BRACHIORADIALIS TRANSFER FOR WRIST EXTENSION IN TETRAPLEGIC PATIENTS WHO HAVE 5TH-CERVICAL-LEVEL NEUROLOGICAL FUNCTION

The brachioradialis tendon was transferred to the extensor carpi radia lis longus and brevis tendons to restore active extension of the wrist in nine patients who had traumatic tetraplegia. The classification of neurological function was the fifth cervical level for all patients. The average time from the injury to the operation was six years (range , one to twenty years), and the average duration of follow-up was ten years (range, two to fifteen years). The evaluation of the patient inc luded a determination of the preoperative and postoperative ranges of motion of the wrist, manual muscle-testing of the strength of the brac hioradialis and the wrist extensors, a functional assessment of the ab ility to perform activities of daily living (eating, grooming, dressin g, personal hygiene, and desktop activities [writing, typing, using a telephone, and so on]), and an assessment of functional independence. In addition, the result of the operation was evaluated subjectively by the patient. No patient had active extension of the wrist against gra vity preoperatively. The strength of the wrist extensors improved post operatively to a grade of good in six patients and to a grade of fair- plus in three. Function of the hand improved markedly in seven patient s, and no patient had a loss of function. The patients had improvement in the ability to pick up objects, to feed and groom themselves, to t end to personal hygiene, to write and type, and to use a telephone.