title: Tetraplegia Management Update.
abstract: Tetraplegia is a profound impairment of mobility manifesting as a paralysis of all 4 extremities owing to cervical spinal cord injury. The purpose of this article is to provide an update and analyze current management, treatment options, and outcomes of surgical reconstruction of arm and hand function. Surgical restoration of elbow and wrist extension or handgrip has tremendous potential to improve autonomy, mobility, and critical abilities, for example, eating, personal care, and self-catheterization and productive work in at least 70% of tetraplegic patients. Tendon and nerve transfers, tenodeses, and joint stabilizations reliably enable improved arm and hand usability, reduce muscle imbalance and pain in spasticity, and prevent joint contractures. One-stage combined procedures have proven considerable advantages over traditional multistage approaches. Immediate activation of transferred muscles reduces the risk of adhesions, facilitates relearning, avoids adverse effects of immobilization, and enhances functional recovery. Transfer of axillary, musculocutaneous, and radial nerve fascicles from above the spinal cord injury are effective and promising options to enhance motor outcome and sensory protection, especially in groups with limited resources. Improved communication between medical disciplines, therapists, patients, and their relatives should help that more individuals can benefit from these advances and could empower many thousands tetraplegic individuals "to take life into their own hands" and live more independently.
authors.affiliation: Centre for Advanced Reconstruction of Extremities (C.A.R.E.) and Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden; Swiss Paraplegic Centre, Nottwil, Switzerland. Electronic address: jan.friden@orthop.gu.se.
authors.forename: Jan
authors.initials: J
authors.lastname: Fridén
authors.affiliation: Swiss Paraplegic Centre, Nottwil, Switzerland; Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, University Hospital, Basel, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Gohritz
mesh_terms: D003286:Contracture / Q000209:etiology / Q000517:prevention & control; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D009128:Muscle Spasticity / Q000209:etiology / Q000517:prevention & control; D016067:Nerve Transfer; D059408:Pain Management; D011782:Quadriplegia / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D013119:Spinal Cord Injuries / Q000503:physiopathology; D013709:Tendon Transfer; D034941:Upper Extremity / Q000503:physiopathology / Q000601:surgery*
keywords: Combined procedures; early activation; nerve transfer; tendon transfer; tetraplegia