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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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Hand reconstruction in a patient with MCP contractures – a case report

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  • presenting/speaker Sabrina Koch-Borner - Swiss Paraplegic Centre, Nottwil, Switzerland
  • Silke Grether - Swiss Paraplegic Centre, Nottwil, Switzerland
  • Stephanie Juch - 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. DocIFSHT19-1313

doi: 10.3205/19ifssh1482, urn:nbn:de:0183-19ifssh14829

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: Grip ability is generally lost in patients with a cervical spinal cord injury. Surgical reconstruction allows restoration of grip function providing motors available for transfer. MCP-joint contractures is relative a contraindication for surgery. Here we report functional outcome after surgical reconstruction without successful conservative pretreatment.

Materials and Methods: A 47 year old man with a tetraplegia sub C6 AIS A since 2012, classified as OCu4 in the ICSHT, would therefore be a suitable candidate for surgical reconstruction. However, MCP contractures in the MCP IV and V as well a bouncing back phenomena in all MCP joints were present. Manual therapy, dynamic and static splinting was tried over 7 months but the contractures changed only minimally. A surgical procedure for a full grip reconstruction was planned despite joint motion limitations. Canadian Occupational Performance Measure (COPM), Grasp Release Test (GRT), key pinch and grip strength as well as MCP ROM were performed preop. The surgical reconstruction included a tendon transfer of ECRL to FDP, BR to FPL, CMCI arthrodesis, ECU tenodesis and a muscle slide of EDC. An intrinsic plus splint was applied and early active training was performed 4 times a day under guidance by a specialised therapist. After 3 weeks, functional electrical stimulation was used for motor learning on the BR and after 5 weeks for adhesion treatment of the ECRL.

Results: After 6 month COPM changed in performance from 1.2 to 5.8 and in satisfaction from 1.2 to 4.8. GRT increased from 0 to 77, the grip strength from 0 to 2.1 kg and the key pinch from 0 to 0.4 kg. MCP flexion mobility increased from 50° to 90° in Dig IV and V.

Conclusions: Successful surgical reconstruction may be achieved despite treatment-resistent contractures. The increased constant tension provided by the active finger flexion act as a powerful internal splint and together with the active finger training, a reduction of the contractures in the MCP joints may be obtained.