Tendon Transfers

At Tetrahand Cyprus, we specialize in advanced tendon transfer surgeries to restore critical hand and arm functions lost due to spinal cord injuries, brachial plexus injuries, or nerve damage. By redirecting the strength of working muscles, we help patients regain independence and control in their daily lives.

Tendon Transfers to Balance the Hand and Restore Functions

Loss of hand function due to neurological injury, paralysis, or trauma can be profoundly disabling, affecting a person's ability to perform even the most basic tasks of daily living. At Tetrahand Cyprus, we specialize in advanced tendon transfer surgeries designed to rebalance the hand and restore critical functions such as grip, pinch, release, and wrist stability.

Tendon transfers are a cornerstone of reconstructive surgery in patients with tetraplegia, brachial plexus injuries, peripheral nerve damage, and other conditions where muscle function is lost but anatomical structures remain intact. These procedures harness the power of functioning muscles and redirect it to replace lost movement—helping patients regain independence and control.

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What Are Tendon Transfers?

A tendon transfer is a surgical procedure in which the tendon of a working muscle is moved to a new position to take over the job of a paralyzed or non-functioning muscle. The transferred muscle must have adequate strength and a similar line of pull to replicate the lost function effectively.

This technique is most successful in patients with partial paralysis, where some muscles remain under voluntary control, often following injuries to the spinal cord (e.g., C6-C7 tetraplegia) or peripheral nerves (e.g., radial, median, or ulnar nerve palsy).

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Goals of Tendon Transfer Surgery

The main objective is to restore key hand functions, which typically include:

• Wrist extension or flexion

• Thumb opposition

• Key pinch and precision grip

• Finger flexion and extension

• Stabilization of the wrist and hand

Depending on the patient's injury pattern, available muscle strength, and goals, a custom surgical plan is developed to optimize both functional outcome and cosmetic appearance.

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Conditions Commonly Treated with Tendon Transfers

Tendon transfers are highly effective in restoring hand function in a variety of conditions:

• Tetraplegia (spinal cord injuries at C5–C8 levels)

• Brachial plexus injuries

• Peripheral nerve injuries (radial, ulnar, median)

• Spasticity-related deformities

• Trauma or surgical loss of muscle units

At Tetrahand Cyprus, we see patients with both congenital and acquired causes of upper limb dysfunction and tailor each procedure accordingly.

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Common Tendon Transfers for Hand Function

Here are several key tendon transfers used to restore hand function:

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1. Tendon Transfers to Restore Wrist Extension

Target condition: Radial nerve palsy or high tetraplegia with wrist drop

Typical procedure:

• Transfer of pronator teres to extensor carpi radialis brevis (ECRB)

• This restores the ability to extend the wrist, which is critical for hand positioning and functional grip.

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2. Tendon Transfers for Thumb Opposition

Target condition: Median nerve palsy or C6–C7 spinal injuries

Typical procedure:

• Transfer of extensor indicis proprius (EIP) or flexor digitorum superficialis (FDS) to abductor pollicis brevis (APB)

• Allows for thumb opposition, which is essential for pinching and grasping.

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3. Tendon Transfers to Restore Key Pinch

Target condition: Tetraplegia with weak or absent lateral pinch

Typical procedure:

• Transfer of brachioradialis to flexor pollicis longus (FPL)

• Enables the patient to hold small objects between the thumb and index finger.

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4. Restoration of Finger Flexion (Grasp)

Target condition: Loss of hand grasp due to high spinal cord injury

Typical procedure:

• Transfer of brachioradialis or ECRL to flexor digitorum profundus (FDP)

• Recreates the ability to make a fist or hold cylindrical objects.

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5. Restoration of Finger Extension (Release)

Target condition: Ulnar/radial nerve palsy or imbalance due to spasticity

Typical procedure:

• Transfer of FDS or palmaris longus to extensor digitorum communis (EDC)

• Allows for finger straightening and object release.

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Principles of Successful Tendon Transfer

Successful tendon transfer surgery depends on a combination of anatomical precision, biomechanical knowledge, and post-operative rehabilitation. At Tetrahand Cyprus, we follow key principles:

1. Only functional muscles should be used – with at least Grade 4/5 strength

2. Muscle excursion and line of pull must match the intended function

3. One tendon should perform one function to simplify re-education

4. Joints must be supple before surgery to allow full range of motion post-operatively

5. Early but controlled rehabilitation is critical to retrain the brain and maximize function

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The Surgical Process

Tendon transfer surgery typically takes 2 to 4 hours, depending on the complexity and number of tendons involved. It is usually performed under general or regional anesthesia. Most patients require:

• A short hospital stay (1–3 days)

• Immobilization in a splint or cast for 3–6 weeks

• Gradual introduction of movement and function through therapy

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Rehabilitation: The Key to Success

Rehabilitation is not just an afterthought—it is central to regaining function. After the tendons are transferred, the brain must learn to use them in new ways. This process, called motor re-education, is guided by experienced hand therapists and includes:

• Passive range of motion exercises

• Muscle re-training and coordination drills

• Functional activities like grasping, pinching, and writing

• Splinting to protect the transfers during healing

Patients typically notice significant improvements within 8–12 weeks, with continued progress over the next several months.

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Outcomes and Benefits

Tendon transfers have an excellent success rate when performed by skilled surgeons and followed by structured rehab. At Tetrahand Cyprus, we see the following common outcomes:

• Restoration of critical hand functions, such as grip and pinch

• Improved independence in daily activities (eating, grooming, dressing)

• Reduction in caregiver assistance

• Enhanced appearance and positioning of the hand

• Increased self-esteem and quality of life

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Why Choose Tetrahand Cyprus?

Led by Professor Jan Fridén and Dr. Constantinos Kritiotis, Tetrahand Cyprus is a regional center of excellence for functional upper limb reconstruction. We are internationally recognized for our expertise in tendon transfers, nerve surgery, and spasticity treatment, offering patients from Cyprus and abroad the chance to regain meaningful hand function and independence.

Our approach is patient-centered, outcome-driven, and supported by a dedicated multidisciplinary team of therapists, nurses, and support staff.

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Conclusion

Tendon transfer surgery is a life-changing option for patients living with hand paralysis or severe dysfunction. By rebalancing the hand and restoring lost movements, this procedure opens the door to greater independence, self-care, and dignity. Whether recovering from a spinal injury, nerve damage, or other neurological conditions, patients at Tetrahand Cyprus receive personalized care backed by the latest techniques in reconstructive surgery.

If you or someone you love is struggling with hand function loss, we're here to help rebuild strength, motion, and confidence—one tendon at a time.