SCI Forum Reports

Tendon Transfers

February 6, 1996

Transfers are surgical procedures that attempt to restore lost function by moving spared muscles or tendons so that they take over the functions of paralyzed systems. "We try to make the most of what you have," said Thomas Trumble, MD, an associate professor in the UW School of Medicine's Department of Orthopedics.

Three critical abilities for people with tetraplegia are bending the elbow, bringing the wrist up, and having a stable shoulder, Trumble said. In injuries above the C5 level, the rotator cuff, which allows us to lift our arms, may no longer function. However, "the shoulder blade drives about half of the shoulder joint motion," Trumble said. "The scapular wing, if fused, can still bring the arm up to shoulder height."

Lower injuries offer more options, such as moving the latissimus dorsi muscle in order to help bring the elbow up. "The original equipment is always the best," Trumble cautioned. "Anything we do is always second best." However, that second best can make a big difference in the life of someone with SCI. "Just a simple muscle that gives you maybe 45 degrees of function, with a little shoulder rotation, can allow you to reach your own head for self care," he said. "Getting elbow flexion can all of a sudden allow you to transfer, to drive, to eat."

However, the price of these gains in function includes losing the original function of the muscle or tendon that has been moved. "You don't get something for nothing," Trumble said. "You're robbing Peter to pay Paul." In patients with SCI, it's very important to wait until all natural recovery has taken place-usually at least one year after the injury-before considering transfer surgery.

For more information about tendon and muscle transfers, contact the UWMC Bone and Joint Center's Hand Service at 206-598-6502.