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.