (2015) Review of upper extremity nerve transfer in cervical spinal cord injury. J Brachial Plex Peripher Nerve Inj 10:e34–e42.  https://doi.org/10.1055/s-0035-1558427 CrossRefGoogle Scholar
  15. 15.
    Fu SY, Gordon T (1995) Contributing factors to poor functional recovery after delayed nerve repair: prolonged denervation. J Neurosci 15:3886–3895CrossRefGoogle Scholar
  16. 16.
    Fu SY, Gordon T (1995) Contributing factors to poor functional recovery after delayed nerve repair: prolonged axotomy. J Neurosci 15:3876–3885CrossRefGoogle Scholar
  17. 17.
    Lamb DW, Chan KM (1983) Surgical reconstruction of the upper limb in traumatic tetraplegia. A review of 41 patients. J Bone Joint Surg Br 65:291–298CrossRefGoogle Scholar
  18. 18.
    Bertelli JA, Ghizoni MF (2013) Single-stage surgery combining nerve and tendon transfers for bilateral upper limb reconstruction in a tetraplegic patient: case report. J Hand Surg Am 38:1366–1369.  https://doi.org/10.1016/j.jhsa.2013.03.056 CrossRefGoogle Scholar
  19. 19.
    Bertelli JA, Ghizoni MF, Tacca CP (2011) Transfer of the teres minor motor branch for triceps reinnervation in tetraplegia. J Neurosurg 114:1457–1460.  https://doi.org/10.3171/2010.12.JNS101519 CrossRefGoogle Scholar
  20. 20.
    Arnet U, Muzykewicz DA, Fridén J, Lieber RL (2013) Intrinsic hand muscle function, part 1: creating a functional grasp. J Hand Surg Am 38:2093–2099.  https://doi.org/10.1016/j.jhsa.2013.08.099 CrossRefGoogle Scholar
  21. 21.
    Muzykewicz DA, Arnet U, Lieber RL, Fridén J (2013) Intrinsic hand muscle function, part 2: kinematic comparison of 2 reconstructive procedures. J Hand Surg Am 38:2100–2105.e1.  https://doi.org/10.1016/j.jhsa.2013.08.098 CrossRefGoogle Scholar
  22. 22.
    Moberg E (1990) Surgical rehabilitation of the upper limb in tetraplegia. Spinal Cord 28:330–334.  https://doi.org/10.1038/sc.1990.43 CrossRefGoogle Scholar
  23. 23.
    Fridén J, Gohritz A (2012) Brachialis-to-extensor carpi radialis longus selective nerve transfer to restore wrist extension in tetraplegia: case report. J Hand Surg Am 37:1606–1608.  https://doi.org/10.1016/j.jhsa.2012.05.005 CrossRefGoogle Scholar
  24. 24.
    Hentz VR, House J, McDowell C, Moberg E (1992) Rehabilitation and surgical reconstruction of the upper limb in tetraplegia: an update. J Hand Surg Am 17:964–967CrossRefGoogle Scholar
  25. 25.
    Johanson ME (2016) Rehabilitation after surgical reconstruction to restore function to the upper limb in tetraplegia: a changing landscape. Arch Phys Med Rehabil 97:S71–S74.  https://doi.org/10.1016/j.apmr.2016.03.015 CrossRefGoogle Scholar
  26. 26.
    House JH, Gwathmey FW, Lundsgaard DK (1976) Restoration of strong grasp and lateral pinch in tetraplegia due to cervical spinal cord injury. J Hand Surg Am 1:152–159CrossRefGoogle Scholar
  27. 27.
    Mackinnon SE, Yee A, Ray WZ (2012) Nerve transfers for the restoration of hand function after spinal cord injury. J Neurosurg 117:176–185.  https://doi.org/10.3171/2012.3.JNS12328 CrossRefGoogle Scholar
  28. 28.
    van Zyl N, Hahn JB, Cooper CA, Weymouth MD, Flood SJ, Galea MP (2014) Upper limb reinnervation in C6 tetraplegia using a triple nerve transfer: case report. J Hand Surg Am 39:1779–1783.  https://doi.org/10.1016/j.jhsa.2014.06.017 CrossRefGoogle Scholar
  29. 29.
    Fox IK, Davidge KM, Novak CB, Hoben G, Kahn LC, Juknis N, Ruvinskaya R, Mackinnon SE (2015) Use of peripheral nerve transfers in tetraplegia: evaluation of feasibility and morbidity. Hand (N Y) 10:60–67.  https://doi.org/10.1007/s11552-014-9677-z CrossRefGoogle Scholar
  30. 30.
    Fox IK, Davidge KM, Novak CB, Hoben G, Kahn LC, Juknis N, Ruvinskaya R, Mackinnon SE (2015) Nerve transfers to restore upper extremity function in cervical spinal cord injury: update and preliminary outcomes. Plast Reconstr Surg 136:780–792.  https://doi.org/10.1097/PRS.0000000000001641 CrossRefGoogle Scholar
  31. 31.
    Mohammed KD, Rothwell AG, Sinclair SW, Willems SM, Bean AR (1992) Upper-limb surgery for tetraplegia. J Bone Joint Surg Br 74:873–879CrossRefGoogle Scholar
  32. 32.
    Allieu Y (2002) General indications for functional surgery of the hand in tetraplegic patients. Hand Clin 18:413–421CrossRefGoogle Scholar
  33. 33.
    House JH, Comadoll J, Dahl AL (1992) One-stage key pinch and release with thumb carpal-metacarpal fusion in tetraplegia. J Hand Surg Am 17:530–538CrossRefGoogle Scholar
  34. 34.
    Bertelli JA, Tacca CP, Ghizoni MF, Kechele PR, Santos MA (2010) Transfer of supinator motor branches to the posterior interosseous nerve to reconstruct thumb and finger extension in tetraplegia: case report. J Hand Surg Am 35:1647–1651.  https://doi.org/10.1016/j.jhsa.2010.07.012 CrossRefGoogle Scholar
  35. 35.
    Bertelli JA, Ghizoni MF (2016) Nerve and free gracilis muscle transfers for thumb and finger extension reconstruction in long-standing tetraplegia. J Hand Surg Am 41:e411–e416.  https://doi.org/10.1016/j.jhsa.2016.08.003 CrossRefGoogle Scholar
  36. 36.
    Bertelli JA (2015) Transfer of the radial nerve branch to the extensor carpi radialis brevis to the anterior interosseous nerve to reconstruct thumb and finger flexion. J Hand Surg Am 40:323–328.e2.  https://doi.org/10.1016/j.jhsa.2014.10.060 CrossRefGoogle Scholar
  37. 37.
    Bertelli JA, Ghizoni MF (2017) Nerve transfers for restoration of finger flexion in patients with tetraplegia. J Neurosurg Spine 26:55–61.  https://doi.org/10.3171/2016.5.SPINE151544 CrossRefGoogle Scholar
  38. 38.
    García-López A, Navarro R, Martinez F, Rojas A (2014) Nerve transfers from branches to the flexor carpi radialis and pronator teres to reconstruct the radial nerve. J Hand Surg Am 39:50–56.  https://doi.org/10.1016/j.jhsa.2013.10.011 CrossRefGoogle Scholar
  39. 39.
    Bertelli JA, Ghizoni MF, Tacca CP (2016) Results of wrist extension reconstruction in C5-8 brachial plexus palsy by transferring the pronator quadratus motor branch to the extensor carpi radialis brevis muscle. J Neurosurg 124:1442–1449.  https://doi.org/10.3171/2015.3.JNS142428 CrossRefGoogle Scholar
  40. 40.
    Bertelli JA, Mendes Lehm VL, Tacca CP, Winkelmann Duarte EC, Ghizoni MF, Duarte H (2012) Transfer of the distal terminal motor branch of the extensor carpi radialis brevis to the nerve of the flexor pollicis longus: an anatomic study and clinical application in a tetraplegic patient. Neurosurgery 70:1011–1016.  https://doi.org/10.1227/neu.0b013e3182367642 CrossRefGoogle Scholar
  41. 41.
    Zancolli E (1979) Structural and dynamic bases of hand surgery. Lippincott, New YorkGoogle Scholar
  42. 42.
    Mangus DJ (1973) Flexor pollicis longus tendon transfer for restoration of opposition of the thumb. Plast Reconstr Surg 52:155–159CrossRefGoogle Scholar
  43. 43.
    Bourrel P (1974) Restoration of opposition of the thumb. Apropos of 52 cases. Ann Chir 28:309–317Google Scholar
  44. 44.
    Gupta V, Consul A, Swamy M (2015) Zancolli lasso procedure for correction of paralytic claw hands. J Orthop Surg 23:15–18.  https://doi.org/10.1177/230949901502300104 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopedics and Traumatology II, Surgery for Hand and Upper Limb, CTO HospitalAOU Città della Salute e della Scienza di TorinoTurinItaly
  2. 2.Department of Orthopaedic and Traumatology, CTO HospitalUniversity of TurinTurinItaly
  3. 3.Reconstructive Microsurgery and Hand surgery UnitIstituto Giannina GasliniGenoaItaly
  4. 4.Department of Physical Medicine and Rehabilitation, Spinal UnitAOU Città della Salute e della Scienza di TorinoTurinItaly
  5. 5.Department of Neurosurgery, Unit of Clinical Neurophysiology, CTO HospitalAOU Città della Salute e della Scienza di TorinoTurinItaly

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