Recent activities
The Tetraplegia Hand Surgery Unit is devoted to science-based clinical practice. We prioritize participation at international meetings, interactions with colleagues sharing our interest and, most importantly, the persons living with tetraplegia. Posted below are messages and reports as well as relevant activities that we have participated in lately.

Friday, October 2, 2015

Tetraplegia Hand Surgery Topic at Austrian Trauma Society

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Old Town Salzburg
The Austrain Trauma Society (Österreichische Gesellschaft für Unfallchirurgie) congress in Salzburg, arranged a symposium on reconstruction of hand function after damage to central and peripheral nervous system. Professors Robert Schmidhammer and Jan Fridén overviewed the topics "Functional Improvement of  Upper Extremity Function after Peripheral Nerve Injuries and "Improvement of Upper Extremity Function in Tetraplegia by Surgery".  Both presenters not only detailed the surgical procedures but also emphasized the need for a solid team efforts and patient-perceived outcome measurements. Discussions dealt with several important issues in a broader perspective for example  strategies to establish routines for early assessments and how to establish solid and sustainable organizations to guarantee continous development and service.

Tuesday, August 25, 2015

Review Article on Upper Extremity Nerve Transfer Published with Australian Research Partners

An important state-of-the-art paper entitled “Review of Upper Extremity Nerve Transfer in Cervical Spinal Cord Injury” was published in the open-access journal “Brachial Plexus and Peripheral Nerve Injury“. Together with first and last authors Sarah Cain and Natasha van Zyl from University of Melbourne, Australia, Andreas Gohritz and Jan Fridén summarized an analysis of  all nerve transfer cases published to date in the literature. This review summarizes the functional results in 59 cases with 89 nerve transfers performed, including 15 cases of double-nerve transfer and 1 case of triple-nerve transfer from 13 studies with extractable data. Overall, 89 nerve transfers have been performed in 57 males and 2 females with a mean age of 34 years. The mean SCI level was C6 (range: C5–7), time to surgery post-SCI was 19.9 months (range: 4.1–156 months), and follow-up time was 18.2 months (range: 3–60 months). All case reports recorded a Medical Research Council (MRC) score of 3 or 4 for recipient muscle power, but two early case series reported more variable results.

Saturday, June 27, 2015

Invited State-of-the-Art Lecture at German-Speaking Spinal Cord Society Meeting


An invited special lecture on tetraplegia hand surgery was delivered by Jan Fridén at the 28th congress of the Deutschsprachige Medizinische Gesellschaft für Paraplegie (DMGP, German-Speaking Medical Society of Paraplegia) on June 24-27, 2015. This annual meeting united physicians and therapists working at spinal cord centers of Germany, Austria and Switzerland was held in Kassel, Germany, perfectly organized by Dr. Marion Saur (photo left). Important scientific contributions were made by the Nottwil team and the special lecture was exceptionally well received by the audience. Many detailed and inspiring questions and a lively discussion reflected the growing interest of the rehabilitation medicine community on surgical rehabilitation of arm and hand function. The next DMGP meeting will be in 2016 in Hamburg, Germany - www.dmgp-kongress.de

Friday, June 12, 2015

“Trinational Hand Meeting” in Basel

Swimming in the Rhein (photo Dr. Gohritz)
  The „Trinational Hand Meeting“ in Basel, Switzerland in May 2015 was organized by Prof. Schaefer, head of Plastic and Hand Surgery and his team at Basel University Hospital. This special meeting united only personally invited hand surgeons from the Rhein region of Germany, Switzerland and France to exchange practical experience and knowledge by discussing clinical cases in a friendly and relaxed atmosphere. The invited speaker of this year was Jan Fridén who presented an “Update on Functional Restoration in the Upper Extremity after Spinal Cord Injury and Amputation”.
The meeting took place at the Medartis Campus in Basel and also included an exciting guided tour through the high-technology production sites of modern osteosynthesis material. The scientific part was followed by a refreshing swim in the Rhein and an invitation of the host to have a superb dinner with amicable conversations at the traditional Basel restaurant “Schlüsselzunft”.

Friday, May 22, 2015

Grand Opening of Centre for Advanced Reconstruction of Extremities at Sahlgrenska University Hospital

Using his robotic arm, Magnus Niska cuts the symbolic band

A highly anticipated and much wanted dream came true when C.A.R.E., "Centre for Advanced Reconstruction of Extremities", was officially opened on May 22nd.  More than 150 patients and visitors attended the event. 
Filip Andersson demonstrates his hand skills after reconstruction
Vice Chair of Sahlgrenska University Hospital, Professor Lars Grip spoke to the audience. Lars Grip said: "This is day of completion of a deliberate effort by the Hospital and Academy to merge two highly specialized branches of hand and orthopaedic surgery to the benefit of our patients. They will be welcomed to an integrated, translational, research-intensive, modern and patient-friendly facility. We have high expectations that this new unit will allow development of advanced reconstructions in patients with paralyses of extremities or amputations after injuries and diseases".  Targeted muscle innervation, nerve and tendon transfer techniques, osseo-integration of brain-governed robotic arms and skilled personnel for rehabilitation will guarantee development and expert treatment at many levels. According to Dr. Carina Reinholdt, chair of C.A.R.E., patients with needs for assessment and treatment after cervical spinal cord injuries, brain injury with spasticity, plexus injuries and other peripheral nerve injuries as well as amputations are welcome to this new unit. "I also want to stress that patients from other countries outside Sweden may be referred to us", said Dr. Reinholdt.

Friday, May 15, 2015

Grand Rounds Presentation at Rehabilitation Institute of Chicago


The Rehabilitation Institute of Chicago (RIC) invited Jan Fridén on May 13-14th, 2015 to give a presentation during „Grand Rounds“ on modern strategies of “Upper Extremity Surgical Rehabilitation in Tetraplegia“. He was invited by Prof. Richard L. Lieber (photo) who was recently selected as the new Chief Scientist and Senior Vice President of Research. The RIC is recognized since more than 20 years as the nation`s highest ranked provider of physical medicine and comprehensive rehabilitation and operates the largest rehabilitation research enterprise in the world. Special areas of its innovative applied research and discovery programs include spinal cord injury, stroke, traumatic brain injury, neurological rehabilitation, outcomes research, pediatric orthopedics and bionic extremity reconstruction.

Saturday, May 2, 2015

World-Wide Internet Distribution of “Update on Hand Surgery in Tetraplegia” in IFSSH-Ezine


A 14 page digital report of the committee of nerve and spinal cord injury (chaired by Ann Nachemson, Sweden) on current practice of hand surgery in spinal cord injury was published by the International Federation of Societies of Surgery of the Hand (IFSSH). The authors were Jan Fridén and Andreas Gohritz. The article is in 2 parts, the first included principles (definition, clinical outcomes, current utilization) and a second part on operative techniques, above all tendon and nerve transfer, to restore elbow and wrist extension, forearm pronation, hand grip and opening intrinsic function and reduce spasticity.
The IFSSH Ezine, a digital publication available to the global Hand Surgery and Hand Therapy communities free of charge. It has been established with the purpose of uniting the global hand surgery community and is intended to be a publication for IFSSH members, by IFSSH members.

Monday, February 23, 2015

South African Society for Surgery of the Hand Refresher Course

South African Society for Surgery of the Hand arranged their annual refresher course in Johannesburg in the end of February. Topics included this year were:

ANATOMY AND BIOMECHANICS CONGENITAL ABNORMALITIES
CP, STROKE AND BRAIN INJURY TETRAPLEGIA
TENDON TRANSFERS

Invited speakers were Drs Donald Sammut, UK and Jan Fridén, Sweden. Dr Sammut covered the complicated anatomy and biomechanics of the hand in a most fascinating way. Using didactic drawings and animations, the 3-D perspectives and the deformities caused by simulated paralyses became comprehensible. Brachial plexus and peripheral nerve injuries were taught in step by step assessment/treatment style with the presenters´ personal recommendations. Dr Fridén gave overview lectures about tendon transfer surgery, tetraplegia, brain and peripheral nerve injuries. Prof. Hans Myburgh reported the "South African tetraplegia surgery experience so far and the way forward" and Ms Melanie Skeen presented program for "Rehabilitation of the Tetraplegic Patient. The outcomes demonstrated clear improvements of functions, performance and satisfaction after surgery

Plenty of time was given for discussions at this highly appreciated and well-organized Refresher course.

Friday, December 12, 2014

Nordic Therapist Meeting on Tetraplegia Upper Limb Surgery


Therapists from Denmark, Finland, Iceland, Norway and Sweden met in Gothenburg in the end of November. During three intensive days we discussed, learned from each other and tried to reach consensus upon rehabilitation after reconstructive upper limb surgery. We had detailed discussions about outcome measures and rehabilitation strategies for triceps reconstructions, grip reconstructions and surgery for spasticity-induced deformities. Each country described the rehabilitation strategies today and Jette Skyggebjerg from Denmark gave us a short report from the recently published article about long term follow up on the surgeries performed in Denmark. We also visited a training session with a patient two days after grip reconstruction.  At the end of this brief summit, a first version of Nordic guidelines for rehabilitation after tetraplegia upper limb surgery was agreed upon.  Each unit will discuss this initial version and further work will be done during the next NORTH-meeting that will be hosted in Denmark in September 2015. The meeting did however not only include hard work. During the evenings we had social activities including dining, singing, boat trip and sauna including bath in the 7°C “warm” ocean! We got to know each other more and are looking forward to future cooperation between our countries.
Finally, we would like to extend a special thanks to Professor Leiv Hove in Bergen, Norway and the Nordic Council for financial support that made this meeting both memorable and fruitful.

Johanna Wangdell, Anna-Karin Gustavsson & Lina Bunketorp- Käll

Participants shown in picture: Island: Sigþrúður (Sissu) Loftsdóttir, Sunna Kristinsdóttir. Finland: Leena Mäntylä, Pia Nahi. Denmark: Susanne Berner Nielsen, Jette Skyggebjerg. Norway: Anett Myhre Kallevik, Elin Widegren Norum. Sweden: Johanna Wangdell, Anna-Karin Gustavsson, Lina Bunketorp- Käll

Thursday, December 11, 2014

Surgical denervation for joint arthritis in spinal cord injured patients – small incisions for great pain relief



Patients with para- or tetraplegia frequently suffer from painful arthrosis, especially in their upper extremity due to heavy load during wheel-chair driving and transfers. However, frequently used bony procedures, such as fusions (arthrodesis), arthroplasty or joint implants have great disadvantages for this population, as they require long post-operative immobilization or severely restrict joint mobility which is a prerequisite for using manual wheel-chairs.
Surgical denervation means selective transection of nerve fibers transmitting pain from the joint to the brain which leads to significant reduction of pain symptoms. Joint integrity, skin sensitivity and motor innervation remains unaffected. No implants, postoperative rehabilitation or immobilization is required and early functional training is possible. All more invasive procedures, if needed in future, remain feasible.
This technique requires thorough anatomical knowledge and meticulous surgical technique. Since its introduction in the 1960ies, initial success rates of 80% or more have been reported for wrist but also in other joints, such as the shoulder, elbow, hand (finger and thumb) or the lower extremity (knee and ankle) have been successfully treated with this technique.
The effect of the operation can be predicted pre-operatively by temporarily blocking the nerves responsible for the respective joint by local anaesthesia.


In patients with spinal cord injuries, the method has been introduced recently at the Swiss Paraplegia Center in Nottwil by Dr. Andreas Gohritz. The incisions are small as depicted in the schematic picture, but great relief is possible, above all in painful wrists and thumb carpo-metacarpal (basis of the thumb) joints.