Purpose
To evaluate the effects of aging on hand function among patients with tetraplegia
who had forearm tendon transfer surgery between 1982 and 1990.
Methods
The study used a longitudinal cohort design that compared hand function outcomes in
2012 with those obtained 11 years earlier. A digital analyzer was used to measure
key pinch and grip strength, and results were compared with those obtained in 2001
to determine changes in strength over time. The study also evaluated changes in participant's
employment status, wheelchair use, and subjective changes in function using the Lamb
and Chan questionnaire.
Results
Participants had a mean key pinch strength force between 11.5 N (tenodeses) and 32.9 N
(active transfers) and grip strength forces between 23 N (tenodeses) and 59 N (active
transfers). Since 2001, people with active transfers either maintained strength or
experienced decreased strength of 5% to 14%. Thumb tenodesis power decreased 40% to
51%, whereas finger tenodeses power increased 32% to 70%. Three activities in the
Lamb and Chan questionnaire were identified by the majority of participants as being
worse or much worse over the past 11 years. These were performing a pressure relief
and propelling a manual wheelchair on level ground and up a ramp. These findings correspond
with the increased number of participants who used a power wheelchair in 2012 (64%)
compared with 2001 (26%). Close to half of the participants (46%) were employed compared
with the 90% in 2001.
Conclusions
Tendon transfers continued to provide pinch and grip function for individuals with
tetraplegia for many years following spinal cord injury. The decrease in strength
of those with active transfers over the 11-year period was within the reported aging
loss for the normal population. The small number of participants with tenodesis, however,
limited our ability to draw meaningful conclusions for this group.
Type of study/level of evidence
Prognostic III.
Key words
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References
- Surgical treatment for absent single-hand grip and elbow extension in quadriplegia. Principles and preliminary experience.J Bone Joint Surg Am. 1975; 57: 196-206
- SCIRE Research Team. Enhancing upper extremity function with reconstructive surgery in persons with tetraplegia: a review of the literature.Top Spinal Cord Inj Rehabil. 2007; 13: 58-80
- A synthesis of best evidence for the restoration of upper-extremity function in people with tetraplegia.Physiother Can. 2011; 63: 474-489
- Upper limb surgery in tetraplegia.J Bone Joint Surg Br. 1992; 74: 873-879
- Upper limb surgery for tetraplegia: a 10-year re-review of hand function.J Hand Surg Am. 2003; 28: 489-497
- The Second International Conference on Surgical Rehabilitation of the Upper Limb in Tetraplegia (Quadriplegia).J Hand Surg Am. 1986; 11: 604-608
- Assessment of the upper limb in tetraplegia: considerations in evaluation and outcomes research.J Rehabil Res Dev. 2007; 44: 91-102
- Surgical reconstruction of the upper limb in traumatic tetraplegia. A review of 41 patients.J Bone Joint Surg Br. 1983; 65: 291-298
- Reliability and validity of grip and pinch strength evaluations.J Hand Surg Am. 1984; 9: 222-226
- Grip and pinch strength: normative data for adults.Arch Phys Med Rehabil. 1985; 66: 69-74
- Age trajectories of grip strength: cross-sectional and longitudinal data mong 8342 Danes aged 46 to 102.Ann Epidemiol. 2006; 16: 554-562
- Changes in movement capabilities with aging.Exerc Sport Sci Rev. 1995; 23: 65-104
- Aging with spinal cord injury.Phys Med Rehabil Clin N Am. 2010; 21: 383-402
- Long-term spinal cord injury: functional changes over time.Arch Phys Med Rehabil. 1993; 74: 1030-1034
- Short-term versus long-term comparative results after reconstructive upper-limb surgery in tetraplegic patients.J Hand Surg Am. 2006; 31: 1490-1494
- Identification of key pinch forces required to complete functional tasks.J Rehabil Res Dev. 2004; 41: 215-224
- Aging, spinal cord injury, and quality of life: structural relationships.Arch Phys Med Rehabil. 2003; 84: 1137-1144
- Shouder pain in persons with thoracic spinal cord injury: prevalence and characteristics.J Rehabil Med. 2008; 40: 277-283
- Return to work after spinal cord injury: a review of recent research.Neurorehabilitation. 2002; 17: 177-186
- Return to work following spinal cord injury: a review.Disabil Rehabil. 2007; 29: 1341-1375
Article info
Publication history
Accepted:
November 20,
2013
Received:
July 24,
2013
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
