Saturday, July 12, 2008

Surgery

Elbow Extension

The ability to bend and straighten the elbow is crucial for the person's independence, so this is often the first surgery to be performed. In most cases, a portion of the deltoid muscle in the shoulder is used to provide elbow extension. The back (posterior) portion of the deltoid is brought down toward the elbow. Because the deltoid portion is not long enough to reach the attachment point in the lower arm, a tendon graft is taken from a lower leg muscle (tibialis anterior) to provide the necessary length. In some cases, the biceps muscle in the upper arm is used instead of the deltoid muscle. After the surgery, the arm is immobilized in a straight position for up to four weeks. When the cast is removed, a hinged brace is used to allow a gradual stretching and strengthening of the muscles. Initially, the brace is worn night and day, but as the individual gains the ability to fully extend the arm, the brace is worn only at night. Tendon transfer to achieve elbow extension is done on one arm at a time because the arm is totally immobilized during rehabilitation. This means that the person becomes even more dependent on others for the simple activities of daily living. However, the results are impressive.

It can eliminate the need for many adaptive devices and enable the person with tetraplegia to propel a wheelchair, to move independently from bed to chair, to shift weight within a chair or bed and to reach up and outwards.

Key Pinch
Restoring key pinch enables the individual to grip items between the thumb and the hand. This greatly enhances the ability of the patient with tetraplegia to accomplish activities of daily living, such as writing or feeding themselves. In this surgery, one of the forearm muscles (brachioradialis) is grafted to the tendon that flexes the thumb and another muscle that stretches the wrist is moved to flex the fingers. The surgeon may also stiffen the basal thumb joint so that when the wrist is extended, the grip forms automatically.

Finger Flexion
In persons with strong wrist extension, one of the wrist extensors may be grafted to the finger flexors. This enables the individual to actively (under voluntary control) flex the fingers. Training of this new function starts immediately after surgery (the day after). As for the key pinch, the active training is guided and supervised by a physiotherapist.

Grip Function
These two surgeries significantly improve hand and arm function in many patients, providing them with much greater independence.

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