Tetraplegia is a profound impairment of mobility manifesting as a paralysis of all
4 extremities owing to cervical spinal cord injury. The purpose of this article is
to provide an update and analyze current management, treatment options, and outcomes
of surgical reconstruction of arm and hand function. Surgical restoration of elbow
and wrist extension or handgrip has tremendous potential to improve autonomy, mobility,
and critical abilities, for example, eating, personal care, and self-catheterization
and productive work in at least 70% of tetraplegic patients. Tendon and nerve transfers,
tenodeses, and joint stabilizations reliably enable improved arm and hand usability,
reduce muscle imbalance and pain in spasticity, and prevent joint contractures. 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. Transfer of axillary, musculocutaneous, and radial nerve fascicles from
above the spinal cord injury are effective and promising options to enhance motor
outcome and sensory protection, especially in groups with limited resources. Improved
communication between medical disciplines, therapists, patients, and their relatives
should help that more individuals can benefit from these advances and could empower
many thousands tetraplegic individuals “to take life into their own hands” and live
more independently.
Key words
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Article info
Publication history
Published online: November 01, 2015
Accepted:
June 13,
2015
Received:
March 5,
2015
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
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© 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
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