Mj. Mulcahey et al., A prospective evaluation of upper extremity tendon transfers in children with cervical spinal cord injury, J PED ORTH, 19(3), 1999, pp. 319-328
Three children (five hands) between 6 and 11 years of age with cervical lev
el spinal cord injuries underwent tendon transfers to restore voluntary lat
eral pinch. Repeated measures of pinch force and the Grasp and Release Test
(GRT) were obtained before surgery and at regular intervals after tendon t
ransfers. The Functional Independence Measure (FIM) was administered before
surgery and at 12 months after surgery. Responses to open-ended questions
were used to supplement the FIM data at 1 year after surgery. Before surger
y, no measurable force was obtained in any hand; after tendon transfers, pi
nch and finger flexion forces increased throughout the follow-up period. On
the GRT, manipulation of the heavy objects was possible only after tendon
transfers. Improvements were realized in feeding, grooming, bladder managem
ent, play, and school tasks. Each child requested surgery to restore pinch
in the nondominant hand. Two hands required tenolysis procedures. Despite c
apsulotomies and aggressive therapy, three hands continued to have range li
mitations at the metacarpophalangeal joints.