Tendon transfer surgery can help improve hand and elbow function in quadriplegics. However, according to Loyola Medicine hand surgeon Michael S. Bednar, MD, FAAOS, the procedure is greatly underused.

Among the reasons why include lack of communication among rehabilitation specialists, physicians, and surgeons; poor access to care; and lack of awareness. The greatest barrier appears to be a lack of coordinated collaboration among specialists, writes Bednar in an article about the procedure published recently in Hand Clinics.

“Although the long-term outcomes of these procedures are good, few patients eligible for these procedures actually have them performed,” Bednar writes, according to a media release from Loyola Medicine.

The procedure is performed to redirect muscles that still work to do the job of muscles that are paralyzed after a spinal cord injury, explains Bednar, professor in the department of orthopaedic surgery and rehabilitation at Loyola University Chicago Stritch School of Medicine, in the article.

During the procedure, the release explains, the surgeon will shift the tendon of one of the spare muscles to a new location. For example, the surgeon may detach one of the working elbow muscles (the brachioradialis) and reattach it to a nonworking muscle that flexes the thumb (the flexor pollicis longus).

Depending on the number of functioning muscles that the patient has left after the spinal cord injury, the procedure cannot restore full function but can help patients to perform such tasks as grasping objects, opening the hand, and straightening the elbow.

The best candidates for the procedure have spinal cord injuries in the C5-C8 cervical nerves in the lower neck, and do not have acute or chronic medical conditions such as infections, pressure sores, medical instability, or spasticity.

In addition, “a good surgical candidate has functional goals, is motivated, understands benefits and limitations of surgery, demonstrates emotional and psychological stability/adjustment to disability, and is committed to the postoperative rehabilitation process,” Bednar explains.

The procedure typically involves two surgeries on each arm, performed 3 months apart. One arm is worked on at a time. During rehabilitation, patients learn how to use the transferred muscles, per the release.

Bednar concludes that continuing education of patients, their caregivers, and the rehabilitation community will hopefully increase the utilization of tendon transfer procedures.

[Source: Loyola Medicine]