23 to 30 year followup of tetraplegic persons following tendon transfers alastair rothwell, jennifer...
TRANSCRIPT
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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
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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
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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
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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
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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
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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
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DIGITAL DYNOMOMETER
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DIGITAL DYNOMOMETER
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DIGITAL DYNOMOMETER
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RESULTS
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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
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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
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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
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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
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2001 20120
5
10
15
20
25
30
35
40
45
RightLeft
Year
Mean strength
(N)
Active Key Pinch
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2001 20120
5
10
15
20
25
30
35
RightLeft
Year
Mean strength
(N)
Tenodesis Key Pinch
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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
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2001 201248
50
52
54
56
58
60
62
64
RightLeft
Year
Mean strength
(N)
Active Grasp
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2001 20120
5
10
15
20
25
30
35
40
45
RightLeft
Year
Mean strength
(N)
Tenodesis Grasp
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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
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DISCUSSION
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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
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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
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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