Restoring Hand Function After Stroke

UC San Diego Health System takes a comprehensive approach to hand dysfunction following stroke or brain injury. Frequently, patients who have a good recovery from a stroke may continue to have functional impairments that do not respond to most contemporary rehabilitation efforts. Our Stroke Hand Restoration Program specialists provide novel and innovative treatments for our patients to bring back the functionality they rely on.

After a stroke, the nervous system “rewires” itself to compensate for the lost motor systems. Often, the nervous system can’t restore normal control to all of the muscles of the arm. Some muscles do not respond well at all, while others are significantly overactive, resulting in dysfunctional postures of the arm and hand. These dysfunctional muscles at times hide muscles that may actually have good control.

Restoring Function, Changing Lives

In order to achieve the highest level of arm and hand functioning, our specialists work with you to develop a reconstructive plan. We identify the level of electrical activity present in each muscle. Diagnostic technologies, including multichannel EMG studies, can test specific muscles within the arm and help determine what can be accomplished with treatment.

In some cases, when a small number of muscles are “deactivated”, the hand is able to function more normally. In other cases, numerous muscles work against each other. By partially cutting or rerouting nerves, the hand can regain normal function.  We also see patients who develop fixed shortenings of muscles or tendons following a stroke, which requires releasing the tendon or lengthening it to restore the ability to grasp.

In order to predict the effectiveness of surgical treatment, local injections of lidocaine can mimic the effect of surgery before the surgery is performed by temporarily relaxing a problematic muscle.

Treatment Types

  • Injections of Botox
  • Partial cutting of an overactive nerve (neurotomies)
  • Transfer of nerves to restore function to inactive muscles
  • Lengthening or cutting of tendons that are in a fixed position
  • Rerouting of tendons to balance forces across a joint

Our multidisciplinary team includes Geoffrey Sheean, MD,  an expert in the diagnostic testing and in the application of Botox for reducing spasticity;  Justin Brown, MD, an expert in peripheral neurotomies to reduce spasticity within specific muscles and nerve transfers for restoring activity to inactive muscle groups; Reid Abrams, MD, an expert in orthopedic procedures such as tendon releases and transfers. Dr. Abrams leads a team of upper extremity surgeons including Eric Hentzen, MD and Matthew Meunier, MD.

By providing a greater balance of function across the joint, physicians at the Stroke Hand Restoration Program are able to help individuals recover movement and function that could not otherwise be accomplished.