Tetraplegic Hand Reconstruction Using Double Nerve Transfers for All Finger Flexion: Motor Grading and Hand Functional Tests.

Abstract

Purpose: To evaluate motor grading and hand functional outcomes of restoring tetraplegic hands using single-stage multiple nerve transfers, including double nerve transfers, for finger flexion.

Methods: Patients with tetraplegia who had single-stage multiple nerve transfers between January 2016 and December 2021 were included in the study. We evaluated the patients using muscle grading, the International Spinal Cord Injury Upper Extremity basic data set, the Toronto Rehabilitation Institute-Hand Function Test, the Spinal Cord Independent Measure III, and the Spinal Cord Ability Ruler.

Results: During the research study period, 7 patients with tetraplegia underwent a total of 41 nerve branch transfers for upper-extremity motor reanimation, including 6 posterior deltoid to the long head of the triceps, 11 supinator to the posterior interosseous nerve, 11 extensor carpi radialis brevis to the flexor digitorum profundus of the ulnar nerve, 9 brachialis to the anterior interosseous nerve, 2 pronator teres to the anterior interosseous nerve, 1 extensor carpi radialis brevis to the anterior interosseous nerve, and 1 pronator teres to the flexor digitorum profundus component controlled by the ulnar nerve. Following the nerve transfers, the motor grade, and functional tests of each limb showed improvement. The brachialis to anterior interosseous nerve transfer improved more slowly than the other nerve transfers, and two of those transfers only resulted in grade 1 thumb and index flexor strength, with the latter requiring tendon transfer.

Conclusions: Single-stage multiple nerve transfers can increase the function of the hand in patients with tetraplegia. In C6 and C7 patients with tetraplegia who have two good donors, double nerve transfers to the anterior interosseous nerve and flexor digitorum profundus branch controlled by the ulnar nerve can restore flexion in all fingers. The brachialis to the anterior interosseous nerve transfer requires a longer recovery time than the other transfers and has a lower success rate.

Type of study/level of evidence: Therapeutic V.