Related Experiment Videos
A prospective evaluation of upper extremity tendon transfers in children with cervical spinal cord injury
M J Mulcahey1, R R Betz, B T Smith
1Shriners Hospitals for Children, Philadelphia, Pennsylvania, USA.
Insights
Tendon transfers significantly improved pinch force and object manipulation in children with cervical spinal cord injuries. Functional independence in daily tasks like feeding and schoolwork also saw notable gains post-surgery.
Area of Science:
- Pediatric Orthopedics
- Spinal Cord Injury Rehabilitation
- Hand Surgery
Background:
- Cervical spinal cord injuries in children often result in loss of hand function, specifically voluntary lateral pinch.
- Restoring pinch is crucial for independence in daily activities and fine motor tasks.
Purpose of the Study:
- To evaluate the effectiveness of tendon transfers in restoring voluntary lateral pinch in pediatric patients with cervical spinal cord injuries.
- To assess functional outcomes, including pinch force, object manipulation, and activities of daily living, after tendon transfer surgery.
Main Methods:
- A cohort of three children (five hands) with cervical spinal cord injuries underwent tendon transfer surgery.
- Pinch force, Grasp and Release Test (GRT), and Functional Independence Measure (FIM) were measured pre- and post-surgery.
- Open-ended questions supplemented FIM data at 1 year post-surgery.
Main Results:
- Post-surgery, all hands showed increased pinch and finger flexion forces, with measurable force achieved where none existed before.
- The Grasp and Release Test (GRT) demonstrated the ability to manipulate heavier objects after tendon transfers.
- Significant improvements were observed in feeding, grooming, bladder management, play, and school-related tasks.
Conclusions:
- Tendon transfers are an effective surgical intervention for restoring voluntary lateral pinch in children with cervical spinal cord injuries.
- The procedure leads to enhanced functional independence and improved performance in daily activities.
- While generally successful, some patients may require additional procedures like tenolysis, and range of motion limitations can persist in some cases.
Abstract:
Three children (five hands) between 6 and 11 years of age with cervical level spinal cord injuries underwent tendon transfers to restore voluntary lateral pinch. Repeated measures of pinch force and the Grasp and Release Test (GRT) were obtained before surgery and at regular intervals after tendon transfers. The Functional Independence Measure (FIM) was administered before surgery and at 12 months after surgery. Responses to open-ended questions were used to supplement the FIM data at 1 year after surgery. Before surgery, no measurable force was obtained in any hand; after tendon transfers, pinch and finger flexion forces increased throughout the follow-up period. On the GRT, manipulation of the heavy objects was possible only after tendon transfers. Improvements were realized in feeding, grooming, bladder management, play, and school tasks. Each child requested surgery to restore pinch in the nondominant hand. Two hands required tenolysis procedures. Despite capsulotomies and aggressive therapy, three hands continued to have range limitations at the metacarpophalangeal joints.