Upper Limb Table 15 Reconstructive Surgery Elbow Extension Studies (Biceps to Triceps Transfer)

Author Year
PEDro Score
Research Design
Total Sample Size



Kozin et al. 2010
Case Series
NInitial=45; NFinal=40

Population: Mean age: 17.3 yr (range=66.4-21.7); Level of injury: 10 at C5, 29 at C6, 1 at C7.
Treatment: Surgery for a biceps to triceps tendon transfer (36 left, 32 right).
Outcome Measures: Manual muscle testing and Canadian Occupational Performance Measure.
  1. Manual muscle testing for elbow extension revealed a statistically significant increase in preoperative to postoperative muscle strength (p<.001).
  2. 42/68 arms able to extend completely against gravity (manual muscle testing 3/5 or greater).
  3. 9/68 arms had mild extension lag against gravity (manual muscle testing of 3/5).
  4. 75% (51/68) arms were able to function overhead.
  5. 17/68 arms were less than 3/5 (lack of strength attributed to a post-operative complication).
  6. Improvement in one goal on the Canadian Occupational Performance Measurewas observed by each patient.
  7. Canadian Occupational Performance Measure total mean score statistically increased from 2.6 to 5.6 and from 1.8 to 5.7 for performance (p<.001) and satisfaction (p<.001), respectively.

Mulcahey et al.

Population: Gender: males=7, females=2; Level of injury: tetraplegic. ICSHT: 0-4; Tendon transfer for elbow extension: deltoids n=8, biceps n=8.
Treatment: Surgery.
Outcome Measures: Muscle strength, Flexion torque, Modified University of Minnesota Tendon Transfer Functional Improvement Questionnaire, Canadian Occupational Performance Measure (COPM).
  1. After surgery, elbow extension muscle strength was improved in bicep and deltoid groups (p<0.001).
  2. No significant increase in elbow extension muscle strength was found following surgery.
  3. 7 of 8 bicep-to-triceps procedures had clinical improvements in antigravity muscle strength, in comparison with 1 of 8 deltoid transfers completed.
  4. No significant difference between the groups was found for elbow flexion torque (47% reduction in torque after 2 years versus baseline).
  5. Following surgery, 48/63 elbow extension ADL did not improve in subjects and there was no alteration in the remaining 15/63.
  6. Performance and satisfaction with personal goals improved post-surgery as well.

Kuz et al. 1999
Case Series

Population: Level of injury: tetraplegia.
Treatment: Surgery.
Outcome Measures: Not specified.
  1. No statistical results reported:
  2. Subjects indicated they were satisfied with the surgery.
  3. Activities that required precision hand placement had improved.
  4. Elimination of the need for some adaptive aids was possible post-surgery.