Shortened rehabilitation period using a modified surgical technique for reconstruction of lost elbow extension in tetraplegia

Abstract

Our aim was to evaluate the functional outcome of reconstruction of elbow extension in tetraplegia using a new technique for improving the attachment sites of posterior deltoid-to-triceps transfer in conjunction with an active rehabilitation programme. Ten tetraplegic patients (15 arms) had modified deltoid-to-triceps transfer using a tibialis anterior tendon graft. The operation included large overlaps between the tendon attachments, and additional security by anchoring the distal stump of the tendon graft to the olecranon. During the first 3 weeks of immobilisation, isometric contractions were made and during the following 4 weeks the flexion angle of the elbow was increased by 15° a week; weights were also used to reinforce muscle strength. The mean follow up was 10 months (range 5–19). The elbow extension strength after posterior deltoid-to-triceps transfer was measured in horizontal and vertical planes. After rehabilitation the active range of motion and strength of elbow extension had improved substantially. The mean active elbow extension range of motion was 132° (range 120°–145°) and the elbow could be extended actively in all planes. Elbow extension strength was restored to well above the counteraction of the weight of the arm. Mean (SEM) elbow extension was significantly greater in the horizontal shoulder plane compared with the vertical plane (10.4 (1.0) compared with 6.5 (1.2) Nm, p < 0.001) and strength increased roughly linearly as the degree of flexion of the elbow increased. The most dramatic increase was in the range between 120° and 135° of flexion, regardless of the plane of action of the shoulder. We have shown good functional results and a shorter rehabilitation period using a rigorous suturing technique that allows for active strength and mobility training without additional adverse effects.

Key Words::

• Posterior deltoid-to-triceps transfer
• elbow extension
• tetraplegia
• force-joint angle relationship

Acknowledgements

This investigation conforms to the Jósa András County Hospital and University of Gothenburg Human Research Protection Program guidelines. Funding for this project was provided by the Swedish Research Council Grant 11200, University of Gothenburg, and Sahlgrenska University Hospital. Dr. Richard L. Lieber is acknowledged for his help with statistical analyses.

Declaration of interest: The authors have no financial disclosures.