Simultaneous powering of forearm pronation and key pinch in tetraplegia using a single muscle-tendon unit

Abstract

This study clinically assessed the concept that both thumb flexion and forearm pronation can be restored by brachioradialis (BR)-to-flexor pollicis longus (FPL) tendon transfer if the BR is passed dorsal to the radius. Six patients [two women and four men, mean age 32.3 years (SD 4.9, range 23–56)] underwent BR-to-FPL transfer dorsal to the radius and through the interosseous membrane (IOM). Lateral key pinch strength and pronation range of motion (ROM) were measured 1 year after surgery. A group of six patients [two women and four men, mean age 31.2 years (SD 5.0, range 19–52)] who underwent traditional palmar BR-to-FPL was included for comparison. Postoperative active pronation was significantly greater in the dorsal transfer group compared to the palmar group [149 (SD 6) and 75 (SD 3), respectively] and pinch strength was similar in the two groups [1.28 (SD 0.16) kg and 1.20 (SD0.21) kg, respectively]. We conclude that it is feasible to reconstruct lateral key pinch and forearm pronation simultaneously using only the BR motor.

Keywords

Tetraplegia tendon transfer surgery thumb flexion forearm pronation brachioradialis muscle

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References

Brand

Hollister

. Clinical mechanics of the hand, 2nd Edn. St Louis, Mosby, 1993.

Brown

Hentzen

Kwan

Ward

Fridén

Lieber

. Mechanical strength of the side-to-side versus Pulvertaft weave tendon repair. J Hand Surg Am. 2010, 35: 540–5.

Erdfelder

Faul

Buchner

. GPOWER: A general power analysis program. Behav Res Meth Instrum Comput. 1996, 28: 1–11.

Freehafer

. Tendon transfers in patients with cervical spinal cord injury. J Hand Surg Am. 1991, 16: 804–9.

Freehafer

Peckham

Keith

Mendelson

. The brachioradialis: anatomy, properties, and value for tendon transfer in the tetraplegic. J Hand Surg Am. 1988, 13: 99–104.

Freiman

Chalmers

Smith

Kuebler

. The importance of beta, the Type II error and sample size in the design and interpretation of the randomized controlled trial: survey of 71 ‘negative’ trials. N Engl J Med. 1978, 299: 690–4.

Fridén

Albrecht

Lieber

. Biomechanical analysis of the brachioradialis as a donor in tendon transfer. Clin Orthop Relat Res. 2001, 383: 152–61.

Fridén

Lieber

. Tendon transfer surgery: clinical implications of experimental studies. Clin Orthop Relat Res. 2002, 403(Suppl.): S163–70.

McDowell

Moberg

House

. The Second International Conference on Surgical Rehabilitation of the Upper Limb in Tetraplegia (Quadriplegia). J Hand Surg Am. 1986; 11: 604–8.

10.

Medical Research Council. Aids to the investigation of peripheral nerve injuries. War memorandum No. 7, 2nd Edn. London, Her Majesty’s Stationery Office: 1976.

11.

Murray

Buchanan

Delp

. The isometric functional capacity of muscles that cross the elbow. J Biomech. 2000, 33: 943–52.

12.

Ward

Peace

Fridén

Lieber

. Dorsal transfer of the brachioradialis to the flexor pollicis longus enables simultaneous powering of key pinch and forearm pronation. J Hand Surg Am. 2006, 31: 993–7.