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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.

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Summary

Nerve surgeries for upper-limb spasticity offer targeted solutions. Peripheral techniques precisely modulate spastic muscles, preserving or restoring function for meaningful, durable results.

Keywords:
Contralateral C7 transferNerve transfersPeripheral neurotomyReflex circuit modulationSelective dorsal rhizotomyUpper-limb spasticity

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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.