A unique surgical technique is helping people with SCI gain better use of their hands and wrists by rewiring nerves around their injury.
Shaking hands. Using a fork. Composing a message on a touch-screen phone. These everyday tasks become difficult to perform for an individual with a cervical spinal-cord injury (SCI). Many get by through the use of clever workarounds, tools and aids and the assistance of caretakers. Recently, another option has emerged to help these individuals regain fine motor skills in their wrists and fingers — nerve transfer surgery. For Craig Trimmell, nerve transfer surgeries not only enabled him to better use his wrists and open, close and straighten his fingers, they also skyrocketed his independence. These surgeries empowered him to complete more daily tasks, as well as enjoy hobbies and activities with loved ones.
“I now have freedom to do a lot of things with my son,” says Trimmell. “I can work out again. I can push a manual wheelchair. Before, I couldn’t keep my hands open to push. That’s been a big one, too.”
Trimmell was one of the early patients with SCI to undergo the unique procedure in 2015. Ultimately, he had two of these surgeries, once for each arm. Trimmell served in the U.S. Marine Corps from 2004 to 2008, performing two combat tours in Iraq and earned the rank of sergeant. After sustaining a C4 SCI, Trimmell became involved with the Paralyzed Veterans of America (PVA) Gateway Chapter in St. Louis. While researching his injury and options, Trimmell came across some case studies about nerve transfer surgeries. His occupational therapist put him in touch with Ida K. Fox, MD, a pioneer in the use of nerve transfers for patients with SCI.
Fox is co-director of the Center for Nerve Injury and Paralysis at the Washington University School of Medicine in St. Louis. She was beginning to establish a relationship with the local Department of Veterans Affairs (VA) office when Trimmell first met with her, and she is now also an attending surgeon for the VA St. Louis Healthcare System. After expressing his interest in the surgery, Trimmell underwent several tests to identify whether he was a good candidate. While his SCI included a fracture at the C4 level, his motor level is around C6 to C7. The tests determine if there’s a nerve that the brain can talk to and control that can be sacrificed and swapped in to talk to a muscle below the level of the SCI, without downgrading current function. Trimmell’s results qualified him for the surgery, and he began preparing with physical and occupational therapy sessions. The actual surgery lasted less than a day, and Trimmell described his pain as easily manageable.
“The bottom line is I need an expendable donor,” says Fox. “So if you think about arm function, there’s some redundancy or extras built in. For example, to bend the elbow there are three different muscles that do that. There’s your biceps, or your Popeye muscle, that everyone knows about. Underneath that is a muscle called brachialis, and then there’s a third muscle called brachioradialis that kind of helps with elbow flexion. Someone that has all three muscles working, I can probably take one or two of those if their brain can talk to those. I can swap the nerve over and swap it down to a nerve that goes to a muscle that the brain can’t talk to. So I’m kind of rewiring and working around the injury.
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