STRATEGY and INDICATIONS

Groups 3, 4, and 5

 

When extension of the wrist is strong, ECRL and ECRB are active, then ECRL can be used as a motor along with BR.

Because harvesting ECRL when ECRB is paralysed would be a functionnal disaster in tetraplegic patient, it is of paramount importance to make sure that ECRB is active, and to not confuse group 2 and group 3. Many tricks have been proposed for  this purpose, including intra-operative testing under local anesthesia. In our experience, the most efficient and the simplest ways to make sure that both ECR muscles are active are :

OK! Wrist extension is strong. So you have 2 motors : BR and ECRL. What for ?

There are two options :

       

SITUATION

(see table)

Remaining functions
  • active flexion of the elbow
  • active and strong extension of the wrist
  • PT active in group 4, FCR active in group 5
 
Paralysed functions
  • active extension of the elbow (remains sometimes in group 5 or 4)
  • active flexion of the wrist (groups 4 and 5)
  • all extrinsic and intrinsic functions of the fingers and thumb
 
Muscles available for transfers
  • BR
  • ECRL
  • (ECRI)
  • PT (groups 4 and 5)
 
       
       
       
       

SUGGESTED

SURGICAL PROGRAM

for groups 3, 4, and 5

(3 stages)

1st surgical stage  
2nd surgical stage Postoperative immobilization : 4 weeks (elbow in flexion at 90, wrist in extension, fingers MP joints in flexion)
3rd surgical stage
  • restoration of fingers flexion (ECRL to FDP transfer)
  • restoration of pinch closure : ECRI- (if exists), BR- (groups 3 or 4) , PT- (group 4 or 5), or ECRL-(in any group 3 to 5) to-FPL transfer)
Postoperative immobilization : 4 weeks (elbow in flexion at 90, wrist in flexion, fingers MP joints in flexion)
       

GROUP 3

1st surgical stage  
2nd surgical stage Postoperative immobilization : 4 weeks (elbow in flexion at 90, wrist in extension, fingers MP joints in flexion)
3rd surgical stage Postoperative immobilization : 4 weeks (elbow in flexion at 90, wrist in flexion, fingers MP joints in flexion)
       

GROUP 4

1st surgical stage  
2nd surgical stage Postoperative immobilization : 4 weeks (elbow in flexion at 90, wrist in extension, fingers MP joints in flexion)
3rd surgical stage Postoperative immobilization : 4 weeks (elbow in flexion at 90, wrist in flexion, fingers MP joints in flexion)
       

GROUP 5

1st surgical stage  
2nd surgical stage Postoperative immobilization : 4 weeks (elbow in flexion at 90, wrist in extension, fingers MP joints in flexion)
3rd surgical stage Postoperative immobilization : 4 weeks (elbow in flexion at 90, wrist in flexion, fingers MP joints in flexion)