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Surgical Rehabilitation of the Tetraplegic Upper Extremity

  • Andreas GohritzEmail author
  • Istvan Turcsányi
  • Jan Fridén
Chapter

Abstract

First priority for many individuals with cervical spinal cord injury (SCI) is to regain arm and hand function and thus more independence, mobility, and quality of life. This is a realistic goal in at least 70 % of patients with tetraplegia. However, a specialized treatment is only provided to few of possible candidates (less than 10 %) or not at all in many countries.

Main goals include restoration of elbow and wrist extension and hand grip against gravity which can be achieved by muscle or nerve transfer, joint stabilizations, and procedures reducing spasticity. One-stage combined procedures have proven considerable advantages over traditional multistage approaches. Immediate activation of transferred muscles reduces the risk of adhesions, facilitates relearning, avoids adverse effects of immobilization, and enhances functional recovery regarding strength, range of motion, and patient satisfaction.

Transfer of axillary, musculocutaneous, and radial nerve fascicles from above the SCI is effective and promising options to simplify aftertreatment and enhance motor outcome and sensory protection, especially in groups with limited resources. Functional recovery is yet less reliable and may take at least 6–9 months – ideally, nerve and muscle transfer should be combined to optimize results. Improved multidisciplinary cooperation of physiatrists, hand surgeons, and therapists should give more tetraplegic individuals the chance to profit from upper extremity surgery and get the chance to “take their life into their own hands” again.

Keywords

Spinal Cord Injury Elbow Extension Tendon Transfer Wrist Extension Hand Opening 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

APB

Abductor pollicis brevis

APL

Abductor pollicis longus

BR

Brachioradialis

CMC

Carpometacarpal

DIP

Distal interphalangeal

ECU

Extensor carpi ulnaris

EDC

Extensor digitorum communis

EDM

Extensor digiti minimi

ECRB

Extensor carpi radialis brevis

ECRL

Extensor carpi radialis longus

EPL

Extensor pollicis longus

FDP

Flexor digitorum profundus

FDS

Flexor digitorum superficialis

FPL

Flexor pollicis longus

MCP

Metacarpophalangeal

PIP

Proximal interphalangeal

PNI

Peripheral nerve injury

PT

Pronator teres

SCI

Spinal cord injury

Notes

Declaration of Conflicting Interests

The authors have no financial disclosures.

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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Andreas Gohritz
    • 1
    • 2
    Email author
  • Istvan Turcsányi
    • 3
  • Jan Fridén
    • 4
    • 1
  1. 1.Department of Hand SurgerySwiss Paraplegia CentreNottwilSwitzerland
  2. 2.Department of Plastic, Reconstructive and Aesthetic Surgery, Hand SurgeryUniversity HospitalBaselSwitzerland
  3. 3.Department of OrthopaedicsSzabolcs-Szatmár-Bereg County Hospitals and University HospitalNyíregyházaHungary
  4. 4.Centre of Advanced Reconstruction of Extremities (C.A.R.E.), and Department of Hand SurgeryInstitute of Clinical Sciences, Sahlgrenska University HospitalGöteborgSweden

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