Functional Independence and Elbow Strength in Tetraplegia: Analysis of Tendon Transfers

Abstract

Background

Over half of spinal cord injuries result in tetraplegia, profoundly impairing daily activities (ADLs).

Objective

To evaluate biceps-to-triceps (B-T) and deltoids-to-triceps (D-T) tendon transfers, comparing their impacts on elbow extension strength and ADL independence.

Methods

Retrospective review of tendon transfers performed between 2003 and 2023 at a neurorehabilitation center. Post-surgery muscle strength was assessed using the Medical Research Council (MRC) scale and ADL independence with the motor Functional Independence Measure (mFIM). We used ANOVA to identify post-surgery associations between MRC achieved scores and performance in ADLs.

Results

A total of 34 individuals (42 arms) underwent B-T or D-T surgeries, predominantly at C5 level (66.7%) with 69.0% classified as AIS A. Post-surgery, 81% of B-T and 76.2% of D-T achieved antigravity elbow extension (MRC 3–4), with mean MRC scores of 3.2 for both groups. The B-T group, older at surgery (39.9 vs. 27.8 years) and with shorter time since injury to surgery (2.3 vs. 5.0 years), showed significant post-surgery improvements in Self-care, Transfers, Locomotion, and total mFIM. In contrast, significant associations between MRC scores and mFIM outcomes in D-T transfers involved Self-care, Sphincter control, Transfers, and total mFIM.

Conclusions

MRC scores and ADLs were positively impacted by rehabilitation tendon transfers.

Keywords

spinal cord injury elbow extension tetraplegia tendon transfers daily activities

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