The following studies report results from multiple procedures to reconstruct the upper limb.
In reviewing the identified studies as a whole, the operative interventions on the tetraplegic hand and upper limb bring definite gains in pinch force, cylindrical grasp, and the ability to reach above shoulder height that result in an improvement in ADL function and quality of life for the individual with tetraplegia. Despite the low level of evidence (grade 4) the subjective acceptance among patients who have had reconstructive surgery is high. One of the reported downsides of surgery is the high complication rate (infection, torn attachments) and the extended period of time post-surgery for rehabilitation and increased need for personal care (Meiners et al. 2002).
Many SCI centres do not offer or have access to reconstructive surgery or neuroprothesis interventions. It is also debated whether the overall cost of surgery or use of neuroprostheses is more beneficial to the client, as the client has to relearn new movement strategies in order to perform activities of daily living (ADL) (van Tuijl et al. 2002).
There is level 4 evidence (see Table 9-18) that support the use of reconstructive surgery for the tetraplegic upper limb for the improvement of ADL and quality of life.