Prospective Evaluation of Biceps to Triceps and Deltoid to Triceps for Elbow Extension in Tetraplegia

Mary Jane Mulcahey, Cheryl Lutz, Scott H. Kozin, Randal R. Betz

Research output: Contribution to journalArticlepeer-review

59 Scopus citations


Purpose: The purpose of this study was to evaluate and compare the deltoid to triceps and biceps to triceps transfers for restoration of elbow extension in young persons with tetraplegia. Methods: This was a prospective randomized study. Sixteen arms of 9 subjects between 8 and 20 years of age with cervical-level spinal cord injuries were assigned randomly to undergo either a deltoid to triceps transfer or a biceps to triceps transfer. All arms were followed-up prospectively for at least 2 years after surgery. Results: Elbow extension was restored in 8 arms via the deltoid and in 8 arms via the biceps transfers. At the 24-month follow-up evaluation 7 of the 8 biceps transfers produced antigravity strength (grade 3 or better); in contrast only one arm with the deltoid transfer was able to extend against gravity. There was a considerable but subclinical loss (no subject appreciated any functional deficit) of elbow flexion torque after both transfers. Three months after surgery the deltoid group showed a 51% loss of elbow flexion torque and the biceps group showed a 52% loss of elbow flexion torque. By 24 months after surgery both groups improved but still showed a loss of flexion torque (deltoid 32%, biceps 47%). After gaining elbow extension the subjects in both groups rated the performance of most activities of daily living (ADL) and all self-selected activities as better, as measured on the Modified University of Minnesota Tendon Transfer Functional Improvement Questionnaire and the Canadian Occupational Performance Measure, respectively. Likewise all subjects were more satisfied with performance of their goals after undergoing elbow extension reconstruction. Conclusions: This study showed the benefits of restoring elbow extension in persons with tetraplegia and provided support for the biceps transfer as an alternative to the deltoid to triceps transfer in individuals with good brachialis and supinator strength.

Original languageEnglish
Pages (from-to)964-971
Number of pages8
JournalJournal of Hand Surgery
Issue number6
StatePublished - Nov 2003
Externally publishedYes


  • Spinal cord injury
  • Tendon transfers
  • Upper-extremity reconstruction


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