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Published on: October 29, 2021
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Current Concepts for Nerve-Based Procedures to Treat Upper Limb Spasticity.
Olga Politikou1, Oskar C Aszmann2
1Hand Surgery Unit, Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland; Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.
Summary
Nerve surgeries for upper-limb spasticity offer targeted solutions. Peripheral techniques precisely modulate spastic muscles, preserving or restoring function for meaningful, durable results.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Rehabilitation Medicine
Background:
- Upper-limb spasticity significantly impacts motor function and quality of life.
- Current treatments often lack muscle specificity, leading to unintended consequences.
- Nerve-based surgical interventions are evolving for more precise spasticity management.
Purpose of the Study:
- To review nerve-based surgical approaches for upper-limb spasticity.
- To compare central versus peripheral nerve interventions.
- To analyze anatomic targets and functional outcomes of these procedures.
Main Methods:
- Review of existing literature on surgical treatments for upper-limb spasticity.
- Categorization of procedures into central and peripheral nerve-based techniques.
- Analysis of studies reporting on anatomic targets, muscle specificity, and functional outcomes.
Main Results:
- Central procedures (e.g., selective dorsal rhizotomy) reduce overall tone but lack muscle specificity.
- Peripheral techniques (e.g., hyperselective neurectomy, nerve transfers) allow targeted modulation of specific spastic muscles.
- Peripheral interventions demonstrated potential for preserving strength and restoring volitional movement.
Conclusions:
- Peripheral nerve-based surgeries offer a more targeted approach to managing upper-limb spasticity.
- These techniques provide durable, functionally significant improvements.
- Personalized treatment plans combining nerve surgery with other therapies are recommended.
