title: Activation of brachioradialis muscles transferred to restore lateral pinch in tetraplegia.
abstract: OBJECTIVE
  Surgical transfers of muscles are used to restore lateral pinch in tetraplegia; however, outcomes are variable. The purpose of this study was to compare activation of the brachioradialis (Br) after transfer to the flexor pollicis longus during maximum effort in its primary function (elbow flexion) with maximum effort in its postoperative function (lateral pinch) and to record Br activation during functional tasks.
  
  
  METHODS
  Fine-wire electrodes recorded activation of the Br in 11 arms with tetraplegia. Subjects produced maximum lateral pinch force with and without elbow stabilization and were classified according to elbow strength. The elbow was stabilized by supporting the arm and limiting elbow motion. A force sensor mounted on a custom grip recorded the pinch force. Electromyographic (EMG) signals recorded during lateral pinch were expressed as a percentage of the maximum voluntary contraction recorded during maximum-effort elbow flexion.
  
  
  RESULTS
  The EMG activation was significantly lower during lateral pinch compared with resisted elbow flexion. The mean EMG during lateral pinch in the self-supported elbow condition was 34% of the maximum voluntary contraction; with the elbow stabilized the EMG increased to 55% of the maximum voluntary contraction. Postoperative pinch-force magnitude was 14 N with self-support and 20 N with the elbow stabilized. Subjects with weak elbow extension strength produced significantly lower pinch forces compared with subjects with strong elbow extension but had similar ability to activate the Br. The Br activation was higher when the pinch tasks were performed successfully.
  
  
  CONCLUSIONS
  These findings suggest a reduced ability to activate the transferred muscle fully in lateral pinch function after surgery, even with the addition of elbow support. The Br activation is linked to successful performance of lateral pinch tasks. The subjects' inability to activate the transferred muscle fully may be affected by postoperative muscle re-education and contribute to postoperative weakness.
authors.affiliation: Laboratory for Upper Extremity Research in Spinal Cord Injury, Rehabilitation Research and Development Center, VA Palo Alto Health Care System, 3801 Miranda Ave/153, Palo Alto, CA 94304-1200, USA. johanson@VA51.stanford.edu
authors.forename: M Elise
authors.initials: ME
authors.lastname: Johanson
authors.forename: Vincent R
authors.initials: VR
authors.lastname: Hentz
authors.forename: Niels
authors.initials: N
authors.lastname: Smaby
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Murray
mesh_terms: D000328:Adult; D000368:Aged; D004566:Electrodes; D004576:Electromyography; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D018482:Muscle, Skeletal / Q000503:physiopathology / Q000637:transplantation*; D011782:Quadriplegia / Q000601:surgery*; D020127:Recovery of Function; D013709:Tendon Transfer