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

In a series of 65 tetraplegic hands with severe disabling spasticity and/or flexion contracture, selective flexor tendon elongation procedures were employed to improve their static and kinetic postures. A kinetic approach was adopted, utilizing local anesthesia in a wide-awake patient. This was employed to allow for the patient's cooperation in determining at surgery the desired length of digital extension at the time of wrist tenodesis action. Elongation of the extensor digitorum communis (EDC), extensor indicis proprius (EIP), and extensor digiti quinti (ED V) were added to correct an 'extrinsic-plus' posture observed in 16 patients following flexor tendon lengthening. With the resultant improvement in the static posture of the digits, tendon transfers could then be employed to provide a more functional tenodesis action. These measures provided both improved palmar contact and prehension.