Tetraplegics can move again in the hand – a light in Nottwil makes it possible

Thanks to the new methods, the quadriplegics can move again with their hands and hands. Such operations can only be performed by about 30 surgeons around the world. Jan Friden of the Swiss Paraplegic Center in Nottwil is one of them.

Niels Jost

Hand surgeon Jan Friden has already performed surgery on more than 1,200 tetraplegics, so he can re-raise his hands again. (Photo: Nadia Schärli (Nottwil, 30 October 2018))

Hand surgeon Jan Friden has already performed surgery on more than 1,200 tetraplegics, so he can re-raise his hands again. (Photo: Nadia Schärli (Nottwil, 30 October 2018))

Jan Fridén is a sought-after man. He does not have time for an interview. The appointment is therefore organized several weeks in advance. It is surprising, therefore, how the surgeon at our meeting at the Swiss Paraplegic Center (SPZ) in Nottwil appears: a t-shirt, pants for regular coaches and finches. Friden looks charismatic, relaxed, but his eyes are focused. He was just on the operating table, explains the Swede, but his colleagues in the hand and tetrahedral surgery department are now proceeding.

Although Friden speaks well German and even Swiss Germans, we speak English. So he could better explain how quadriplegic can move his hands and hands again again – and why one in five opted for such an OP.

Jan Friden, you are considered a source of light in tetrahedral surgery, you have done approximately 1200 hands reconstruction in patients with spinal cord injuries. Only about 30 surgeons around the world can do it – although this methodology has been known since the 1970s.

At that time the method received too little attention. Only ten years ago, nerve transfer technology has been restored and has evolved since then. My technique is unique because we can do it with just one operation so that the patient can open and close the fingers without using the original muscles or tendons. This is done by placing the muscles or nerves in a different position.

Which patients treat you and your team of six people with the SPL?

Those with spinal cord injuries, but also the brain, come to us. People who do not have or have limited manual and manual functions. Whether it is due to an accident, illness or infection, we are able to restore all or part of the hand functions. There are three surgical methods: either move the muscles, tendons or nerves and reassemble them.

"If you can move again, you will get a great quality of life."

How does it work?

The method we use depends on how the spinal cord is damaged. If the paralysis is relatively deep, for example, interrupts muscle transduction. We move the intact muscle from the upper or lower shoulder to the point where it can perform central functions such as bending the fingers or closing and opening the fist.

This means that the tetraplegic muscles are paralyzed but still intact?

The muscles are fully functional. They need only one impulse. To this end, cut the intact nerve and insert it into the non-functional nerve. The nerves are growing again – up to a millimeter per day! We ensure that the growing nerve finds the target muscle, which in turn allows for the functions of the hand.

The interview is interrupted. Friden's cell phone rings. "This is the operating room, I have to get there quickly," he says. Several advice later will focus on the interview again, but says, "In 30 minutes, I must be back in the operating room, is it possible?"

How long does the operation take?

Five to six hours. But that's not enough.

What do you mean?

After this complicated operation, patients must remain in the license plate for up to three months and then spend several months in the outpatient area. Say: Far from home, back to the clinic. This is the main reason why about one in five refuses surgery.

How long does the rehabilitation process take?

The patient must restart all arm and hand functions. It takes up to 12 months – and it's hard work. Because even for simple actions in everyday life, movements are extremely complex. For example, if you want to lift the glass, you must first stretch your hand, then open your hand, hold the glass sufficiently under pressure, and then turn off the glass again. This requires a lot of timing and balance.

"If someone is not willing to face the learning process, the surgery will not help."

Is your method always successful?

If someone is not willing to face the learning process, the OP will not help. But before each procedure, we perform tests and prognosis to get the patient back. Obtaining 100% skill is hardly possible, but in any case we can improve.


If you can move your hands again, you get a great quality of life. Whether you can shake someone's arms or embrace them, or even communicate, for example with a mobile phone. In addition, patients can move their own wheelchair. Such interventions alter the life of the patient and his surroundings. It motivates me to work every day.

Will he pay the insurance for the procedure?

Yes, but we need to tell the insurers exactly what skills the patient will return. However, when someone can get dressed again, it is aggravated by the long-term health system.

Recently, the media said the paraplegic may go through ETH therapy again. Would it also be possible with your method?

No. Feet carries all body weight. Currently, we can not reanimate as much muscle mass through techniques of muscle or nerve transfer.

However, modern medicine has no limitations. How far should it be? Also play your ethics at work
Do the rules play a role?

Of course. On the contrary, I wonder how I can give as many people as possible access to such modern methods. They are only available in 15 countries around the world. It would be good if it was much more.

You have been in the Registry since 2011, before you headed the Center for Surgery of Tetral Surgery at the Göteborg University Hospital, at your home. Why change in Nottwil?

The competence center with Nottwil hand surgery is unique in Europe. Our team consists not only of physicians, but also of physiotherapists and therapists from occupations, researchers and doctoral students.

After 60 minutes, the conversation is over. Friden left for five minutes for a photo session. "Then I have to go to the operating room."

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