Dr. Steven Rueda is one of the most sought after hand doctors for the treatment of tetraplegia in Palm Beach. Patients who sustained spinal cord injury suffer from decreased hand function that limits daily activities. The function of the hand is highly dependent on the level of spinal cord injury, with higher levels often leading to worse hand function. Surgery for tetraplegia has existed for many years and helped many patients improve their hand function. Awareness continues to increase in the tetraplegia community to visit the hand specialist as patients continue to achieve results that improve their lifestyle.

Tetraplegia Symptoms and Diagnosis

Some of the most common upper extremity symptoms after spinal cord injury include:


  • Inability to extend the wrist
  • Inability to pinch with the thumb
  • Decreased function of the hand
  • Inability to bend the fingers
  • Inability to extend the elbow

The function muscle in the arm of a spinal cord injury patient depend on the level of trauma. Patients with the high levels of spinal cord injury are severely affected with no ability to pinch or extend their wrist. Those with lower injury have improved hand function.

Patients who present to the hand specialist with tetraplegia already have a diagnosis from the time of their injury or since birth. The diagnosis of hand specific conditions is usually performed with physical examination alone. Nerve conduction studies and EMG are frequently ordered to assess the innervation and condition of different muscles and nerves.

WHAT CAUSES Tetraplegia?

Tetraplegia can result from many causes including birth defects, brain or spinal cord injury, stroke, and trauma among others. After prolonged therapy, some patients are able to recover neurologic function of their hand and upper extremity. Unfortunately, some are unable to regain some function and sensation. The latter usually seek treatment from a hand specialist.

Tetraplegia Treatment Options

Treatment of the hand after spinal cord injury is complex and requires the work of neurologists, physical medicine specialist, therapists, and hand specialists. The initial part of the treatment is therapy to ensure the joints remain loose and do not freeze. There are special splints that can be worn to stabilize joints and enhance function of parts of the hand. Neurologist and Physical Medicine specialists may suggest different medical treatments that can potentially enhance function.
Surgery remains an option for patients who have not found desirable function after therapy, splints, and rehabilitation. Neurologic recovery needs to have reached a plateau prior to considering any surgical intervention. Surgery focuses on identifying working muscles and tendons (donors) that can be transferred to replace non-functioning muscles and tendons (recipients). In order to enable them to be transferred, the donor muscle needs to have normal function. The end goal of surgery is to enhance hand function so that he patient can extend their wrist and regain pinch. For patients who have lower injuries, the surgery focuses in regaining finger movement and more advanced and specific hand functions.

Tetraplegia Procedure

Tendon transfers are the most common procedures used to treat tetraplegia. The type of procedure performed depends on the level of paralysis and those muscles that remain available to transfer their function to spastic or weak muscles. The higher the level of injury, the more limited the options are to regain full hand function. On the other hand, the lower the level of paralysis the more options are available to replace weak functioning muscles.

Tendon transfer is a procedure in which a tendon with good function and strength is moved to another tendon that is weak or has no function. In tetraplegia, the tendons are transferred to muscles that are weak to regain previously lost functions. In some other cases, spastic muscles are also treated with tendon transfers or lengthening to prevent them from overpowering residual limb function that other muscles provide.


Procedures for tetraplegia are outpatient in most cases. Recovery is variable and depends on the areas treated and type of procedure. Most of these procedures achieve recovery in 2 weeks, but there is need for therapy for at least 3-6 months after the surgery. The patients needs to train their body to the new muscle function.

Wound healing for tetraplegia surgery is typically complete in 1-2 weeks after the procedure. Return to work or activities depends on the procedure performed and is discussed at the time of the visit.

Why Choose Precision Hand Center for your Tetraplegia Procedure?

Dr. Rueda, a Hand Fellowship trained surgeon who has 7 years and 2,000 procedures of experience will be your safe and best choice for treatment of upper extremity treatment after spinal cord injury. Successful results in this procedure requires a surgeon that is experienced and knowledgeable in hand surgery and hand anatomy. Dr. Rueda has published articles in expert peer reviewed journals and his work has been presented in several national conferences. Dr. Rueda’s passion for patient education and custom centered approach will guarantee you feel comfortable every step of the way. Dr. Rueda also believes in treating his patients as if he was treating his own family; you can trust you will enter a trusting and long-term relationship and have some of the best tetraplegia treatment Palm Beach can offer.


It is important that patients have achieved a plateau of neurologic recovery after their initial injury. If no recovery is seen the idea of surgery can then be studied. Procedures for tetraplegia are goal directed and need patients who are very well motivated, have some residual voluntary control of forearm and hand muscles, and who are able to commit to prolonged therapy. They also must be in good medical condition to perform the procedure under general anesthesia or sedation. 

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