Surgical alterations were combined with functional neuromuscular stimulation to enhance hand function in the patient with high-level spinal injury. These alterations are: thumb interphalangeal joint arthrodesis, finger tendon synchronization, and tendon transfer of muscles with upper motor neuron lesions. These procedures resulted in more uniform movement of the digits, generation of movement unavailable because of denervation, and use of an additional stimulated muscle. The main difficulty with the tendon transfer synchronization procedures was the development of postsurgical adhesions. This problem has been mitigated by earlier postsurgical mobilization of the tendons, with no instances of rupture.
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