Surgery to improve movement in the arms and hands
There are 2 types of surgery that research shows can help improve movement in the arms and hands after cervical SCI:
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Nerve transfer: A surgeon connects an extra working nerve to a nerve that is not working. After the transferred nerve grows down the new pathway, the working nerve can carry a signal to help improve a movement that you lost.
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Tendon transfer: A surgeon cuts an extra tendon that is connected to a muscle that you can move and attaches it to one or more tendons that you can’t move. After the tendon heals, the working muscle can help improve a movement that you lost. (Tendons are the tissues that attach your muscles to your bones.)
These surgeries can help improve movements to straighten your elbow and wrist, and open and close your hands. This may help you do daily activities more independently. For example, surgery can help people reach out their arms to grasp and release things with their hands.
How do these surgeries work?
Surgeons connect a part of your body that works (that you can move) to a part of your body that does not work (that you can’t move). Both surgeries are done in your arms or your hands, or both. They are not done on your spinal cord itself.
This lets the brain send a signal to the nerves and muscles in your arms and hands by going around the SCI.
What is nerve transfer?
Nerves connect your brain to muscles in different parts of your body. Your brain sends signals through your spinal cord to nerves to tell your muscles to move.
In nerve transfer:
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A surgeon cuts an extra nerve that is working and can carry a signal, and connects it to a nerve that is not working and can’t carry a signal anymore.
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Once the transferred nerve grows down its new pathway, it can carry the signal to tell your muscle to move.
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This improves some movement that you lost because of the SCI.
Nerve transfer surgery may only be an option within 6-12 months after SCI.
Keep the window of opportunity open and talk to your health care team about surgery as soon as possible (ideally within 6 months after SCI).
Why might the option for nerve transfer go away?
There are different patterns of injury in SCI. Each person with SCI has a unique (or “different”) pattern of injury. Even in one person, the left and right side may have different patterns of injury.
In some patterns of SCI, your brain cannot send a signal out through the injured spinal cord and damaged nerves. With time, the muscles become damaged too. Nerve transfer surgery is time sensitive and should be done within 6-12 months of SCI. Tendon transfer surgery may still work.
In other patterns of SCI, your brain cannot send a signal because the pathway is blocked by the SCI. However, the nerves and muscles are not damaged. Nerve transfer surgery is not time sensitive and may still work over 1 year after SCI. Tendon transfer surgery may work as well.
Why are some injuries time sensitive?
How can I tell if my pattern of SCI is time sensitive for nerve transfer surgery?
A doctor can check how responsive your nerves and muscles are with a special test called electrodiagnostic testing.
This test uses a very small amount of electricity to see if your nerves can carry a signal (called nerve conduction testing or NCS) and if your muscles are working (electromyography or EMG).
Results from this test can help tell:
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If your SCI is time sensitive
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If nerve transfer is an option for you
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How soon you should get nerve transfer if it is an option for you
There might be other tests that are helpful, including imaging (such as MRI) or surface electrical stimulation (E-stim). However, researchers still need to learn more about how helpful these tests may be.
The graph below shows how many people may lose the option of nerve transfer within 6-12 months after SCI, based on electrodiagnostic testing:
How many people have a time sensitive pattern of SCI?
This data is based on results from electrodiagnostic testing, which shows whether nerves and muscles are damaged.
This graph is adapted from: Berger MJ, Dengler J, Westman A, Curt A, Schubert M, Abel R, Weidner N, Röhrich F, Fox IK. Nerve Transfer After Cervical Spinal Cord Injury: Who Has a "Time Sensitive" Injury Based on Electrodiagnostic Findings? Arch Phys Med Rehabil. 2023 Nov. PMID: 37979641.
What is tendon transfer?
Tendons are the rope-like tissues that attach your muscles to your bones. When your muscles move, tendons pull on the bone, and this allows you to move your elbows, wrists, fingers and thumbs.
In tendon transfer:
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Surgeons cut an extra tendon that is connected to a muscle you can move.
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They then attach it to one or more tendons that you can’t move.
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After the tendon heals, the working muscle can help improve a movement that you lost.
Why might I get surgery?
Surgery can improve certain arm and hand movement
In general, both nerve transfer and tendon transfer can help you:
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Straighten and pull your wrist back, which can allow you to grasp and release objects
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Straighten your elbow
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Close your hand by bending your thumb and fingers
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Open your hand by straightening your thumb and fingers
Surgery can improve movement and strength
Surgery can restore movement and strength. This may make certain activities easier to do on your own, such as:
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Eating without assistive devices
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Grooming, such as putting on make-up, washing up, putting on clothing
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Writing or using a phone, computer, or other electronic devices, such as a USB cable or charger cord
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Doing tasks to help with bladder function, such as inserting a catheter or emptying a urinal
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Helping with transfers, such as moving from your wheelchair to your bed
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Driving
Surgery can treat spasticity
Surgery can also be used to treat stiffness and spasticity. Losing spasticity is helpful for most people.
Nerve transfer and tendon release surgery can both help with spasticity. In tendon release surgery, a surgeon cuts a tendon to allow more movement and relieve pain. Talk with your health care team to learn more about tendon release.
Talk to your health care team about if surgery is right for you
Every SCI is different, and every person has different goals. You and your health care team can talk about:
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Your injury
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If surgery is right for you
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The kinds of movements that surgery may improve
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How these movements may be helpful for your daily activities
What else should I know about improving movement with surgery?
Research shows that nerve and tendon transfer can help people with SCI improve movement. However, it does not guarantee that you will be able to do more things on your own:
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Surgery may improve your movement, but this may not always help you carry out your daily activities. Being able to do the activity also depends on things such as your overall health, strength, and weight.
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There is a very small chance that you can lose some movement or strength that you had before surgery.
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Research shows that the chance of losing movement after surgery is low. If movement is lost, it is usually temporary and recovers with time.
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Surgeons do their best to make sure any movement that you lose after surgery does not take away from an ability you have and want to keep.
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Surgery does not work 100% of the time.
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Some people have unexpected changes after surgery, such as:
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Tingling or burning sensations (with nerve transfer)
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Stiffness (with tendon transfer)
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