Tendon Transfer Surgery

During a tendon transfer surgery, an undamaged tendon is transferred to a new place to improve or fix use of a hand that has lost some or all functionality. 

Tendon transfer surgery can help fix a number of conditions. If a particular muscle, for example, loses functionality because of an injury to a nerve, tendon transfer surgery may restore its functionality. The surgery is often used if an injured nerve cannot be repaired and no longer sends signals to the muscle it serves, thereby paralyzing the muscle. Transferring a tendon to the non-working muscle can often make the muscle work again. The surgical transfer of tendons is a procedure that is also used to fix spinal cord injuries and injuries involving the radial, median, or ulnar nerve.

Additionally, tendon transfer surgery is an effective procedure when use of a hand muscle has been lost because it has ruptured, been cut, or simply can not be fixed. The type of surgery is also used to treat tendons that have been ruptured because of rheumatoid arthritis or fractures. If a tendon has been cut in an injury or accident, tendon transfer surgery can help restore hand or finger use.

If a muscle is no longer effective because of a nervous system disorder, tendon transfer surgery may be an effective procedure to regain muscle use. In these cases, the usual signals carried by the nerves are missing or impaired, and the muscles served by the nerves may either refuse to work or work erratically. If treated with a tendon transfer, the effects of conditions such as cerebral palsy, strokes, or spinal muscle atrophy can be alleviated.

Hypoplastic thumbs, birth brachial plexopathy, and certain other birth defects can also be ameliorated by a tendon transfer, which can repair some lost muscle functions.

To begin with, there are more than forty muscles between the elbow and the tips of the fingers, each fulfilling a different function. The thumb, alone, has nine muscles that control its movement. Every one of these muscles has a thin origin or starting point, a thicker portion, and then grows slimmer as it ends in a tendon that attaches to the bone in a particular place. The bone is moved in a specific way when the muscle contracts or "fires," which results from a signal down from the brain through a motor nerve that is attached to the muscle.

During a tendon transfer surgery, the origin of the muscle and its nerves and blood supply are left alone, but the point where the tendon is inserted onto the bone is moved to a new place. That new location can either be a different bone or the insertion piece can be sewn onto another tendon.

After being moved, a different reaction is triggered when the muscle fires, but regaining the ability to act typically is the ultimate goal.

There are other ways to treat loss of muscle function, and these should be discussed with your hand surgeon. The other options include trying to repair the damaged nerve or the tendon or muscle that was injured. Sometimes part of a working tendon can be grafted onto a gap in an injured one, a tendon can be made longer, or injured bones can be fused to repair use of a hand. 

There is a risk, sometimes quite small, with any surgery. Before the surgery, your complete medical history will be needed and you will need to have a complete physical examination to see if there are any special risks about the use of anesthesia. The risks and options of the chosen anesthetic will be evaluated by you and your anesthesiologist. 

The tendon that was moved will need a month or two to heal, and a splint or cast will normally support it during this time. A therapist will help you learn how to use it, and after the tendon has healed, your hand surgeon will give you some exercises to do to strengthen the muscle.

It is important that you obey and follow any instructions you are given after the surgery. Use of the tendon too soon after surgery can rupture it. Conversely, if you wait too long to start the exercises and therapy, the tendon may become excessively scarred and the area served may grow stiff. Your hand surgeon and you will need to discuss all aspects of the surgery, and a series of visits should be expected and planned for.

For the sake of example, let us say that an individual falls in a skiing accident and severely damages his wrist. At first, he may think that his wrist is sprained. If left untreated, the fracture may ultimately destroy the tendon used by a muscle to straighten the tip of the thumb. Once the injured individual actually realizes the extent of the damage, the tendon may be too frayed to repair.

The index finger, however, has two muscles and tendons that are used to straighten it only needs one set to work. During the surgery, one tendon is left on the index finger and the other is transferred over to the thumb and sewn onto either the thumb bone or its tendon.

After the surgery, a splint is placed to prevent the tendon from moving. After a month, supervised therapy enables the patient to learn how to move the thumb. For another month, gentle movement is begun, still with the splint, and if the progress is good, another month's therapy strengthens the muscle and facilitates further learning of how to proper use the thumb.