Prof. Jan Fridén

Professor Jan Fridén is an internationally recognized leader in the field of hand surgery, specializing in the restoration of upper extremity function for patients with tetraplegia. Originally from Sweden, Professor Fridén earned his Ph.D. in Muscle Physiology from the prestigious Karolinska Institute in Stockholm. He later served as a Professor of Hand Surgery at the Sahlgrenska Academy, University of Gothenburg, Sweden. Today, he continues his groundbreaking work as a Senior Consultant in Hand and Tetrahand Surgery at the Swiss Paraplegic Centre in Nottwil, Switzerland.

Over his career, Professor Fridén has transformed how surgeons approach the paralyzed upper limb, combining deep scientific knowledge of muscle mechanics with practical surgical innovation. His techniques have set new standards for treating upper extremity paralysis, offering patients life-changing improvements in function and independence.

Pioneering Surgical Techniques

Professor Fridén has developed and refined several surgical procedures that rebuild functional movement in individuals with spinal cord injuries, including tendon transfers, nerve transfers, and spasticity management techniques.

1. Posterior Deltoid to Triceps Tendon Transfer

One of Professor Fridén’s most significant contributions is the posterior deltoid-to-triceps transfer. In patients with tetraplegia, elbow extension is often lost due to paralysis of the triceps. By rerouting the posterior deltoid tendon and attaching it to the triceps tendon, surgeons can restore elbow extension. This single-stage procedure uses the preserved strength of the deltoid to power elbow straightening, enabling critical functions like overhead reaching, transfers, and wheelchair propulsion.

Performed through a minimally invasive approach, patients begin active rehabilitation just days after surgery, promoting muscle activation and minimizing scar tissue formation. Reliable tendon attachment techniques ensure long-term success, with studies demonstrating significant gains in independence and patient satisfaction.

2. The ALPHABET Procedure for Grip Restoration

To address the loss of hand function, Professor Fridén developed the ALPHABET procedure, a structured combination of tendon transfers and tenodesis. This innovative approach restores vital grasp and pinch abilities, empowering patients to perform essential daily activities such as eating, dressing, and grooming.

The ALPHABET procedure strategically redirects available functioning muscles, such as the brachioradialis, to power flexor tendons, restoring grip strength. Conducted in a single surgery, the technique accelerates recovery, with early mobilization helping patients adapt quickly. Tailored to each patient’s specific needs and residual function, it significantly improves hand dexterity and autonomy.

3. Spasticity Reduction: Hyperselective Neurectomy, Tenotomies, and Tendon Lengthening

Spasticity is a common and challenging complication after spinal cord injury. Professor Fridén has refined a combination of hyperselective neurectomies, tenotomies, and tendon lengthenings to manage muscle overactivity effectively.

Hyperselective neurectomy involves cutting select nerve branches to reduce excessive muscle tone while preserving voluntary strength. Tenotomies release overly tight tendons, and tendon lengthenings adjust muscle tension, preventing contractures and improving joint mobility. These precision procedures enhance limb positioning, reduce pain, and ease caregiving. Recovery is swift, integrating seamlessly into rehabilitation programs for maximum functional gain.

4. Nerve Transfers: A Modern Breakthrough

For some patients, nerve transfers provide a transformative option. This technique redirects healthy donor nerves to reinnervate paralyzed muscles, restoring natural movement patterns without altering muscle-tendon biomechanics. Ideal within the first 18 months post-injury, nerve transfers can recover critical functions such as elbow extension, grasp, and hand opening.

While reinnervation requires time, often several months, outcomes are impressive. Research indicates that over 80% of patients undergoing nerve transfers achieve significant improvements in strength and function. Professor Fridén often combines nerve and tendon transfers when appropriate, a synergistic strategy that maximizes recovery potential.

Research and Innovation

Beyond his surgical practice, Professor Fridén has made pivotal research contributions to the fields of muscle physiology and biomechanics. His work on intraoperative sarcomere length measurement has enhanced the precision of tendon transfer surgeries, optimizing muscle-tendon tension for better functional outcomes.

His extensive publications in peer-reviewed journals and presentations at international conferences have shaped global best practices. Professor Fridén’s research continues to drive innovation, offering new hope for people with spinal cord injuries around the world.

Patient-Centered Philosophy

A hallmark of Professor Fridén’s approach is his commitment to personalized care. He recognizes that every spinal cord injury is unique, and tailors surgical plans based on each patient’s specific pattern of paralysis, functional goals, and lifestyle needs.

His emphasis on early, active rehabilitation reflects his deep understanding of neuromuscular adaptation. After surgery, patients typically engage in intensive therapy programs focused on activating transferred muscles, preventing adhesions, and integrating new movement patterns into daily life.

This holistic, patient-centered philosophy not only maximizes surgical outcomes but also fosters a sense of empowerment and renewed independence among his patients.

Awards and Recognition

Professor Fridén’s extraordinary contributions have been recognized internationally. He is a recipient of prestigious honors including:

• The Kappa Delta Award, one of orthopedic surgery’s highest research distinctions.
• The Ludwig Guttmann Prize, awarded for excellence in advancing spinal cord injury treatment.

These accolades reflect the profound impact of his work on both clinical practice and scientific advancement.

Transforming Lives

The surgical techniques pioneered by Professor Jan Fridén have fundamentally changed what is possible for individuals living with tetraplegia. By restoring key upper limb functions — from elbow extension to gripping and pinching — his work has enabled thousands of patients to regain independence, return to work, and participate fully in society.

Every restored movement represents a step toward freedom: the ability to eat independently, write a note, propel a wheelchair, or simply shake a loved one’s hand. Thanks to Professor Fridén’s skill, vision, and dedication, these everyday miracles are now within reach for many more.

Over his career, Professor Fridén has transformed how surgeons approach the paralyzed upper limb, combining deep scientific knowledge of muscle mechanics with practical surgical innovation. His techniques have set new standards for treating upper extremity paralysis, offering patients life-changing improvements in function and independence.