Results and complications of superficialis-to-profundus tendon transfer in brain-damaged patients, a series of 26 patients

Peraut, Emmanuella; Taieb, Laura; Jourdan, C.; Coroian, F.; Laffont, I.; Chammas, Michel; Coulet, Bertrand

doi:10.1016/j.otsr.2017.08.019

Cited by 19 publications

(14 citation statements)

References 12 publications

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“…We included a distal tenotomy of the lumbrical tendons to the index and middle fingers to prevent future overactivity in the median innervated lumbricals. This comprehensive surgical approach to spasticity in the wrist and fingers precludes recurrence of severe deformity as shown in two publications of 31 patients with a mean follow-up of 50 months (Keenan et al., 1987) and 26 patients over 47 months (Peraut et al., 2018). In our series, none of the five patients with a clinical follow-up of over 2 years showed recurrent deformity.…”

Section: Discussionmentioning

confidence: 99%

“…Previous publications have shown the long-term benefit of upper limb surgery in severe spasticity, mostly with regards to function, appearance or hygiene (Heijnen et al., 2008; Keenan et al., 1987; Peraut et al., 2018; Pomerance and Keenan, 1996; Thevenin-Lemoine et al., 2013). The patients we treated were in the worst group of the Keenan classification (Keenan et al., 1987) for hand position and would have been rated as 0 (=does not use hand) in the functional classification of House et al.…”

Section: Discussionmentioning

confidence: 99%

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Upper limb surgery for severe spasticity after acquired brain injury improves ease of care

Gschwind

Yeomans

Smith

2019

J Hand Surg Eur Vol

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For individuals with acquired brain injury and severe upper limb spasticity, personal care is often difficult, time-consuming and painful. Previous studies on outcomes after surgery for upper limb spasticity have focused on functional gain, pain, hygiene and appearance. We operated on 38 non-communicative patients (45 limbs, 535 procedures) with severe spasticity and a non-functional upper limb(s). The surgical goals were to provide opening of the fingers and thumb, wrist stability and, if required, to release muscles around the elbow and shoulder. We used the Carer Burden Score as a relevant outcome measure. Preoperatively and 3 months postoperatively, the carer rated the degree of difficulty in cleaning the palm, cutting the fingernails, cleaning the axilla and dressing the upper body on a 5-point Likert scale. Surgery significantly improved the ease of care, which has implications not only for the patient but also for carers and associated health costs. Level of evidence: IV

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Upper limb surgery for severe spasticity after acquired brain injury improves ease of care

Gschwind

Yeomans

Smith

2019

J Hand Surg Eur Vol

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“…Many articles suggest tendon transfer to enhance function or to ease the care in spastic hands. Transfer of the FDS tendon to the FDP is one of the most common techniques (38)(39)(40)(41). Keenan et al (38) reported full accomplishment of goals after the procedure in 34 clenched-fist which were hand open position with the resolution of hygienic problems of palmar skin.…”

Section: Wrist and Fingermentioning

confidence: 99%

Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review

Hashemi

Sturbois-Nachef

Keenan

et al. 2021

Front. Rehabilit. Sci.

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Introduction: Spasticity is the main complication of many upper motor neuron disorders. Many studies describe neuro-orthopedic surgeries for the correction of joint and limb deformities due to spasticity, though less in the upper extremity. The bulk of care provided to patients with spasticity is provided by rehabilitation clinicians, however, few of the surgical outcomes have been summarized or appraised in the rehabilitation literature.Objective: To review the literature for neuro-orthopedic surgical techniques in the upper limb and evaluate the level of evidence for their efficacy in adult patients with spasticity.Method: Electronic databases of MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were searched for English, French as well as Farsi languages human studies from 1980 to July 2, 2020. After removing duplicated articles, 2,855 studies were screened and 80 were found to be included based on the criteria. The studies were then divided into two groups, with 40 in each trial and non-trial. The results of the 40 trial articles were summarized in three groups: shoulder, elbow and forearm, and wrist and finger, and each group was subdivided based on the types of intervention.Results: The level of evidence was evaluated by Sackett's approach. There were no randomized control trial studies found. About, 4 studies for shoulder, 8 studies for elbow and forearm, 26 studies for wrist and finger (including 4 for the thumb in palm deformity), and 2 systematic reviews were found. Around, two out of 40 trial articles were published in the rehabilitation journals, one systematic review in Cochrane, and the remaining 38 were published in the surgical journals.Conclusion: Most surgical procedures are complex, consisting of several techniques based on the problems and goals of the patient. This complexity interferes with the evaluation of every single procedure. Heterogenicity of the participants and the absence of clinical trial studies are other factors of not having a single conclusion. This review reveals that almost all the studies suggested good results after the surgery in carefully selected cases with goals of reducing spasticity and improvement in function, pain, hygiene, and appearance. A more unified approach and criteria are needed to facilitate a collaborative, evidence-based, patient referral, and surgical selection pathway.

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“…The comprehensive approach to shoulder, elbow, wrist motor tenotomy with fusion, adequate lengthening of the finger flexors, neurotomy of the deep branch of the ulnar nerve with or without intrinsic release, neurotomy of the recurrent branch of the median nerve with or without release of the thumb adductor, as well as correction of interphalangeal joint deformities provide long lasting effects as all structures potentially hindering access for hygiene in the future are addressed. We referenced the relevant publications with longer follow-up using a similar surgical approach (Heijnen et al., 2008; Keenan et al., 1987; Peraut et al., 2018; Pomerance and Keenan, 1996). We decided against recalling our cohort for logistics and cost reasons.…”

Section: Replymentioning

confidence: 99%

Re: Gschwind CR, Yeomans JL, Smith BJ. Upper limb surgery for severe spasticity after acquired brain injury improves ease of care. J Hand Surg Eur. 2019, 44: 898–904.

Ryan

Song

Chan

2019

J Hand Surg Eur Vol

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Results and complications of superficialis-to-profundus tendon transfer in brain-damaged patients, a series of 26 patients

Abstract: IV-retrospective or historical series.

Cited by 19 publications

References 12 publications

Upper limb surgery for severe spasticity after acquired brain injury improves ease of care

Upper limb surgery for severe spasticity after acquired brain injury improves ease of care

Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review

Re: Gschwind CR, Yeomans JL, Smith BJ. Upper limb surgery for severe spasticity after acquired brain injury improves ease of care. J Hand Surg Eur. 2019, 44: 898–904.

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