Surgical reconstruction of the upper limb in traumatic tetraplegia. A review of 41 patients

Lamb, Douglas W.; Chan, KM

doi:10.1302/0301-620x.65b3.6841399

Cited by 113 publications

(47 citation statements)

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“…7 The time before surgery seemed to be an important variable. The lowest results were obtained between 13 and 20 months with an exception (patient 5, left side).…”

Section: Referencesmentioning

confidence: 99%

Length–tension relationship of the posterior deltoid to triceps transfer in C6 tetraplegic patients

et al. 1993

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We assessed the length-tension relationship of the posterior deltoid to triceps transfer in 8 tetraplegics (n = 11 transfers) and compared the results to the length-tension relationship of the normal triceps measured in a check sample composed of 9 able bodied, right handed women. We designed a device to lock the arm and forearm and used a force transducer to assess the torque output isometrically. The muscle was tested at 6 different lengths (130, 110, 90, 70, 45 and 0° of elbow flexion) with the shoulder abducted at 90°. As expected, the transfer behaved differently from the normal triceps. The mean maximum torque recorded was 7. 8 Nm in patients while it was 27 Nm in the check sample. When compared, the absolute values (ie values expressed with a dimension of torque) were significantly different between groups (0. 00001 < P < 0. 002). The expression of this relation (ie the relative values expressed as percentage of maximum values) revealed significant statistical differences (p < 0. 002) at 90 and 70° of elbow flexion; the peak torque was recorded at 130° in patients while it was recorded at 110° in the check sample, with a plateau between 110° and 70°. On the other hand, if the length-tension relationship was fairly similar among subjects of the check sample, it exhibited tremendous differences among patients; it seemed that initial tension given by the surgeon represented a variable difficult to control without a device dedicated to that task.

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“…7 The time before surgery seemed to be an important variable. The lowest results were obtained between 13 and 20 months with an exception (patient 5, left side).…”

Section: Referencesmentioning

confidence: 99%

Length–tension relationship of the posterior deltoid to triceps transfer in C6 tetraplegic patients

et al. 1993

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“…32 The samples were felt to be representative of the diagnostic group and were demographically similar to those in previous studies. 7,13,16,18,19 There is a substantial amount of published literature in the ®eld of tendon transfer surgery but none comparing surgical and non-surgical subjects. Therefore some of the di culties of subject recruitment and matching may not have been encountered by previous authors.…”

Section: Discussionmentioning

confidence: 99%

“…Methods of patient evaluation vary throughout the literature making comparison of ®ndings from di erent researchers di cult. Improvements in wheelchair control and mobility have been reported 5,9,13,14,18,19 yet it appears that objective testing was not used to support these observations. Functional independence has been assessed by interview or questionnaire in some studies and by locally devised ADL scales in others.…”

Section: Introductionmentioning

confidence: 99%

“…Functional independence has been assessed by interview or questionnaire in some studies and by locally devised ADL scales in others. 13,20 Few studies 17,21 have used existing measures such as the Functional Independence Measure (FIM). 22 Objective The aims of the study were to describe and compare the functional capacity of a group of people with tetraplegia with and without deltoid triceps transfer surgery.…”

Section: Introductionmentioning

confidence: 99%

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Deltoid triceps transfer and functional independence of people with tetraplegia

2000

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Study design: Matched case control study. Setting: Two regional spinal units ± Salisbury, UK (surgical centre) and London, UK (control centre). Objective: To compare the functional independence and wheelchair mobility of spinal cord injured subjects, post deltoid triceps transfer, with matched control subjects. Methods: Two matched groups of subjects, with tetraplegia resulting in triceps paralysis, were studied. The surgical group consisted of ®ve of the six patients who had previously undergone deltoid triceps transfer at Salisbury. The control group (n=6) had not undergone surgical intervention but were comparable with respect to level of lesion, age, age at injury and duration of disability. All subjects completed standardised assessments of activities of daily living (Functional Independence Measure ± FIM) and wheelchair mobility (10 m push and ®gure of 8 push). Surgical subjects completed additional questions, regarding the perceived e ects of surgery on function. Results: It was not possible to demonstrate absolute functional di erences with the chosen outcome measures in this small series of matched case controls. All surgical subjects cited speci®c functional improvements since surgery and recommended the procedure. However the FIM lacked su cient sensitivity to detect these changes. Conclusion: Further investigation of the functional outcome of deltoid triceps transfer in tetraplegia is warranted. Development of more sensitive outcome measures would be useful. Spinal Cord (2000) 38, 435 ± 441.

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“…Tendon transfer procedures are commonly used to improve upper extremity function by restoring movements such as elbow extension, wrist extension, and grasp/release. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] In addition, there are procedures to reduce contractures such as the rotational radial osteotomy to correct a forearm supination contracture or a biceps tendon lengthening to reduce elbow flexion contractures. [16][17][18][19][20][21] Tendon transfer procedures have traditionally been most effective for individuals who have sustained injuries at the C5-C7 level, as persons at this level have strong but redundant donor muscles to be used for providing additional function.…”

Section: Introductionmentioning

confidence: 99%

Perceived outcomes and utilization of upper extremity surgical reconstruction in individuals with tetraplegia at model spinal cord injury systems

et al. 2004

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A mailed survey eliciting responses with respect to: (1) utilization of upper extremity reconstructive procedures and (2) the clinicians' perceived outcomes of these procedures. Results: In all, 76% responded positively about the availability and appropriateness of upper extremity surgical reconstruction at their center. Of the respondents, 75% felt that surgery recipients were generally satisfied with their surgeries, 80% felt that the surgery made a positive impact on recipients' lives, 81% felt that recipients showed increased independence, and 70% reported a positive impact on recipients' occupation. In all, 93% felt insurance companies should pay for the procedures. Compared to the satisfaction of surgery recipients using a similar instrument, clinicians anticipated slightly greater improvements in all areas except occupation. Conclusions: There is a positive perception of the benefits of reconstructive surgery for tetraplegia; however, procedures are not routinely offered at all centers. The primary reasons reported for this include the misconception that insurance does not remit payment, that a surgeon is not available, and that surgical candidates are referred to another center.

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Surgical reconstruction of the upper limb in traumatic tetraplegia. A review of 41 patients

Cited by 113 publications

References 0 publications

Length–tension relationship of the posterior deltoid to triceps transfer in C6 tetraplegic patients

Length–tension relationship of the posterior deltoid to triceps transfer in C6 tetraplegic patients

Deltoid triceps transfer and functional independence of people with tetraplegia

Perceived outcomes and utilization of upper extremity surgical reconstruction in individuals with tetraplegia at model spinal cord injury systems

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