Understanding human reproduction for beginners
Spinal cord injury is caused by car accident, fall from height with a head collision or gunshot wounds. The moment collision occurs, the impacted vertebrae dislocate and hit spinal nerve fibres, damaging spinal cord in the process and paralyzing the victim below the injury side.
Spine is classified into three broad regions known as cervical, therosic and lumbar.
Cervical injured loose most or all functionalities of hands as well as of legs while therosic and lumbar victims maintains upper limbs functions, though lower limbs are paralyzed.
We discuss below an important remedial measure for cervical patients, also called quadriplegics, who due to hand paralysis are dependent on assistants for their daily tasks. Most quadriplegics are unable to extend their elbows, grip their hands or pinch thumb to the index finger.
The surgical procedure I am going to discuss here are for quads, who have active biceps, brachioradialis, extensor carpi radialis longus and brevis( used for wrist extension) and posterior deltoid muscles.
Different tendon transfer techniques have been in practice for last several decades now, but the one recent addition, i have undergone through, has integrated 2 different hand reconstruction techniques into a single procedure. Previously, these two, elbow extension and hand grips were restored in separate surgical operations.
On an average 6 hours long surgery, the plastic or orthopaedic surgeons would attach the posterior portion of the deltoid, through a donor tendon graft taken from leg, to the elbow joint to work as a triceps, which helps restoring elbow extension in quadriplegics.
Brachio-radialis muscle, which naturally works for arm flexion, is woven to thumb’s flexor policis longus muscle, to help the paralyzed person make key pinch. This thumb pinch can be used to hold items such as tooth brush, cup, comb etc.
External carpi-radialis is attached to flexor digitorium superfacialis, which naturally flexes four fingers, simultaneously, to grip hands. After the surgery, a quad trying to contract his wrist muscle would instead, get his four fingers flexed. Regaining hand grip functionality would mean holding items weighing around 3 kgs.
After the surgery, fore arm is kept fixed through arm-locking techniques for a month or two, before commencing rehabilitation in a rehab centre.