SURGICAL CLASSIFICATION

Also called "Giens classification" as it was established at the second international meeting in Giens (France), in 1984, the international classification of upper limbs in tetraplegia is a very powerful tool for the surgeon, because it is the basis for surgical indications.

 

 

       
       
 
INTERNATIONAL SURGICAL CLASSIFICATION
(each upper limb is classified separately)
group 0 No muscle below elbow  
group 1 BR (grade 4) Strong elbow flexion
group 2 ECRL Weak wrist extension
group 3 ECRB Strong wrist extension
group 4 PT Active forearm pronation
group 5 FCR Strong wrist flexion
group 6 EDC Fingers extension
group 7 EPL Thumb retroposition
group 8 FDP partial Fingers flexion
group 9 FDS Lacks only intrinsics
group 10 Exceptions
     
(click) >>> Algorithm for classification
 
(click) >>> What about sensibiliy ?
This classification does not inlude the triceps status
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
       
     
       
       
       
       
       
       
       
       
     
       
     
       
     
       
     
       
     
       
       

 
       
  group 0

 

  
       
  group 1

Strong elbow flexion

BR grade 4
surgical situation
 
surgical indications
       
  group 2

Weak wrist extension

Do NOT use ECRL !!!
surgical situation
 
surgical indications
       
  group 3

Strong wrist extension

ECRB is active, therefore ECRL can be transferred
surgical situation
 
surgical indications
       
  group 4

Active forearm pronation (PT)
surgical situation
 
surgical indications
       
  group 5

Strong wrist flexion (FCR)
surgical situation
 
surgical indications
       
  group 6

EDC is active
surgical situation
 
surgical indications
       
  group 7

EPL is active

 
surgical situation
 
surgical indications
       
  group 8
surgical situation
 
surgical indications
       
  group 9

Lacks only intrinsics
surgical situation
 
surgical indications
       
    group 10

Exceptions

  
       
       
       
       
       
       
   
       
       
  click >>> Algorithm for classification  
       
       
 

WHAT ABOUT SENSIBILITY ?

    
       
 
  • Whenever a motor surgical indication exists in tetraplegia, there is a protective sensibility on the radial side of the hand.
  • When sensibility of the hand is impaired, no surgical procedure exists to improve it.

Consequently, Moberg's classification according sensibility of the hand has no surgical interest.

    
       
       
       
       
       
 

WHAT ABOUT SPASTICITY ?

    
       
       
       

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