A prospective evaluation of upper extremity tendon transfers in children with cervical spinal cord injury

Three children (five hands) between 6 and 11 years of age with cervical level spinal cord injuries underwent tendon transfers to restore voluntary lateral pinch. Repeated measures of pinch force and the Grasp and Release Test (GRT) were obtained before surgery and at regular intervals after tendon transfers. The Functional Independence Measure (FIM) was administered before surgery and at 12 months after surgery. Responses to open-ended questions were used to supplement the FIM data at 1 year after surgery. Before surgery, no measurable force was obtained in any hand; after tendon transfers, pinch and finger flexion forces increased throughout the follow-up period. On the GRT, manipulation of the heavy objects was possible only after tendon transfers. Improvements were realized in feeding, grooming, bladder management, play, and school tasks. Each child requested surgery to restore pinch in the nondominant hand. Two hands required tenolysis procedures. Despite capsulotomies and aggressive therapy, three hands continued to have range limitations at the metacarpophalangeal joints.