Tendon transfers in tetraplegic patients: the Cleveland experience

The author has taken care of patients with spinal cord injury for over 30 years. A major part of these years was spent doing tendon transfers on the patients with tetraplegia. Thirteen were not better, but not worse out of the 285 patients who had an operation. All of the patients have had a period of rehabilitation, waited 1 year following spinal injury, and had a stable neurological examination. The goals of the surgery were wrist extension, elbow extension, thumb pinch, and finger grasp. This was based on the author's classification of the characteristic muscle strengths that are present in the completely paralysed tetraplegic patient. One group of patients had weak or no wrist extension. These patients needed a transfer of the brachioradialis to the extensor carpi radialis brevis. Some of these patients required a posterior deltoid transfer to act as an obstacle to the brachioradialis. The next group of patients had no elbow extension, but had brachioradialis and two radial wrist extensors. They required a posterior deltoid transfer, and an opponens transfer and a transfer to give finger flexion. The next group had elbow extension, brachioradialis, two radial wrist extensors and a pronator teres, and needed an opponens transfer, and a transfer to give finger flexion. The last group of patients had poor or no opposition, and required an opponens transfer.