TENDON TRANSFER
We need to pinch our thumb for nearly 90% of the tasks we do each day with our hands. It's something most of us take for granted, but if you lose that ability, it can make life very difficult. Here's how doctors are restoring the ability to pinch in some people with spinal cord injuries.
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What may seem like a simple stroke of the brush is a major accomplishment for Rose O'Lague.
A car accident left rose a quadriplegic. But, she says not being able to walk was not the hardest part.
Rose O'Lague
Quadriplegic
"My thumb hung away from my hand so I had no grip."
No grip meant not being able to hold her paintbrush.
Rose O'Lague
"No matter how hard I tried, I could not grip anything. That was terribly frustrating."
To restore function in Rose's thumb, doctors took a tendon from Rose's forearm and transferred it to her thumb.
Doctor Allan Peljovich performed rose's surgery.
Allan Peljovich, M.D., M.P.H.
Orthopedic Hand Surgeon
Shepherd Center
Atlanta, GA
"So in the end, it doesn't cause her any difficulty or impairment in her elbow, but now provides her with function she doesn't have."
After five weeks in a cast and months of therapy, Rose is now able to paint with great detail.
Allan Peljovich, M.D., M.P.H.
"Taking care of people like Rose are about as much fun as it gets because you can really make a difference for what they do."
Rose O'Lague
"I can put on my own lipstick. I can pick up finger food."
She can also turn pages, a necessity for a director of a community theater.
Rose O'Lague
"I know I'm not going to walk again and I'm not concerned about that, but not to be able to do anything with my hands, that probably would have been the hardest thing to really live with."
Doctors say new techniques have made tendon transfers more successful and better for the patient. Tendon transfers can be done in other areas of the body including the shoulder, elbow and hand.
PROBLEM: According to the National Spinal Cord Injury Association, about 200,000 people in the United States have spinal cord injuries. Every year, about 10,000 people sustain new spinal cord injuries. Most of these people are injured in auto and sports accidents, falls, and industrial mishaps. About 60 percent of these people are 30 years old or younger, and the majority of them are men. Different parts of the body can be paralyzed. A quadriplegic is someone who has lost total use or at least some use of all four limbs. Researchers say it's not just about losing the ability to walk. They say losing the use of one's hands has a major impact on quality of life.
90% of the things you do each day with your hand involve the ability to pinch your thumb. Losing the ability to pinch can become very frustrating. That inability is a problem for many quadriplegics as they often have very limited use of their hands. The lack of handgrip means people cannot feed themselves with a fork, use a telephone, or even write a note. Now, some of these patients are regaining the use of their hands with an advanced tendon transfer surgery.
SURGERY: Tendon transfer surgeries have been around for a while, but doctors say new surgery techniques and advancements are making the surgery more successful and easier for the patient. In a tendon transfer, doctors take a muscle that someone is able to use and simply detach that muscle from its original location and reattach it to a new location. Basically, when the person uses the muscle, it does the same function in a new place. For example, when a tendon is transferred from an elbow to the hand - instead of flexing the elbow - the tendon may now work to push a person's thumb down. The procedure can be used for any patient who has difficulty moving a joint because of a muscle rupture or paralysis. For example, patients with spinal cord injury or stroke may be candidates for a tendon transfer. Specifically, those with C-5 or C-6 spinal cord injury are prime candidates for the surgery.
HARD ON PATIENT: Though the tendon transfer procedure has been improved recently, doctors say it's still a hard on the patient when it comes to recovery. The procedure gives people more independence and flexibility in the long-term, but it will be hard on them in the short run. Before the surgery, patients undergo six weeks of preparation of at-home strengthening and range of motion exercises to prepare the arm for surgery. The surgery usually requires a one-day hospital stay. The patient then goes home with a cast on the arm for at least two to four weeks after the surgery. A splint is then worn. Finally, in order to use the new muscle in the new location, the person must undergo intensive rehabilitation therapy. The therapy is typically two to three times a week for two hours lasting for 8 to 12 weeks. The hard work often pays off for the patient because they are able to use a portion of their hand they were not able to use before and to do things they couldn't do before. For example, one patient says after the surgery she can eat potato chips again because she has the ability to pick them up without breaking them. She is also able to paint and put on her own lipstick. While the strength is not the same as an able-bodied person, doctors and patients say it is enough to make a difference in a patient's quality of life.
Sarah Morrison
Shepherd Center
2020 Peachtree Rd., NW
Atlanta, GA 30309
(404) 350-7523
sarah-morrison@shepherd.org
www.shepherd.org
Copyright © 2003 Ivanhoe Broadcast News, Inc.
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