Next steps

Some nerve transfer surgeries may only be an option within 6-12 months after SCI. If you want to keep the window of opportunity open, take these next steps as soon as possible after SCI:

Talk to your health care team (ideally within 6 months after SCI) and ask about recovery of your arm and hand movement. This can help:
- Find out if your injury is time sensitive for nerve transfer surgery
- Give you and your family and friends time to think about treatment options and start to make plans
Figure out if surgery is an option for you. This will include an evaluation and electrodiagnostic testing.
Ask your health care team for help finding a surgeon if you don’t have one.
Start to plan for the costs of surgery.
Talk to your family and friends about the type of help and support you may need as you heal from surgery.

If you want to learn more about surgery, please talk to a member of your health care team who knows you well, such as your occupational therapist, physical therapist, and your SCI doctor. They may be able to help with evaluation and a referral for surgery. You can share this website and the list of questions.

The choice to have surgery is personal, and your options depend on your situation. We wish you good luck as you continue to explore your options.

Talk to your health care team

Figure out if surgery is an option for you

Ask your health care team for help finding a surgeon

Start to plan for the costs of surgery

Talk to your family and friends

Learn more about SCI

Talk to your health care team

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You might decide you want to take the next step and look into having surgery. If so, you’ll want to talk with a member of your health care team who knows you well. This could be an occupational therapist, physical therapist, SCI doctor, or other person.

If you don’t have a surgeon who does nerve transfer or tendon transfer surgery, your health care team may be able to refer you to one.

If you are interested in surgery:

Show your health care team this list of questions, then talk about your answers, and how they affect your decision about surgery.
- Talk about your goals for improving movement – for example, what do you want to do on your own? Then ask about the chance that surgery will help you do that.
- Ask about the kinds of caregiver support you may need while you are healing from surgery, and for how long.

Talk to your health care team

Figure out if surgery is an option for you

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Ask your health care team or surgeon if surgery can help you. For surgery to be an option, you need to have a working nerve, muscle, or tendon that the surgeon can connect to something that is not working. Most people who have surgery as an option have:

Mid-cervical level SCI (motor level C5, C6 or C7)
Near normal shoulder and elbow bending movement (flexion)
AIS Grade A, B, or C SCI (not motor incomplete or AIS Grade D). Talk to your health care team about your AIS score.

You will need a physical exam and may need some tests to see if surgery is an option for you. These could include:

Upper limb strength and range of motion testing to see if you have nerves or tendons that are working and can be used to improve movements using surgery
An electrodiagnostic test, also called nerve conduction study (NCS) and electromyography (EMG) testing. This may tell your health care team if nerve transfer surgery is an option for you and how soon you should get surgery. If you don't know where to get this testing, ask for a referral from your doctor.

With this information, your health care team will be able to tell you more about your surgery options. For example, they can tell if you should get surgery as soon as possible or if you can wait a while.

Figure out if surgery is an option for you

Ask your health care team for help finding a surgeon

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If you don’t have a surgeon who does nerve or tendon transfer surgery, ask your health care team for a referral.

Sometimes, it can take time to plan for a surgery. Schedule a visit as soon as possible, ideally within 6 months after your SCI.

Important note: Even if it has been years since your SCI, you may still be able to have surgery, but there is less of a rush to get testing or make a decision.

Ask your health care team for help finding a surgeon

Start to plan for the costs of surgery

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This may be different depending on what country you live in and what healthcare coverage you have. There may be cost from taking time off work or getting extra help around the time of surgery.

When planning for the costs of surgery, consider:

Access to rehab or therapy after surgery varies across countries and health care settings
Time off work to recover may impact your finances and those of your family

Note: The information below is mostly relevant to the US health care system. This may be different for other countries and health care plans.

Questions to ask your insurance plan about surgery

If you are in the US, talk with your insurance plan to learn about costs for surgery and rehab and therapy, and if you need to follow any specific steps.

Here are some questions to ask about surgery:

Do I need a referral to get testing or see a surgeon?
How much of the cost of testing, surgery, and rehab will I have to pay out-of-pocket?
Do I need pre-approval (prior authorization) for electrodiagnostic testing or surgery?

Questions to ask your insurance plan about rehab

Rehab therapy after surgery is an important part of your recovery and care.

Here are some questions to ask about rehab:

Is there a set number of visits that are covered?
What are the co-pays for these visits?
Is rehab covered and do I need pre-approval (prior authorization)?

Start to plan the costs of surgery

Talk to your family and friends

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Think about who among your family and friends can support you as you recover, such as providing transportation or helping you every day. Then include them in discussions around your choice to have surgery and creating a care plan for after.

Talk to your family and friends

Learn more about SCI

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Visit these resources to learn more about SCI:

VA SCI national website