Outcome from a brachialis donor for wrist extension in tetraplegia—time to reconsider the International Classification for Surgery of the Hand in Tetraplegia (ICSHT)

Jan Fridén, Jongsang Son, Sabrina Koch-Borner, Richard L. Lieber*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Article number73
JournalSpinal cord series and cases
Volume7
Issue number1
DOIs
StatePublished - Dec 2021

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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