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Thread: Info Please on Tendon Transfer

  1. #1

    Question Info Please on Tendon Transfer

    Hi,
    I'm considering having a tendon transplant and am trying to get as much information as I can on the procedure. I am a C-4,5 with use of only my left arm and hand. My left-hand has been getting progressively weaker ever since my accident in 1981. This was caused by several spinal cord tetherings as well as a myelomalaciac spinal cord according to my doctor. I've recently had several OT sessions using the Bioness system but for some reason my fingers would go into extension even though the therapist had the machine set up for flexion. Since the Bioness system isn't working for me, I'm considering the tendon transfer.

    I'd like to hear from anyone that can provide information but would especially like to hear from those that have had the procedure done over a year ago. Can you please tell me exactly what the surgery involves? How long do you have to wait after the surgery before you can use that hand? Did you experience much pain after the surgery? Do you experience that pain still? I know everyone is different, but I'm just trying to get a ballpark. What are some of the things you could not do before but can do now thanks to the tendon transfer? How about the opposite, are there any things you cannot do because of the tendon transfer? Do you have anything negative to say about the procedure? Do you know what the success rate of this procedure is? I'm very concerned about any complications I might have considering I only have use of my left-hand. I also have Hydromorphone in my intrathecal pump to alleviate the severe pain I would get in my left-hand. I'm concerned a tendon transfer surgery might bring on even more pain.

  2. #2
    The pain you are experiencing in your hand does not start there, it starts in the spinal cord or higher in the brain. So, the surgery, per se, should not have any impact one way or another on your pain except for the transient pain of an incision as it heals. I have a few patients who have had tendon transfers and it has helped them with functional activities. But we don't do them at my center so my experience with them is limited.

    RAB

  3. #3
    Hi Quadzila,

    Here's a very long thread and thorough "step by step" account of Chris Chappell's tendon transfer surgery. It's very interesting and should keep you busy reading for a while.

    http://sci.rutgers.edu/forum/showthread.php?t=5767

    And here's a "quickie" by Dr. Young:

    http://sci.rutgers.edu/forum/showthread.php?t=64704

    Have a good day.
    "Be kind, for everyone you meet is fighting a great battle." - Philo of Alexandria

  4. #4
    Hi Quadzila,
    I didn't read the long thread (1st link given by bob clark), so will answer just based on my own experience.
    I'd like to hear from anyone that can provide information but would especially like to hear from those that have had the procedure done over a year ago.
    Mine was completed 5 yrs ago (was done in 3 surgeries within a yr).
    Can you please tell me exactly what the surgery involves?
    1.) Tendon lengthening in wrist & forearm: a series of diagonal cuts in this tight tendon to help relieve some excess tone before transfers. I got to be awake for it since it only involved a block, not general anesthesia. Surgeon could then tell when he'd done enough cuts -- my fingers extended more easily (I could respond to what he said, i.e., straighten my fingers). He wouldn't part the curtain for me dammit, I could only see my hand -- not the interesting part, the incision & cuts. I was just curious. Recuperation didn't take long & not too much pain, but I don't remember how long or what the restrictions were. I think I just had a dressing & splint. Back to work in 2 wks (was part-time & restricted anyway).

    2.) About 3-6 mos later had first actual transfer. An extra tendon was taken from my foot, sliced lengthwise & spliced onto enervated muscle(s) which were then sewn into each finger. There was more pain since it was a more extensive surgery. Had a soft cast on for several wks. (foot too). Then I was fitted w/different splint for arm & fingers.

    3.) About 6 months later, repeated #2 for thumb (took tendon from other foot this time). Pain not as bad, cast on for less time. Fitted w/thumb splint for daytime & wore newly-created splint incorporating thumb & finger positioning at night.
    Do you experience that pain still?
    Post-op pain is naturally more intense, but it doesn't last very long. The only residual pain (different from nerve pain) now is a slight dull muscle-ache type of pain, but to me it seems minor in exchange for the use of my hand again. Plus it's only present about 1/4th of the time. It's worse when I've used the hand awhile. You have to respect limitations & not do more than you're supposed to.

    Will finish this later. Got a notice that my AV program is updating & will close all processes!
    Last edited by awakenow; 09-17-2006 at 06:31 AM.

  5. #5
    Before continuing, the extent of my disability (think it's in profile too) is: C6/7 inc. for 8 yrs, w/herniations since then @ C/7-T/1, & C4/5. Also tethering & some other things.

    But as we all know "incomplete" isn't descriptive due to tremendous range of variables/variations... Plus some SCI first looks complete (mine did), but then return occurs, to some extent. Most of my problems are below chest level, but since the hand problem is the topic I'll stick to that!

    I'm right-handed & the surgery was on my right hand. It was much worse than the left one. I do have use of both arms & hands, but they're weak, w/stiffness & range of motion problems, etc. Abnormal dexterity in hands due to this weakness, & intrinsic muscle damage (but my right hand is MUCH better now). Have the usual grabber, jar opener & other ADL stuff.

    OK, here's the rest:

    What are some of the things you could not do before but can do now thanks to the tendon transfer?
    Before the tendon transfer, only one finger had enough strength to use a keyboard. I couldn't use a computer mouse, so had to train my left hand for that. To this day I still mouse left-handed since I got used to it (became more ambidextrous), though I can use right; I just don't want to over-use it. I also regained the ability to brush my teeth w/right hand, use forks/knives, open doors, basically everything.

    What amazed me the most back then was that I could type fairly fast again (in time), even use my thumb for the spacebar. I could also again do job activities such as RAM upgrades, install PC cards, swap out hard drives, etc. I could even pinch the cable connectors so I could work with the network again -- data jacks & the hub closet, etc.! (Sorry, I guess that's stuff only a nerd could get excited about... )
    How about the opposite, are there any things you cannot do because of the tendon transfer? Do you have anything negative to say about the procedure?
    Nothing I could do before but not after, nothing negative to say about any of it.
    Do you know what the success rate of this procedure is? I'm very concerned about any complications I might have considering I only have use of my left-hand.
    I don't know this, & don't blame you for your concern. Surgeon reputation would be important. Mine has an excellent reputation, & I had a good rapport w/him. He complimented me too on the last visit -- he yelled out to another doctor, "See, I told you it's all about patient selection!"

    He was funny too. When removing one of my arm casts I asked him if he had a Hall of Shame for casts, since I'd spilled coffee & assorted stuff on it. I told him he'd probably find coffee grounds too. He replied that he'd once found a "small baggie containing white powder" in someone's cast!

    One of the OTs said that with his surgeries, there was little need for the hand exercises (but of course I did them) because after healing, the muscles knew what to do. Forgot to mention there's Occupational Therapy involved during the process. Obviously they make the splints, do assessments, assign exercises, & give nice soothing hot wax treatments! They're important & were great too.

    I did a quick Google search & found this on deserthand.com. It's also repeated word-for-word on other sites, apparently the party line of ASSH -- American Society for Surgery of the Hand...

    "Outcomes
    Because tendon transfers use the patient’s own tissues, the risk of infection is lessened. However, the risk of developing a latex allergy is increased so precautions should be taken. The length of the surgery (approximately six hours) also increases the risk of postoperative respiratory problems.

    In general, the results using tendon transfer surgery to restore arm and hand function after spinal cord injury are good. People with tetraplegia can often benefit from the increased self-confidence and independence they gain after tendon transfer surgery."

    Sorry my memory isn't better as far as timeframes, i.e, length of recuperation, etc., but this was also the year my mom was being treated unsuccessfully for cancer -- in fact the last surgery was 4 days after she died.

    Hope this info helps, & good luck w/whatever you decide. Feel free to PM me if you have more questions, or just post back in this thread.
    Lis

  6. #6

    Info Please on Tendon Transfer

    Hey Lis,
    Thanks for all the info! Approx. how long was your OT? Did docs allow you to use the hand for anything else after the surgery? I can do my BP pretty much independently. I use a suppository inserter that I strap to my hand, was wondering if I'd be able to do stuff like that after the surgery w/the cast on? That'd mean I could still brush teeth & hair w/brushes strapped to my hand. I know it would be up to my doc but it sounds like most people can't use the hand at all while it's in a cast.

    Sorry to hear that about your mom, it must have made you recovery much more difficult? Glad to hear you got good results from the transfer though.

    Take care.

  7. #7
    Quadzila-I would also recomend that you ask the doc for some patient references since each doc has their own protocols. That way you may have a better idea of what to expect from your procedures.Many of the people that I know that had the procedures swear by them. I do not know of anyone who lost function! I do not know of anyone who had their pain relieved. I think that you need to figure out why you want this (if you haven't already) and then weigh the pros and cons. It is a big comitment from you.SCI NURse

  8. #8
    Hi again,
    Meant to check back sooner but have had a lot of family stuff happening, ranging from teenage melodrama to more serious. Anyways --
    Approx. how long was your OT? Did docs allow you to use the hand for anything else after the surgery?
    OT between surgeries & after the final one decreased as time passed. Mostly I was given simple exercises to do at home. Went in maybe once a week at first, then every 2 wks., then once a mo., I can't remember clearly.

    The cast after finger tendon transfers covered my forearm, hand, & fingers -- only the top inch of each finger was visible. I wasn't supposed to, & didn't, use my hand for anything; couldn't risk damaging internal or external stitches. The cast for the thumb was similar except with more reinforcement around the thumb. I don't think my fingers were enclosed by that one.
    I can do my BP pretty much independently. I use a suppository inserter that I strap to my hand, was wondering if I'd be able to do stuff like that after the surgery w/the cast on?
    That's really iffy. Maybe a traditional plaster cast could be used for you? I'm totally guessing -- it might not be allowed since it could give a false sense that the surgical site is more protected than it really is. My casts were constructed in stages including a cottony layer w/firm outside, then something wet that dried hard (looked like plastic-coated cloth tape?). Last it was wrapped w/stretchy Ace bandage-type material.

    As SCI Nurse mentioned, each doctor has their own way of doing things. Patient references would be an idea. But since we are all so different, if I were you I'd want to talk to a patient whose condition is similar.

    Since you rely on your left hand for basically everything, I would think you'd need live-in care for a time afterward. Meaning, to do the things you mention. It's a delicate surgery & I wouldn't risk injury, to the internal stitches especially. Scar tissue could result or possibly even the need for re-do surgery (again I'm guessing). Then the surgeon & insurance co. would not be happy campers. It's possible the surgeon wouldn't even do the transfer(s) unless you had home care...

    So I'd call surgeons' offices & get as much info as possible over the phone & then schedule one or more consultations ...oops, almost typed confrontations -- that would be me. (Seems to be my luck lately, have had a couple of visits in past yr. w/two docs whose feet are planted firmly on pedestals of their own making -- legends in their own minds.) Another long story, it's late so am having Freudian slips I suppose!

    Thanks for condolences about my mom. Some of the post-SCI years have been a blur & that was one of them.

    Good luck to you whatever you decide, & keep us posted!

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