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Beverly Hills
9301 Wilshire Boulevard
Beverly Hills, California 90210
West Hills
7301 Medical Center Drive
West Hills, California 91307
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Tendon Transfer Surgery
Treatment Conditions
Tendon Transfer Surgery Procedure
Alternatives for Injured Tendons
Risks Involved with Surgery
Recovery after Surgery
An Example
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.
| Treatment Conditions |
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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.
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| Tendon Transfer Surgery Procedure |
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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.
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| Alternatives for Injured Tendons |
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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.
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| Risks Involved with Surgery |
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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.
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| Recovery after Surgery |
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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.
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| An Example |
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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.
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