Aust surgery restores hand movement

Henrietta Strickland
July 5, 2019

A number of patients who were diagnosed with complete paralysis have been given new hope, after pioneering nerve surgery restored movement in their elbows and hands. Dr Van Zyl told The Guardian that she had been using nerve transplants in brachial plexus injuries, where neck and shoulder nerves have been pulled out of the spinal cord, and wondered why they did not try them to restore function in patients who had been paralysed.

Surgery to attach functioning nerves above the injury to paralyzed nerves below it, combined with 2 years of physical therapy, helped tetraplegic patients grasp, pinch, and open and close their hands and improved their ability to propel their wheelchair and transfer into a bed or a auto, reported Natasha van Zyl, MBBS, of Austin Health in Melbourne, Australia, and co-authors, in The Lancet. Restoring elbow extension improved their ability to propel their wheelchair and to transfer into bed or a auto.

Surgeons in Australia have managed to restore arm function in paralysed patients, allowing them to feed themselves, use tools and handle electronic devices, according to the results of a groundbreaking study released today.

"Nerve transfers can lead to significant functional improvement and can be successfully combined with tendon transfers to maximise functional benefits".

But nerve transfers have disadvantages, including a long runway to see results: it can take months to see new motion and years to achieve full strength. Nerve transfers also have substantially shorter immobilization periods after surgery, pose fewer surgical challenges, and offer more options for reconstruction. We believe that nerve transfer surgery offers an exciting new option, offering individuals with paralysis the possibility of regaining arm and hand functions to perform everyday tasks, and giving them greater independence and the ability to participate more easily in family and work life.

The team say more research is needed to identify who is most likely to benefit from the technique. They transferred the nerve to a spare wrist extensor muscle to the anterior interosseous nerve to restore the ability to grasp and pinch.

The working nerves were then able to "reanimate" the paralysed muscle in people with tetraplegia, the paralysis of the upper and lower limbs. In contrast, nerve transfers allow the direct reanimation of the paralyzed muscle itself. As he explained, "most muscles have multiple nerve branches controlling the same muscle function". But this is the first prospective study to use standardized functional outcome measures and combinations of multiple nerve and tendon transfer surgeries.

The study included 16 young adults (average age 27) with paralysis of the upper and lower limbs due to spinal cord injuries suffered within the previous 18 months.

On the other hand, the researchers acknowledged as a lot as 250,000 other folks at some stage in the enviornment had spinal wire accidents that resulted in quadriplegia every 365 days.

"These findings show that tendon and nerve transfers improve upper limb movement in cervical spinal cord injury", observed Elspeth Hill, MD, PhD, and Ida Fox, MD, both of Washington University in St. Louis, in an accompanying editorial. Surgeons took nerves from functioning expendable muscles above the spinal injury and attached them to paralyzed muscles below the spinal injury.

In total, 59 nerve transfers were completed in 16 participants (13 men and three women; 27 limbs). Hand function is everything you use your hand for.

The level of ardour is on two areas - opening and shutting the hand and being in a location to broaden the elbow to attain for something.

The patients were assessed before surgery, and one and two years afterward.

Prior to surgery none of the patients were able to score on grasp or pinch strength tests.

The surgery did not work in three people, with two participants experiencing a permanent decrease in sensation and two a temporary decrease in wrist strength which was resolved by surgery. Five serious adverse events occurred, including a fall from a wheelchair with femur fracture, but none were related to surgery.

Other reports by Click Lancashire

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