Nothing to lose: a phenomenological study of upper limb nerve transfer surgery for individuals with tetraplegia

Mooney, Alysha; Hewitt, Alana; Hahn, Jodie

doi:10.1080/09638288.2020.1750716

Cited by 9 publications

(7 citation statements)

References 21 publications

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“…People with SCI value receiving information from medical providers 29,30 and individuals with SCI. 24,31 However, UE reconstructive surgeries were not commonly discussed in medical care, and participants often had to seek out information on their own. Independent research can be challenging because information about UE reconstructive surgery is difficult to find online, is often presented at a complex medical reading level, and typically is not included in general online information about SCI.…”

Section: Discussionmentioning

confidence: 99%

“…10,11,[20][21][22] Although there are reports of successful functional gains with nerve transfers done a decade after SCI, 23 data show better results if the nerve transfers are performed within 12 months of SCI. 11,24 Thus it becomes imperative to ensure that people with SCI and their caregivers have information about surgical options to help in their decision-making in a timely fashion. The purpose of this study was to assess the surgical knowledge and experiences of individuals with cervical SCI and their caregivers in accessing information about surgery to enhance UE function.…”

Section: Introductionmentioning

confidence: 99%

“…Postoperative outcomes for nerve transfer have varied and may in part relate to the time‐sensitive nature of this intervention 10,11,20–22 . Although there are reports of successful functional gains with nerve transfers done a decade after SCI, 23 data show better results if the nerve transfers are performed within 12 months of SCI 11,24 . Thus it becomes imperative to ensure that people with SCI and their caregivers have information about surgical options to help in their decision‐making in a timely fashion.…”

Section: Introductionmentioning

confidence: 99%

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Surgery to restore upper extremity function in tetraplegia—Preferences for early and frequent access to information

L’Hotta

James

Curtin

et al. 2022

PM&R

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Introduction People with cervical spinal cord injury (SCI) identify improving upper extremity (UE) function as a top priority. In addition to comprehensive rehabilitation, UE surgeries, including nerve and tendon transfers, enhance function. However, barriers exist to disseminating information about surgical options to enhance UE function. Objective To assess the experiences and preferences of people with cervical SCI and their caregivers in accessing information about surgery to enhance UE function. Design Prospective cohort study. Participants were followed up for 24 months and completed up to three interviews. Setting Tertiary care at academic and affiliated Veterans Administration Health Care Centers. Participants Adults with cervical SCI (n = 35) ages 18 to 80 years with mid‐cervical SCI American Spinal Injury Association Impairment Scale A, B, or C (at least 6 months post‐injury) and their caregivers (n = 23) were eligible to participate. Participants were enrolled in three groups: nerve transfer, tendon transfer, or no UE reconstructive surgery. Interventions Not applicable. Main Outcome Measure Semi‐structured interviews about surgical knowledge and experiences. Results Data were analyzed and three themes were identified. First, providing information about UE surgical options early post‐injury was recommended. The acute or inpatient rehabilitation phases of recovery were the preferred times to receive surgical information. Second, challenges with information dissemination were identified. Participants learned about UE surgery through independent research, medical provider interactions, or peers. Third, peers were identified as valuable resources for SCI needs and surgical information. Conclusions Following cervical SCI, information about UE reconstructive surgeries should be a standard component of education during rehabilitation. An increased understanding of the reconstructive options available to improve UE function is necessary to educate stakeholders. Future research is needed to support the development of strategies to effectively present surgical information to individuals with SCI and health care providers.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgery to restore upper extremity function in tetraplegia—Preferences for early and frequent access to information

L’Hotta

James

Curtin

et al. 2022

PM&R

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“…Nerve transfers have gained popularity in spinal cord patients (Khalifeh et al, 2019; Ledgard & Gschwind, 2020; Mooney et al, 2020) after the first report of NS transfer to the PIN (Bertelli et al, 2010). They offer several advantages over tendon transfers including preservation of biomechanics, maintaining the force and excursion of the native tendon, as well as no need for prolonged immobilization required for tendon transfers.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Selective transfer of nerve to supinator to restore digital extension in central cord syndrome: An anatomical study and a case report

et al. 2022

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Background Nerve transfers are increasingly used to restore upper extremity function in patients with spinal cord injury. However, the role of nerve transfers for central cord syndrome is still being established. The purpose of this study is to report the anatomical feasibility and clinical use of nerve transfer of supinator motor branches (NS) to restore finger extension in a central cord syndrome patient. Materials and Methods The posterior interosseous nerve (PIN), its superficial division, and branches were dissected in 14 fresh cadavers, with a mean age of 65 (58–79). Measurements included number and length of branches of donor and recipient, diameters, regeneration distance from coaptation site to motor entry point and axonal counts. A NS transfer to extensor carpi ulnaris (ECU), extensor digiti quinti (EDQ) and extensor digitorum communis (EDC) was performed in a 28‐year‐old patient, with central cord syndrome after a motorcycle accident, who did not recover active finger extension at 10 months post injury. Results The PIN consistently divided into a deep and superficial branch between 1.5 cm proximal to, and 2 cm distal to the distal boundary of the supinator. The superficial branch provided a first common branch to the ECU and EDQ. In 12/14 dissections, the EDC was innervated by a 4 cm long branch that entered the muscle on its radial deep surface. In all cases, the superficial branch of the PIN could be separated in a retrograde fashion from the PIN and coapted with NS. The mean myelinated fiber count in nerve to EDC was 401 ± 190 compared to 398 ± 75 in the NS. At 48 months after surgery, with the wrist at neutral, the patient recovered full metacarpophalangeal extension scoring M4. Supination was preserved with the elbow extended or flexed. Conclusions Restoration of finger extension in central cord syndrome is possible with a selective transfer of the NS to EDC, and is anatomically feasible with a short regeneration distance and favorable axonal count ratio.

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Spinal Cord Injury: Epidemiology, Spontaneous Recovery, and Hand Therapy for the Reconstructive Hand Surgeon

Hill

Bertelli

2023

The Journal of Hand Surgery

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Nothing to lose: a phenomenological study of upper limb nerve transfer surgery for individuals with tetraplegia

Cited by 9 publications

References 21 publications

Surgery to restore upper extremity function in tetraplegia—Preferences for early and frequent access to information

Surgery to restore upper extremity function in tetraplegia—Preferences for early and frequent access to information

Selective transfer of nerve to supinator to restore digital extension in central cord syndrome: An anatomical study and a case report

Spinal Cord Injury: Epidemiology, Spontaneous Recovery, and Hand Therapy for the Reconstructive Hand Surgeon

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