Purpose: 75% of tetraplegic patients consider use of their hands the one function they would most like restored, more important than use of the lower extremities, bladder or bowel control and sexual function.1 There is strong evidence that reconstructive surgical procedures enhance upper extremity function, and although there is a need for higher quality studies there are ethical and logistical constraints that limit studying this population.2 The purpose of this study is to assess objective functional outcomes and satisfaction of tetraplegic patients following surgery to restore pinch and grasp and to compare the results of active tendon transfer to tenodesis procedures.
Method: An independent retrospective chart review identified 26 procedures in 24 patients over a 12 year period (1994–2006) at an average follow up of 4 years. Objective measurements of pinch and grip strength using three successive measurements was compared to the nonoperative side (control). Hand function was assessed using a validated scoring system (LiNK Hand Function Test). A validated outcome questionnaire specific to this population was administered to assess patient satisfaction in improvements of ADL (mobility dressing, communication, personal care, feeding, miscellaneous ADL) Moberg key pinch reconstruction was performed in all 26 limbs (20 active transfers and 6 tenodesis) and active transfer for hook grip (grasp) was performed in 16 of the 26 limbs (ECRL to FDP).
Results: None of the patients had measurable key pinch or grasp prior to reconstruction in the operated limb. Post operative pinch strength measured 4.1 pounds in the active transfer group and 2.1 pounds in the tenodesis group (mean 3.7) Hook grip measured 9.6 pounds in the operated limb and zero in the control. No anticipated improvement in mobility was identified postoperatively. Improvement in communication and personal care was improved or greatly improved in 60% of patients. 85% described improved independence in feeding and drinking. 90% of patients felt that their overall expectations of surgery were met, that surgery had improved their quality of life, that they would recommend the surgery to others, and that they would have the same surgery again.
Conclusion: Functional hand surgery can have a profound impact on the function and quality of life in the tetraplegic patient, both subjectively and objectively. Limitations of this study include the lack of a proper control population, small study numbers, difference in follow up period at the time of evaluation and recall bias of the questionnaire.
