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Intrinsic hand muscle function, part 2: kinematic comparison of 2 reconstructive procedures
David A Muzykewicz1, Ursina Arnet, Richard L Lieber
1Department of Orthopaedic Surgery, University of California, San Diego, California; Swiss Paraplegic Centre, Nottwil, Switzerland; Sahlgrenska University Hospital, Gothenburg, Sweden.
The Journal of Hand Surgery
|November 12, 2013
Summary
The House procedure better restores hand function for tetraplegic patients than the Zancolli-lasso technique. Both methods improve grasp, but only the House procedure mimics natural hand movement for better finger flexion.
Area of Science:
- Orthopedic surgery
- Reconstructive surgery
- Hand surgery
Background:
- Restoring grasp is crucial for tetraplegic patients.
- Surgical restoration of finger flexion can lead to suboptimal "roll-up" flexion.
- Improving intrinsic hand function is key to better grasp kinematics.
Purpose of the Study:
- To compare grasp kinematics between the Zancolli-lasso and House intrinsic balancing procedures.
- To evaluate the effectiveness of these procedures in restoring hand function for tetraplegic patients.
Main Methods:
- 12 cadaver hands underwent either Zancolli-lasso or House reconstruction (6 each).
- Flexor digitorum profundus (FDP) was mechanically activated to simulate hand closure.
- Video analysis compared kinematics (MCP and IP joint flexion order) with 5 control hands.
Main Results:
- House procedure hands demonstrated MCP joint flexion preceding IP joint flexion, mimicking intrinsic-activated hands.
- Zancolli-lasso hands showed IP joint flexion before MCP joint flexion, similar to intrinsic-minus hands.
- Both procedures improved maximal fingertip-to-palm distance compared to controls, with no significant difference between the two.
Conclusions:
- Both Zancolli-lasso and House procedures enhance grasp in tetraplegic patients.
- The House procedure more closely replicates physiological hand kinematics.
- The House procedure is recommended for restoring intrinsic function in tetraplegic patients due to its more natural kinematic restoration.
