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Brachioradialis Transfer for Wrist Extension in Tetraplegic Patients Who Have Fifth-Cervical-Level Neurological Function*

JOHNSON, DARREN L. M.D.†; GELLMAN, HARRIS M.D.‡; WATERS, ROBERT L. M.D.§; TOGNELIA, MONICA O.T.R.§, DOWNEY, CALIFORNIA

Journal of Bone & Joint Surgery - American Volume: July 1996 - Volume 78 - Issue 7 - p 1063–7
Article

The brachioradialis tendon was transferred to the extensor carpi radialis 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 included a determination of the preoperative and postoperative ranges of motion of the wrist, manual muscle-testing of the strength of the brachioradialis and the wrist extensors, a functional assessment of the ability to perform activities of daily living (eating, grooming, dressing, 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 gravity preoperatively. The strength of the wrist extensors improved postoperatively 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 patients, 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 tend to personal hygiene, to write and type, and to use a telephone.

†University of Kentucky Sports Medicine Center, Kentucky Clinic, K401, Lexington, Kentucky 40536-0284.

‡Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences Medical Center, Slot 531, 4301 West Markham Street, Little Rock, Arkansas 72205.

§Rancho Los Amigos Medical Center, 7601 East Imperial Highway, Downey, California 90242.

Copyright 1996 by The Journal of Bone and Joint Surgery, Incorporated
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