23 TO 30 YEAR FOLLOWUP OF TETRAPLEGIC PERSONS FOLLOWING TENDON TRANSFERS

Alastair Rothwell, Jennifer Dunn, Khalid Mohammed & Anne Sinnott-Jerram

from the

Upper Limb Group, Burwood Spinal Unit Christchurch New Zealand

AGING WITH TENDON TRANSFERS

The authors are all members of the BSU Upper Limb Group but none are employed directly by it or have received any financial benefit

CONFLICT of INTEREST

Conclusions

Mean grasp & key pinch values maintained or improved

Active transfers had approximately twice strength of tenodeses

Levels of functional independence & expectations had been maintained

Upper Limb Surgery for Tetraplegia: A 10 Year Re-review of Hand Function 1991-2001

Re evaluate grasp & key pinch strength in same cohort 21-30 years post transfer surgery

Determine effects of aging on active transfers & tenodeses

Determine long term outcomes on levels of function and satisfaction.

AIMS OF FURTHER REVIEW

19 of the previous 24 from the 2001review were eligible & willing to participate in the 2012 review.

All had had bilateral simultaneous hand surgery between 1982 & 1989

Approval for study granted by regional ethics committee

PARTICIPANTS

Grasp & key pinch tested by same (recalibrated) digital analyser as for 2001 study and results recorded in newtons

ASHT positioning protocol used for testing Best of three attempts recorded with minute rest

between tests. Same person (JD) performed all testing Lamb & Chan questionnaire again used for function

assessment with respondents asked to compare performance of each of the 25 tasks with that of 2001

METHODOLOGY

DIGITAL DYNOMOMETER

DIGITAL DYNOMOMETER

DIGITAL DYNOMOMETER

RESULTS

Years SD Range

Mean age 53 4.3 47-61

Mean time since SCI 31 4.0 26-39

Mean time from 1st U.L. surg 26 2.3 23-30

18 male 1 female

DEMOGRAPHICS

IC Right Left Total

O1 2 2 4 O2/OCu2 2 3 5 O3/OCu3 2 4 6 OCu4 9 5 14 OCu5 4 4 8 OCu6 0 1 1 Total 19 19 38

IC of PARTICIPANTS ARMS

KEY PINCH BR > FPL 27 PT > FPL 4 FPL tenodeses 6 Total 37

GRASP ECRL > FDP 20 BR > FDP 6 FDP tenodeses 4 Total 30

SURGICAL PROCEDURES

Active n mean2001(Ns) mean2012(Ns) % changeR 17 38.3(17.5) 32.9(12.9) -14

L 14 26.9(17.3) 27.1(13.7) -0.8

R & L combined -2.4%

Tenodeses R 2 19.0(1.4) 11.5(9.2) -39.5 L 4 31.8(10.7) 15.5(1.9) -51.2

KEY PINCH

2001 20120

5

10

15

20

25

30

35

40

45

RightLeft

Year

Mean strength

(N)

Active Key Pinch

2001 20120

5

10

15

20

25

30

35

RightLeft

Year

Mean strength

(N)

Tenodesis Key Pinch

Active n mean2001(Ns) mean2012(Ns) % change R 15 62.1(31.7) 59.0(30.3) -5 L 12 57.3(36.9) 52.7(35.1) -8.1 R & L combined -10%

Tenodeses R 2 31.0(4,2) 41.0(25.5) +32.3 L 2 13.5(10.6) 23.0(24.0) +70.4

GRASP

2001 201248

50

52

54

56

58

60

62

64

RightLeft

Year

Mean strength

(N)

Active Grasp

2001 20120

5

10

15

20

25

30

35

40

45

RightLeft

Year

Mean strength

(N)

Tenodesis Grasp

Majority of participants believed no change in their ability to perform most of the 25 tasks

10 stated had decreased ability to propel manual wheelchair on the flat & up a slope

7 stated had decreased ability to pressure relieve Overall 12 now used power chair for at least

some of mobility needs compared to 5 in 2001

LAMB and CHAN Q

DISCUSSION

Mathowetz et al 1985: 0.5-1% loss/year from age 39 in normal population

Grabner & Enoka 1995: 1.5% loss/year from 50-70 years Frederkkson et al 2006 0.6% males, 0.3% females loss/yr

from 50-85 years Summary: 0.5%-1.5% loss/yr from age 40-50

Charlifue et al 2010: loss commences more quickly post SCI

Current study: The mean10% reduction of grasp & 2.5% of key pinch strength

over the 11year period for the age range of our study group (47-61) falls within the normal population reduction

EFFECT of AGING on MUSCLE STRENGTH

Smaby et al 2004: majority of daily tasks require grip of 10.5Ns or less for tetraplegic persons

Most of study participants had key pinch/grasp far in excess of 10.5 Ns (mean 30 & 56Ns respect.)

Hence the reported unchanged ability to perform daily tasks except for whchair prop. & wt relief

These tasks require use of shoulder & elbow muscles more than hand grip

LAMB & CHAN RESULTS

Active transfers to provide key pinch and grasp, continue to provide hand function for ADLs for at least 23 and up to 30 years.

The % decline in strength of active transfers is similar to that of the normal population in the same age range.

The small number of participants with FDP tenodeses make invalid any conclusions regarding possible reasons for the dramatic increase in their strength.

CONCLUSIONS