National Spinal Cord Injury Association Resource Center
Factsheet #7:
Tendon Transfer Surgery to Restore Hand
Function in Persons with Quadriplegia
Introduction
Hand surgery can play a very important role in the
rehabilitation of selected individuals with paralysis
following spinal cord injury. When the spinal cord is
injured as a result of a fracture or dislocation in the
neck, or as a result of direct injury to the spinal cord
from a bullet, knife, tumor or other disorder there is a
profound disturbance of function at the level of injury
and a loss of voluntary control of all muscles and
sensory function that occur below that level. Individuals
with these injuries are often referred to as persons with
quadriplegia or tetraplegia because all four limbs have
at least some degree of paralysis.
Anatomy 101
The upper limbs are supplied by nerves originating in
the spinal cord from the fifth cervical vertebra to the
first thoracic vertebra designated as C5, C6, C7, C8, and
T1 (see diagram). There are over thirty-five muscles
involved in controlling voluntary movements in the
forearm, wrist and hand which receive their nerve supply
from C6, C7, C8, and T1. Since the most common area of
injury to the cervical spinal cord results in paralysis
below C6, these persons usually have only two to five of
their arm muscles that are not paralyzed.
Tendons are strong cords that connect muscles to bones
and transmit muscle action into movement of the joints
where they cross. The important muscles that move the
wrist and fingers are located in the forearm and their
tendons are attached to bones in the hand. In tendon
transfer surgery the tendon of muscle that is not
paralyzed is transferred to the tendon or tendons of
paralyzed muscles so that the transferred muscle will be
able to replace the important action that was lost. When
a tendon is transferred, its former action will be
weakened so it is essential to select the proper muscles
for transfer. It is of greatest importance to maintain
wrist extension so one strong muscle must be retained for
that purpose. Many individuals at the C6 level will be
able to maintain wrist control and have one or more other
muscles that can be transferred to provide another
action, such as pinching, with the thumb.
Other topics covered in this fact sheet
include:
- Definition of Tendonitis
- Tendonesis
- Selection of persons for surgery
- Hand Surgery Centers
- Suggested Readings
For a complete text of this fact sheet,
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The National Spinal Cord Injury
Association would like to thank James H. House, M.D., and
Ann L. Dahl, OTR, for contributing their time and
expertise in the preparation of this Factsheet. This
Factsheet is offered as an information service and is not
intended to cover all treatments or research in the
field, nor is it an endorsement of the methods mentioned
herein. Any information you may have to offer to further
update this Factsheet would be greatly appreciated. The
National Spinal Cord Injury Association Resource Center
(NSCIRC) provides information and referral on any subject
related to spinal cord injury. Contact the resource
center at 1-800-962-9629.
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