Overview

Tetraplegic hand is the name given to the different forms of hand palsy of medullary origin, that is to say to the consequences of spinal cord injuries on the hand.

This type of paralysis results mainly from a severe injury that damaged the spinal column, severing the spinal cord at cervical level. This is tetraplegia.

Treatment should be pluridisciplinary.In the first stages of the spinal cord lesion, the hand’s palsy is not a priority and treatment is handled first by our neurologist and/or neurosurgeon colleagues and then by rehabilitation physicians. Finally, at least a year into the evolution, once palsy is stabilized, specific hand treatment involving a consultation with a specialized hand surgeon can be arranged.

There are different forms of tetraplegic hand which depend on where the spinal cord is damaged. The more proximal the lesion, the more severe the palsy.

Three zones can be defined:

  • the supralesional zone (above the lesion) in which all muscles are intact;
  • the lesional zone in which muscles are paralyzed but show no spasticity;
  • the sublesional zone in which muscles are paralyzed but spastic.

The lesion types will thus be described using the last intact muscle that belongs to the sublesional zone. However the sublesional zone alone is not adequate to fully qualify palsy as lesional zones differ.

Careful and repeated clinical examination will aim at assessing the functional muscles (muscular testing) so as to determine which surgery is possible.

Because of the medullary origin of the paralysis, direct nerve surgery is not possible and only palliative tendon transfer, tenodesis (tendon attachment), and/or arthrodesis (joint fusion) can be performed.