Outcomes


Change of grip after surgery (left=before, right=after)



Surgical reconstruction and rehabilitation improves the individual´s ability to perform many of her/his prioritized goals. The greatest improvements are observed not only in the basic activity like “eating” but in activities generally regarded as complex and not measured in standard Activity-of-Daily Life measurements e.g. “doing housework” and “leisure”. Also, it is important to remember that improvement continues during first year after surgery. A critical function for controlling the hand is elbow extensor (Triceps). Ability to stretch elbow is important for reaching out the hand and reach overhead objects. The combination of triceps function, opening of the hand and grasping is a substantial improvement of hand control and ability.














Another important skill linked to triceps function is maneuvering a wheelchair. The footage below demonstrates the function of triceps 6 months after surgical reconstruction and the improved wheelchair push from reconstructed triceps one year after reconstruction.



This movie shows the elbow extension 6 months after a tendon transfer to replace loss of triceps function. Compare the right reconstructed side with the left and yet non-reconstructed side.



This movie demonstrates the improved power of pushing the driving wheel och the wheelchair after reconstruction of triceps but before grip reconstruction.

Recent studies in our unit have demonstrated that the combination of triceps and grip reconstruction increased the tetraplegic person's ability to maneuver a manual wheelchair. For example, performance of sprint, uphill driving and static push improved by more than 60 percent after surgery. This may be the change that makes a person willing to drive the wheelchair outdoors or even swap from electric to manual wheelchair for good.

Regarding reconstruction of grip and grasp function our studies have demonstrated:
  1. Substantial improvement of activity-related performance and satisfaction
  2. Improvements in activities the individual depicts as most important
  3. Task-specific patient performance and satisfaction
Picture above demonstrates a birthday party where a man who less than half a year ago underwent reconstruction of triceps and grip function dances with his grandson.

Surgical reconstruction of upper extremity function after diving accidents

Background: Diving accidents are catastrophic events frequently causing spinal high level tetraplegia, mostly in active adolescents or young adults. Many papers have been dedicated to the epidemiology, trauma mechanism, and prevention of these events, yet the effect of upper extremity surgery in this specific population has not been adequately studied previously. Recently, we investigated the clinical improvement and subjective patient satisfaction after upper extremity surgery to improve arm and hand function in high-level tetraplegia after diving accidents.
Study design: Between the years 2000 and 2009, a total of 28 patients with a mean age of 24.7 years (range: 17 to 37 years) underwent surgery to restore upper extremity function lost at a mean 4.6 years earlier due to cervical spinal cord injury caused by a diving accident. Functional parameters, such as key pinch, grasp strength and active thumb-index opening were measured prospectively.
Results: Upper extremity reconstruction included a mean of 2.6 (max: 5) stages. Overall, 21 patients underwent restoration of elbow extension, 24 had a key pinch reconstruction (6 passive, 18 active with active finger grasp), 7 had restoration of active finger extension combined with their thumb extension or abduction, passive finger extension were performed in 3 and a thumb stabilization procedure in 19 patients. Outcome of surgery measured according to Canadian Occupational Performance Measure (COPM) did not differ compared to results of reconstruction after other causes of tetraplegia (traffic accidents, fall, sports and violence).
Conclusions: Operations using tendon transposition and joint stabilizations have a great potential to improve arm and hand function and thus independence and mobility in tetraplegic patients, even when suffering from high-level SCI due to diving accidents.
Jan Fridén, Carina Reinholdt and Andreas Gohritz
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