An Australian research team has published a large case series chronicling 59 nerve transfers in quadriplegic patients. A case series is a group of reports involving consecutive patients who receive similar medical treatment. (1) 

Regaining Upper Limb Function

Quadriplegia occurs when a spinal cord injury results in partial or complete paralysis in all four limbs and the torso. About 50% of the 250,000 to 500,000 people who have a spinal cord injury each year become quadriplegic. (1)

Not being able to use their arms and hands has extensive impacts for people with quadriplegia. It affects their work, social, and family lives. Because of this, regaining arm and hand function is one of the highest priorities for quadriplegic patients. (1, 2)

Nerve Transfer Surgery

In the past, doctors used tendon transfer surgery to help patients get their upper limb functionality back. This involves moving the tendon of a working muscle to another part of the body. Nerve transfers, on the other hand, directly reanimate the muscles so they can do what they were designed to. (1)

In a nerve transfer, working nerves from muscles that were not impacted by the spinal injury are attached to paralyzed muscles. Since some nerves control more than one muscle, one nerve transfer can bring functionality back to multiple paralyzed muscles. (1)

Case Series of Nerve Transfers

For this case series, a team from the Royal Melbourne Hospital and Austin Health in Australia recruited 16 patients. The patients, 13 male and three female, received 59 nerve transfer surgeries on 27 limbs. The goal of the surgeries was to restore elbow extension, grasp, pinching, and hand opening. In 10 patients, nerve transfers were combined with tendon transfers. (1, 2)

Patients completed a survey related to their independence before surgery, 12 months after surgery, and 24 months after surgery. The survey asked questions about daily living such as: caring for themselves, upper limb function, ability to open their hands, and grasping and pinching. After two years, researchers found that patients’ independence had improved significantly. (1)

Researchers also assessed participants’ limb function before surgery and at 12 and 24 months afterward. The researchers used an action research arm test (ARAT), grasp release test (GRT), and spinal cord independence measure (SCIM) to measure upper limb function. (2)

Before getting the surgery, none of the patients could perform the grasp and pinch strength tests. But after two years, their grasp and pinch strength had improved enough for them to independently perform most daily living tasks. (1)

Patients who had a nerve transfer to restore grasp and pinch function rather than a tendon transfer said they were more satisfied with the surgery. Their hands opened more easily for using electronic devices. And they said their hand function looked and felt more natural for social interactions. (1)

Four of the nerve transfers failed. The three patients with the failed nerve transfers later had tendon transfer surgery. (1)

The researchers are seeking funding to set up a registry of people who have had nerve transfer surgeries. They want to follow the effects of this surgery to study long-term results. (1)

Reclaiming Independence

Paul Robinson is one of the participants in the nerve transfer case study. He landed on his head in a dirt bike accident in 2015 and broke a vertebra. Robinson was paralyzed from the chest down and had little arm function and zero hand function. He said, “Before [the surgery], I was confined to a wheelchair but I couldn’t push it unless I wore special gloves. If I dropped something on the ground, I had to ask someone to pick it up. I couldn’t drive. To pick up a drink, I’d have to use two hands and squeeze them up.” (3)

But after the surgery, Robinson is able to use his arms and hands to push his own wheelchair. He got a tendon transfer in one hand and a nerve transfer in the other, giving his hands different functions. The tendon transfer provides more power and ability to lift heavier objects. The nerve transfer allows for fine motor control and natural movement. (3)

Describing the differences in his hands, Robinson said, “I’ve got less opening in my right hand, but a stronger grip. But the two hands do different things. I pick things up with my left hand and put [them] in the right hand to hold them.” (3)

Robinson is incredibly grateful for the surgery. “It’s made a massive difference to my life,” he said. (3) Something seemingly as simple as grasping an object can mean everything to someone who suddenly lost the ability to do so.