Restoring Hand Function
Paralysis (quadriplegia or tetraplegia) may result from upper spine damage. Tendon transfer can increase arm and leg function for some patients.
What is a tendon transfer?
After spinal cord surgery, hand function can be restored through a tendon transfer procedure.
Tendon transfer surgery is a planned operation that re-routes a working muscle and its tendon to take over the job of a damaged or paralysed muscle. It’s most commonly used in the hand, wrist and elbow when nerve injury, muscle loss, or neurological conditions have left a useful muscle intact but another important muscle non-functional.
The goal is not to create a perfect replacement, but to restore practical, reliable movement so you can perform daily tasks with less effort and more independence.
What can be achieved with a tendon transfer?
Tendon transfers can restore key hand and arm functions that matter to everyday life: opening and closing the hand,
- Pinching the thumb to pick up small objects,
- Straightening the elbow to push or reach,
- Restoring wrist position for better grip.
As with any reconstructive procedure, there are trade-offs (for example a small loss of the donor muscle’s original function), so your surgeon will balance benefits and compromises for your specific needs.
Elbow tendon transfer (elbow extension)
A fraction of the shoulder's deltoid muscle is removed and grafted to the elbow in elbow tendon transfer procedures.
The operation uses a nearby working elbow tendon that can be re-routed and attached to the triceps so that the patient can actively push the elbow straight again.
Restoring elbow extension significantly improves the ability to reach, push up from a chair, transfer in and out of a car or bed, and perform many daily tasks.
Wrist and hand tendon transfer (for key pinch)
In hand and wrist tendon transfer procedures, functional forearm muscles are attached to finger and hand tendons.
Loss of thumb pinch is debilitating for everyday activities like buttoning, writing, and holding utensils. To restore a reliable “key pinch,” surgeons can transfer a functioning tendon (for example a finger flexor or extensor with adequate strength) to act on the thumb’s pinch mechanism.
The procedure is tailored to the patient’s pattern of weakness and hand dominance; sometimes multiple small transfers are combined.
Electronic implants
When tendon transfers are not possible, electronic implants are a new alternative.
Functional electrical stimulation (FES) can activate paralyzed muscles to produce useful contractions and has been paired with tendon procedures in research and specialized clinics to restore grasp and finger extension.
Emerging research also explores how electrical fields and implants might enhance tendon healing or work with transfers to improve outcomes, but these technologies are used selectively and
Dr Oscar Brumby-Rendell will discuss with you whether stimulation or implants are relevant to your condition.
What can we expect from tendon transfer surgery?
This surgical procedure usually takes around 6 hours. There are specific risks involved as this procedure is relatively invasive.
1. Assessment and Planning
Dr Brumby-Rendell first evaluates which muscles work, which don’t, and what movements you want to regain. Imaging, strength testing, and goal-setting help design a personalised surgical plan.
2. The Operation
During surgery, a healthy tendon is re-routed to replace a non-functioning one. This allows the transferred tendon to take on a new role, such as helping you pinch, grip, or extend the elbow.
3. Protection and Initial Healing
After surgery, the tendon needs several weeks to heal in its new position. A splint or cast protects the repair and prevents stress on the transfer.
4. Progressive Hand Therapy
Once healing is secure, therapy begins with gentle movements to prevent stiffness. Exercises are then advanced to restore strength and coordination.
5. Functional Re-education
Because the tendon now has a new job, your brain must relearn how to use it. With practice and guidance, movements like grasping or pinching become smoother and more natural.
6. Recovery Expectations and Risks
Recovery usually takes months, and results mean improved, reliable function rather than pre-injury strength. Risks such as stiffness, infection, or tendon failure are uncommon in experienced hands.
Frequently Asked Questions
Candidates are usually people who have lost muscle function from nerve injury, muscle damage, or certain neurological conditions, but still have other strong muscles available to transfer. A consultation helps determine if this option suits your needs.
How Dr Oscar Brumby-Rendell can help?
Dr Oscar Brumby-Rendell is an Adelaide-based orthopaedic surgeon with a focus on shoulder, elbow, wrist and hand disorders.
He evaluates each patient’s pattern of weakness, lifestyle needs, and expectations to design a personalised reconstruction plan; whether that means a single tendon transfer, a combination of transfers, or the involvement of stimulation technologies. Dr Brumby-Rendell’s approach emphasises careful preoperative planning, clear discussion of realistic goals and risks, and coordinated postoperative rehabilitation to maximise functional recovery.
If you’re interested, we can arrange an assessment to review your specific problem, imaging, and a tailored treatment recommendation.
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Learn more about hand and wrist related injuries with Dr Oscar Brumby-Rendell.
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