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Updated: Feb 22, 2026

Structured Motor Rehabilitation After Selective Nerve Transfers

Structured Motor Rehabilitation After Selective Nerve Transfers

Published on: August 15, 2019

Hyperselective Neurectomy for Upper-Limb Spasticity: Clinical Outcomes From a Systematic Review.

J Terrence Jose Jerome^1,2, G Surendran^1,3, Thirumagal Kuppusamy¹

¹Olympia Hospital & Research Centre, Trichy, India.

Hand (New York, N.Y.)

|February 21, 2026

Summary

This summary is machine-generated.

Hyperselective neurectomy (HSN) effectively reduces upper-limb spasticity after neurological injury, improving function and care. This surgical technique offers durable tone reduction with minimal complications, preserving voluntary muscle strength.

Keywords:

House Functional Classification Modified Ashworth Scale WALANT hyperselective neurectomy peripheral nerve surgery selective peripheral neurotomy spasticity surgery systematic review upper-limb spasticity wide-awake local anesthesia

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Area of Science:

Neurosurgery
Rehabilitation Medicine
Neurology

Background:

Upper-limb spasticity is a common and disabling consequence of neurological conditions like stroke, traumatic brain injury, cerebral palsy, multiple sclerosis, and spinal cord injury.
Spasticity significantly limits functional independence, activities of daily living, and the ability of caregivers to provide assistance.

Purpose of the Study:

To systematically review the existing literature on Hyperselective Neurectomy (HSN) for managing upper-limb spasticity.
To evaluate the efficacy, durability, safety, and functional outcomes associated with HSN.

Main Methods:

A systematic review was conducted following PRISMA 2020 guidelines.
Ten studies involving 260 adult patients were analyzed.
Data on spasticity reduction (Modified Ashworth Scale), functional improvements, complications, and recurrence rates were extracted and synthesized.

Main Results:

HSN demonstrated a significant reduction in spasticity, averaging 1.64 points on the Modified Ashworth Scale (95% CI, 1.36-1.92).
These benefits were durable, lasting up to 4-5 years, and were associated with improved function, range of motion, and easier patient care.
Complications were rare and transient, with no reported permanent weakness in treated muscles. Recurrence was uncommon and manageable.

Conclusions:

Hyperselective Neurectomy (HSN) is a safe and effective treatment for reducing upper-limb spasticity, leading to meaningful functional gains.
The procedure offers durable tone reduction and improves quality of life for patients with various neurological conditions.
Future research should focus on optimizing patient selection, utilizing advanced spasticity assessment tools, and comparing different anesthesia techniques, including Wide-Awake Local Anesthesia No Tourniquet (WALANT).