The Surgical Restoration of Arm and Hand Function in Tetraplegic Patients

Dtsch Arztebl Int, 2023 · DOI: 10.3238/arztebl.m2023.0141 · Published: July 21, 2023

Spinal Cord Injury Orthopedics Rehabilitation

Simple Explanation

Spinal cord injuries can impair limb function, but surgery can restore some lost abilities. Muscle and nerve transfers can enable patients to regain use of their arms and hands. Tendon transfers involve moving functional muscles to compensate for paralyzed ones, while nerve transfers reroute intact nerve fascicles to reinnervate paralyzed muscles. These surgeries aim to improve quality of life by increasing independence in daily activities. Early interdisciplinary consultation is important for suitable patients.

Study Duration

Not specified

Participants

1258 patients (across 40 studies)

Evidence Level

Level III-IV, Retrospective/Prospective Case Series

Key Findings

1
Tendon transfers improved elbow extension strength and grip strength.
2
Nerve transfers led to strength improvements in most cases, particularly in younger patients undergoing early surgery.
3
Combined nerve and tendon transfer procedures in a single operation offer advantages over traditional multistep approaches.

Research Summary

Modern hand surgery techniques can restore upper limb function in selected tetraplegic patients. Muscle and tendon transfers, tenodeses, and joint stabilizations can reliably improve upper limb function. Early interdisciplinary counseling about surgical options should be offered to all affected persons as part of their treatment plan.

Practical Implications

Improved Quality of Life

Restoration of arm and hand function significantly enhances independence and self-confidence for tetraplegic patients.

Expanded Surgical Options

Combining muscle and nerve transfers widens the indications for surgery and improves patient outcomes.

Early Intervention

Early assessment and advice from an experienced team are crucial for optimizing the timing of nerve transfer procedures.

Study Limitations

1
Small sample sizes in many studies.
2
Risk of bias in included studies due to self-selected study populations and lack of blinding.
3
Country-specific differences in awareness and availability of treatment options.

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