TY - JOUR
T1 - Outcome from a brachialis donor for wrist extension in tetraplegia—time to reconsider the International Classification for Surgery of the Hand in Tetraplegia (ICSHT)
AU - Fridén, Jan
AU - Son, Jongsang
AU - Koch-Borner, Sabrina
AU - Lieber, Richard L.
N1 - Funding Information:
This work was supported by the Swiss Paraplegic Foundation and U.S. Department Veterans Affairs Rehab R&D Grant I01 RX002462 and NIH/NICHD Grants R01 HD048501 and R24 HD050837. This work was supported in part by Research Career Scientist Award Number IK6 RX003351 from the United States (U.S.) Department of Veterans Affairs Rehabilitation R&D (Rehab RD) Service.
Publisher Copyright:
© 2021, This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.
PY - 2021/12
Y1 - 2021/12
N2 - Introduction: Surgical reconstruction after quadriplegia represents a powerful solution to restore lost function by injury. A case is presented in which surgical reconstruction of a patient with a C4 level spinal cord injury is performed using the brachialis (BRA) muscle as the donor. Case presentation: The patient previously had no hand function. This transfer, in combination with fusion of the thumb CMC joint and transfer of the flexor pollicis longus (FPL) tendon to the radius, gives the patient full thumb key pinch powered by BRA transferred to the wrist extensors. Theoretical analysis of muscle architectural properties demonstrates that the BRA has sufficient force and excursion to substitute for both the long and short radial wrist extensors. Furthermore, based on the fact that the BRA has almost twice the excursion compared to the extensor carpi radialis longus (ECRL), wrist extension can occur throughout the entire wrist and elbow ranges of motion. Finally, peak tension is lower than the rupture tension previously measured by us using this type of tendon-to-tendon attachment technique, suggesting that the transfer itself is safe and, importantly, can be immediately mobilized for neuromuscular rehabilitation. Discussion: This procedure can thus restore tremendous functional capacity in patients who were previously categorized as group 0 by the International Classification of Hand Surgery in Tetraplegia (ICSHT). We suggest that, based on the BRA being an excellent donor for surgical reconstruction, that the ICHST system be reconsidered.
AB - Introduction: Surgical reconstruction after quadriplegia represents a powerful solution to restore lost function by injury. A case is presented in which surgical reconstruction of a patient with a C4 level spinal cord injury is performed using the brachialis (BRA) muscle as the donor. Case presentation: The patient previously had no hand function. This transfer, in combination with fusion of the thumb CMC joint and transfer of the flexor pollicis longus (FPL) tendon to the radius, gives the patient full thumb key pinch powered by BRA transferred to the wrist extensors. Theoretical analysis of muscle architectural properties demonstrates that the BRA has sufficient force and excursion to substitute for both the long and short radial wrist extensors. Furthermore, based on the fact that the BRA has almost twice the excursion compared to the extensor carpi radialis longus (ECRL), wrist extension can occur throughout the entire wrist and elbow ranges of motion. Finally, peak tension is lower than the rupture tension previously measured by us using this type of tendon-to-tendon attachment technique, suggesting that the transfer itself is safe and, importantly, can be immediately mobilized for neuromuscular rehabilitation. Discussion: This procedure can thus restore tremendous functional capacity in patients who were previously categorized as group 0 by the International Classification of Hand Surgery in Tetraplegia (ICSHT). We suggest that, based on the BRA being an excellent donor for surgical reconstruction, that the ICHST system be reconsidered.
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U2 - 10.1038/s41394-021-00436-z
DO - 10.1038/s41394-021-00436-z
M3 - Article
C2 - 34381016
AN - SCOPUS:85112325089
SN - 2058-6124
VL - 7
JO - Spinal cord series and cases
JF - Spinal cord series and cases
IS - 1
M1 - 73
ER -