Strategy for improving hand opening in the tetraplegic upper limb.

In the tetraplegic patient, restoring an adequate grip requires primary restoration of proper hand opening. This opening (or "extensor") surgical stage is performed 3 or 4 months before the closing (or "flexor") stage. Surgical strategy is based on group 5 of the IC, which represents a turning point. Above this group (i.e., in IC groups 2-4), opening is essentially based on passive procedures (such as tenodesis and arthrodesis). Starting at group 5, restoration of active digital extension is [table: see text] feasible, as well as active stabilization of the thumb ray in lower groups. In those lower groups, all efforts should aim at re-establishing an intrinsic balance, keeping in mind the difference between supple and rigid claw deformities, which require different corrective procedures (Table 1).