Spinal 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.
These can be life changing surgeries. The ability to reach out for an object, grasp it firmly, and efficiently control it opens up 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 are functioning before surgery, the more function can be regained by surgery. The first goal is to regain 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 made 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 control remains in the upper extremity from the injury, 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.
Only one hand is operated on at a time. After surgery, motion is usually started early, but the hand often can’t be used to perform most activities for 4 weeks, and activities requiring strength can’t be performed for up to 3 months. However, most patients are able to transfer on their forearms immediately. Some patients choose to be admitted to a rehab hospital for part of this time. This means that there is a period of decreased independence, which must be balanced against the lifelong increase in independence afforded by having a functional hand. There is a significant amount of post-operative hand therapy. This is why patient motivation is important. However, for the determined tetraplegic, hand surgery can provide a rewarding and successful outcome.