It is widely known that damage to the spinal cord can result in paralysis whether it be permanent or temporary. Each vertebra of the spinal column corresponds to the motor nerves of a part of the body, and in a healthy person, controls physical movement.
If an individual were to suffer an injury to the upper part of the spinal cord, specifically above the cervical vertebrae C6 and C7, they are likely to experience some form of paralysis in their arms, hands and legs. This is referred to as tetraplegia (or quadriplegia).
In some cases of tetraplegia, surgical methods, in conjunction with physical therapy, can be used to attempt restoration of hand function that was lost after the spinal cord injury. Dependent upon the location of the injury, paired with which muscles were affected, a procedure known as tendon transfer can restore hand function, ultimately aiding an individual’s independence and their quality of life.
The vertebrae serving the upper limbs are supplied by nerves which originate from C5, through to C8 and T1. These cervical vertebrae are found in the neck, and as a most SCIs occur from C6 and below, there is a chance that an individual may have between three and five arm muscles (out of a total of 35 which control the entire arm and hand region) still functional.
This procedure, although not ideal for all spinal cord injury patients, aims to restore the hand function in paralyzed arms and hands by delegating different jobs to remaining functioning muscles. As mentioned above, this surgery is recommended for those who still have some muscle function remaining, as this is the basis of the procedure.
Tendons connect muscle to bone, and they transmit the message for joint movement when they cross a joint in the body. The main premise of the tendon transfer procedure is to reposition a working muscle’s tendons to a paralyzed muscle; ultimately restoring its function.
Tendon transfer is a procedure which can dramatically change the life of a spinal cord injury patient, giving them the means to undertake actions such as self-care and general day to day living in an independent way. The three main capabilities which this surgery can restore include the ability to straighten and bend the elbow, bend and straighten the wrist, and grip with the hand and fingers.
If you have been labelled as eligible for tendon transfer surgery, you will be required to go under general anaesthesia, and the operation can last anywhere between 3-6 hours, depending on if you need just one or two surgeries. It is likely you will be required to stay in the hospital for just a few days and wear a long arm cast for the better part of a month. It is rare you will have both hands operated on at once, as the individual is likely to find themselves even more dependent on others to help with simple tasks during recovery. At least with one arm and hand free, this is alleviated a little.
Following the procedure, there will be a lengthy period of intensive rehabilitation in order to strengthen the hand and arm muscles, but mostly for the tendons to heal and recover from the surgery. Returning to the hospital as an outpatient to receive rehabilitation and physical therapy can be an exciting, although tough, time. Most doctors place a 3-6 month waiting time between operating on the other hand, as this will give sufficient time for the best rehabilitation after initial surgery on the first hand.
Tendon transfer surgery, if suitable for an individual and their injuries, can be a massively positive and exciting prospect. This surgery can instill and restore valuable independence for someone who may have lost much of their abilities after SCI. In short, this surgery can bring hope to those resigned to not using their hands again.