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Renewing Hope

Tendon and nerve transfer surgeries restore some use of hands and arms post-spinal cord injury.

For many people recovering from a spinal cord injury (SCI), hand and arm movement is limited. Fortunately, tendon and nerve transfer surgeries can re-animate a muscle and restore function in the arm, wrist and/or hand, potentially opening up a world of possibilities.

“These operations are all about giving patients who’ve been through trauma greater independence and more control of their lives,” says Allan Peljovich, M.D., MPH, a Shepherd Center consulting orthopedic surgeon.

For decades, surgeons reconstructed hand function in people with SCI strictly using tendon transfers. But over the past five years, Shepherd Center is among the first centers to explore transferring nerves in combination with or instead of tendon transfers for people with SCI. Based on this experience, doctors can determine what type of surgery will work best for a patient with SCI: using a tendon transfer, nerve transfer or a combination.

“One thing that sets our program apart is that we have the expertise and the ability to reconstruct arm and hand function with every surgical technique that’s available,” Dr. Peljovich says. “We can actually get a little bit deeper into exactly what kind of function would benefit the patient the most and then tailor our approach using a combination of techniques rather than having only one surgical option.”

How These Surgeries Work

When explaining tendon and nerve transfer surgeries to patients, Dr. Peljovich often uses the expression “Robbing Peter to pay Paul.”

“We essentially are taking a tendon and/or a nerve from one place where there are other muscles or nerves that help perform the same function, and moving it to another. Patients don’t notice the difference, and there is everything to gain from a successful transfer,” he explains.

The two most common surgical goals are to regain pinch between the thumb and fingers and restore someone’s ability to extend the elbow with strength. With those two functions alone, people can complete 90% or more of daily living activities.

For example, there are several muscles that help to flex or bend the elbow. Surgeons can take the tendon of the biceps muscle, which is one of a few muscles that bends the elbow, and transfer it to the triceps muscle which straightens the elbow. In doing so, patients can learn how to reuse the triceps muscle through rehabilitation and extend their arm, allowing them to get dressed and reach for things above their head with control. Since they have two other muscles that flex the elbow, there is no loss of that critical function.

Similarly, with nerve transfers, surgeons take a part of a nerve that feeds a working muscle, or sometimes part of a working muscle, and plug it into the nerve of the muscle that isn’t working.

Helping Patients Regain Meaningful Function

Patients often share that these highly specialized surgeries have allowed them to get a part of their life back and be more independent.

“Most of the time, it’s less about, ‘I can hold my toothbrush again,’ and more about the joy and amazement of getting back to hobbies and leisure activities,” says Jana Candia, OT/L, a case manager in Shepherd Center’s Upper Extremity Rehabilitation Clinic.

The functional gains also give patients a confidence boost and hope for the future.

“People can feel stuck after SCI: Hopes about their future suddenly seem like they are on hold, and these surgeries can help them jump that hurdle,” says Dr. Peljovich, adding that in his 20 years of practicing medicine, the outcomes from these surgeries remain his favorite part of the job. “It’s awesome to hear from people who are going back to school or work.”

While the team often performs these surgeries on patients who are already being cared for at Shepherd Center, they also see patients from across the country and have developed protocols that can be shared with local therapists to maximize results no matter where patients live.

The Upper Extremity Rehabilitation Clinic at Shepherd Center offers a comprehensive treatment program. For more information on these reconstructive procedures and other services offered at the clinic, click here.


Written by Amanda Crowe

About Shepherd Center

Shepherd Center provides world-class clinical care, research, and family support for people experiencing the most complex conditions, including spinal cord and brain injuries, multi-trauma, traumatic amputations, stroke, multiple sclerosis, and pain. An elite center recognized as both Spinal Cord Injury and Traumatic Brain Injury Model Systems, Shepherd Center is ranked by U.S. News as one of the nation’s top hospitals for rehabilitation. Shepherd Center treats thousands of patients annually with unmatched expertise and unwavering compassion to help them begin again.