Upper Limb Table 13 Reconstructive Surgery Elbow Extension Studies (Posterior Deltoid to Triceps)

Author Year
Country
PEDro Score
Research Design
Total Sample Size

Methods

Outcome

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 months; Follow-up time=46.1 mo.
Treatment: 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 and absolute values.
  1. The muscle was tested at 6 different lengths (130, 110, 90, 70, 45 and O degrees 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 90 and 70 degree of elbow flexion; peak torque was at 130 degrees in experimental group and 110 degrees in control group with a plateau between 110 and 70 degrees.
  4. Length-tension relationship was fairly similar among control group, but great differences in experimental group.

Remy-Neris et al.
2003
France
Pre-post
N=16

Population: Mean age=27 yr; Gender: males=11, females=5; Severity of injury: AIS=16-20.
Treatment: Surgery. Control group members sat on a chair, while the tetraplegics sat in a wheelchair. All were asked to perform 2 movements; a straight arm lateral and maximal raising and return.
Outcome Measures: Straight Arm Raising and 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. Conclusion-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.

Dunkerley et al.
2000
UK
Case-Control
NInitial=15; NFinal=11

Population: Age=23-38 yr; Time since injury=5-16 yr.
Treatment: Surgery.
Outcome Measures: Questionnaire, FIM, 10 m push, and the 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.

Lacey et al. 1986
USA
Case Series
N=10

Population: Level of injury: C6-C7; Time since injury=24 months.
Treatment: Surgery.
Outcome Measures: Not specified.
  1. No statistically significant differences between pre and post-operative stages.
  2. 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 months.
Treatment: Surgery.
Outcome Measures: Activities of daily living, and use of wheelchair.
  1. 15 of 18 reported function improvement after surgery, 13 felt they gained an increase in independence.
  2. Functional improvements and grooming was noted.
  3. 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.
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