Surgical Management of Spasticity of the Elbow

Berger, Aaron J.; Salhi, Saoussen; Payares-Lizano, Monica

doi:10.1016/j.hcl.2018.06.007

Cited by 9 publications

(7 citation statements)

References 11 publications

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Section: Systematic Upper Limb Examinationmentioning

confidence: 97%

“…23 If a deficit of active elbow extension is noted and the flexion contracture has been corrected to within 20°, one can consider biceps transfer for extension if the supinator and brachialis are functional. 24 Improvements after partial release are maintained over 5 years. 25 Elbow flexion contracture exceeding 45°, more common in patients with CP after age 12, 26 warrants complete release of the anterior capsule and brachialis with biceps Z-lengthening, although the latter can exacerbate pronation deformity.…”

Section: Elbowmentioning

confidence: 97%

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The Spastic Upper Extremity in Children: Multilevel Surgical Decision-making

Chaudhry

Bhardwaj

Venkatramani

et al. 2021

J Am Acad Orthop Surg

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Multilevel surgery for upper extremity spasticity is the current surgical standard. While the literature details surgical techniques and outcomes, a comprehensive guide to surgical planning is lacking. Patients commonly present with posturing into shoulder internal rotation, elbow flexion, forearm pronation, wrist flexion with ulnar deviation, finger flexion, and thumb adduction, although variations exist. Multiple surgical options exist for each segment; therefore, repeated examinations for contracture, pathologic laxity, and out of phase activity are necessary to optimize the surgical plan. To avoid decreasing function, one must carefully balance the benefits of contracture release and tendon transfers with their weakening effects. In certain cases, stability from joint fusion outweighs the loss of motion. Failure to recognize dynamic posturing, grasp and release requirements, or hand intrinsic spasticity can worsen function and cause new deformities. Surgical indications are formulated for individual deformity patterns and severity along with personal/family goals. General comprehension, voluntary control, and sensation, although not modifiable, influence decision making and are prognostic indicators. Functional improvement is unlikely without preexisting voluntary control, but appearance and visual feedback may be improved by repositioning nonetheless. Appropriate interventions and management of expectations will optimize limb appearance and function while avoiding unexpected sequelae.

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Section: Systematic Upper Limb Examinationmentioning

confidence: 97%

Section: Elbowmentioning

confidence: 97%

The Spastic Upper Extremity in Children: Multilevel Surgical Decision-making

Chaudhry

Bhardwaj

Venkatramani

et al. 2021

J Am Acad Orthop Surg

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“…Provođenje vježbi istezanja umanjuje rizik od kontraktura pa se u procesu rehabilitacije za njihovo provođenje osposobljavaju bolesnik i članovi obitelji. Koristi se i botulinski toksin te kirurško opuštanje tetiva u slučaju neuspjeha konzervativnog liječenja 28,29 . Važna je pravilna prehrana i hidracija blesnika 12 .…”

Section: Prevencija Kontrakturaunclassified

Rehabilitacija osoba nakon moždanog udara

Laktašić-Žerjavić

Slivar

Perić

2022

Med. Flum. (Online)

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Moždani udar, iako nastupa naglo, u svojoj biti je kronično stanje. Morbiditet i mortalitet od moždanog udara i dalje su vrlo visoki, a onima koji su preživjeli moždani udar, u pravilu, potrebna je akutna bolnička skrb koja se zatim nastavlja kroz subakutnu rehabilitaciju i, u konačnici, reintegraciju u zajednicu. Rehabilitacija se provodi timskim interdisciplinarnim pristupom. Usprkos uloženim naporima, još uvijek postoji mnogo nezadovoljenih potreba preživjelih koji su doživjeli moždani udar, počevši od dostupnosti akutne bolničke skrbi, potom dostupnosti i organizacije subakutne rehabilitacije te, u konačnici, od mogućnosti reintegracije u zajednicu. Rehabilitacija bi trebala započeti tijekom akutne bolničke skrbi unutar prvih 24 do 48 sati kroz ranu mobilizaciju bolesnika. U subakutnoj fazi ishod rehabilitacije izravno ovisi o broju sati dnevno provedenih u rehabilitacijskom programu. Za uspješan ishod rehabilitacije važno je individualno procijeniti oštećenje i funkciju pomoću specifičnih mjernih instrumenata, postaviti individualizirane ciljeve i sukladno tome izraditi plan rehabilitacije te pratiti učinkovitost rehabilitacijskog programa. Primarni je cilj rehabilitacije uspostavljanje samostalnosti u obavljanju aktivnosti svakodnevnog života. U članku su pregledno prikazani tijek rehabilitacije nakon moždanog udara, primarna i sekundarna oštećenja tjelesnih funkcija i struktura nakon moždanog udara, kao i ograničenja aktivnosti koja iz njih proizlaze, te osnovni principi njihove rehabilitacije.

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“…Problems include pain, difficulty washing/dressing, cosmetic appearance and abilities to conduct activities of daily living. 1 Surgical options are explored when more conservative measures are unable to meet patient needs.…”

Section: Introductionmentioning

confidence: 99%

Surgical management of the spastic elbow

Luo

Nixon

2022

Shoulder & Elbow

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Background We performed a retrospective review of patients undergoing surgery for elbow spasticity. We present our findings and expected outcomes according to degree of elbow fixed flexion contracture. Methods Data collected included age, Modified Ashworth Score, pre and post-operative range of motion, indications for surgery and the Goal Attainment Score. Contracture severity was classified into five groups based on goniometric measurements. Surgical procedures were categorised into three groups. Results A total of 114 elbows underwent surgical release. The mean age at surgery was 18.5 years and the mean follow-up was 20 months. Preoperatively, the median Modified Ashworth Score was 2 and the mean contracture was 68° (35° fixed and 33° dynamic). The median number of structures released was 3 (range: 1–6). Surgical procedures were classified as biceps sparing (27%), biceps lengthening (53%) and extended releases (18%). Mean improvement in extension was 59°, and the mean improvement in Goal Attainment Score was 36 (mean attainment score 62). The mean residual contracture was 9°. Patient satisfaction was high with over 90% of surgical indications met. Discussion Contracture severity of the spastic elbow can be categorised by degree of fixed flexion deformity and therefore treatment can be allocated accordingly.

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Surgical Management of Spasticity of the Elbow

Cited by 9 publications

References 11 publications

The Spastic Upper Extremity in Children: Multilevel Surgical Decision-making

The Spastic Upper Extremity in Children: Multilevel Surgical Decision-making

Rehabilitacija osoba nakon moždanog udara

Surgical management of the spastic elbow

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