Tetraplegic Hand Surgery
The objectives of tetraplegic hand surgery should be realistic; complex movements are not pursued, but rather a functional extremity.
1.- These depend on the degree of function, that is, the number of muscles preserved (force 4 or 5) below the elbow.
2.- The overriding goal is to be able to grab an object with the hand and move it.
3.- Therefore, the functions required are: elbow extension, finger extension, finger flexion and thumb opposition/flexion.
It is paramount that the patient accepts their neurological injury, that the injury is stable—that is, that no changes occur upon neurological examination—and that the candidate is collaborative and understands the process they are about to undergo, which takes place approximately six to twelve months after the injury.
The participation of the tetraplegic and their family is essential, since during the post-operative period and part of the rehabilitation period their limited autonomy will be reduced and, as we all know, this is an extremely prized possession for the injured party which they do not like to relinquish.
1.- Spinal injury which is preferably completely established, with more than six months having passed since the trauma.
2.- Neurological level below C5 (strong elbow flexion).
3.- No changes found in neurological examination in recent weeks.
4.- Controlled spasticity and no joint rigidities.
5.- Realistic expectations.