gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Rebalancing hand opening in a patient with flexion spasticity

Meeting Abstract

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  • Sabrina Koch-Borner - Swiss Paraplegic Centre, Nottwil, Switzerland
  • presenting/speaker Stephanie Juch - Swiss Paraplegic Centre, Nottwil, Switzerland
  • Silke Grether - Swiss Paraplegic Centre, Nottwil, Switzerland
  • Jan Fridén - Swiss Paraplegic Centre, Nottwil, Switzerland

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSHT19-1295

doi: 10.3205/19ifssh1479, urn:nbn:de:0183-19ifssh14796

Published: February 6, 2020

© 2020 Koch-Borner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Spasticity in the upper extremities is a common problem in patients with an incomplete tetraplegia. Spasticity in both finger and wrist flexors hinders grasp as well as release of objects actively. Surgical lengthening procedures can only partially release the hyper-tonicity in the spastic muscles. Here we present a case where we combined reconstruction of active finger extensors and passive intrinsics of the fingers.

Materials and Methods: Patient is a 64 year old man with a tetraplegia sub C3 AIS D since 2014. The spasticity in his right hand makes it difficult to grasp and release the crutch actively. To avoid major loss of finger flexion power for grasping, it was decided to perform a tendon transfer instead of a lengthening procedure to rebalance his finger position. A fusion of the thumb CMC joint was performed to optimize the power of the pinch. The Canadian Occupational Performance Measure (COPM), Grasp Release test (GRT), pinch and grip strength were performed preoperative. The surgical reconstruction included a tendon transfer of pronator to extensor digitorum communis with palmaris longus interposition tendon graft, CMCI arthrodesis and intrinsic reconstruction (House). The training of the new functions started one day post surgery and between treatment sessions, the hand positioned in an intrinsic plus splint. The training was performed 4 times a day by a specialised therapist.

Results: After 6 month, regular reassessments were made to measure treatment progress. COPM changed in performance from 2.2 to 5.4 and in satisfaction from 1.8 to 7.2. GRT increased from 82 to 117 points. Grip strength preop was 4.8 kg and 6.9 kg 6 months later. Corresponding values for key pinch were 1.1 kg and 0.9 kg, respectively.

Conclusions: Reconstruction of active finger extension is an alternative procedure to reduce spasticity and achieve an efficient object release. We judge that a rigours treatment control and early activation of the motor were key factors to success in this case.