Comparing Outcomes of Elbow Extension Tendon Transfers
Comparing Outcomes of Elbow Extension Tendon Transfers
Active elbow extension has significant functional benefits for individuals with tetraplegia.
 The proposed work will provide information to assess how effectively people are using their
 elbow extension tendon transfers, and whether one surgery works more effectively than the
 other. This study will provide recommendations to clinicians about the possibility of
 improving function after surgery using rehab techniques.
Voluntary control of elbow extension significantly improves functional abilities for
 individuals with tetraplegia. As a result, surgical reconstruction of elbow extension via
 tendon transfer is considered a fundamental intervention that benefits the patient, even if
 other tendon transfers aimed at improving hand function are never performed. Presently, there
 are two common tendon transfer surgeries used to restore elbow extension following spinal
 cord injury. These are the posterior deltoid to triceps transfer and the biceps to triceps
 transfer. Both surgeries significantly improve voluntary elbow extension, although there is
 variability in the amount of control that is restored among patients. This study will
 directly compare the performance of the posterior deltoid transfer to the biceps transfer
 with regard to: voluntary elbow extension strength, the ability to activate the transfer, and
 neural factors associated with voluntary and involuntary control of individual muscles. These
 comparisons will be made in functionally relevant postures and will provide fundamental
 information that will improve clinical understanding of the capacity of each of these two
 procedures to restore elbow extension.

 The fundamental hypothesis of this proposal is that an inability to maximally activate the
 transferred posterior deltoid and the transferred biceps significantly limits the elbow
 extension moment that can be produced.
Inclusion Criteria:

 -  Cervical Spinal Cord Injury (C5-C7)

 -  Posterior Deltoid to Triceps Tendon Transfer at least one year post-surgery

 -  Biceps to Triceps Tendon Transfer at least one year post-surgery

 Exclusion Criteria:

 -  Subjects will be excluded from the studies if there is presence of concurrent severe
 medical illness, including:

 -  unhealed decubiti

 -  use of baclofen pumps

 -  existing infection

 -  cardiovascular disease

 -  significant osteoporosis (as indicated by a history of fractures following
 injury)

 -  or a history of pulmonary complications or autonomic dysreflexia