Outcome from a brachialis donor for wrist extension in tetraplegia—time to reconsider the International Classiﬁcation for Surgery of the Hand in Tetraplegia (ICSHT)

Spinal Cord Series and Cases, 2021 · DOI: https://doi.org/10.1038/s41394-021-00436-z · Published: July 26, 2021

Simple Explanation

This case report describes a novel application of tendon transfer using the brachialis (BRA) muscle as the donor to restore wrist extension in tetraplegia when no other motors are available for reconstruction of hand function. In combination with ﬂexor pollicis longus (FPL) tenodesis to the radius and fusion of the thumb carpo-meta-carpal (CMC1) joint, this provides key pinch for a patient previously deﬁned as ICSHT 0. Theoretical analysis of muscle architectural properties demonstrates that the BRA has sufﬁcient force and excursion to substitute for both the long and short radial wrist extensors.

Study Duration

3 years

Participants

1 patient with C4 level spinal cord injury

Evidence Level

Level IV, Case Report

Key Findings

1
The brachialis (BRA) muscle can be successfully transferred to restore wrist extension in tetraplegic patients classified as ICSHT 0.
2
The transferred BRA provides sufficient force and excursion to substitute for both the long and short radial wrist extensors, enabling functional key pinch.
3
Postoperative rehabilitation, including electrical stimulation and strength training, is crucial for achieving functional goals.

Research Summary

This case report presents the successful use of brachialis (BRA) muscle transfer to restore wrist extension in a C4 tetraplegic patient previously classified as ICSHT 0, who had no other available motors for hand reconstruction. The procedure involved transferring the BRA to the extensor carpi radialis brevis (ECRB), along with fusion of the thumb CMC joint and tenodesis of the FPL tendon to the radius, resulting in functional key pinch. The patient achieved significant improvement in wrist stability, hand function, and independence, as demonstrated by increased COPM performance and satisfaction scores, suggesting the potential for reconsidering the ICSHT classification to include BRA as a viable donor muscle.

Practical Implications

Reclassification of ICSHT

The International Classification of Hand Surgery in Tetraplegia (ICSHT) should be reconsidered to include the brachialis muscle as a potential donor, which would reclassify some patients and expand surgical options.

Expanded Surgical Options

Brachialis transfer offers a viable surgical option for restoring wrist extension and key pinch in tetraplegic patients with no other available donor muscles.

Improved Functional Outcomes

This procedure has the potential to significantly improve functional outcomes, independence, and quality of life for tetraplegic individuals.

Outcome from a brachialis donor for wrist extension in tetraplegia—time to reconsider the International Classiﬁcation for Surgery of the Hand in Tetraplegia (ICSHT)

Simple Explanation

Key Findings

Research Summary

Practical Implications

Reclassification of ICSHT

Expanded Surgical Options

Improved Functional Outcomes

Study Limitations

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Was this summary helpful?

Outcome from a brachialis donor for wrist extension in tetraplegia—time to reconsider the International Classiﬁcation for Surgery of the Hand in Tetraplegia (ICSHT)

Simple Explanation

Key Findings

Research Summary

Practical Implications

Reclassification of ICSHT

Expanded Surgical Options

Improved Functional Outcomes

Study Limitations

Your Feedback

Was this summary helpful?