National Spinal Cord Injury Association Resource Center

Factsheet #7:
Tendon Transfer Surgery to Restore Hand Function in Persons with Quadriplegia


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

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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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