Purpose: To review the evidence for interventions in peer-reviewed published literature for reconstructive surgical procedures in the upper extremity for persons with tetraplegia following spinal cord injury (SCI). Method: A critical review and synthesis of articles addressing reconstructive surgical procedures was conducted. Each article was assessed for quality using the Downs and Black evaluation tool. Following this, a level of evidence using a modified Sackett scale was assigned to each intervention within these categories. Results: Each of the surgical procedures reviewed had numerous pre-post or case series studies that provide level 4 evidence (grade C) to support the use of reconstructive surgical procedures in improving upper extremity motor and functional use of the limb in individuals with tetraplegia following an SCI. Conclusion: There is evidence that reconstructive surgical procedures enhance upper extremity function for persons with tetraplegia. Although there is a need for higher quality evidence through improved study designs, there are both ethical and logistical constraints that present challenges in studying this population.

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