Tendon transfer surgery is a hand surgery performed to improve lost hand function. During this, a functioning tendon is transferred from its original attachment to a new one to restore the lost action.
Tendon Transfer
In case the nerve supplying the muscle is damaged beyond repair, your muscle loses function. A tendon transfer surgery is performed to replace it with a functioning tendon to restore the lost function. A tendon is a cord-like fibrous band that attaches a muscle to a bone to aid movement during muscle action. Your hand has two groups of tendons:
Extensor tendons: These run from the forearm across the back of the hand to the fingers and thumb.
Flexor tendons: These run from the forearm through the wrist and across the palm.
A tendon transfer surgery may be performed to repair damage to both these groups of tendons.
What is Tendon Transfer Surgery?
Tendon transfer surgery is a sophisticated orthopedic procedure designed to restore function to a muscle that has lost its action due to nerve damage, injury, or illness. This surgery involves relocating a fully functional tendon from one part of the body to another to compensate for a non-functioning muscle and tendon. The process is akin to reassigning a healthy worker to a role left vacant by an absent colleague, thereby ensuring that the necessary tasks are still completed.
Tendon transfer surgery can be performed on various parts of the body, including the hands, feet, and limbs. It is particularly beneficial for individuals who have suffered from conditions like stroke, cerebral palsy, traumatic brain injuries, or spinal muscle atrophy, which can lead to muscle paralysis or weakness.
While the procedure can significantly improve the quality of life by restoring essential functions such as grip strength or the ability to walk, it is not without risks. Complications can include bleeding, infection, or injury to nearby nerves and blood vessels. There's also the possibility of hand stiffness, weakness of the transferred muscle, or rupture of the transfer, which may necessitate additional surgery.
The success of tendon transfer surgery depends on various factors, including the patient's overall health, the extent of muscle and nerve damage, and the specific muscles and tendons involved. Rehabilitation plays a crucial role in recovery, with physical therapy often prescribed to help regain strength and flexibility in the affected area.
Who needs Tendon Transfer Surgery?
A tendon transfer surgery can treat different conditions. This surgery is necessary when a certain muscle function is lost due to nerve injury. If a nerve is injured and cannot be repaired, then the nerve no longer sends signals to certain muscles. Due to this muscle paralysis, the muscle function will be lost. Tendon transfer surgery can be used to attempt to replace that function. Common nerve injuries that are treated with tendon transfer surgery are spinal cord, radial nerve, ulnar nerve, or median nerve injury.
Tendon transfer surgery may also be necessary when a muscle has ruptured or been lacerated and cannot be repaired. Tendon transfer surgery may also be needed if a muscle function has been lost due to a disorder of the nervous system. Common nervous system disorders treated with tendon transfer surgery are cerebral palsy, stroke, traumatic brain injuries, and spinal muscle atrophy. Some babies may be born without certain muscle functions, which can be treated with tendon transfer surgery. Common conditions treated this way include hypoplastic thumbs and birth brachial plexopathy.
What happens during Tendon Transfer Surgery?
During tendon transfer surgery, the origin of the muscle as well as the nerve supply and blood supply are left in place. The tendon insertion onto the bone is detached and re-sewn into a different place. This can be done into a different bone or a different tendon. Depending on the new location the tendon is transferred to it will produce a different action.
What are the alternatives to Tendon Transfer Surgery?
Your surgeon will go over your treatment options with you. Other options may include repairing the nerve that has been injured or repairing the tendon or muscle that has been injured. For some situations you may only need tendon grafts; in which a portion of the intact tendon is removed without the muscle, then used to bridge a gap in an injured tendon. In other cases, tendon lengthening or bone fusions may be necessary as part of reconstructing hand function.
Tendon Transfer Surgery Risks
Infection
Pain
Repair failure
Tendon adhesion (tendons become stuck to the surrounding tissue and lose their range of movement)
Hand deformity
Bleeding
Injury to nearby nerves, tendons, or blood vessels
Hand stiffness
Hand weakness
Swelling
Rupture of the transferred tendon and the need for another corrective surgery
Tendon Transfer Recovery Period
The recovery period following tendon transfer surgery is a critical phase that requires careful management to ensure the best possible outcome. This period can vary depending on the individual, the specific tendons involved, and the complexity of the surgery, but generally, it spans several months to a year.
Immediately after the surgery, the affected area is typically immobilized with a cast or splint to protect the new tendon transfer until the tendon heals to its new position, which usually takes one to two months. During this time, it's crucial to follow the surgeon's instructions on care and restrictions to avoid complications.
Pain management is also an essential aspect of the recovery process. Patients may need to take painkillers for up to two weeks post-surgery to manage discomfort as the anesthetic wears off and the healing process begins. Keeping the hand elevated and avoiding getting the splint wet are other key recommendations to aid in a smooth recovery.
Rehabilitation starts soon after surgery, with a hand therapist or surgeon advising on specific exercises to prevent the repaired tendons from getting stuck to surrounding tissue, which would reduce the range of motion. These exercises are vital for regaining strength, mobility, and function.
You will need to wear a splint or cast to support your tendon as it heals which may take a month or two. Patients will need physical therapy following the recovery period to learn how to use the new tendon. You will also be given exercises to strengthen the muscles. Make sure to follow your doctor’s instructions since using the tendon too soon can rupture it.
The complete recovery process, including the return to the full range of activities, can take up to 12 months. At this stage, results are generally very good, with patients often regaining significant function and range of motion.
Conclusion
Tendon transfer surgery embodies the pinnacle of surgical innovation, offering a lifeline to those hindered by muscular impairments. Its ability to restore movement and independence is a remarkable feat, reflecting the profound advancements in medical science. As we look to the future, tendon transfer surgery will undoubtedly continue to evolve, bringing new possibilities to those who once thought their limitations were insurmountable. It stands as a shining example of medicine's power to not only heal the body but also uplift the human spirit.