Surgical Rehabilitation of the Tetraplegic Upper Extremity

cal skeletal injury. Hand rehabilitation once focused exclusively on the application of splints or the surgical conversion of the hand to provide equivalent internal splinting by extensive use of arthrodeses at the expense of joint motion. Surgical reconstruction of the upper extremity was once limited to passive tenodeses, arthrodeses of major joints (1), and internalization of the flexor hinge splint concept. These procedures yielded stiff yet functional hands (2). The lessons learned in this early experience were that gravity assists and immobility limits function. Tendon transfer surgery of the hand has constantly evolved based on clinical experience and the advancement of technology (3,4). Classification of the residual potential for surgical reconstruction and evaluation of new surgical procedures have evolved over the past decades, based on the inspirational work of Moberg and elaborated by members of an international study group (5). Recent experience and refine-