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The Spastic Upper Extremity in Children: Multilevel Surgical Decision-making.
Sonia Chaudhry1, Praveen Bhardwaj, Hari Venkatramani
1From the Department of Orthopaedic Surgery (Chaudhry), University of Connecticut, Connecticut Children's Medical Center, Hartford, CT, and the Department of Hand and Microsurgery (Bhardwaj, Venkatramani, and Sabapathy), Ganga Hospital, Coimbatore, India.
Multilevel surgery for upper extremity spasticity requires careful surgical planning to optimize outcomes. Comprehensive assessment is crucial to balance contracture release with functional goals, avoiding worsened function or new deformities.
Area of Science:
- Orthopedic Surgery
- Neurology
- Rehabilitation Medicine
Background:
- Multilevel surgery is the standard for upper extremity spasticity.
- Existing literature lacks comprehensive surgical planning guidance.
- Patient presentations involve complex posturing patterns.
Purpose of the Study:
- To provide a comprehensive guide for surgical planning in upper extremity spasticity.
- To detail considerations for optimizing surgical outcomes.
- To address common challenges in surgical decision-making.
Main Methods:
- Detailed examination for contracture, laxity, and aberrant muscle activity.
- Balancing contracture release and tendon transfers against functional weakening.
- Considering joint fusion for stability when necessary.
Main Results:
- Recognizing dynamic posturing and intrinsic hand spasticity is vital.
- Surgical indications must be tailored to individual deformity patterns and goals.
- Preexisting voluntary control is a key prognostic indicator for functional improvement.
Conclusions:
- Careful surgical planning is essential for successful multilevel surgery in upper extremity spasticity.
- Balancing interventions and managing expectations optimizes limb function and appearance.
- Failure to plan adequately can lead to worsened function and new deformities.
