Biceps-to-Triceps Transfer for Elbow Extension in Persons With Tetraplegia

Purpose Restoration of elbow extension via tendon transfer is an integral part of upper extremity surgical reconstruction in persons with tetraplegia. The purpose of this investigation was to assess patient satisfaction and elbow extension strength after biceps-to-triceps transfers. Methods This is a retrospective chart review of biceps-to-triceps transfers in patients with spinal cord injury. Forty-five patients (77 arms) with spinal cord injury underwent biceps-to-triceps transfer. A total of 40 patients (68 arms) were available for follow-up. The average age at surgery was 17.3 years (range, 6.4–21.7 y).The biceps tendon was transferred around the medial aspect of the arm. The preoperative elbow extension strength was 0/5 (54 arms), 1/5 (10 arms), or 2/5 (4 arms). We also used the Canadian Occupational Performance Measure to measure patient-perceived outcome in a subset of 8 subjects. Results Stringent manual muscle testing (MMT) for elbow extension revealed a statistically significant increase in muscle strength after surgery (p < .001). Forty-two arms were able to extend completely against gravity (MMT 3/5 or greater). Nine arms had a mild extension lag against gravity (MMT of 3/5). Therefore, 75% (51/68) of arms were able to function overhead. Seventeen arms had MMT scores less than 3/5. The top 5 goals of the 8 patients with completed preoperative and postoperative Canadian Occupational Performance Measure results were analyzed. After transfer, all 8 patients reported improved performance of and/or satisfaction with at least one goal. Performance and satisfaction were greatly improved (at least 4 points) for activities of living such as dressing, grooming, reaching for objects, recreational activities, wheelchair propulsion, and transfers. Conclusions Based on these results, we believe the biceps-to-triceps transfer is a reliable technique for restoration of elbow extension in persons with tetraplegia. Overhead function is obtainable in most cases with careful surgical technique and meticulous postoperative therapy. Type of study/level of evidence Therapeutic IV.