NEUROSURGERY ARTICLES

Tendon Transfer Surgeries to Improve Arm and Hand Function

Kim Anderson, Ph.D.

Having a spinal cord injury of any kind is a life-changing situation. However, an injury to the neck area (cervical region) is exceptionally difficult because it causes paralysis of the arms and hands. The amount of paralysis that occurs depends on how bad the spinal cord was damaged and in what area of the neck. The most common injury is to the fifth cervical region (C5), which results in a person still being able to move their shoulders and bicep muscles, but not being able to move their tricep muscles, wrists, or fingers. A person with a C5 injury typically has to hire a personal care attendant to help them with daily activities, such as getting in and out of bed, cooking, and bathing. Hence, anything that can be done to restore some arm or hand function could be very beneficial to a person with such an injury.

Tendon transfer surgeries are one option currently available to people with injuries between C5 and C8 (see picture to the right). A tendon is what attaches muscle to bone and transmits muscle action into movement of a joint. A tendon transfer is when the tendon of a muscle that is not paralyzed is surgically transferred to a muscle that is paralyzed, which then enables movement of the previously paralyzed muscle. Tendon transfers do not heal damaged nerves, but do restore functions that were lost due to paralysis. The most common types of tendon transfer surgeries are targeted at restoring elbow extension (e.g., straightening the arm), finger pinch, and hand gripping ability. These are all very important functions that contribute to independent living.

It is critical to know, however, that tendon transfers do not show results instantaneously. The arm must be immobilized for several weeks following surgery so that healing can occur. Then several months of rehabilitative exercise are needed to retrain the tendons and muscles. Therefore, an individual will likely require more assistance for a few months following surgery and then gradually regain more function and independence than before surgery.

Tendon transfer surgeries are performed commonly in Europe, but less so in the U.S. To try to understand why this difference exists, I conducted a survey of people living with cervical spinal cord injury in the U.S. The detailed results of the study are currently under peer-review for publication in the journal Spinal Cord. Briefly, over 90% of the people that participated in the survey felt that improving their arm/hand function would improve their quality of life, as would be expected. Less than half of the participants had ever been told about tendon transfer surgeries and only 9% had ever had one. Nearly 80% reported that they would be willing to spend 2-3 months being less independent while recovering from surgery in order to ultimately become more independent. Over 75% reported that the ideal time preferred to have a tendon transfer surgery, if chosen, would be within 5 years post-injury.

These findings indicate that regaining arm and hand function is of primary importance to individuals with cervical spinal cord injury, particularly to increase independence in multiple activities of daily living. There is a critical need in the US to improve awareness of tendon transfer surgeries as a viable option for improving function in some people. This information needs to be provided early after injury so that informed choices can be made within the first 5 years.

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