HandSpinal cord injury resulting in tetraplegia is a devastating, life-changing injury. Life becomes a battle for independence when even the smallest activity of daily living becomes a challenge.
The human mind and the human hand are wonderfully adaptable. Many determined tetraplegics can accomplish much without functioning fingers. Writing can be accomplished by wedging pens and pencils in the web spaces of the fingers. Both hands and the mouth can be used to manipulate objects. However, performing tasks in this way is neither fluid, effective, or time efficient.
Many tetraplegics do not realize that surgical hand reconstruction is available to help them regain significant hand and wrist function. In many cases, experienced hand surgeons can help them regain strong thumb pinch (up to 12 pounds). In some cases, good grip strength can also be regained. Elbow extension is important and can also be restored, allowing the patient to reach out to grasp objects, turn the lights on or off, etc. This triceps function is regained by moving the biceps tendon to the back of the arm, so that it now extends the elbow.
This can be life changing surgery. The ability to reach out for an object, and to grasp it firmly, and be able to efficiently control it opens the possibility of real independence. Tasks, such as writing, which used to be accomplished slowly, using unnatural manipulations, become simple and easy once again. Objects can be picked up off the floor. Activities of daily living become possible once again.
The more muscles that work the more function can be regained. The first goal is to regain some pinch between the thumb and index finger. If more muscles are available, strong thumb pinch and even finger grasp and release can be accomplished. The hand may never look normal, or function normally, but it can be extremely functional, allowing the tetraplegic to regain much of the function he or she has lost.
Surgery leads to improvement in approximately 95 percent of patients. Loss of function is rare. What can be accomplished depends on a number of factors. These include: 1) The determination of the patient, 2) How much motor function remains in the upper extremity, 3) How much spasticity is present, 4) Whether the joints are supple or contracted.
Surgery is considered after nine months from the time of injury, after bowel and bladder care issues have been addressed, and psychological adjustment has occurred. All fractures and wounds should be healed, and swelling should be gone. Motor function should be stable for at least three months.
After surgery, splinting lasts for 3-4 weeks. This is a period of decreased independence which must be balanced against the lifelong increase in independence afforded by having a functional hand. Then there is a significant amount of hand therapy. Rehabilitation takes roughly three months. You cannot use the hand to transfer during that time; most patients are able to transfer on their forearms. Some patients choose to be admitted to a rehab hospital for part of this time.
If only thumb pinch is reconstructed, just one surgery is required. However, if finger grasp is regained, there is usually a second, much smaller surgery, that must be undertaken in order to restore release (letting go of an object). Therefore, complete restoration of a hand often takes two operations, with a total recovery of six months (three months each). To get both hands functional would therefore take a total of approximately one year. This is why patient motivation is important. However, for the determined tetraplegic, hand surgery can provide a rewarding and successful outcome.
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