{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T22:12:36Z","timestamp":1780524756715,"version":"3.54.1"},"reference-count":119,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T00:00:00Z","timestamp":1739318400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Muscle and Nerve"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Spinal cord injuries (SCI) can substantially affect independence and quality of life, particularly by limiting upper extremity function. Surgical reconstruction offers the potential to restore motion in the hand, wrist, and elbow for those with deficits following cervical spinal cord injury. Techniques such as tendon transfer, tenodesis, and arthrodesis\u2014often used in combination\u2014are well\u2010established strategies for enhancing upper extremity function. Nerve transfers have more recently been employed and differ from other procedures in that they are often time sensitive and should be performed before permanent muscle atrophy occurs. A comprehensive preoperative evaluation, including clinical examination and electrodiagnostic assessment, is essential to determine the availability and strength of donor tendons and nerves. The International Classification of Surgery for the Hand in Tetraplegia (ICSHT) system is the most utilized surgical classification for determining muscle that can be used for reconstruction. Based on this classification, prioritization is given to restoring elbow extension, wrist extension, pinch, and grasp. Postoperative rehabilitative therapy balances the need for immobilization while preventing joint stiffness and may also incorporate cortical retraining strategies to activate tendon and nerve transfers. Ultimately, a collaborative, interdisciplinary approach is essential for assessing the injury, determining operative candidacy, selecting the optimal treatment strategy, and providing tailored rehabilitation. This article explores the classification of SCI as it pertains to the upper limb, provides an overview of surgical options, describes the preoperative clinical and electrodiagnostic evaluation process, and discusses reconstructive strategies aimed at improving functional outcomes in individuals with SCI.<\/jats:p>","DOI":"10.1002\/mus.28351","type":"journal-article","created":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T09:41:01Z","timestamp":1739353261000},"page":"802-815","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Surgical Strategies for Functional Upper Extremity Reconstruction After Spinal Cord Injury"],"prefix":"10.1002","volume":"71","author":[{"given":"Christopher S.","family":"Crowe","sequence":"first","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery University of Washington  Seattle Washington USA"},{"name":"Northwest Institute for Nerve Injury Harborview Medical Center  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusha Katie","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery University of Washington  Seattle Washington USA"},{"name":"Northwest Institute for Nerve Injury Harborview Medical Center  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine M.","family":"Curtin","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery Stanford Medical Center  Stanford California USA"},{"name":"Spinal Cord Injury Unit VA Health Care System  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent R.","family":"Hentz","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery Stanford Medical Center  Stanford California USA"},{"name":"Spinal Cord Injury Unit VA Health Care System  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott H.","family":"Kozin","sequence":"additional","affiliation":[{"name":"Shriners Hospital for Children  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ida K.","family":"Fox","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery Washington University  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7121-3770","authenticated-orcid":false,"given":"Michael J.","family":"Berger","sequence":"additional","affiliation":[{"name":"Division of Physical Medicine &amp; Rehabilitation, Department of Medicine University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,12]]},"reference":[{"key":"e_1_2_15_2_1","volume-title":"Traumatic Spinal Cord Injury Facts and Figures at a Glance","author":"National Spinal Cord Injury Statistical Center","year":"2023"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2014.08.016"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1310\/sci2003-197"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2004.21.1371"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.sc.3101638"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000005173"},{"issue":"8","key":"e_1_2_15_8_1","first-page":"1615","article-title":"Injuries to Nerves of the Upper Extremity","volume":"56","author":"Omer G. 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