Sabrina Koch-Borner1, Jennifer A Dunn2, Jan Fridén3, Johanna Wangdell4. 1. Swiss Paraplegic Center, Nottwil, Switzerland. Electronic address: sabrina.koch@paraplegie.ch. 2. Burwood Spinal Unit, Burwood Hospital, Christchurch, New Zealand; Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand. 3. Swiss Paraplegic Center, Nottwil, Switzerland; Center of Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Hand Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy at Göteborg University, Gothenburg, Sweden. 4. Center of Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Gothenburg, Sweden.
Abstract
OBJECTIVE: To describe and evaluate the rehabilitation concept after posterior deltoid to triceps transfer in patients with tetraplegia. DESIGN: Retrospective observational study. SETTING: Rehabilitation units. PARTICIPANTS: Patients with tetraplegia who had posterior deltoid to triceps tendon transfer and had muscle strength measurements 1 year postsurgery from 2009 to 2013 (N=44). INTERVENTIONS: Posterior deltoid to triceps tendon transfer to restore elbow extension and postoperative rehabilitation. MAIN OUTCOME MEASURES: Elbow extension range of motion and muscle strength and the modified Canadian Occupational Performance Measure (COPM). RESULTS: Surgery was performed on 53 arms. No major complications (eg tendon rupture, lengthening) were reported. Muscle strength measured 1 year after surgery was on average grade 3 (out of 5) in the 53 operated arms. The ability to extend the elbow against gravity was achieved in 62% of the arms (muscle strength of grade ≥3). In patients with a preoperative elbow extension deficit (n=14), the deficit was reduced on average from 16° to 9°. The performance of the prioritized activities as measured with the COPM improved on average 2.6 scale steps, from 3.3 to 5.9. Satisfaction with the performance improved on average 3.2 scale steps, from 2.8 to 6.0. CONCLUSIONS: The posterior deltoid to triceps tendon transfer with the applied rehabilitation protocol is a safe and effective procedure. There were no tendon ruptures, and all patients were able to complete the rehabilitation protocol. The shorter restriction time after surgery allows the patient to be independent at an earlier stage of the rehabilitation and reduces hospitalization or care burden.
OBJECTIVE: To describe and evaluate the rehabilitation concept after posterior deltoid to triceps transfer in patients with tetraplegia. DESIGN: Retrospective observational study. SETTING: Rehabilitation units. PARTICIPANTS: Patients with tetraplegia who had posterior deltoid to triceps tendon transfer and had muscle strength measurements 1 year postsurgery from 2009 to 2013 (N=44). INTERVENTIONS: Posterior deltoid to triceps tendon transfer to restore elbow extension and postoperative rehabilitation. MAIN OUTCOME MEASURES: Elbow extension range of motion and muscle strength and the modified Canadian Occupational Performance Measure (COPM). RESULTS: Surgery was performed on 53 arms. No major complications (eg tendon rupture, lengthening) were reported. Muscle strength measured 1 year after surgery was on average grade 3 (out of 5) in the 53 operated arms. The ability to extend the elbow against gravity was achieved in 62% of the arms (muscle strength of grade ≥3). In patients with a preoperative elbow extension deficit (n=14), the deficit was reduced on average from 16° to 9°. The performance of the prioritized activities as measured with the COPM improved on average 2.6 scale steps, from 3.3 to 5.9. Satisfaction with the performance improved on average 3.2 scale steps, from 2.8 to 6.0. CONCLUSIONS: The posterior deltoid to triceps tendon transfer with the applied rehabilitation protocol is a safe and effective procedure. There were no tendon ruptures, and all patients were able to complete the rehabilitation protocol. The shorter restriction time after surgery allows the patient to be independent at an earlier stage of the rehabilitation and reduces hospitalization or care burden.