Pinch and elbow extension restoration in people with tetraplegia: a systematic review of the literature.
OBJECTIVE
We conducted a systematic review of the literature to summarize the available data on reconstructive surgeries involving pinch reconstruction and elbow extension restoration in people with tetraplegia.


METHODS
English-language and French-language articles and abstracts published between 1966 and February 2007, identified through MEDLINE and EMBASE searches, bibliography review, and expert consultation, were reviewed for original reports of outcomes with pinch reconstruction and elbow extension restoration in tetraplegic patients after a spinal cord injury. Two reviewers independently extracted data on patient characteristics, surgical methods, and patient outcomes.


RESULTS
Our search identified 765 articles, of which 37 met eligibility criteria (one article contained information on both elbow and pinch procedures). Results from 377 pinch reconstructions in 23 studies and 201 elbow extension restorations in 14 studies were summarized. The mean Medical Research Council score for elbow extension went from 0 to 3.3 after reconstruction. The overall mean postoperative strength measured after surgery for pinch reconstruction was 2 kg.


CONCLUSIONS
More than 500 patients having these procedures experienced a clinically important improvement for both procedures-one restoring elbow extension, and the other, pinch strength. Upper-limb surgeries markedly improved the hand function of people with tetraplegia.


METHODS
Therapeutic IV.
Division of Hand Surgery, Stanford University School of Medicine, Stanford, CA 94304, USA.
Cynthia
C
Hamou
Nirav R
NR
Shah
Lisa
L
DiPonio
Catherine M
CM
Curtin
D004551:Elbow Joint / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D052581:Pinch Strength / Q000502:physiology*; D011782:Quadriplegia / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology*; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology; D053656:Tenodesis / Q000379:methods*