Approaches for restoring elbow extension in tetraplegia: muscle tendon transfer and functional neuromuscular stimulation

Tetraplegia resulting from cervical spinal cord injury typically leaves the muscles paralyzed, with the resulting loss extension function. Elbow extension is for many daily activities, important in the rehabilitation of the spinal cord injured individual. This paper compares the widely used surgical transfer of the posterior deltoid muscle, which restores voluntary control over elbow extension, to a technique based on functional neuromuscular stimulation (FNS) of the triceps muscles. Both methods were found to restore a modest level of elbow extension. The posterior deltoid transfer produced variable results and the resulting elbow extension moments were strongly dependent on shoulder position.