Triceps denervation as a predictor of elbow flexion contractures in C5 and C6 tetraplegia

Arch Phys Med Rehabil. 2004 Nov;85(11):1880-5. doi: 10.1016/j.apmr.2004.01.042.

Abstract

Objective: To determine whether the existence of elbow flexion contractures in persons with C5 or C6 tetraplegia is related to a lack of residual voluntary triceps function and triceps denervation (ie, lower motoneuron damage).

Design: A retrospective study of impairment data from 74 arms to identify the incidence of elbow flexion contractures and the contributing factors toward this deformity.

Setting: Five spinal cord injury (SCI) rehabilitation centers in the United States, 1 in England, and 1 in Australia.

Participants: Forty-three subjects with motor complete C5 or C6 traumatic SCI.

Interventions: Not applicable.

Main outcome measures: Active and passive elbow extension, triceps voluntary muscle strength, and triceps response to electric stimulation.

Results: Subjects with weak voluntary triceps had significantly fewer and less severe elbow flexion contractures than those with paralyzed triceps ( P =.024). Subjects with completely denervated triceps (ie, no response to electric stimulation) had significantly more elbow flexion contractures than subjects with even a weak response to electric stimulation ( P =.003). Overall, 51% of the arms could not be passively extended to zero. Forty-six percent of the arms classified as C5 lacked full passive elbow extension, compared with 63% of the arms classified as C6 ( P =.302).

Conclusions: A relationship has been found between elbow flexion contractures and lack of residual voluntary triceps and triceps denervation in subjects with C5 or C6 tetraplegia. There should be a greater awareness of the elbow flexion contractures that may develop as a result of this relationship. A better understanding of this deformity and its characteristics can lead to more effective clinical treatment and prevention strategies.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Analysis of Variance
  • Arm / innervation*
  • Australia / epidemiology
  • Cervical Vertebrae / injuries
  • Contracture / epidemiology
  • Contracture / etiology*
  • Contracture / physiopathology
  • Contracture / prevention & control
  • Elbow / innervation*
  • Electric Stimulation
  • England / epidemiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Muscle Weakness / complications*
  • Muscle Weakness / diagnosis
  • Muscle Weakness / physiopathology
  • Predictive Value of Tests
  • Prevalence
  • Quadriplegia / complications*
  • Quadriplegia / rehabilitation
  • Range of Motion, Articular
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Spinal Cord Injuries / complications
  • Time Factors
  • United States / epidemiology