Orthopedic Interventions for the Management of Limb Deformities in Upper Motoneuron Syndromes

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

“…The patient should be observed in a variety of different positions and postures, and the shoulder and elbow should be subsequently observed through a variety of both slow and fast motions. Motor control about a single joint subsequently can be classified on a clinical scale as grade 1 (hypotonic, with no active motion), grade 2 (hypertonic, with no active motion), grade 3 (mass flexion or extension in response to a stimulus), grade 4 (patient-initiated mass flexion or extension), grade 5 (slow volitional control of specific joints), or grade 6 (full voluntary control of individual joints) 16 .…”