Article | Published:

Outcomes of reconstructive hand surgery in patients with tetraplegia and neuropathic pain

Spinal Cordvolume 56pages11941198 (2018) | Download Citation

Abstract

Study design

Retrospective cohort study

Objectives

To evaluate the impact of preoperative neuropathic pain on outcome and postoperative compliance after grip reconstructive surgery in people with tetraplegia.

Setting

Specialized tetraplegia upper-limb surgery center in Sweden.

Methods

All patients who underwent grip reconstructive surgery and attended a 6 month follow up during January 2012 and May 2015 were included. Participants were divided into two groups, pain group and no pain group, based on preoperative rating of experienced pain on a visual analog scale. The main outcome measures were grip strength, grasp ability (Grasp and Release Test) and prioritized activity outcome (Canadian Occupational Performance Measure) together with compliance to the rehabilitation plan.

Results

The study include 37 patients (86% of the cohort). Seventeen patients experienced preoperative pain (46%). There were no differences in outcome between the pain- and the no pain group regarding grip strength (5 vs. 4.6 kg), grip ability or activity performance and satisfaction (COPM improvement of 3.1 vs. 3.0 for performance and 3.6 for both groups in satisfaction). Both groups experienced improvements in all aspects and there were no differences in the ability to fulfill postoperative treatment.

Conclusions

Individuals with tetraplegia and preoperative neuropathic pain in the arm/hand improve after grip reconstructions in a similar way to those without pain. Patients with neuropathic pain therefore should be considered as surgery candidates to the same extent as those without pain.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    Norrbrink C, Löfgren M, Hunter JP, Ellis J. Patients’ perspectives on pain. Top Spinal Cord Inj Rehabil. 2012;18:50–6.

  2. 2.

    Finnerup NB. Pain in patients with spinal cord injury. Pain. 2013;154(Suppl 1):S71–6.

  3. 3.

    Finnerup NB, Norrbrink C, Trok K, Piehl F, Johannesen IL, Sorensen JC, et al. Phenotypes and predictors of pain following traumatic spinal cord injury: a prospective study. J Pain. 2014;15:40–8.

  4. 4.

    Norrbrink C. Smärthandboken: om smärta efter ryggmärgsskada. Stockholm: Instant Book; 2013. p.129.

  5. 5.

    Brinkhof MW, Al-Khodairy A, Eriks-Hoogland I, Fekete C, Hinrichs T, Hund-Georgiadis M, et al. Health conditions in people with spinal cord injury: contemporary evidence from a population-based community survey in Switzerland. J Rehabil Med. 2016;48:197–209.

  6. 6.

    Wangdell J, Fridén J. Satisfaction and performance in patient selected goals after grip reconstruction in tetraplegia. J Hand Surg Eur Vol. 2010;35:563–8.

  7. 7.

    Wuolle KS, Bryden AM, Peckham PH, Murray PK, Keith M. Satisfaction with upper-extremity surgery in individuals with tetraplegia. Arch Phys Med Rehabil. 2003;84:1145–9.

  8. 8.

    Bunketorp-Käll L, Wangdell J, Reinholdt C, Fridén J. Satisfaction with upper limb reconstructive surgery in individuals with tetraplegia: the development and reliability of a Swedish self-reported satisfaction questionnaire. Spinal Cord. 2017;55:664–71.

  9. 9.

    Wangdell J, Carlsson G, Fridén J. Enhanced independence: experiences after regaining grip function in people with tetraplegia. Disabil Rehabil. 2013;35:1968–74.

  10. 10.

    Sinnott KA, Brander P, Siegert RJ, Rothwell AG, De Jong G. Life impacts following reconstructive hand surgery for tetraplegia. Top Spinal Cord Inj Rehabil. 2009;15:90–97. 15(2):90-7

  11. 11.

    Bunketorp-Käll L, Reinholdt C, Fridén J, Wangdell J. Essential gains and health after upper-limb tetraplegia surgery identified by the international classification of functioning, disability and health (ICF). Spinal Cord. 2017;55:857–63.

  12. 12.

    Norrbrink C, Lindberg T, Wahman K, Bjerkefors A. Effects of an exercise programme on musculoskeletal and neuropathic pain after spinal cord injury – results from a seated double-poling ergometer study. Spinal Cord. 2012;50:457–61.

  13. 13.

    Anderson KD. Targeting recovery: priorities of the spinal cord-injured population. J Neurotrauma. 2004;21:1371–83.

  14. 14.

    Snoek GJ, van Til JA, Krabbe PF, Ijzerman MJ. Decision for reconstructive interventions of the upper limb in individuals with tetraplegia: the effect of treatment characteristics. Spinal Cord. 2008;46:228–33.

  15. 15.

    Lo C, Tran Y, Anderson K, Craig A, Middleton J. Functional priorities in persons with spinal cord injury: using discrete choice experiments to determine preferences. J Neurotrauma. 2016;33:1958–68.

  16. 16.

    Lamb DW, Chan KM. Surgical reconstruction of the upper limb in traumatic tetraplegia. A review of 41 patients. J Bone Jt Surg. 1983;65:291–8.

  17. 17.

    Wangdell J, Bunketorp-Käll L, Koch-Borner S, Fridén J. Early active rehabilitation after grip reconstructive surgery in tetraplegia. Arch Phys Med Rehabil. 2016;97(6 Suppl):S117–25.

  18. 18.

    Kirshblum SC, Burns SP, Biering-Sörensen F, Donovan W, Graves DE, Jha A, et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011;34:535–46.

  19. 19.

    McDowell C, Moberg E, House J. The second international conference on surgical rehabilitation of the upper limb in tetraplegia (Quadriplegia). J Hand Surg Am. 1986;11A:604–7.

  20. 20.

    Wuolle KS, Van Doren CL, Thrope GB, Keith MW, Peckham PH. Development of a quantitative hand grasp and release test for patients with tetraplegia using a hand neuroprosthesis. J Hand Surg Am. 1994;19:209–18.

  21. 21.

    Law M. The Canadian occupational performance measure. Ottawa: CAOT Publications; 1998.

  22. 22.

    Bryden AM, Sinnott KA, Mulcahey MJ. Innovative strategies for improving upper extremity function in tetraplegia and considerations in meassuring functional outcomes. Top Spinal Cord Inj Rehabil. 2005;10:75–93.

  23. 23.

    Lund ML, Nordlund A, Bernspång B, Lexell J. Perceived participation and problems in participation are determinants of life satisfaction in people with spinal cord injury. Disabil Rehabil. 2007;29:1417–22.

  24. 24.

    Muller R, Peter C, Cieza A, Geyh S. The role of social support and social skills in people with spinal cord injury – a systematic review of the literature. Spinal Cord. 2012;50:94–106.

  25. 25.

    Jörgensen S, Iwarsson S, Lexell J. Secondary health conditions, activity limitations, and life satisfaction in older adults with long-term spinal cord injury. PM R. 2017;9:356–66.

Download references

Author contribution

JW and JF were responsible for designing the research protocol. JW extracted data, did the preliminary analyse and wrote the report. JF gave feedback on data analyse and report. JW and JF interpreting results and updated reference list.

Funding

We thank Promobilia, University of Gothenburg and Sahlgrenska University Hospital for financial support to conduct this study.

Author information

Affiliations

  1. Centre of Advanced Reconstruction of Extremities (CARE), Sahlgrenska University Hospital, Gothenburg, Sweden

    • J. Wangdell
    •  & J. Fridén
  2. Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden

    • J. Wangdell
    •  & J. Fridén
  3. Swiss Paraplegic Centre, Nottwil, Switzerland

    • J. Fridén

Authors

  1. Search for J. Wangdell in:

  2. Search for J. Fridén in:

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of ethics

We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research. Ethical approval was obtained from the Ethic Committee, Gothenburg, Sweden. Number 550-16.

Corresponding author

Correspondence to J. Wangdell.

About this article

Publication history

Received

Revised

Accepted

Published

Issue Date

DOI

https://doi.org/10.1038/s41393-018-0164-1