1. 23 TO 30 YEAR FOLLOWUP OF TETRAPLEGIC PERSONS FOLLOWING TENDON TRANSFERS Alastair Rothwell, Jennifer Dunn, Khalid Mohammed & Anne Sinnott-Jerram from the Upper Limb Group, Burwood Spinal Unit Christchurch New Zealand

2. The authors are all members of the BSU Upper Limb Group but none are employed directly by it or have received any financial benefit

3. Conclusions  Mean grasp & key pinch values maintained or improved  Active transfers had approximately twice strength of tenodeses  Levels of functional independence & expectations had been maintained

4.  Re evaluate grasp & key pinch strength in same cohort 21-30 years post transfer surgery  Determine effects of aging on active transfers & tenodeses  Determine long term outcomes on levels of function and satisfaction.

5.  19 of the previous 24 from the 2001review were eligible & willing to participate in the 2012 review.  All had had bilateral simultaneous hand surgery between 1982 & 1989  Approval for study granted by regional ethics committee

6.  Grasp & key pinch tested by same (recalibrated) digital analyser as for 2001 study and results recorded in newtons  ASHT positioning protocol used for testing  Best of three attempts recorded with minute rest between tests.  Same person (JD) performed all testing  Lamb & Chan questionnaire again used for function assessment with respondents asked to compare performance of each of the 25 tasks with that of 2001

10. RESULTS

11. Years SD Range  Mean age 53 4.3 47-61  Mean time since SCI 31 4.0 26-39  Mean time from 1 st U.L. surg 26 2.3 23-30 18 male 1 female

12. IC Right Left Total  O1 2 2 4  O2/OCu2 2 3 5  O3/OCu3 2 4 6  OCu4 9 5 14  OCu5 4 4 8  OCu6 0 1 1  Total 19 19 38

13.  KEY PINCH  BR > FPL 27  PT > FPL 4  FPL tenodeses 6  Total 37  GRASP  ECRL > FDP 20  BR > FDP 6  FDP tenodeses 4  Total 30

14. Active n mean2001(Ns) mean2012(Ns) % change R 17 38.3(17.5) 32.9(12.9) -14 L 14 26.9(17.3) 27.1(13.7) -0.8 R & L combined -2.4% Tenodeses R 2 19.0(1.4) 11.5(9.2) -39.5 L 4 31.8(10.7) 15.5(1.9) -51.2

17. Active n mean2001(Ns) mean2012(Ns) % change R 15 62.1(31.7) 59.0(30.3) -5 L 12 57.3(36.9) 52.7(35.1) -8.1 R & L combined -10% Tenodeses R 2 31.0(4,2) 41.0(25.5) +32.3 L 2 13.5(10.6) 23.0(24.0) +70.4

20.  Majority of participants believed no change in their ability to perform most of the 25 tasks  10 stated had decreased ability to propel manual wheelchair on the flat & up a slope  7 stated had decreased ability to pressure relieve  Overall 12 now used power chair for at least some of mobility needs compared to 5 in 2001

21. DISCUSSION

22.  Mathowetz et al 1985: 0.5-1% loss/year from age 39 in normal population  Grabner & Enoka 1995: 1.5% loss/year from 50-70 years  Frederkkson et al 2006 0.6% males, 0.3% females loss/yr from 50-85 years  Summary: 0.5%-1.5% loss/yr from age 40-50  Charlifue et al 2010: loss commences more quickly post SCI Current study:  The mean10% reduction of grasp & 2.5% of key pinch strength over the 11year period for the age range of our study group (47-61) falls within the normal population reduction

23.  Smaby et al 2004: majority of daily tasks require grip of 10.5Ns or less for tetraplegic persons  Most of study participants had key pinch/grasp far in excess of 10.5 Ns (mean 30 & 56Ns respect.)  Hence the reported unchanged ability to perform daily tasks except for whchair prop. & wt relief  These tasks require use of shoulder & elbow muscles more than hand grip

24.  Active transfers to provide key pinch and grasp, continue to provide hand function for ADLs for at least 23 and up to 30 years.  The % decline in strength of active transfers is similar to that of the normal population in the same age range.  The small number of participants with FDP tenodeses make invalid any conclusions regarding possible reasons for the dramatic increase in their strength.