Tendon transfers to improve grasp in patients with cervical spinal cord injury

Patients with cervical spinal cord injury can gain useful hand function from a good rehabilitation programme and non-operative hand care. Effective prehension can usually be achieved by proper positioning, exercises, and splinting but when grasp is poor, tendon transfers are very effective in furthering the goal of independence. These patients have been reviewed extensively and classified into groups according to remaining neurological function. Group I patients have weak elbow flexion and weak shoulder function or less. No tendon transfers were done. Group II patients have shoulder control, elbow flexion and weak wrist extensors. Some of these patients can be improved by transferring the brachioradialis to the radial wrist extensor. Group III patients have the above and good to normal brachioradialis and two radial wrist extensors. Transferring the brachioradialis to restore opposition and the extensor carpi radialis longus to the flexor digitorum profundi provides strong and effective prehension. Group IV patients have the above plus pronator teres and flexor carpi radialis which can be used for transfer. Opposition and finger flexion can be restored by a variety of transfers. In groups III and IV tendon transfers were done only when automatic grasp was poor or absent. If finger grasp was good and thumb function ineffective only opponens transfers were done in order to achieve key pinch. Group V patients have all muscles functioning but with varying degrees of intrinsic weakness. Opponens transfer is useful for these patients. Indications and contraindications to surgery are given. All the patients have improved function and strength following their tendon transfers. No patient has regretted having had surgery.