Brachioradialis to flexor pollicis longus tendon transfer for active lateral pinch in the tetraplegic.

Seventeen hands in 15 patients with posttraumatic tetraplegia had transfers of the brachioradialis tendon to the flexor pollicis longus in an attempt to create an active lateral pinch. In addition, interphalangeal joint fixation with a Moberg screw was performed in 16 thumbs and tenodesis of the extensor pollicis longus and brevis tendons to the metacarpal was performed in 11 patients. Average patient age was 32 years, time from onset of tetraplegia to operation was 5.3 years, and postoperative follow-up was 2.3 years. Functional improvement was noted in 15 hands and 80% of the patients could name at least four activities of daily living that were now possible or made more efficient as a result of surgery. With the elbow flexed to 90 degrees, the average lateral pinch was 3.9 pounds with the wrist extended 30 degrees, 4 pounds with the wrist in the neutral position, and 2.3 pounds with the wrist flexed 30 degrees. There was a direct correlation between pinch strength and the amount of residual triceps and wrist extensor strength.