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Restoring Hand Function After Spinal Cord Injury | Debary Personal Injury Attorney

Restoring Hand Function After Spinal Cord Injury

An injury to the upper portion of the spinal cord can leave a person with limited or no sensation or movement in their legs and arms, a condition known as tetraplegia.

A surgical procedure called a tendon transfer can help in restoring function and movement to paralyzed hands and arms by giving different jobs to working muscles. This can enhance the quality of life by enabling those with tetraplegia to do many tasks for themselves.

The types of available tendon transfer surgeries depend on the site of the spinal cord injury and the muscles affected.

How Tendon Transfer Surgery Works
Tendons are the strong cords that connect bone to muscle. At the point where a tendon crosses a joint, muscle action is transmitted into joint movement.

A tendon transfer moves the tendons of a working muscle so that they perform the functions of a paralyzed muscle. The working muscle can now do what the paralyzed muscle could not. For example, in the upper arm, the triceps muscle is used to straighten the elbow. The larger deltoid muscle pulls the arm backwards and forwards away from the body. If the triceps muscle is paralyzed but the deltoid is still functional, surgeons can split the deltoid muscle and attach (graft) a portion of it to the triceps. This restores elbow function without greatly diminishing the function of the deltoid in the shoulder.

Tendon transfer surgery can help in the restoration of three upper extremity critical capabilities that are needed for self-care and greater independence:

    • Ability to extend and bend the elbow
    • Ability to straighten and bend the wrist
    • Ability to grip with the hand and fingers

Preparing for Tendon Transfer Surgery
Typically, a tendon transfer is not performed until at least a year after the injury. For the first few months after an injury, retaining passive range of motion is the focus of rehabilitation. These set of exercises help prevent shoulder pain and stiffness.

During this time, the range and strength of motion (both passive and active) of the upper extremity must be frequently assessed. Severe muscle spasms or contractures may require a different type of surgery. Tendon transfer surgery is usually scheduled only after there is no more progress in function.

Before surgery can be performed, several evaluations must be made, including:

      • Identifying the muscles that still work and assessing how well they work to determine if they can be used in the transfer
      • Evaluating the patient’s abilities to determine the functions that need to be restored
      • Coordinating available muscles with functional requirements
      • Assessing whether another procedure, like joint fusion or an electrical stimulation implant, is required to restore function
      • Confirming that a patient has a home-support system capable of providing the care needed for rehabilitation
      • Evaluating the patient’s commitment to the process
      • Deciding which surgeries should be performed, their timing and the order in which they should be performed.

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