Handchirurgie und Tetrahandchirurgie im Schweizer Paraplegiker Zentrum

Hand and Tetra Hand Surgery

The Department for Hand Surgery is one of a kind in Europe: the only centre of excellence geared towards patients with underlying neurological diseases. The hand team specialises in fully or partially returning arm and hand function to patients with tetraplegia (cervical spine paralysis). In this process, muscles, tendons or nerves are surgically relocated and joined together. The interdisciplinary team consists of surgeons, rehabilitation doctors and hand therapists.

Treatments we offer

  • Outpatient consultations for patients with or without underlying neurological diseases
  • Reconstruction of elbow extension or hand function for patients with tetraplegia
  • Nerve transfer for reconstructing elbow extension and hand function for patients with tetraplegia
  • Surgical procedures to reduce spasticity (operation for muscle balancing and joint stabilisation)
  • All elective procedures in hand surgery, such as scar correction, Dupuytren’s contracture, tendon sheath narrowing (trigger digit), ganglion, nerve congestion syndromes in the arm and hand (e.g. carpal tunnel or ulnar nerve entrapment), joint denervations, surgery in the event of osteoarthritis

Consultation for hands

  • Interdisciplinary examination of existing hand and arm functions,
  • Comprehensive information on non-surgical and/or surgical treatment options by a hand team.
  • Assessment of present pain or sensitivity problems in the hand and initiation of non-surgical and/or surgical treatment options.

 

Surgical operations are mostly only performed if no further improvement is to be expected. This is the case after six months in the event of complete spinal cord injury, for example. However, examination and advice is useful as soon as possible after paralysis occurs, particularly if nerve transposition is under consideration. The hand team consults with patients regularly in initial rehabilitation.

Detailed information on procedures

  • Outpatient hand consultation for surgical reconstruction of the hand function

    • An assessment will be made during the first appointment.
    • Further appointment for testing of the existing hand and arm motor function with the aim of possibly improving the hand function (e.g. grip function and pinch grip strength).
    • The neurological and therapeutic tests needed to determine whether surgery should be performed, e.g. joint mobility, muscle and hand strength status grasp release test and COPM (Canadian Occupational Performance Measure), are conducted on the same day by the relevant disciplines (occupational therapy /physiotherapy) before the interdisciplinary consultation.
    • During this interdisciplinary consultation the therapeutic tests will be discussed with you, including the desired goals from the COPM, and you will review the possible outcomes and limits (e.g. which functions might or might not work post operation?).
    • The hand surgeons will also explain the planned surgery and the ensuing inpatient rehabilitation period. If is decision is made to operate, an inpatient stay of 2-3 months can be expected.

    Further tests may need to be performed at a later date prior to the operation. Please bring the hand and arm splints that you currently use to this appointment.

     

    Inpatient hospitalisation

    Useful information on the operation and subsequent rehabilitation

    • Limited mobility: After the operation, various movements such as completely closing the hand are prohibited in order not to put the results of the operation at risk.
    • Splint support after the operation: Splints must be worn (24/7) for the first 3 weeks after the operation. They should then be replaced with a protective splint during the day, whilst continuing to wear the initial splint at night.
    • This limited mobility and the splint support will severely restrict your independence in the first few weeks (e.g. during transfers, everyday activities etc.) During this period, the nursing team will take over any day-to-day activities (personal hygiene etc.) which cannot yet be performed independently. The limited mobility will improve in the course of the inpatient rehabilitation stay, which will increase your independence.
    • Therapy sessions: With the help of the hand therapists, you will learn to control the newly reconstructed muscle functions, to use the new hand function in everyday life, and to strengthen the muscles. In the first two weeks, training sessions will take place approx. 4x daily.
    • Self-exercises are created and you will be responsible for performing these yourself from the 2nd week after the operation.
    • Regular follow-up checks will be carried out by the hand surgeons during the inpatient stay.


    Day of admission

    Admission is scheduled for the day before the operation. Any remaining discussions with the treating doctors, the ward nursing team and the hand therapists will be held on this date. The operation incl. the declaration of consent will be explained by the hand surgeons and the premedication administered by the anaesthesiologists.

     

    Day of surgery

    After the operation, a plaster splint will be applied in the recovery room. The hand therapists will replace this with a thermoplastic splint on the first day after the operation.

     

    1st day post operation

    • The first dressing change will be performed in the room by the hand surgeons and the hand therapy team.
    • The Senior House Officer and the nursing staff will be on hand if necessary to provide information.
    • Adjustment of the thermoplastic splint.
    • Start of training of the new hand function.
    • Initial mobilization normally takes place in the wheelchair with the assistance of the nursing staff and the hand therapists.

     

    Follow-up outpatient care

    Further outpatient follow-up appointments are scheduled for 3, 6 and 12 months after the operation. These include the specific tests and the consultation with the hand surgeons and hand therapists. These settings will take one full day.

     

    Contact

    Hand Surgery, Swiss Paraplegic Centre

    hch.spz@paraplegie.ch

    T +41 41 939 52 00

     

  • Outpatient hand consultation for surgical reconstruction of the arm function

    • An assessment will be made during the first appointment.
    • Further appointment for testing of the existing arm motor function with the aim of possibly improving the arm function (e.g. greater radius of movement of the arm, pulling back bed sheets independently, stretching the elbow, etc.).
    • The tests needed to determine whether surgery should be performed, e.g. joint mobility, muscle status and COPM (Canadian Occupational Performance Measure), are conducted on the same day by the relevant disciplines (occupational therapy/physiotherapy) before the interdisciplinary consultation.
    • During this interdisciplinary consultation, the therapeutic tests incl. the desired goals from the COPM will be discussed with you, and the possible outcomes and limits will be reviewed together (e.g. which functions might or might not work post operation?)
    • The hand surgeons will also explain the planned surgery and ensuing inpatient rehabilitation period. If a decision is made to operate, then the inpatient stay will be at least 3 months.

    Further tests may need to be performed at a later date prior to the operation. Please bring the hand and arm splints that you currently use to this appointment.


    Inpatient hospitalisation

    Useful information on the operation and subsequent rehabilitation

    • Limited mobility: After the operation, various movements such as moving the arm towards the body or lifting the arm in front of the body are prohibited in order not to put the results of the operation at risk.
    • After the operation, an electric wheelchair with a specially adapted arm rest may have to be used for 7 to 9 weeks for mobility purposes.
    • Splint support after the operation: Splints must be worn (24/7) for 7 to 9 weeks after the operation.
    • This limited mobility and the splint support will severely restrict your independence in the first few weeks (e.g. during transfers, everyday activities etc.) During this period, the nursing team will take over any day-to-day activities (personal hygiene etc.) which cannot yet be performed independently. The limited mobility will improve in the course of the inpatient rehabilitation stay, which will increase your independence.
    • Therapy sessions: With the help of hand therapists, you will learn to control function of the newly reconstructed muscle, to use the new arm function in everyday life, and to strengthen the muscles. In the first two weeks, training sessions will take place approx. 4x daily.
    • Self-exercises are created and you will be responsible for performing these yourself from the 2nd week after the operation.
    • Regular follow-up checks will be carried out by the hand surgeons during the inpatient stay.

    Admission date

    • Admission is scheduled for the day before the operation.
    • If you have an electric wheelchair you must bring it with you. This will be adapted on the day of the operation in the Wheelchair Mechanics department of Orthotec Ltd (e.g. switching the control unit side, fitting the arm rest, etc.).
    • Any remaining discussions with the treating doctors, the ward nursing team and the hand therapists will be held on the admission date. The operation incl. the declaration of consent will be explained by the hand surgeons and the premedication administered by the anaesthesiologists.

    Day of surgery

    After the operation an elbow splint, with elbow joint fixed at an angle of 20°, will be fitted in the recovery room.

    1st day after the operation

    • The first dressing change will be performed in the room by the hand surgeons, hand therapy team, the Senior House Officer and the nursing staff.
    • Start of training of the new elbow function.
    • Initial mobilization normally takes place in the electric wheelchair with the assistance of the nursing staff and the hand therapists.

    Follow-up outpatient care

    Further outpatient follow-up appointments are scheduled for 3, 6 and 12 months after the operation. These include the specific tests and the consultation with the hand surgeons and hand therapists. These appointments will take one full day.

     

    Contact

    Hand Surgery, Swiss Paraplegic Centre

    hch.spz@paraplegie.ch

    T +41 41 939 52 00

  • Outpatient hand consultation for surgical reconstruction of the hand function

    • Further appointment for testing of the existing hand and arm motor function with the aim of possibly improving the hand function (e.g. finger and hand extension). The nerve transposition should ideally be performed within a timeframe of 12 months following the spinal cord injury.
    • The neurological and therapeutic tests needed to determine whether surgery should be performed, e.g. electrophysiological study, muscle status and testing by functional electrical stimulation, are conducted on the same day by the relevant disciplines (neurology, occupational therapy/physiotherapy) before the interdisciplinary consultation.
    • During this interdisciplinary consultation, the neurological and therapeutic tests incl. the desired goals will be discussed with you, and the possible outcomes and limits will be reviewed together (e.g. which functions might or might not work post operation?)
    • The hand surgeons will also explain the planned surgery and the ensuing inpatient rehabilitation period. If a decision is made to operate, then the inpatient stay will be approx. 3 weeks.

    Further tests may need to be performed at a later date prior to the operation. Please bring the hand and arm splints that you currently use to this appointment.

     

    Inpatient hospitalization

    Important information on the operation and rehabilitation

    • Limited mobility: After the operation, various movements such as bending the wrist are prohibited in order not to put the results of the operation at risk.

    • Splint support after the operation: Splints must be worn (24/7) for 2 weeks after the operation.

    • An electric wheelchair may have to be used for 2 weeks after the operation for mobility purposes.

    • This limited mobility and the splint support will restrict your independence in the first few weeks (e.g. during transfers, everyday activities etc.) During this period, the nursing team will take over any day-to-day activities (personal hygiene etc.) which cannot yet be performed independently.

    • Regular follow-up checks will be carried out by the hand surgeons during the inpatient stay.

    Day of admission

    Admission is scheduled for the day before the operation. Any remaining discussions with the treating doctors, the ward nursing team and the hand therapists will be held on this date. The operation incl. the declaration of consent will be explained by the hand surgeons and the premedication administered by the anaesthesiologists.

    Day of surgery

    After the operation, a plaster splint will be applied in the recovery room.

    1st day post operation

    • The first dressing change and a check-up of the splint will be performed in the room by the hand surgeons, hand therapy team, the Senior House Officer and the nursing staff.
    • Initial mobilization normally takes place in the wheelchair with the assistance of the nursing staff and the hand therapists.

    Follow-up outpatient care

    Six weeks after the operation, outpatient follow-ups are scheduled for testing and providing instructions regarding functional electrostimulation, which should then be performed daily by the patient. Further outpatient follow-up appointments are made for 3, 6 and 12 months after the operation. These include the specific tests and the consultation with the hand surgeons and hand therapists. These appointments will take one full day.

     

    Contact

    Hand Surgery, Swiss Paraplegic Centre

    hch.spz@paraplegie.ch

    T +41 41 939 52 00

Hand and Tetra Hand Surgery Team

Team Handchirurgie Schweizer Paraplegiker Zentrum

Our team is made up of experienced hand surgeons with training in reconstructive surgery for people with spinal cord injuries, as well as occupational therapists and physiotherapists with many years of experience in the rehabilitation of people with spinal cord injuries, who have specialised in treatment following reconstructive surgery.

Our specialists

Contact and enquiries

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