Decision-Making in the Treatment of the Spastic Shoulder and Elbow: Tendon Release Versus Tendon Lengthening

Abstract

Spastic deformities of the shoulder and elbow are often seen after injury to the upper motor neuron system. | JBJS REVIEWS 2014;2(10):e3 · http://dx.

Surgical Intervention for Spastic Upper Extremity Improves Lower Extremity Kinematics in Spastic Adults: A Collection of Case Studies

“…Three patients with an anoxic brain lesion (two stroke patients SP1, SP2, and one CP patient SP3) were recruited through the hand surgeon's clinic. The criteria for eligibility and inclusion in the study were (Thevenin-Lemoine et al, 2013) upper limb spasticity due to an anoxic brain lesion, Photopoulos et al (2014) observed gait abnormalities, Sheean (2002) an ability to ambulate independently with or without assistive devices, and (Emos and Agarwal, 2018) no history of previous surgery to release spasticity in the upper limb. In all three patients, there were no pharmacological treatment to reduce spasticity and no history of rehabilitation on upper or lower limbs within 6 months prior to enrollment in the study.…”

“…Impairments of motor and sensory function and coordination are often consequences of injury to the central nervous system (Thevenin-Lemoine et al, 2013;Photopoulos et al, 2014). Upper motor neuron syndrome (UMNS) is a condition that arises as a result of the disturbance of the UMN inhibitory pathways extending all the way from the cerebral cortex to the lower end of the spinal cord (Sheean, 2002).…”

Surgical Management of the Spastic Forearm, Wrist, and Hand: Evidence-Based Treatment Recommendations

“…Hyperreflexia can produce an increase in motor tone, with exaggerated muscle activation or tendon jerk, known as spasticity (in response to quick stretch stimuli) or rigidity (in response to slow stretch stimuli) 3,5 . Additionally, agonist muscle activation can trigger spastic co-contraction of the antagonist muscle, which is known as dyssynergy 2,3,6 .…”

“…For example, active forearm pronation can be assessed with the elbow flexed or extended to preferentially test the pronator quadratus and pronator teres muscles, respectively. A clinical scale from 1 to 6 can be utilized to classify motor control across a specific joint as shown in Table IV 2,3 . Last, careful visual observation and palpation to detect co-contraction of antagonist muscles when voluntarily activating the agonist muscle should be performed to identify the presence of dyssynergy.…”

“…entral nervous system injuries can manifest as a constellation of deficits, known as upper motor neuron syndrome, consisting of decreased motor control, motor weakness, easy fatigability, distorted muscle tone, and exaggerated deep tendon reflexes 1,2 . Altered regulation and/or loss of voluntary motor activity due to damaged upper motor neuron inhibitory pathways can lead to unbalanced forces across a joint, which can lead to dynamic or static deformities 3,4 .…”