Individualized Comprehensive Approach
Dr. Ray works with a team of professionals to develop a comprehensive plan to treat his patients. By working with specialists in their respective fields, Dr. Ray is able to develop an individualized plan for each patient. Every procedure is personalized to each patient’s level of injury, and to his or her own preserved motor and sensory function.
The team consists of:
- A hand surgeon who will examine the patient and confirm diagnosis and proposed treatment.
- A neurologist who will determine the neurologic level of injury and motor and sensory function by conducting a thorough neurological exam.
- A hand therapist who works closely with these patients. She develops a therapeutic treatment plan that may include orthotics and active and passive modalities to maximize the potential return of function to the patient’s arm/hand. She is also a valuable resource in patient education.
Types of Nerve Transfers
| Level of Injury | Nerve Transfer Procedure | Functional Recovery |
|---|---|---|
| C5 | Brachialis to Extensor Carpi Radialis Brevis/Longus | Wrist Extension |
| C5 | Axillary to Triceps | Elbow Extension |
| C5 | Teres Minor to Triceps | Elbow Extension |
| C6 | Axillary to Radial | Wrist and Finger Extension |
| C6 | Extensor Carpi Radialis Brevis to Anterior Interosseous Nerve | Finger and Thumb Flexion |
| C7 | Distal Extensor Carpi Radialis to Flexor Pollicis | Finger and Thumb Flexion |
| C7 | Brachialis to Anterior Interosseous Nerve | Finger and Thumb Flexion |
| C7 | Extensor Carpi Radialis Brevis to Anterior Interosseous Nerve | Finger and Thumb Flexion |
| C7 | Supinator to Posterior Interosseous Nerve | Finger and Thumb Extension |
Recovery/Regeneration Following Nerve Transfer Surgery
While nerve transfers offer a viable improvement to a tetraplegia patient, it is imperative that patient education is provided.
Nerve regeneration is very slow – approximately 1 mm/day or 1 inch/month. First signs of recovery can take anywhere from 6-18 months. This depends on the distance from the donor nerve to target muscles.
Patients can get discouraged after months of no improvement if they are not educated prior to surgery that this is normal and expected.