Tendon Transfers to Restore Function of Hands in Tetraplegia, Especially after Fracture-Dislocation of the Sixth Cervical Vertebra on the Seventh

Abstract

The number of surviving patients with tetraplegia following trauma is increasing. Many of these patients are injured between time sixth and the seventh cervical vertebra. These patients have on one side, and often on both, the following muscles functioning below the level of the elbow: extensor carpi radialis longus, extensor carpi radialis brevis, brachioradialis, flexor carpi radialis, and pronator teres. By two-stage surgical transfer of tendons in each upper extremity, active extension and flexion of all digits, the correction of clawing, and opposition of the thumb can be accomplished. These tendon transfers utilize time function of automatic motion of the fingers that accompanies movement of the wrist. Arthrodesis of the wrist rarely, if ever, should be done in patients who have tetraplegia. Patients in whom such tendon transfers are done regain the function of hooking, light pinching, and grasping. They are able to discard special hand appliances and become more independent.