FAQs

Who is the program for?

Anyone with decreased function of their shoulder, elbow, arm or hand as a result of a spinal cord injury or other neurological condition.

What does the program offer?

The Upper Limb Program clinic provides information and assessment for surgical reconstruction options as well as other non-surgical treatments. When identified as suitable, people generally wait less than 6 months to proceed to surgery at the Austin Hospital. The outcome for each person will vary depending on the type of surgery offered, the strength and integrity of the muscles and nerves that are working, flexibility of joints, the individual's goals and their participation in post surgery therapy. 

Some common types of surgical reconstruction options offered are:

• Tendon transfer surgery involves transferring the tendon of a working muscle to another position to do the work of a muscle that is weak or paralysed. The muscle which is transferred will always be a strong muscle, under active control and one that can be ‘spared' due to other working muscles doing the same action. For example, we can use part of the deltoid muscle at the shoulder, which normally helps to pull the arm up and back behind the body, and transfer it to the triceps tendon to restore elbow extension.
• Nerve transfer surgery involves transferring the nerve that supplies a working muscle to the nerve that supplies a muscle that is paralysed. The donor nerve needs to be from a strong muscle, under active control that can be ‘spared' as other non-paralysed muscles do the same action. This surgery needs ideally to be completed within 12 months of injury and can restore functions such as elbow extension, finger/thumb flexion and hand opening in those with suitable donor nerves. Nerve transfer surgery often occurs alongside tendon transfer surgery and often both arms are operated on during one surgery.
• Spasticity-related surgery can involve several different procedures, such as lengthening the affected muscle or tendon and releasing the tight structures around a joint to allow better movement or position. For example, the tendon of biceps (which bends the elbow) can be cut or lengthened to allow the elbow to straighten better. Tendon transfers can be used to rebalance a 'spastic' limb or posture by moving the tendon of a muscle with ‘tone' to act in a different direction. For example a 'spastic' muscle that bends the wrist into flexion can be transferred to the back of the wrist to help with wrist extension.

When should I be assessed?

Due to the sensitivity of the nervous system, nerve transfer surgery following tetraplegia should be completed within the first 12 months of injury. It is therefore recommended that you be assessed as early as possible following spinal cord injury. However there are definitely still surgical options using muscle and tendons in people with tetraplegia and/or spasticity that are recommended and effective at any time post injury. You may be appropriate for nerve transfer surgery many years after spinal cord injury but this requires further assessment.

How are decisions about surgery made?

At the initial Upper Limb Program clinic appointment surgeons and therapy staff take a careful history and do a thorough physical examination to determine suitability for surgery. You and your family are encouraged to ask questions and talk through the process. If appropriate, a tailored surgical plan is decided by the team in conjunction with you taking into consideration both your physical limitations and lifestyle. If surgery is not indicated then other conservative options may be discussed. Additional pre-surgery clinic appointments are made as needed in the planning stage and some routine tests may be ordered.

If I choose surgery, where is surgery performed and by whom?

If you are covered by Medicare, surgery is completed at the Austin Hospital by the plastic and reconstructive surgeons: Stephen Flood, Natasha van Zyl and Michael Weymouth. Surgery is completed under a general anaesthetic and can last anything from one to eight hours depending on the procedure/s. Self-funded international clients or those not covered by Medicare can be treated by the team via the private healthcare system.

How long is the stay in hospital?

The aim is to get people home as soon as possible after surgery. Admission to hospital is on the day of surgery or the day before surgery, depending on scheduled pre-operative assessments, bed availability and preference. After surgery you need only stay until you are medically stable and feel comfortable to go home; usually between one and three days post-operatively.

What happens after discharge?

Follow up care and rehabilitation is completed as an outpatient, either by Upper Limb Program therapists or by liaison with local therapists. The recovery time varies depending on the procedures. The team will discuss with you how to protect your arm/s after the surgery and what splints and movement limitations are required. After nerve transfer surgery, normal activity is resumed following a short immobilisation but improvements are not seen until months later when the nerve re-grows. For other surgeries normal activity is resumed at somewhere between 4-12 weeks depending on procedure type. During the period following surgery, additional help is usually required with personal care, transfers and mobility. This often means increased attendant care hours and use of additional aids and equipment.

What are the results of surgery?

Outcomes depend on the severity of your pre-existing injury or condition and the number and type of surgical procedures performed as well as your participation in the post surgery therapy. Surgery to improve function after spinal cord injury can allow people to reach an item on a shelf, extend the hand to shake hands and to pick up and release objects like a fork or a cup. People undergoing surgery for spasticity report improvements in pain and tightness, improved arm position for dressing and washing and improved appearance of their arm and hand. In some instances a second surgery may be necessary to improve the final outcome.

We encourage those considering surgery to speak with others who have undergone similar procedures. This allows individuals to hear a lived experience of the benefits and the inconveniences of surgery.