title: Tendon Transfer Surgery for People With Tetraplegia: An Overview.
abstract: After cervical spinal cord injury, the loss of upper limb function is common. This affects an individual's ability to perform activities of daily living and participate in previous life roles. There are surgical procedures that can restore some of the upper limb function lost after cervical spinal cord injury. Tendon transfer surgery has been performed in the tetraplegic population since the early 1970s. The goals of surgery are to provide a person with tetraplegia with active elbow extension, wrist extension (if absent), and sufficient pinch and/or grip strength to perform activities of daily living without the need for adaptive equipment or orthoses. These procedures are suitable for a specific group, usually with spinal cord impairment of C4-8, with explicit components of motor and sensory loss. Comprehensive team assessments of current functioning, environment, and personal circumstances are important to ensure success of any procedure. Rehabilitation after tendon transfer surgery involves immobilization for tendon healing followed by specific, targeted therapy based on motor learning and goal-orientated training. Outcomes of tendon transfer surgery are not limited to the improvements in an individual's strength, function, and performance of activities but have much greater life affects, especially with regard to well-being, employment, and participation. This article will provide an overview of the aims of surgery, preoperative assessment, common procedures, postoperative rehabilitation strategies, and outcomes based on clinical experience and international published literature.
authors.affiliation: Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand; Burwood Spinal Unit, Burwood Hospital, Christchurch, New Zealand. Electronic address: jennifer.dunn@otago.ac.nz.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Dunn
authors.affiliation: Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand; Burwood Academy of Independent Living, Burwood Hospital, Christchurch, New Zealand.
authors.forename: K Anne
authors.initials: KA
authors.lastname: Sinnott
authors.affiliation: Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Alastair G
authors.initials: AG
authors.lastname: Rothwell
authors.affiliation: Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Khalid D
authors.initials: KD
authors.lastname: Mohammed
authors.affiliation: Department of Surgery, University of Otago, Christchurch, New Zealand.
authors.forename: Jeremy W
authors.initials: JW
authors.lastname: Simcock
mesh_terms: D004550:Elbow / Q000503:physiopathology / Q000601:surgery; D006225:Hand / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D026741:Physical Therapy Modalities; D011782:Quadriplegia / Q000209:etiology* / Q000534:rehabilitation / Q000601:surgery*; D016059:Range of Motion, Articular; D013119:Spinal Cord Injuries / Q000150:complications*; D013709:Tendon Transfer / Q000379:methods* / Q000534:rehabilitation; D013997:Time Factors; D034941:Upper Extremity / Q000503:physiopathology / Q000601:surgery*; D014953:Wrist / Q000503:physiopathology / Q000601:surgery
keywords: Quadriplegia; Reconstructive surgical procedures; Rehabilitation; Tendon transfer; Upper extremity