Upper limb spasticity surgery in adults: What we learned in 5 years of practicing it

Abstract

We have been practicing surgical management of adult upper limb spasticity for the past 5 years. So far, we have evaluated 20 patients, and we have operated on nine patients with spasticity of the upper limb in Cyprus and the United Kingdom. We aim to present the setup and running of a new service, which is devoted to Surgery for Spasticity of the Upper Limb. We present our structure, organisational processes and service provision as well as our results in the nine cases that had surgical treatment as a part of their management (as well as our preferred techniques). We discuss our outcomes as well as our learning points from these cases. We also believe that selective neurectomy procedures can be very useful in the surgical management of upper limb spasticity. Tendon transfers to augment finger extension have a limited role and provide no significant benefits in adult spasticity cases. In addition, we found that the extensor carpi ulnaris transfer to extensor carpi radialis brevis has in our experience, reliable results regarding concentric wrist extension as well as easier rehabilitation. Furthermore, in severe cases, where no functional improvement is expected, joint fusions have a more predictable outcome. Spasticity reduction surgery does gain ground with the increase in survival of stroke patients as well as traumatic brain injury patients. Therefore, up to date methods for assessing, operating and evaluating postoperatively this category of patients need to be vigorously checked.