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Study Design: Retrospective audit., Objectives: The objective of this study was to identify the proportion of patients with cervical spinal cord injury who would potentially benefit from nerve transfer surgery to gain active hand opening, and to determine when a safe nerve transfer decision can be made., Setting: Christchurch, New Zealand., Methods: Case note review of the first 12 months following acute cervical spinal cord injury (2007-2012). Neurological assessment at 6 weeks, 12 weeks and 1 year following injury., Results: Fifty-three patients had complete assessments and showed changes in the level of injury and severity of neurological injury between assessments. Forty-two percent of patients had motor complete C5-7 level injuries 12 weeks following injury and would benefit from consideration for nerve transfer to improve hand opening. Fewer (26%) would benefit 1 year following injury owing to a change in the neurological level of injury., Conclusions: Twelve-week neurological assessment identifies patients who may benefit from nerve transfer surgery. This enables referral for comprehensive upper limb assessment and reassessment of motor function to determine suitability for surgical intervention. Nerve transfer within the window of opportunity provides active hand opening for patients following cervical spinal cord injury.

Purpose: To perform a 10-year re-review of hand function outcome for 24 tetraplegic persons who had received bilateral tendon transfers and tenodeses., Methods: The Lamb and Chan questionnaire with additional questions, the Quadriplegic Index of Function (QIF), the Swanson sphygmomanometer technique for hook grip, the Preston Pinch Meter (PP) for key pinch, and a digital analyzer (DA) for both hook and key pinch were the test instruments used. The QIF and DA had not been used previously., Results: Levels of functional independence and expectations were maintained. Mean hook grip values were maintained for the right hand but increased significantly for the left to reach right hand values. Mean pinch grip values decreased significantly. DA measurements confirmed similar hook grip values for both hands but key pinch values were significantly higher than the PP values. Active transfers averaged approximately twice the strength of tenodeses., Conclusions: Hand function improvements gained from tendon transfers and tenodeses are maintained over time.