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Posterior Deltoid to Triceps

The most commonly performed surgery for elbow extension is using the posterior third of the deltoid (PD) to motor the triceps. This converts the transferred portion of the deltoid into a two joint muscle but causes no functional loss at the shoulder (Moberg 1975).

Table 21 Reconstructive Surgery: Elbow Extension (Deltoid to Triceps)

Author Year

Country

Research Design

Score

Total Sample Size

MethodsOutcome
Rabischong et al., 1993

France

Prospective Controlled Trial

N=20

Population: Mean age: 33.6 yr; Level of injury: C6; Time since injury: 28-173 mo.

Intervention: The arm and forearm were locked in position and a force transducer was used to assess the torque output isometrically. The muscle was tested at 6 different lengths with the shoulder abducted at 900.

Outcome Measures: Maximal torque.

1.     The muscle was tested at six different lengths (130º, 110º, 90º, 70º, 45º and 0º of elbow flexion) with the shoulder abducted at 90.

2.     When compared, the absolute values (dimension of torque) were significantly different between groups (0.00001<p<0.002).

3.     The expression of this relation (% of maximum values) revealed significant statistical differences (p<0.002) at 90º and 70º degree of elbow flexion; peak torque was at 130º in experimental group and 110º in control group with a plateau between 110º and 70º.

4.     Length-tension relationship was fairly similar among control group, but great differences in experimental group.

Dunkerley et al., 2000

UK

Case-Control

NInitial=15; NFinal=11

Population: Age: 23-38 yr; Time since injury: 5-16 yr.

Intervention: Surgery.

Outcome Measures: Questionnaire, Functional independence measure (FIM), 10m push, Figure of 8 push.

1.     Both groups scored identically on the FIM.

2.     No significant differences in mobility were noted (p=0.256, and p=0.432).

3.     Questionnaire was answered only by the treatment group; clients gave positive response to the questions.

Remy-Neris et al., 2003

France

Pre-Post

N=16

Population: Mean age: 27 yr; Gender: males=11, females=5.

Intervention: Surgery. Control group members sat on a chair, while those with tetraplegia sat in a wheelchair. All were asked to perform two movements; a straight arm lateral and maximal raising and return.

Outcome Measures: Straight Arm Raising, Hand-to-nape-of-neck movement.

1.     Straight Arm Raising-statistically significant decrease in maximal shoulder abduction (mean 57 SEM 12 before, 14 SEM 6 after surgery).

2.     Shoulder flexion increased after deltoid-to-triceps transfer by 42% (mean 113 SEM 11), remained significantly lower (121 SEM 12) than control group (p<0.0001).

3.     Hand-to-nape-of-neck-movement-no significant improvements were noted after surgery.

4.     Peaks of shoulder and elbow flexion speed are almost normal, indicating the importance of restoring elbow extension torque for improving the whole kinematic picture of the upper limb.

Dunn et al., 2017

New Zealand

Case Series

N=75

 

Population: Mean age=31 yr; Gender: males=68, females=7; Time since injury: 23±9 yr; Level of injury: C4-C6; Severity of injury: AISA A/B=63, C/D=5, unknown=7.

Intervention: No intervention. A retrospective chart review of deltoid-triceps transfers in patients with tetraplegia was performed between 1983 and 2014. Patients received tibialis anterior, synthetic or hamstring tendon grafts. Outcome measures were assessed prior to surgery and 12 to 24 months after surgery.

Outcome Measures: Elbow extension strength (MRC); Complications.

1.     Following surgery, 70% of cases were able to extend their elbow against gravity (MRC grade 3 of 5 or greater); Hamstring grafts achieved grade 3 of 5 or more in 79% of cases compared with 77% tibialis anterior and 33% with synthetic grafts.

2.     Post-surgery elbow extension increased significantly with autologous tendon grafting (tibialis anterior and hamstring grafts) when compared to the synthetic graft group (p<0.05).

3.     Complications occurred in 14% of patients, the majority occurring immediately after surgery and associated with wounds, while the rest occurred due to dehiscence of synthetic grafts.

Lacey et al., 1986

USA

Case Series

N=10

Population: Level of injury: C6-C7; Mean time since injury: 24 mo.

Intervention: Surgery.

Outcome Measures: ADL task performance.

1.     No statistically significant differences between pre-and post-operative stages.

Activities that were noted as improved were: the overhead use of the arms, use of arms while lying supine and eating.

Raczka et al., 1984

USA

Case Series

NInitial=22; NFinal=18

Population: Time since injury: 10-242 mo.

Intervention: Surgery.

Outcome Measures: Activities of Daily Living (ADL), use of wheelchair.

1.     15/18 reported function improvement after surgery, 13 felt they gained an increase in independence.

2.     Functional improvements and grooming was noted.

Improvements were noted in subject’s ability to relieve ischial pressure from their wheelchair, writing improved, and driving in a small percentage was positively affected.