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Spasticity and hyperselective neurectomy in the upper limb
M Gras1, C Leclercq1
1Institut de la main, clinique Bizet, 23, rue Georges-Bizet, 75116 Paris, France.
Hand Surgery & Rehabilitation
|October 17, 2017
Summary
Hyperselective neurectomy (HSN) effectively reduces spasticity and improves function in both children and adults. This surgical technique offers a reliable, long-term solution for upper limb spasticity, even in functional hands.
Area of Science:
- Neurology
- Orthopedic Surgery
- Rehabilitation Medicine
Background:
- Spasticity presents complex challenges in assessment and treatment.
- Neurectomy, a surgical option for spasticity since 1912, has traditionally been reserved for nonfunctional hands.
- Advancements in anatomical understanding have refined neurectomy techniques.
Purpose of the Study:
- To describe the history and anatomical basis of neurectomy.
- To detail the hyperselective neurectomy (HSN) technique for upper limb nerves (musculocutaneous, median, ulnar).
- To evaluate the efficacy and durability of HSN in pediatric and adult spastic patients.
Main Methods:
- Review of neurectomy history and anatomical dissections.
- Description of the hyperselective neurectomy (HSN) surgical technique.
- Prospective study evaluating spasticity, mobility, performance, and function post-HSN in children and adults.
Main Results:
- HSN demonstrated a reduction in spasticity across targeted functions (elbow extension, wrist extension, supination).
- Significant improvements were observed in the functional House score.
- Results showed stability at both short-term (few months) and long-term (12 months) follow-ups.
Conclusions:
- Hyperselective neurectomy (HSN) is a reliable therapeutic option for managing upper limb spasticity.
- HSN improves functional outcomes and is effective even for patients with functional hands.
- The positive effects of HSN on spasticity and function appear to be durable.