The hyperflexed seemingly useless tetraplegic hand: a method of surgical amelioration

Area of Science:

• Orthopedic surgery
• Hand surgery
• Rehabilitation medicine

Background:

• Severe spasticity and flexion contractures in tetraplegic hands significantly impair function.
• Existing treatments often have limitations in restoring hand posture and prehension.

Purpose of the Study:

• To evaluate the efficacy of selective flexor tendon elongation in improving static and kinetic hand postures in tetraplegic patients.
• To assess the impact of these procedures on palmar contact and prehension.

Main Methods:

• A kinetic, wide-awake surgical approach under local anesthesia was used in 65 tetraplegic hands.
• Selective flexor tendon elongation was performed, with patient cooperation to determine optimal digital extension during wrist tenodesis.
• Elongation of extensor digitorum communis (EDC), extensor indicis proprius (EIP), and extensor digiti quinti (ED V) was added in 16 patients to correct 'extrinsic-plus' posture.

Main Results:

• The procedures resulted in significant improvement in the static posture of the digits.
• Improved hand postures facilitated subsequent tendon transfers for functional tenodesis.
• Enhanced palmar contact and prehension were achieved post-operatively.

Conclusions:

• Selective flexor tendon elongation is an effective surgical intervention for improving hand function in tetraplegic individuals.
• The wide-awake kinetic approach allows for precise surgical adjustments, optimizing outcomes.
• This technique offers a viable solution for restoring hand function and improving quality of life in patients with severe spasticity.