Triceps denervation as a predictor of elbow flexion contractures in C5 and C6 tetraplegia  Anne M. Bryden, OTR/L, Kevin L. Kilgore, PhD, Benjamin B. Lind, BA, David T. Yu, MD  Archives of Physical Medicine and Rehabilitation  Volume 85, Issue 11, Pages 1880-1885 (November 2004) DOI: 10.1016/j.apmr.2004.01.042 Copyright © 2004 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 1 Passive elbow extension measurements for 2 groups: one with weak voluntary triceps and one with paralyzed triceps. Measurements of 0° indicate full passive elbow extension, whereas measurements of any degree of flexion indicate the minimum angle to which the elbow can be passively extended. Median and mean measurements are represented by a line and a symbol, respectively. The box represents data within the 25th to 75th percentiles. Participants with weak voluntary triceps had significantly fewer and less severe elbow flexion contractures than participants with paralyzed triceps (P=.024). *One participant had 25° hyperextension. No participants had grades 3, 4, or 5 voluntary triceps strength. Archives of Physical Medicine and Rehabilitation 2004 85, 1880-1885DOI: (10.1016/j.apmr.2004.01.042) Copyright © 2004 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 2 Passive elbow extension measurements are shown for 3 groups: one without electrically excitable triceps (denervated), one with weak electrically excitable triceps, and one with strong electrically excitable triceps. Median and mean measurements are represented by a line and a symbol, respectively. The box represents data within the 25th to 75th percentiles. Overall, the difference in passive elbow extension among the 3 groups was statistically significant (P=.003). Abbreviation: EMMT, electric excitation manual muscle test. Archives of Physical Medicine and Rehabilitation 2004 85, 1880-1885DOI: (10.1016/j.apmr.2004.01.042) Copyright © 2004 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 3 Passive elbow extension measurements, grouped into 10° increments, for C5 and C6 participants. The difference between the mean passive elbow extension measurements for the C5 and C6 participants was not statistically significant (P=.302). The largest percentage of elbow flexion contractures is within 10° to 29°. *One arm measured −25° (hypertension). Archives of Physical Medicine and Rehabilitation 2004 85, 1880-1885DOI: (10.1016/j.apmr.2004.01.042) Copyright © 2004 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 4 Passive elbow extension measurements (in degrees) from each participant presenting bilateral data. Data from right arms are plotted against data from left arms. Most subjects presented bilateral measurements that were within 20° of each other (r=.955, P<.001). Twelve pairs exhibited full passive elbow extension bilaterally. Archives of Physical Medicine and Rehabilitation 2004 85, 1880-1885DOI: (10.1016/j.apmr.2004.01.042) Copyright © 2004 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 5 Passive elbow extension measurements plotted against voluntary strength measurements for (A) biceps/brachialis and (B) brachioradialis. No clear linear relationship was found between elbow flexion contractures and voluntary elbow flexor strength. Archives of Physical Medicine and Rehabilitation 2004 85, 1880-1885DOI: (10.1016/j.apmr.2004.01.042) Copyright © 2004 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions