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Praxis



                                                                                                                                           «Hands are some of the most
A handful of freedom                                                                                                                         fascinating phenomenon that exists»
Suddenly raise your arm and grab something with force – the wish for many tetraplegics.                                                    Hopeless cases? No, that does not exist for    in everyday life. Therefore, operations are      Tendons and muscles
Thanks to surgery, it is now possible to awaken paralyzed hands to new life.                                                               the two doctors. «We can almost always offer   usually performed at the earliest six months     The surgical procedure is delicate: The sur-
                                                                                                                                           an improvement», says Simeon Grossmann.        after hospital discharge. Professor Jan Fridén   geons use intact, upper – or forearm muscles
                                                                                                                                           Before leaving the SPC after about nine        says: «We ask the patients to present the five   and their tendons to connect with certain
                                                                                                                                           months of rehabilitation, the patients meet    most important abilities to regain after         tendons of the hand. This effectively makes
Text: Christine Zwygart | Photos: Astrid Zimmermann-Boog, Walter Eggenberger                                                               again with the Tetrahand team to share in-     surgery to make sure that the outcome of         the muscle to perform new tasks e.g. so fin-
                                                                                                                                           formation. However, before an intervention     the procedure will meet the needs of the         gers, previously paralyzed, can move and flex
                                                                                                                                           is planned, patients need to gain experience   patient.»                                        and stretch again. We restore both closing



A      loved one to touch. A child to put to
       sleep. Or someone to welcome warmly.
«The hands belong to an individual’s person-
                                                   he is the professor of hand surgery and
                                                   leader of the Swedish Center for tetraplegia
                                                   hand surgery at University Hospital in Goth-
                                                                                                    The doctors in Jan Fridén, Bijan
                                                                                                    Cheikh-Sarraf and Simeon Grossman
                                                                                                    (left) inspect the hand of a patient
ality. They show emotions, can carress, but        enburg. «It is a stroke of luck that we can      with tetraplegia.
also beat», says Jan Fridén, specialist in Tetra   work together with him», says Grossmann.
Hand Surgery. Eight fingers and two thumbs
– together they assist us in communicating         Strength and flexibility
and are indispensable helpers in so many           Consultation in Nottwil. The two surgeons,
performances in everyday life. By a spinal         occupational and physical therapists and
cord injury, can hands, arms and shoulders         physicians from the Department of Ortho-
be weak, stiff and numb. The higher up the         pedic Surgery and Spinal Cord Injury par-
spinal cord is damaged, the more serious are       ticipate in the consultations. Today’s sched-
the limitations. For those concerned, this         uled patients represent different phases of
means losing some of their independence.           the Tetrahand service: those who will soon
Simple things – opening a bottle, reaching         be operated on, others who have already
for a book or putting on a sock – the spinal       passed the biggest efforts and come for the
cord injured persons have to cope with daily       follow-ups. Also newly injured patients
tasks that are difficult or even impossible to     come to learn about possibilities of further
perform. «With an operation we can now en-         improvement.
sure that certain functions of paralyzed           A young man comes rolling in, he drives the
hands can be restored», says Jan Fridén. To-       wheels awkwardly with the heel of the hand.
gether with physician colleague Simeon             The doctors want to see whether the patient
Grossmann in the Swiss Paraplegic Centre           can move his joints better since the previous
(SPC) in Nottwil, he can restore the hand          test. «When intervention would be useful,
function of the injured person and thereby         those concerned should strengthen the ex-
help to get a bit of freedom back.                 isting muscles and train the mobility of the
210 consultations have been done by the two        joints», says Jan Fridén. «If someone is not
doctors in the past year, and more than 30         willing to make this effort, there will be no
surgical procedures have been performed.           operation.» Using simple exercises like
This year the team expects an increase in          stretch your arm, bend your thumb tests the
treatment because of the highly specialized        patients’ mobility and strength is tested. The
area is still under build-up in the SPC. Tetra-    experts register exactly what is possible, how
hand expert Jan Fridén has been working            powerful the muscles work and what does
regularly here since January 2011. Otherwise,      not work at all.




22 | Paraplegie, März 2012                                                                                                                                                                                                                                           Paraplegie, März 2012 |   23
praxis
                                                                                                                                                  Operation.
                                                                                                                                                  1 
                                                                                                                                                    Grossmann, Fridén and Cheikh-Sarraf (from left)
                                                                                                                                                    identify the right tendon to link to a new
                                                                                                                                                    function.
                                                                                                                                                  2 
                                                                                                                                                    Prior to surgery, the patient can only hold the
                                                                                                                                                    pen using both hands.
                                                                                                                                                  3 
                                                                                                                                                    After surgery: The fingers have power again
                                                                                                                                                    and the writing works better.




and opening of the hand in a single inter-                                                                                                        with regard to patients from abroad (see
vention – which is «quite unique in the                                                                                                           box). Either way, the expert is convinced                              International Network
world», says Jan Fridén. To adjust the length                                                                                                     that the state can save money in the long                              The Tetrahand surgery is a medical field that has only about 80 doctors specialized
and tension of tendons, the surgeon secures                                                                                                       term: «In effect, patients will receive much                           worldwide. Therefore, the exchange of knowledge among them is of immense
the future position of the thumb and fingers                                                                                                      more independency and require less assis-                              importance. «The procedures are delicate and have absolutely no margin for er-
                                                                                                                                                                                                                         ror», says specialist Jan Fridén. Every three years, the experts meet at an internatio-
precisely. To form an optimal gripping hand                                                                                                       tance.»
                                                                                                                                                                                                                         nal conference to share their experiences. In addition, an international Tetrahand
that opens and closes, custom solutions are                                                                                                       Dressing, cooking, writing, driving a wheel-
                                                                                                                                                                                                                         course is arranged annually and will take place this year in Nottwil from 9 to 12
required. Sometimes the thumb must be                                                                                                             chair forward, shake hands when greeting                               April 2012 in the Swiss Paraplegic Centre (SPC).
stabilized, because it sticks out too little out                                                                                                  someone – that’s usually possible for tetra-                           The SPC is one of the few clinics in Europe that offers a comprehensive Tetrahand
of hand. «It’s a fascinating and responsible                                                                                                      plegics after surgery. Or how Fridén puts it:                          surgery service. Therefore, patients come from abroad here to seek advice and
task to balance the function and position of                                                                                                      «Hand control is one of the most sophisti-                             treatment. «We also open the center for so-called ‹Visiting Fellowships’, where we
                                                                                                                                                                                                                         show our interested guest doctors our work. We want to expand this in the futu-
the fingers and thumb again because the              1                                                                                            cated and fascinating things that exists.»
                                                                                                                                                                                                                         re», says Fridén. The Swede is actually one of the world’s only two professors in the
new hand function will serve the patient un-                                                                                                                                                                             field of Tetrahand surgery. Together with physician colleague Simeon Grossmann,
til the end of the patient’s life.» Fridén has                                                                                                                                                                           he is building now a center of excellence at the SPC and would like to establish a
invested much time to perfect the process.                                                                                                                                                                               European Society based in Nottwil. The aim of the European Society is to coordi-
Thus, the specialist has developed his own                                                                                                                                                                               nate the training and research and to create a network of doctors and therapists,
                                                                                                                                                                                                                         «because it makes no sense to start all over again from scratch».
technique, as he sews together two tendons:
an overlap length of about five centimeters
on both sides with cross-stitches, and sev-
                                                                                                                                                                                                                             For more information, please visit:
eral times all around. «So they can later
                                                                                                                                                                                                                             w
                                                                                                                                                                                                                              ww.tetrahand.com
withstand a load up to 25 kilograms.»                                                                                                                                                                                        Function before and after surgery can be
In addition to surgery of the hand, the sur-                                                                                                                                                                                 viewed at www.paraplegie.ch/magazin
geons also restore the triceps and thus en-
sure that a tetraplegic person can lift his
arm again. «This expands its action space.
He can reach for something that is further
                                                     2                                                3
away», says Jan Fridén. He speaks about
strong emotional moments, when a patient
after months and years for the first time
himself or herself can stretch out the arm         Independence and mobility                     gery», says Jan Fridén. Totally understand-
again. «It still touches me deeply every           After surgery, patients must remain for re-   able but also sad when you see the potential.
time and I’m reminded of how important             habilitation up to three months in the SPC.   After the first difficult weeks, the functions
our job is.»                                       «Mobility and independence are restricted     and abilities will improve.
This feeling of happiness is confirmed by          in the first weeks after surgery», says       Accident insurance usually pays for the sur-
the young man who now visits the clinic.
His arm is wrapped in thick splints and
                                                   Simeon Grossmann. Therefore, those in-
                                                   volved must instruct and guide the patient
                                                                                                 gery. The cost of the long rehabilitation and
                                                                                                 follow-ups, however, always lead to discus-                                                                                                     Avantgarde
bandages, the procedure was a month ago
– and his face shines. «Sensational! Before,
                                                   carefully when the new features of the
                                                   hands and arms are first trained. This time
                                                                                                 sions, because no one feels responsible for
                                                                                                 this important part of the treatment. «We
                                                                                                                                                  © Ottobock · OK2583-M_CH_DE-01-1201
                                                                                                                                                                                                                                                 So individuell wie Sie!
I had no control over my hand. And now it          is for many people a big setback, to be way   will have to develop a new model, so that
just works. Chop, chop.» From his doctors          from home, back in the hospital, and tem-     the patient’s rehabilitation after a shorter                                                                                                    Besuchen Sie unsere Webseite und erfahren
he wants to know when he again could               porarily more dependent than before.          hospital stay is guaranteed at home with                                                                                                        Sie mehr: www.ottobock.ch
change from electric to manual wheelchair.         «That’s the main reason why about 20 per-     the help of assistance and trained thera-
«Please, as soon as possible.»                     cent of our patients do not want the sur-     pists», says Fridén. This applies particularly                                                                                                  Wünschen Sie Unterlagen zum Avantgarde oder eine
                                                                                                                                                                                                                                                 Adresse eines Fachhändlers in Ihrer Nähe? Rufen Sie
                                                                                                                                                                                                                                                 uns an unter Tel. 041 455 61 71.



                                                                                                                                                                                                                                                 www.ottobock.ch · suisse@ottobock.com · T 041 455 61 71
24 | Paraplegie, März 2012
                                                                                                                                                                                OK2583_210x94,5-M_CH_DE-01-1201.indd 1                                                                                     01.02.12 15:00

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MEDICAL PROFESSIONALISM Class of compassionate care
 

Tetrahand

  • 1. Praxis «Hands are some of the most A handful of freedom fascinating phenomenon that exists» Suddenly raise your arm and grab something with force – the wish for many tetraplegics. Hopeless cases? No, that does not exist for in everyday life. Therefore, operations are Tendons and muscles Thanks to surgery, it is now possible to awaken paralyzed hands to new life. the two doctors. «We can almost always offer usually performed at the earliest six months The surgical procedure is delicate: The sur- an improvement», says Simeon Grossmann. after hospital discharge. Professor Jan Fridén geons use intact, upper – or forearm muscles Before leaving the SPC after about nine says: «We ask the patients to present the five and their tendons to connect with certain months of rehabilitation, the patients meet most important abilities to regain after tendons of the hand. This effectively makes Text: Christine Zwygart | Photos: Astrid Zimmermann-Boog, Walter Eggenberger again with the Tetrahand team to share in- surgery to make sure that the outcome of the muscle to perform new tasks e.g. so fin- formation. However, before an intervention the procedure will meet the needs of the gers, previously paralyzed, can move and flex is planned, patients need to gain experience patient.» and stretch again. We restore both closing A loved one to touch. A child to put to sleep. Or someone to welcome warmly. «The hands belong to an individual’s person- he is the professor of hand surgery and leader of the Swedish Center for tetraplegia hand surgery at University Hospital in Goth- The doctors in Jan Fridén, Bijan Cheikh-Sarraf and Simeon Grossman (left) inspect the hand of a patient ality. They show emotions, can carress, but enburg. «It is a stroke of luck that we can with tetraplegia. also beat», says Jan Fridén, specialist in Tetra work together with him», says Grossmann. Hand Surgery. Eight fingers and two thumbs – together they assist us in communicating Strength and flexibility and are indispensable helpers in so many Consultation in Nottwil. The two surgeons, performances in everyday life. By a spinal occupational and physical therapists and cord injury, can hands, arms and shoulders physicians from the Department of Ortho- be weak, stiff and numb. The higher up the pedic Surgery and Spinal Cord Injury par- spinal cord is damaged, the more serious are ticipate in the consultations. Today’s sched- the limitations. For those concerned, this uled patients represent different phases of means losing some of their independence. the Tetrahand service: those who will soon Simple things – opening a bottle, reaching be operated on, others who have already for a book or putting on a sock – the spinal passed the biggest efforts and come for the cord injured persons have to cope with daily follow-ups. Also newly injured patients tasks that are difficult or even impossible to come to learn about possibilities of further perform. «With an operation we can now en- improvement. sure that certain functions of paralyzed A young man comes rolling in, he drives the hands can be restored», says Jan Fridén. To- wheels awkwardly with the heel of the hand. gether with physician colleague Simeon The doctors want to see whether the patient Grossmann in the Swiss Paraplegic Centre can move his joints better since the previous (SPC) in Nottwil, he can restore the hand test. «When intervention would be useful, function of the injured person and thereby those concerned should strengthen the ex- help to get a bit of freedom back. isting muscles and train the mobility of the 210 consultations have been done by the two joints», says Jan Fridén. «If someone is not doctors in the past year, and more than 30 willing to make this effort, there will be no surgical procedures have been performed. operation.» Using simple exercises like This year the team expects an increase in stretch your arm, bend your thumb tests the treatment because of the highly specialized patients’ mobility and strength is tested. The area is still under build-up in the SPC. Tetra- experts register exactly what is possible, how hand expert Jan Fridén has been working powerful the muscles work and what does regularly here since January 2011. Otherwise, not work at all. 22 | Paraplegie, März 2012 Paraplegie, März 2012 | 23
  • 2. praxis Operation. 1  Grossmann, Fridén and Cheikh-Sarraf (from left) identify the right tendon to link to a new function. 2  Prior to surgery, the patient can only hold the pen using both hands. 3  After surgery: The fingers have power again and the writing works better. and opening of the hand in a single inter- with regard to patients from abroad (see vention – which is «quite unique in the box). Either way, the expert is convinced International Network world», says Jan Fridén. To adjust the length that the state can save money in the long The Tetrahand surgery is a medical field that has only about 80 doctors specialized and tension of tendons, the surgeon secures term: «In effect, patients will receive much worldwide. Therefore, the exchange of knowledge among them is of immense the future position of the thumb and fingers more independency and require less assis- importance. «The procedures are delicate and have absolutely no margin for er- ror», says specialist Jan Fridén. Every three years, the experts meet at an internatio- precisely. To form an optimal gripping hand tance.» nal conference to share their experiences. In addition, an international Tetrahand that opens and closes, custom solutions are Dressing, cooking, writing, driving a wheel- course is arranged annually and will take place this year in Nottwil from 9 to 12 required. Sometimes the thumb must be chair forward, shake hands when greeting April 2012 in the Swiss Paraplegic Centre (SPC). stabilized, because it sticks out too little out someone – that’s usually possible for tetra- The SPC is one of the few clinics in Europe that offers a comprehensive Tetrahand of hand. «It’s a fascinating and responsible plegics after surgery. Or how Fridén puts it: surgery service. Therefore, patients come from abroad here to seek advice and task to balance the function and position of «Hand control is one of the most sophisti- treatment. «We also open the center for so-called ‹Visiting Fellowships’, where we show our interested guest doctors our work. We want to expand this in the futu- the fingers and thumb again because the 1 cated and fascinating things that exists.» re», says Fridén. The Swede is actually one of the world’s only two professors in the new hand function will serve the patient un- field of Tetrahand surgery. Together with physician colleague Simeon Grossmann, til the end of the patient’s life.» Fridén has he is building now a center of excellence at the SPC and would like to establish a invested much time to perfect the process. European Society based in Nottwil. The aim of the European Society is to coordi- Thus, the specialist has developed his own nate the training and research and to create a network of doctors and therapists, «because it makes no sense to start all over again from scratch». technique, as he sews together two tendons: an overlap length of about five centimeters on both sides with cross-stitches, and sev- For more information, please visit: eral times all around. «So they can later w ww.tetrahand.com withstand a load up to 25 kilograms.» Function before and after surgery can be In addition to surgery of the hand, the sur- viewed at www.paraplegie.ch/magazin geons also restore the triceps and thus en- sure that a tetraplegic person can lift his arm again. «This expands its action space. He can reach for something that is further 2 3 away», says Jan Fridén. He speaks about strong emotional moments, when a patient after months and years for the first time himself or herself can stretch out the arm Independence and mobility gery», says Jan Fridén. Totally understand- again. «It still touches me deeply every After surgery, patients must remain for re- able but also sad when you see the potential. time and I’m reminded of how important habilitation up to three months in the SPC. After the first difficult weeks, the functions our job is.» «Mobility and independence are restricted and abilities will improve. This feeling of happiness is confirmed by in the first weeks after surgery», says Accident insurance usually pays for the sur- the young man who now visits the clinic. His arm is wrapped in thick splints and Simeon Grossmann. Therefore, those in- volved must instruct and guide the patient gery. The cost of the long rehabilitation and follow-ups, however, always lead to discus- Avantgarde bandages, the procedure was a month ago – and his face shines. «Sensational! Before, carefully when the new features of the hands and arms are first trained. This time sions, because no one feels responsible for this important part of the treatment. «We © Ottobock · OK2583-M_CH_DE-01-1201 So individuell wie Sie! I had no control over my hand. And now it is for many people a big setback, to be way will have to develop a new model, so that just works. Chop, chop.» From his doctors from home, back in the hospital, and tem- the patient’s rehabilitation after a shorter Besuchen Sie unsere Webseite und erfahren he wants to know when he again could porarily more dependent than before. hospital stay is guaranteed at home with Sie mehr: www.ottobock.ch change from electric to manual wheelchair. «That’s the main reason why about 20 per- the help of assistance and trained thera- «Please, as soon as possible.» cent of our patients do not want the sur- pists», says Fridén. This applies particularly Wünschen Sie Unterlagen zum Avantgarde oder eine Adresse eines Fachhändlers in Ihrer Nähe? Rufen Sie uns an unter Tel. 041 455 61 71. www.ottobock.ch · suisse@ottobock.com · T 041 455 61 71 24 | Paraplegie, März 2012 OK2583_210x94,5-M_CH_DE-01-1201.indd 1 01.02.12 15:00