Reconstruction of the Tetraplegic Upper Extremity

Spinal cord injuries (SCI) resulting in Tetraplegia (quadriplegia) occurs most commonly in young, healthy individuals, who are in the prime of their lives and can occur in patients of all ages without discrimination of sex, social background, and/or ethnicity and race. The loss of functional use in the upper extremities is perhaps the most disabling of the numerous bodily functions impaired following a spinal cord injury.

In 1998, Dr. Nathan, along with Dr. Ann Vasile, a Long Beach Physiatrist with national expertise in the medical management of Spinal Cord Injury (SCI) and Tetraplegic patients, assembled a multidisciplinary team providing evaluation and surgical reconstruction for appropriate candidates. This team employed other SCI specialists, including occupational therapists, physical therapists, social workers, and nurse case managers, to best optimize SCI evaluation, treatment, and management. The team has provided evaluations for more than 250 Tetraplegic patients referred from local, regional, and national institutions. Since the inception of this subspecialty service, Dr. Nathan has performed surgical reconstructions in over 100 patients. Indications for surgical reconstruction of the upper extremity in the SCI patient include functional loss of hand and upper extremity function, which interferes with daily living activities. Many patients who have sustained a spinal cord injury may benefit from various surgical reconstructions. Those procedures Dr. Nathan has performed include tendon transfers for elbow extension restoration, key pinch and grip reconstructions, contracture releases, tenodesis procedures, and arthrodesis.

Dr. Nathan also has experience in implantation of neuroprosthetic systems (Freehand®), which has proven extremely valuable in providing functional hand use in higher levels of SCI patients (levels C-5 and C-6).

In 2014, Dr. Nathan was appointed to the staff at the Veterans Affairs Long Beach Healthcare System, where he has developed a specialized surgical service for reconstruction of the tetraplegic upper extremity. This service meets monthly, and in conjunction with VA staff, residents, and therapists, is focused on teaching, continued research and surgical care for injured veterans with spinal cord injury and tetraplegia.

More recently, Dr. Nathan and Dr. Vasile have collaborated with Dr. Justin Brown, Neurosurgeon with expertise in nerve transfers for paralysis (University of California San Diego), and have developed a combined multispecialty upper extremity tetraplegia clinic, known as the California Paralysis Center (CPC). This unique clinical and surgical service focuses on research, reconstruction, and rehabilitation to those with upper extremity paralysis and deformities secondary to spinal cord injury and tetraplegia. Patients are evaluated in a private practice setting, where (as a team) Dr. Nathan, Dr. Vasile and Dr. Brown provide state of the art surgical reconstructions employing the latest techniques such as tendon transfers, tenodesis and nerve transfers.

For more information about the California Paralysis Center (CPC), which meets regularly in Long Beach, please contact our office at (562) 424-9000.

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