Current Concepts in Elbow Extension Reconstruction for the Tetraplegic Patient.
Dan A Zlotolow1, Lee A Kripke, Scott H Kozin
1From the Department of Orthopedic Surgery, The Sydney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (Zlotolow), Shriners Hospital for Children Philadelphia, The Philadelphia Hand to Shoulder Center, Philadelphia, PA (Zlotolow), Shriners Hospital for Children Greenville, Greenville, SC (Zlotolow), The Hospital for Special Surgery, New York, NY (Zlotolow), Department of Orthopedic, Albert Einstein Healthcare Network, Philadelphia, PA (Kripke), Shriners Hospital for Children Philadelphia, American Society for Surgery of the Hand, Chicago, IL (Kozin).
Restoring elbow extension through tendon or nerve transfers can significantly improve independence for individuals with C5-C6 spinal cord injury (SCI). These reconstructive surgeries enhance daily activities and quality of life for those with quadriplegia.
Area of Science:
- Reconstructive surgery for spinal cord injury.
- Upper extremity function restoration.
- Neurorehabilitation.
Background:
- Cervical spinal cord injury (SCI) at C5-C6 levels results in triceps paralysis, impairing elbow extension and limiting hand use above shoulder height.
- Loss of elbow extension hinders essential daily activities such as dressing, eating, and transfers.
- Restoring elbow extension is crucial for improving independence and quality of life in individuals with quadriplegia.
Approach:
- Review of established tendon transfer procedures (deltoid-to-triceps, biceps-to-triceps) for elbow extension restoration.
- Introduction of novel nerve transfer techniques involving axillary nerve branches to triceps.
- Highlighting the potential of these surgical interventions to enhance functional independence.
Key Points:
- Tendon transfers offer established efficacy for restoring elbow extension.
- Nerve transfers represent a promising new approach with early positive outcomes.
- Surgical timing is critical for optimal results in upper limb reconstruction.
Conclusions:
- Restoring elbow extension significantly improves functional independence and quality of life for individuals with C5-C6 SCI.
- Increased awareness of reconstructive options is needed to improve surgical uptake, as fewer than 14% of eligible patients receive surgery.
- Timely referral and surgical intervention are essential for maximizing the benefits of these procedures.
