Marc Revol, MD, Jean-Marie Servant, MD
(Service de Chirurgie Plastique. Hopital Saint-Louis. 75475 Paris Cedex 10. France)
In brachial plexus or peripheral nerve injuries, the loss of active extension in the elbow is not a major impairment, because it usually relates only to one elbow, and because the patient is able to stand up, and thus gravity extends the flexed elbow.
In contrast, active extension is paralysed on both elbows in tetraplegic patient, who is unable to lift either hand over his (her) head or his (her) body when he (she) is lying in bed or sitting in a wheelchair. The restoration of active elbow extension is therefore a top surgical priority for tetraplegic upper limb.
There is a choice between 2 surgical procedures : deltoid-to-triceps, and biceps-to-triceps transfers.