FES Hand Grasp/Tendon Transfer Diary
Short Condensed Version
Click Here to read the long version
Hello. My name is Darrell. The following is a diary that I kept during the period I had my FES Hand Grasp and Tendon Transfer surgery. Hopefully, this will give YOU some indication of what YOU can expect from this surgery. Please remember that your situation will not be exactly the same as I have outlined.
Why do I want to try this procedure?
Currently my fingers do not work, because of my level of injury (C5-C6 quadriplegic). FES surgery is hopefully going to restore some finger movement so I can pick up objects like a pen, pencil, toothbrush, floppy disk, knife, fork, spoon, glass, and a hair brush. All of these things I have to have help with now.
The surgery will involve the placement of a device in my chest with wires going down my left arm. Wires will be attached to the tendons that open and close my hand. All of this is connected to a computer mounted underneath my wheelchair that will send electrical signals to those tendons on my command, therefore allowing me to pick those objects up. In my right hand they will do a common tendon transfer surgery. These procedures will not allow me individual finger movement, but it will give me a tighter grip and also a pinch in both hands.
I have talked to several people who have already had this surgery. They all say it really helped them become more independent - exactly what I want from this surgery. After all of these considerations I have decided to have the surgery.
Before surgeryI have been asked to check into the hospital on September 15, 1996 for some more test prior to surgery. Prior to having a FES Hand Grasp system surgery the client must go through an entry survey and a series of physiological evaluations. Afterwards, a battery of test are done to determine if the paralyzed muscles will respond to electrical stimulation. If the muscles respond in a positive manner, it is then necessary to externally stimulate (exercise) the muscles to prepare them for the operation. This is done so that during the surgery the muscles will not fatigue. This allows the surgeon the best chance of finding the best location for the electrodes to be placed during the surgery.
If the muscles fail to respond to electrical stimulation, other options could be considered. In my situation, the doctor, therapist, and myself elected to have a tendon transfer (posterior deltoid to triceps) on my left arm and the FES electrodes placed in my left hand. Another type of tendon transfer (brachioradialis to flexor pollicis longus and an extensor carpi radialis longus to flexor digitorum profundus) was decided to be performed on my right hand. In English this means I can now close my hand and now have a thumb pinch without the use of electrical stimulation.
The surgeries are set up to be done in two stages. The 1st surgery is going to be a tendon transfer on my right hand and is scheduled for September 19, 1996. The 2nd surgery is for my left hand and arm which will receive the FES Hand Grasp System and a posterior deltoid to triceps transfer and is scheduled for September 26, 1996.
The Big DayThe first surgery to my right hand took place as scheduled on September 19th. The "tendon transfer" surgery is very common and does not require being in Cleveland. Therefore this diary will be related more so to the FES Hand Grasp surgery and the posterior deltoid to triceps surgery, both of which were performed on the left arm and hand.
After being on Demerol for one week, it was then time for the second surgery which took place on September 26th. The first incision was made at 9:16 am, and the surgery was complete by approximately 2:30 pm. A time frame of about 5 hours and 46 minutes which does not include the prep time before surgery or the time that it took in recovery.
The next 3 weeks were spent back at home with cast on both arms. Yes, it involves quit a bit of pain. If you elect to have surgery on both hands, plan on having someone give you lots of tender loving care. I had to keep my mind focused on the end results - more independence. Read on for more details.
Recovery After FES Hand Grasp SurgeryArrived back at MetroHealth Medical Center in Cleveland, Ohio on Tuesday October 15.
On Wednesday the cast were removed. Oh what a relief it is! Oh how ugly my arms and hands looked. Oh how disappointed I was when things were not working immediately. They had to explain to me that things would take time to heal completely and if I moved to fast I could damage all the work they had done.
Thursday - I started therapy today. I could only move my left arm at the elbow 15 degrees. This is the result of the posterior deltoid to triceps part of the surgery, which seems to be the most painful part of this entire ordeal. I asked if this was normal. She told me yes and explained why. Also I could hardly move my right hand, same situation.
Friday - today was more therapy. Moved my left arm 25 degrees. I felt really good today, so they asked if I would like to see the computer lab. Of course I said yes. That is when I got this idea to write. As of now I am not able to type with both hands and things are very slow. I have got very tired and will try to do more tomorrow. My therapist said this is good for me!
November 1, 1996 Friday
Had therapy for 1-1/2 hours, then to the lab for final adjustments on the FES system.
Back at home - November 2,1996I began in-patient occupational therapy once per week for four weeks. This included procedures for tendon transfer training and muscle reeducation, activities of daily living retraining, splint fabrication and modifications, scar massage, exercise and interdisciplinary communication.
November 22, 1996 Thursday
Went to see the therapist today at Rush Clinic. Arm movement increased to 135 degrees. Only 10 degrees to go.
Final ResultsReturned to Cleveland, Ohio on December 2nd for removal of cast. As you can see from the time frame, this is a long process from beginning to end. If you are willing to take the time required, the benefits are very rewarding. The end results may not sound like a huge accomplishment to some, but for me it is simply one more step toward MY GOAL of becoming a more independent.
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