Surgical Management of the Spastic Forearm, Wrist, and Hand: Evidence-Based Treatment Recommendations: A Critical Analysis Review.

Abstract

» The surgical approach for the patient with a spastic upper limb must be individualized and goal-focused.» An injury to the central nervous system can lead to spinal reflex hyperexcitability with exaggerated muscle activation in response to quick stretch stimuli (i.e., spasticity).» Surgical treatment options are dependent on the potential for function in the spastic upper limb.» If volitional motor control is present, spastic motor units can be lengthened or released while preserving function.» In the absence of volitional motor control, spastic muscles can be divided, released, or denervated with selective neurectomies.