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There is little published evidence to support or refute the use of passive ranging to improve tenodesis hand function in people with C6 quadriplegia, in the first 6 months post-injury

Prepared by:

Glenda Price, Senior Occupational Therapist, Spinal Injuries Unit
Princess Alexandra Hospital, Brisbane, Australia
(Glenda_Price@health.qld.gov.au)

Date:

July 2003

Review Date:

September 2004

Clinical Question:

“What is the effectiveness of passive wrist and hand ranging for improving tenodesis grasp in people with complete C6 quadriplegia, in the first six months post injury?"

Clinical Scenario:

Tenodesis refers to opposition of the thumb and index finger with either active or passive wrist extension. Achieving a functional tenodesis grasp is a primary focus of therapy for such a person, to enable participation in activities of daily living. Tenodesis grasp is achieved with people who have a complete C6 level of quadriplegia, using a range of clinical interventions: passive wrist and hand ranging; active and /or resistive wrist extension exercises; hand splinting; and grasp/ release retraining using a graded programme of object size, reach and activities.

Passive ranging is performed daily at PA Hospital, Brisbane (protocol available from author). Education is provided by demonstration and in an education pamphlet about self- ranging. Current techniques assume that an effective tenodesis grasp is achieved by a decrease in the resting length of the flexor digitorum superficialis and profundus, so that the fingers flex when the wrist is extended. Full passive extension of the MCP and IP joints must be maintained so that fingers naturally extend when the wrist is in flexion, in order to achieve placement around an object. Also, stiffening of thumb IP joints in extension is facilitated by not ranging thumb interphalangeal flexion so as to achieve thumb alignment for “pad” pinch or “lateral” pinch. While this practice of tenodesis ranging has continued for many years, it is unclear as to the evidence on which this intervention is based.

Clinical Bottom Line:

There is insufficient evidence to support or refute the use of passive ranging to improve hand function in people with quadriplegia.

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