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Implications of thumb position and trajectory in tetraplegia grip reconstruction – a cohort study

Spinal Cord Series and Cases volume 9, Article number: 26 (2023) Cite this article

Subjects

Abstract

Study design

This study represents a retrospective observational cohort study.

Objectives

The objective of this study was to investigate the impact of thumb position on postoperative patient-rated and functional outcomes in grip reconstruction surgery.

Setting

All consecutive adult patients with tetraplegia undergoing grip reconstruction surgery at the Swiss Paraplegic Centre between 06/2008 and 11/2020 were assessed for eligibility.

Methods

Standardized photo or film documentation was used for individually recreating and categorizing thumb position and trajectory during key pinch. Outcome measurements included key pinch strength, Canadian Occupational Performance Measure (COPM) and Grasp Release Test (GRT).

Results

Fifty-six hands of 44 patients (mean age 42.2 years, range 18–70 years) with a mean follow-up of 14.8 months (range 6 months to 12 years) were included. There was a significant postoperative improvement of key pinch strength, COPM score and GRT. COPM improvement was more pronounced for hands with more palmar abducted trajectories of the thumb.

Conclusions

Regardless of reconstruction type, pinch strength, patient satisfaction and grasp and release abilities improved significantly after surgery. Thumb position and trajectory are strong determining factors for the selected outcome measurements.

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Fig. 1: Thumb on index position during key pinch.
Fig. 2: Correlation between post-operative commissure angle and COPM performance and satisfaction improvement.

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Data availability

The data used for this study were generated, processed, analyzed, and stored following the Swiss legislation regarding data protection and the 5th article of the Swiss Human Research Ordinance. Data from this project were encrypted and saved on a specific case report form designed for this study as required according to the Swiss Ethical Committee Approval. No registration within a recognized repository was performed. The encrypted data are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Department of Tetrahand Surgery and Hand Surgery (Nottwil Tetrahand®), Swiss Paraplegic Centre, Nottwil, Switzerland

    Rémy Liechti, Silvia Schibli, Sabrina Koch-Borner & Jan Fridén

  2. Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Bern, Switzerland

    Rémy Liechti

Authors
  1. Rémy Liechti
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  2. Silvia Schibli
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  3. Sabrina Koch-Borner
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  4. Jan Fridén
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Contributions

All listed authors have made substantial contributions to this article. The design and conception of the work, analysis, and interpretation of data was carried out by RL and JF. SKB crucially contributed to data extraction and provided feedback on the article. RL wrote the first draft of the manuscript. Critical revision for important intellectual content as well as final approval of the version to be published was done by SS and JF. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Jan Fridén.

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Competing interests

The authors declare no competing interests.

Ethical approval

The study was approved by the Swiss Ethical Committee (Swiss Ethics approval number 2020-02261) and conducted in accordance with the World Medical Association Declaration of Helsinki.

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Liechti, R., Schibli, S., Koch-Borner, S. et al. Implications of thumb position and trajectory in tetraplegia grip reconstruction – a cohort study. Spinal Cord Ser Cases 9, 26 (2023). https://doi.org/10.1038/s41394-023-00581-7

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  • DOI: https://doi.org/10.1038/s41394-023-00581-7

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