Tendon Transfer Surgery Can Restore Function in Hands, Wrists and Arms for People with Tetraplegia
Consulting physician in Shepherd Center's Upper Extremity Clinic explains the procedure he performs.
Shannon Tharpe lived 15 years as a tetraplegic, having raised two babies without ever being able to fully use her hands to take care of them. But a surgical procedure changed that, and now she’s experiencing a life she thought she’d never have.
Shannon, 40, of Fort Valley, Ga., underwent tendon transfer surgery six years ago through Shepherd’s Upper Extremity Clinic. The procedure, which is one of several offered through the clinic, can restore elbow and hand functions to people with tetraplegia. People who undergo the procedure can regain wrist extension, grip, pinch and even the ability to straighten their arms.
Shepherd Center consulting hand and upper extremity surgeon Allan Peljovich, M.D., and consulting plastic surgeon Arthur Simon, M.D., perform the tendon transfer surgery. They select a functioning muscle, detach it, and then reattach it to a new location with the right amount of pull and force. Then, with a bit of healing and therapy, the patient learns to activate the muscle, which now does something new. For example, one of the elbow flexor muscles, the brachioradialis, can be detached from one of the forearm bones, and then reattached into a thumb flexor muscle, restoring thumb pinch where there was not any before, Dr. Peljovich explains.
Tendon transfer procedures have been done for decades,and applied in spinal cord injury (SCI) since the 1950s – though Shepherd is one of only a handful of facilities that offer the procedure for people with SCI. In the past several decades, techniques and protocols have been greatly improved through research. In fact, Shepherd’s Upper Extremity Clinic has conducted some of this research and presented it at international meetings and published it in journals and books.
Shannon, who has a C-6 SCI, learned of the tendon transfer procedure in 2004 and then found out she was a good candidate. First, she had surgery on her left arm, and then a year later, on her right arm. The surgery brought dramatic life changes.
“Once I came out of the cast for my left arm, I couldn’t wait to get the right one done,” she says. “It completely transformed everything. I raised two babies, having to use my teeth to pull the diaper tabs. It was awful. After one surgery,I could do everything with that arm.
“Now, I’m doing a whole lot more than I was ever able to do during those 15 years,” Shannon explains. “I have easily done more in the past six years than the 15 years before. I can write with no aid. I can get dressed without the dressing stick, and I can get stuff out of kitchen cabinets now with my grip. I can grab the steering wheel and turn it, and pushing a manual chair is a million times easier now. I can’t say enough about it. For someone injured as long as I had been and to have gotten used to my condition, it is almost like being able to walk.”
Paula Ackerman, manager of Shepherd’s Spinal Cord Injury (SCI) Post-Acute Program, isn’t surprised to hear that patients’ quality of life improves after having the surgery.
“Psychologically, what this provides is huge,” she says. “People gain a lot of independence with very specific goals they want to accomplish, such as self-catheterization.”
Former Shepherd SCI patient Julian Kilpatrick, 21, of Doraville, Ga., is only a few months removed from his tendon transfer procedure, and he hopes to see continued improvement over the next few months. But what he’s seen thus far was enough to let him know he could move across the country and handle attending college beginning this fall at the University of Arizona.
“It’s been a huge boost, emotionally, mentally and physically,” says Julian, who sustained a C-5 SCI in 2008. “I’m going back to college, to Arizona, and I don’t think I’d be ready mentally or physically without the procedure. I feel so much more independent now. I can get things from my lap to the table, get a book without help. Everything in my workspace is so much better now.”
Also, Julian is now able to do things in his personal music studio, such as burning and labeling CDs, and manipulating controls in ways he couldn’t before his surgery. And for someone as into music as Julian is, that’s huge.
Dr. Peljovich, who performs the surgery at Piedmont Hospital, which is adjacent to Shepherd, describes the feedback from patients such as Shannon and Julian as very rewarding.
“Hearing these things makes it all worthwhile,” he says. “Shannon is a great example of someone being able to go through this years after her injury. I am so proud of her accomplishing what she has.”
Dr. Peljovich hopes to see more patients undergo tendon transfer procedures.
“A lot of people don’t think they can do it a long time after injury,” he says. “All we have to do is wait for the person to recover all they can from the injury before we operate. Then, we need someone who wants to get better. In the past 10 years, we’ve had maybe four patients for whom the surgery didn’t work, and we’ve done more than 100 procedures. Even in those four, there were no dramatic failures.”
Surgical candidates need to have strong, working arm and forearm muscles to use for the tendon transfer. People with C-5 injuries, or below, are usually the best candidates. For more information on the tendon transfer procedure and other services offered in Shepherd’s Upper ExremityClinic, see www.shepherd.org/uec.
Written by Bill Sanders
Photography by Gary Meek
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.