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Thread: Surgery to restore hand function in quads?

  1. #1

    Surgery to restore hand function in quads?

    I have been following the High Level Quad Perspective thread. My son having suffered a C5 injury more than two years ago, and no cure in immediate sight, we would like to do whatever we can in the meantime to significantly improve his life. He finds the inability to use his hands the most frustrating thing of all (like most quads it seems). Surgery -- both tendon transfer and peripheral nerve rerouting -- combined with lots of follow-up rehab seems to restore a great deal of function to people with C level injuries.
    Very few people on these forums talk about this type of surgery and I wonder why. Is it unavailable? Unaffordable? Covered/not covered by insurance? Risky? Painful?
    If any of you have had such surgery, could you tell me how it went for you? Where it was done? How satisfied you are with it? Would you do it again? What problems did it solve / not solve?
    If you have decided against having it, what were your reasons?
    Would really appreciate hearing from all of you.

  2. #2
    Junior Member Du1's Avatar
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    I know lots of older quads that have had it and it seems great. I have a meeting next Wednesday with a surgeon to see about it for me. any info I'll post.

  3. #3
    It is not an easy process to go through, in that intially you may lose the independence that you have. For some people, that is not worth it. For others, it is.

    Also, it would depend on your insurance coverage as to whether or not it is covered and you need to have the therapy covered with it.

    Lastly, from what I hear from people who are in a similar situation to your son, they are not ready to give up the hope for the cure. For many, this type of surgery is tantamount to admitting that they don't believe a cure is coming.

    It will be interesting to see what others say.

    CKF

  4. #4
    Thanks for your replies. Du1, please do tell me about your meeting with the surgeon.
    CKF, what you say about lack of insurance coverage for both the surgery and the follow-up therapy is what I had suspected. If it's just a matter of having to spend yet more time in hospitals and losing even more independence for a few months / a year (for both hands), one would think that the prospect of such great improvements would make it worth the temporary setback.
    I realise that tendon transfer may involve a sacrifice of some function in the muscle from which the donor tendon is harvested (seems this is less of an issue with peripheral nerve rerouting) and this may be the reason why some people would prefer to wait for an overall cure. We very much believe that a cure is coming (how can you not?) but no one can tell us when. If trials were at the stage where we could be assured that within a year or two everyone could go and get their stem cell transplants and walk out good as new, then maybe it would be better to wait. Is the reluctance to have this type of surgery based on the idea that because there will soon be a complete cure for SCI one should not undergo procedures that will leave one's body less well functioning than it would be if one left things alone and waited? Or is it more a psychological position (If I have this operation it means I'm giving up hope for a cure)?
    Looking forward to hearing from everyone who has anything to say about this.

  5. #5
    Quick answer, absolutely. If the motivation and supports are there to go through the long recovery. I had a surgery with comparable recovery period over 10 years ago & its the best thing I ever did. I had my left wrist fuised, several tendons transfered and a muscle stimulator implant to give me a grip with my left hand. The recovery (I think 6-8 weeks before I could bend my left elbow and start using my hand) seemed endless, but mt life's been so much better since. Regarding a cure, if it happens the tendson transfers really won't linit function much if any. Plus, I got hurt in '89 and they've been saying we're 10 years away ever since. Definately getting closer, but at least a decade of dramatically increased quality of life and independence is woth it - in my opinion.

    Before having the tendon transfer, look into the research being done at the FES Center in Cleveland, OH - part of Case
    Western Reserve Univ. (http://fescenter.org/index.php?optio...d=13&Itemid=35) I believe the are in trials for an implanted electrical muscle stimulator to restore hand functune. I'm a c4/5 quad and I have the 1st generation of this technology. With my version I have an external device that I tape to my chest/shoulder & it uses movement in my right shoulder to control the opening and closing of my left hand. With the current version, an implanted sensor on a nerve of a muscle the person already has voluntary control of is used to control the grip. The surgery results in 2 different grips - one for pinching objects and a more ooen glasp (like holding a can). I'm not sure where they are in the trials, but it is wothing looking into to see if your son qualifies. After they finish the trials, they sell the technology so it is available to the public. While it was available, my version was covered by medicare and insurance companies. For me, it was a life changer. I can eat, brush hair/teeth, put on my driving belt, handle paper (money, mail, bills...), sign my name, draw, do lihjy cooking, do light housejeeping... independently. It gave me the independence to go from needing a live in attendant to being able to have just morning and evening care (still can't transfer, dress, do bp...).

    Don't get me wrong, if your son's a good candidate for tendon transfer, it can have similar results. I was a marinal candidate because of only having moderate brachial radialus strength & was lucky to be in the right pplace at the right time to get the implant.

  6. #6
    I am going to step back and let the real experts answer. I think that the questions you are asking are better aswered by someone who has gone through the process.
    CKF

  7. #7
    Quote Originally Posted by mamadavid View Post
    Thanks for your replies. Du1, please do tell me about your meeting with the surgeon.
    CKF, what you say about lack of insurance coverage for both the surgery and the follow-up therapy is what I had suspected. If it's just a matter of having to spend yet more time in hospitals and losing even more independence for a few months / a year (for both hands), one would think that the prospect of such great improvements would make it worth the temporary setback.
    I realise that tendon transfer may involve a sacrifice of some function in the muscle from which the donor tendon is harvested (seems this is less of an issue with peripheral nerve rerouting) and this may be the reason why some people would prefer to wait for an overall cure. We very much believe that a cure is coming (how can you not?) but no one can tell us when. If trials were at the stage where we could be assured that within a year or two everyone could go and get their stem cell transplants and walk out good as new, then maybe it would be better to wait. Is the reluctance to have this type of surgery based on the idea that because there will soon be a complete cure for SCI one should not undergo procedures that will leave one's body less well functioning than it would be if one left things alone and waited? Or is it more a psychological position (If I have this operation it means I'm giving up hope for a cure)?
    Looking forward to hearing from everyone who has anything to say about this.
    The advantage of the nerve transfers compared to tendon transfers is that immobilization is generally not required and more patients are candidates (higher injuries) than can receive tendon transfers. The downside is that time from surgery to first new movement can be long (a year in some cases).

  8. #8
    Senior Member
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    I've looked into this surgery some but have decided against it. My injury is/was at c4/5 and is incomplete so I do have wriist function. With wrist movement I can pick quite a few things up and can do things like type on a keyboard.
    It would be great to have more function from the tendon or nerve transfer, however there's the issue of cost and who in the Northeast even does this surgery. I'd also like to avoid more surgery as I've had a few problems with pressure wounds which required surgery. Still...if the hand surgery works for someone else he or she should go for it.

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