Abstract
Tetraplegia is challenging to treat and requires a team of competent and caring physicians and nurses. The initial goal is to facilitate the transition from able-bodied life to a life complicated by spinal cord injury. The issues are enormous and the task seems overwhelming to the patient. Through a series of small steps, the patient is often able to make the changeover. However, complications are endemic including depression, spasticity, autonomic dysreflexia, urinary retention, and decubiti. As part of the rehabilitation, an assessment of the upper extremities is integral. Many patients can benefit from tendon transfers to improve motion and function. The potential to restore elbow extension, wrist extension, pinch, and grasp is critical for independence and spontaneity. This chapter will discuss the evaluation, treatment regimen, and surgical techniques applicable to the person with spinal cord injury.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Bent L, Mulcahey MJ, Kelly E, Calhoun C, Tian F, Pensheng N, Vogel L, Haley S. Child- and parent- report computer-adaptive tests for assessing daily routines among youth with spinal cord injury. Topics Spinal Cord Injury Rehab. 2013;19:104–13.
Bertelli JA, Ghizoni MF. Single-stage surgery combining nerve and tendon transfers for bilateral upper limb reconstruction in a tetraplegic patient: case report. J Hand Surg Am. 2013;38:1366–9.
Curtin CM, Gater DR, Chung KC. Upper extremity reconstruction in the tetraplegic population, a national epidemiologic study. J Hand Surg Am. 2005;30:94–9.
Friden J, Ejeskar A, Dahlgren A, Lieber RL. Protection of the deltoid to triceps tendon transfer repair sites. J Hand Surg Am. 2000;25:144–149.
Kilgore KL, Peckman H, Keith MW, Thrope GB, Wuolle KS, Bryden AM, Hart RL. An implanted neuroprosthesis. Follow-up of five patients. J Bone Joint Surg Am. 1997;79:533–41.
Kozin SH. Biceps-to-triceps transfer for restoration of elbow extension in tetraplegia. Tech Hand Up Extrem Surg. 2003;7:43–51.
Kozin SH. Surgical management of the upper limb after spinal cord injury. In: Trumble TE, Budoff JE, editors. Hand surgery update. Rosemont: American Society for Surgery of the Hand; 2007. p. 777–99.
Kozin SH. Pediatric onset spinal cord injury: implications on management of the upper limb in tetraplegia. Hand Clin. 2008;24:203–13.
Kozin SH, Zlotolow DA. Biceps rerouting and biceps-to-triceps for persons with spinal cord injury. In: Van Heest A, Goldfarb CA, editors. Tendon transfer surgery of the upper extremity: a master skills publication. Rosemont: American Society for Surgery of the Hand; 2012. p. 111–20.
Kozin SH, D’Addesi L, Chafetz RS, Ashworth S, Mulcahey MJ. Biceps-to-triceps transfer for elbow extension in persons with tetraplegia. J Hand Surg Am. 2010;35:968–75.
Krieger LM, Krieger AJ. The intercostal to phrenic nerve transfer: an effective means of reanimating the diaphragm in patients with high cervical spine injury. Plast Reconstr Surg. 2000;105:1255–61.
Kuz J, Van Heest AE, House JH. Biceps-to-triceps transfer in tetraplegic patients: report of the medial routing technique and follow-up of three cases. J Hand Surg Am. 1999;24:161–72.
LeClerq C, Hentx VR, Kozin SH, Mulcahey MJ. Reconstruction of elbow extension. Hand Clin. 2008;24:185–201.
McGinley JC, Heller JE, Fertala A, Gaughan JP, Kozin SH. Biomechanical composition and histologic structure of the forearm interosseous membrane. J Hand Surg. 2003;28A:503–10.
Mulcahey MJ, Lutz C, Kozin SH, Betz RB. Prospective evaluation of biceps to triceps and deltoid to triceps for elbow extension in tetraplegia. J Hand Surg Am. 2003;28:964–71.
Mulcahey MJ, Calhoun C, Tian F, Ni P, Vogel L, Haley S. Evaluation of newly developed item banks for child reported outcomes of participation following spinal cord injury. Spinal Cord. 2012;50:915–9.
Pahys JM, Mulcahey MJ, Hutchinson D, Betz RR. Scapular stabilization in patients with spinal cord injury. J Spinal Cord Med. 2009;32:389–97.
Revol M, Briand E, Servant JM. Biceps-to-triceps transfer in tetraplegia. The medial route. J Hand Surg Br. 1999;24:235–7.
Snoek GJ, Ijzerman MJ, Hermens HJ, Maxwell D, Biering-Sorensen F. Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics. Spinal Cord. 2004;42:526–32.
Tibballs J. Diaphragmatic pacing: an alternative to long-term mechanical ventilation. Anaesth Intensive Care. 1991;19:597–601.
Yang ML, Li JJ, Zhang SC, Du LJ, Gao F, Li J, Wang YM, Gong HM, Liang Cheng L. Functional restoration of the paralyzed diaphragm in high cervical quadriplegia via phrenic nerve neurotization utilizing the functional spinal accessory nerve. J Neurosurg Spine. 2011;15:190–4.
Zlotolow DA. The role of the upper extremity surgeon in the management of tetraplegia. J Hand Surg Am. 2011;36:929–35.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Electronic supplementary material
Video 1
AVI file: 700423 kB
Video 2
WMV file: 4037 kB
Rights and permissions
Copyright information
© 2015 Springer Science+Business Media New York
About this entry
Cite this entry
Kozin, S.H., Zlotolow, D.A., Abzug, J.M. (2015). Upper Limb Reconstruction in Persons with Tetraplegia . In: Abzug, J., Kozin, S., Zlotolow, D. (eds) The Pediatric Upper Extremity. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8515-5_33
Download citation
DOI: https://doi.org/10.1007/978-1-4614-8515-5_33
Received:
Accepted:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4614-8513-1
Online ISBN: 978-1-4614-8515-5
eBook Packages: MedicineReference Module Medicine