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Bessaguet H, Calmels P, Schnitzler A, Coroian F, Giraux P, Angioni F, Adham A, Denormandie P, David R, Ojardias E. Percutaneous needle tenotomies: indications, procedures, efficacy and safety. A systematic review. Ann Phys Rehabil Med 2024; 67:101839. [PMID: 38824898 DOI: 10.1016/j.rehab.2024.101839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Percutaneous needle tenotomies constitute a promising approach that enables direct access to tendons through minimally invasive interventions. They can be performed rapidly without need for large incisions or general anaesthesia. However, the reported procedures are heterogeneous and currently conducted without guidelines. OBJECTIVES We aimed to determine the indications for percutaneous needle tenotomies described in the current literature. Our secondary aim was to identify the different procedures reported, as well as their efficacy and their safety. METHODS A systematic review following PRISMA guidelines was conducted to identify original articles that mentioned percutaneous needle tenotomy in humans and reported its application, description, effectiveness or adverse events. Non-percutaneous tendinous surgical procedures and ineligible designs were excluded. The Downs and Black checklist was used to assess the risk of bias. RESULTS A total of 540 studies were identified from the MEDLINE, Embase, Cochrane Library, and PEDro databases. Fourteen clinical studies met the inclusion criteria and were found to have an acceptable quality (674 individuals, 1664 tenotomies). Our results indicated a wide variety of indications for percutaneous needle tenotomies in children and in adults. We highlighted 24 tendons as eligible targets in the upper and lower limbs. Tenotomies were performed with either 16- or 18-Ga needles, lasted from 1 to 30 min, and were performed using various procedures. Their efficacy was mainly assessed through clinical outcomes highlighting tendon discontinuity on palpation after the procedure. Passive range-of-motion gains after tenotomy were reported for both upper and lower limbs with an estimated 5 % complication rate. CONCLUSION This is the first review to systematically synthesize all the available evidence on the indications, procedures, efficacy and safety of percutaneous tenotomies exclusively performed with needles. Current evidence suggests that procedures are safe and effective for treating various deformities. PROSPERO REGISTRATION CRD42022350571.
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Affiliation(s)
- Hugo Bessaguet
- Physical and Rehabilitation Medicine Department, University Hospital of Saint-Etienne, 25, boulevard Pasteur, 42100 Saint- Etienne, France; Inter-university Laboratory of Human Movement Biology, "Physical Ability and Fatigue in health and disease" team (F-42023), Saint-Etienne "Jean Monnet" & Lyon 1 & "Savoie Mont-Blanc" universities, Saint- Etienne, France.
| | - Paul Calmels
- Physical and Rehabilitation Medicine Department, University Hospital of Saint-Etienne, 25, boulevard Pasteur, 42100 Saint- Etienne, France; Inter-university Laboratory of Human Movement Biology, "Physical Ability and Fatigue in health and disease" team (F-42023), Saint-Etienne "Jean Monnet" & Lyon 1 & "Savoie Mont-Blanc" universities, Saint- Etienne, France
| | - Alexis Schnitzler
- Physical and Rehabilitation Medicine Department, Fernand-Widal Lariboisière University Hospital, 200, Faubourg Saint Denis street, 75010 Paris, France
| | - Flavia Coroian
- Physical and Rehabilitation Medicine Department, Lapeyronie University Hospital, 191, Doyen Gaston Giraud avenue, 34090 Montpellier, France
| | - Pascal Giraux
- Physical and Rehabilitation Medicine Department, University Hospital of Saint-Etienne, 25, boulevard Pasteur, 42100 Saint- Etienne, France; Lyon Neuroscience Research Center, Trajectoires team (Inserm UMR-S 1028, CNRS UMR 5292, Lyon 1 & Saint-Etienne Universities), France
| | - Florence Angioni
- Physical and Rehabilitation Medicine Department, Fernand-Widal Lariboisière University Hospital, 200, Faubourg Saint Denis street, 75010 Paris, France
| | - Ahmed Adham
- Physical and Rehabilitation Medicine Department, University Hospital of Saint-Etienne, 25, boulevard Pasteur, 42100 Saint- Etienne, France
| | - Philippe Denormandie
- Orthopedic Surgery Department, Raymond-Poincaré University Hospital, 104, Raymond-Poincaré boulevard, 92380 Garches, France
| | - Romain David
- Physical and Rehabilitation Medicine Department, PRISMATICS Lab, University Hospital of Poitiers, 2, La Milétrie street, 86000 Poitiers, France
| | - Etienne Ojardias
- Physical and Rehabilitation Medicine Department, University Hospital of Saint-Etienne, 25, boulevard Pasteur, 42100 Saint- Etienne, France; Lyon Neuroscience Research Center, Trajectoires team (Inserm UMR-S 1028, CNRS UMR 5292, Lyon 1 & Saint-Etienne Universities), France
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Nixon M, Zreik N, Bakhit H. Wrist arthrodesis and soft tissue rebalancing in the spastic hand. J Hand Surg Eur Vol 2024; 49:420-427. [PMID: 37879641 DOI: 10.1177/17531934231205548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
The aim of the present study was to investigate the outcomes of wrist arthrodesis with simultaneous soft tissue rebalancing of the digits in the spastic wrist. In 43 wrists (40 patients) the surgical goals, patient selection, procedures and outcomes were assessed. Preoperatively, mean passive extension was to 44° below neutral and only two patients had volitional control. Postoperatively, 33 and 10 cases reported excellent and good outcomes, respectively. A mean Goal Attainment Score of 62.4 indicated better than expected outcomes. In total, 37 hands required simultaneous finger rebalancing: 24 underwent tendon transfers and 13 surgical releases. A total of 12 thumbs required tendon transfers, three soft tissue releases and five metacarpophalangeal joint stabilization. Ten patients experienced complications, most commonly wound problems and implant failure, predominantly observed in patients with severe wrist and elbow contractures. In conclusion, wrist arthrodesis with simultaneous soft tissue rebalancing of the digits offers a viable approach in patients with severe spasticity. Cautious patient selection and consideration of potential complications are crucial for good outcomes.Level of evidence: IV.
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Affiliation(s)
- Matthew Nixon
- Countess of Chester Hospital, Chester, UK
- Royal Manchester Royal Children's Hospital, Manchester, UK
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Hurtado-Olmo P, González-Santos Á, Pérez de Rojas J, Fernández-Martínez NF, del Olmo L, Hernández-Cortés P. Surgical Treatment in Post-Stroke Spastic Hands: A Systematic Review. J Clin Med 2024; 13:945. [PMID: 38398258 PMCID: PMC10888673 DOI: 10.3390/jcm13040945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Background: For more than two decades, the surgical treatment of post-stroke spastic hands has been displaced by botulinum toxin therapy and is currently underutilized. Objectives: This article aimed to assess the potential of surgery for treating a post-stroke spastic upper extremity through a systematic review of the literature on surgical approaches that are adopted in different profiles of patients and on their outcomes and complications. Methods: Medline PubMed, Web of Science, SCOPUS, and Cochrane Library databases were searched for observational and experimental studies published in English up to November 2022. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluations (GRADE) system. Results: The search retrieved 501 abstracts, and 22 articles were finally selected. The GRADE-assessed quality of evidence was low or very low. The results of the reviewed studies suggest that surgery is a useful, safe, and enduring treatment for post-stroke spastic upper extremities, although most studied patients were candidates for hygienic improvements alone. Patients usually require an individualized combination of techniques. Over the past ten years, interest has grown in procedures that act on the peripheral nerve. Conclusions: Despite the lack of comparative studies on the effectiveness, safety, and cost of the treatments, botulinum toxin has displaced surgery for these patients. Studies to date have found surgery to be an effective and safe approach, but their weak design yields only poor-quality evidence, and clinical trials are warranted to compare these treatment options.
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Affiliation(s)
- Patricia Hurtado-Olmo
- Upper Limb Surgery Unit, Orthopedic Surgery Department, San Cecilio University Hospital of Granada, 18016 Granada, Spain
| | - Ángela González-Santos
- BIO 277 Group, Department of Physical Therapy, Faculty of Health Science, University of Granada, 18012 Granada, Spain
- A02-Cuídate, Instituto de Investigación Biosanitaria, 18012 Granada, Spain
| | - Javier Pérez de Rojas
- Department of Preventive Medicine and Public Health, San Cecilio University Hospital of Granada, 18016 Granada, Spain;
| | - Nicolás Francisco Fernández-Martínez
- Escuela Andaluza de Salud Pública (EASP), 18011 Granada, Spain
- Instituto de Investigación Biosanitaria ibs, 18012 Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Laura del Olmo
- Rehabilitation Department, San Cecilio University Hospital of Granada, 18016 Granada, Spain
| | - Pedro Hernández-Cortés
- Upper Limb Surgery Unit, Orthopedic Surgery Department, San Cecilio University Hospital of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs, 18012 Granada, Spain
- Surgery Department, School of Medicine, Granada University, 18012 Granada, Spain
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Herzog S, David R, Speirs A, Hashemi M, Winston P. A Case Report Illustrating the Combined Use of Cryoneurolysis and Percutaneous Needle Tenotomy in the Treatment of Longstanding Spastic Shoulder Contractures After Stroke. Arch Rehabil Res Clin Transl 2023; 5:100285. [PMID: 37744199 PMCID: PMC10517357 DOI: 10.1016/j.arrct.2023.100285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Adduction and internal rotation of the shoulder is a common presentation in post-stroke patients, and can often be caused by spasticity and musculotendinous retraction causing a contracture of the pectoralis major and minor muscles. A post cerebral arteriovenous malfunction rupture patient with severe refractory left shoulder spasticity with contracture was treated with cryoneurolysis to the medial and lateral pectoral nerves, combined with a percutaneous needle tenotomy to the pectoralis major tendon. There was an improvement in shoulder forward flexion, abduction and external rotation immediately and found sustained at 8 weeks by 50°, 45°, and 15°. The patient noted an immediate cessation of limitation of shoulder abduction, a liberation of range of motion of the shoulder, and looseness in their arm and shoulder. They reported a dramatic improvement in their gait, increased independence, and an improvement in overall quality of life in a structured interview 8 weeks after the procedure. The patient relayed a positive experience with the combined neuro-orthopedic procedure of cryoneurolysis and tenotomy for the treatment of their spastic shoulder. This combined treatment could be considered as a management strategy for patients experiencing shoulder spasticity with contracture.
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Affiliation(s)
- Samuel Herzog
- Faculty of Science University of British Columbia, Vancouver BC, Canada
| | - Romain David
- Vancouver Island Health Authority, Victoria, BC, Canada
- Physical and Rehabilitation Medicine Unit, Poitiers University Hospital, University of Poitiers, 86021 Poitiers, France
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Abby Speirs
- Vancouver Island Health Authority, Victoria, BC, Canada
| | | | - Paul Winston
- Vancouver Island Health Authority, Victoria, BC, Canada
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Faculty of Medicine, Victoria, BC, Canada
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium, Kingston, ON, Canada
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Salga M, Gatin L, Deltombe T, Gustin T, Carda S, Marque P, Winston P, Reebye R, Wein T, Esquenazi A, Keenan MA, Molteni F, Zerbinati P, Picelli A, Coroian F, Coulet B, Sturbois-Nachef N, Fontaine C, Yelnik A, Parratte B, Henry P, Venkatakrishnan S, Rigoard P, David R, Denormandie P, Schnitzler A, Allart E, Genet F. International Recommendations to Manage Poststroke Equinovarus Foot Deformity Validated by a Panel of Experts Using Delphi. Arch Phys Med Rehabil 2023; 104:372-379. [PMID: 36030892 DOI: 10.1016/j.apmr.2022.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/27/2022] [Accepted: 07/30/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To establish international recommendations for the management of spastic equinovarus foot deformity. DESIGN Delphi method. SETTING International study. PARTICIPANTS A total of 24 international experts (N=24) in neuro-orthopedic deformities, from different specialties (Physical and Rehabilitation Medicine physicians, neurologists, geriatricians, orthopedic surgeons, neurosurgeons, plastic surgeons). INTERVENTIONS Experts answered 3 rounds of questions related to important aspects of diagnosis, assessment, and treatment of spastic equinovarus foot deformity. MAIN OUTCOME MEASURES A consensus was established when at least 80% of experts agreed on a statement RESULTS: A total of 52 items reached consensus. Experts recommend assessing effect of the deformity on functional activities before treatment. Before treatment, it is crucial to differentiate spastic muscle overactivity from soft tissue contractures, identify which muscles are involved in the deformity, and evaluate the activity of antagonist muscles. Motor nerve blocks, 2-dimensional video analysis, and radiologic examinations are often required to complement a clinical examination. The treatment of equinovarus foot depends on the correctability of the deformity and the patient's ability to stand or walk. The preoperative assessment should include an interdisciplinary consultation that must finalize a formal agreement between physicians and the patient, which will define personalized attainable goals before surgery. CONCLUSION The establishment of guidelines on managing equinovarus foot will help physicians and surgeons, specialists, and nonspecialists to diagnoses and assess the deformity and direct patients to a network of experts to optimize patient functional recovery and improve their autonomy.
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Affiliation(s)
- Marjorie Salga
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France; Versailles Saint-Quentin-en-Yvelines University (UVSQ), UFR Simone Veil - Santé, Montigny-le-Bretonneux, France; Garches Neuro-Orthopaedics Research Group (GRENOG), Garches, France
| | - Laure Gatin
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France; Versailles Saint-Quentin-en-Yvelines University (UVSQ), UFR Simone Veil - Santé, Montigny-le-Bretonneux, France; Garches Neuro-Orthopaedics Research Group (GRENOG), Garches, France; Department of Orthopaedic Surgery, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - Thierry Deltombe
- Department of Physical Medicine and Rehabilitation, CHU UCL Namur site Godinne, Yvoir, Belgium; Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, Ontario, Canada
| | - Thierry Gustin
- Department of Neurosurgery, CHU UCL Namur site Godinne, Yvoir, Belgium
| | - Stefano Carda
- Service of Neuropsychology and Neurorehabilitation, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philippe Marque
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France; Department of Neurological Rehabilitation, University Hospital of Toulouse, Hôpital de Rangueil, Toulouse, France
| | - Paul Winston
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, Ontario, Canada; Division of Physical Medicine and Rehabilitation, University of British Columbia, Victoria, British Columbia, Canada
| | - Rajiv Reebye
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Theodore Wein
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Alberto Esquenazi
- MossRehab and Albert Einstein Medical Center, Elkins Park, Pennsylvania
| | - Mary-Ann Keenan
- Penn Neuro-Orthopaedics Service, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Italy
| | - Paolo Zerbinati
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy; U.O. Neuroortopedia, Ospedale Santa Maria Multimedica Castellanza, Varese, Italy
| | - Alessandro Picelli
- Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research Center, University of Verona, Verona, Italy
| | - Flavia Coroian
- Physical and Rehabilitation Medicine Department, Montpellier University Hospital, Montpellier, France; Euromov, Montpellier University, Montpellier, France
| | - Bertrand Coulet
- Hand and Upper Limb Surgery Department, CHRU Lapeyronie, Montpellier, France
| | - Nadine Sturbois-Nachef
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, Ontario, Canada; Department of Orthopedic Surgery, Lille University Medical Center, Lille, France
| | - Christian Fontaine
- Department of Orthopedic Surgery, Lille University Medical Center, Lille, France
| | - Alain Yelnik
- Department of Physical and Rehabilitation Medicine, Université de Paris, AP-HP Hospital Fernand Widal, Paris, France
| | - Bernard Parratte
- Department of Physical and Rehabilitation Medicine, CHRU Jean Minjoz, Besançon-Franche-Comté University, Besançon, France
| | - Prakash Henry
- Department of Neurological Rehabilitation, Christian Medical College, Vellore, India
| | | | - Philippe Rigoard
- Institut Pprime CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France; Spine and Neuromodulation Functional Unit, Department of Neurosurgery, CHU Poitiers, PRISMATICS Lab, Poitiers, France
| | - Romain David
- Department of Physical and Rehabilitation Medicine, University Hospital Center of Poitiers, PRISMATICS Lab, Poitiers, France
| | - Philippe Denormandie
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France; Department of Orthopaedic Surgery, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - Alexis Schnitzler
- Department of Physical and Rehabilitation Medicine, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - Etienne Allart
- Univ. Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, Neurorehabilitation Unit, Lille, France
| | - François Genet
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France; Versailles Saint-Quentin-en-Yvelines University (UVSQ), UFR Simone Veil - Santé, Montigny-le-Bretonneux, France; Garches Neuro-Orthopaedics Research Group (GRENOG), Garches, France.
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Barnham I, Alahmadi S, Spillane B, Pick A, Lamyman M. Surgical interventions in adult upper limb spasticity management: a systematic review. HAND SURGERY & REHABILITATION 2022; 41:426-434. [DOI: 10.1016/j.hansur.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/11/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
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Mayer NH, Ferraro M, Pauloski-Hunt D, Chervoneva I. Capacity for Hand-as-a-Holder Function of the Spastic Combination Hand: A Proof-of-Concept Study. Am J Phys Med Rehabil 2022; 101:298-302. [PMID: 34173778 DOI: 10.1097/phm.0000000000001834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT We call a hemiparetic hand with paralyzed finger extensors and volitional but spastic flexors a "spastic combination hand." Anecdotally, patients report hand-as-a-holder function with objects like pill bottles, motivating us to formally study spastic combination hand holding capacity using cylinders with different diameters. Nine participants with spastic hemiparesis and spastic combination hand more than 24 mos performed a standardized motor task with 10 cylinder diameters ranging between 1.3 and 9.5 cm and weighing 0.8 and 8.4 oz. Using the unaffected hand, participants attempted to insert a given cylinder into their spastic combination hand, holding it independently for 5 secs. Successful holds were counted during two sessions before and one session after botulinum toxin intervention of Ashworth 3 hand muscles. Findings revealed that a median capacity of six different cylinder diameters was successfully inserted into spastic combination hand at least once before block and a median capacity of 10 cylinders was inserted after block. A mixed-effect statistical model using fixed effects of cylinder diameter and session revealed that total number of successful holds was 43% higher after botulinum. We conclude that this proof-of-concept study does support the idea that spastic combination hand has holding capacity for cylindrical objects of specified diameter and weight and that botulinum neurotoxin offers potential for enlarging spastic combination hand capacity.
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Affiliation(s)
- Nathaniel H Mayer
- From the MossRehab, Elkins Park, Pennsylvania (NHM, MF, DP-H); Temple University, Philadelphia, Pennsylvania (NHM); and Thomas Jefferson University, Philadelphia, Pennsylvania (IC)
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Gross R, Verduzco-Gutierrez M, Draulans N, Zimerman M, Francisco G, Deltombe T. Module 3: Surgical management of spasticity. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2022. [DOI: 10.4103/2349-7904.347809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ramström T, Bunketorp-Käll L, Wangdell J. The impact of upper limb spasticity-correcting surgery on the everyday life of patients with disabling spasticity: a qualitative analysis. Disabil Rehabil 2021; 44:6295-6303. [PMID: 34498998 DOI: 10.1080/09638288.2021.1962988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was to explore the patient perspective of their experiences of daily life after spasticity-correcting surgery for disabling upper limb (UL) spasticity after spinal cord injury (SCI) and stroke. MATERIALS AND METHODS Eight patients with UL spasticity resulting from SCI (n= 6) or stroke (n= 2) were interviewed 6-9 months after spasticity-correcting surgery. A phenomenographic approach was used to analyze the interviews. RESULTS Five themes emerged from the interviews: (1) bodily changes, such as increased muscle strength, range of motion, and reduced muscle-hypertonicity; (2) improved occupational performance, facilitating tasks, mobility, and self-care; (3) regained control, explicating the perception of regaining bodily control and a more adaptable body; (4) enhanced interpersonal interactions, entailing the sense of being more comfortable undertaking social activities and personal interactions; and (5) enhanced psychological well-being, including having more energy, increased self-esteem, and greater happiness after surgery. CONCLUSIONS The participants experienced improvements in their everyday lives, including body functions, activities, social life, and psychological well-being. The benefits derived from surgery made activities easier, increased occupational performance, allowed patients regain their roles and interpersonal interactions, and enhanced their psychological well-being.Implications for rehabilitationSpasticity-correcting surgery benefits patients by improving bodily functions, which in turn, enable gains in activities, social life, and psychological well-being.Patients' experiences of increased body functions, such as enhanced mobility and reduced muscle hypertonicity, appear to increase the sense of bodily control.The surgery can increase participation and psychological well-being, even for patients whose functional or activity level did not improve after the treatment.The benefits expressed by the individuals in this study can be used to inform, planning, and in discussion with patients and other healthcare professionals about interventions targeting spasticity.
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Affiliation(s)
- Therese Ramström
- Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital/Mölndal, Mölndal, Sweden.,Department of Hand surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lina Bunketorp-Käll
- Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital/Mölndal, Mölndal, Sweden.,Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johanna Wangdell
- Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital/Mölndal, Mölndal, Sweden.,Department of Hand surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Hashemi M, Sturbois-Nachef N, Keenan MA, Winston P. Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:709969. [PMID: 36188802 PMCID: PMC9397894 DOI: 10.3389/fresc.2021.709969] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/23/2021] [Indexed: 11/18/2022]
Abstract
Introduction: Spasticity is the main complication of many upper motor neuron disorders. Many studies describe neuro-orthopedic surgeries for the correction of joint and limb deformities due to spasticity, though less in the upper extremity. The bulk of care provided to patients with spasticity is provided by rehabilitation clinicians, however, few of the surgical outcomes have been summarized or appraised in the rehabilitation literature. Objective: To review the literature for neuro-orthopedic surgical techniques in the upper limb and evaluate the level of evidence for their efficacy in adult patients with spasticity. Method: Electronic databases of MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were searched for English, French as well as Farsi languages human studies from 1980 to July 2, 2020. After removing duplicated articles, 2,855 studies were screened and 80 were found to be included based on the criteria. The studies were then divided into two groups, with 40 in each trial and non-trial. The results of the 40 trial articles were summarized in three groups: shoulder, elbow and forearm, and wrist and finger, and each group was subdivided based on the types of intervention. Results: The level of evidence was evaluated by Sackett's approach. There were no randomized control trial studies found. About, 4 studies for shoulder, 8 studies for elbow and forearm, 26 studies for wrist and finger (including 4 for the thumb in palm deformity), and 2 systematic reviews were found. Around, two out of 40 trial articles were published in the rehabilitation journals, one systematic review in Cochrane, and the remaining 38 were published in the surgical journals. Conclusion: Most surgical procedures are complex, consisting of several techniques based on the problems and goals of the patient. This complexity interferes with the evaluation of every single procedure. Heterogenicity of the participants and the absence of clinical trial studies are other factors of not having a single conclusion. This review reveals that almost all the studies suggested good results after the surgery in carefully selected cases with goals of reducing spasticity and improvement in function, pain, hygiene, and appearance. A more unified approach and criteria are needed to facilitate a collaborative, evidence-based, patient referral, and surgical selection pathway.
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Affiliation(s)
- Mahdis Hashemi
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress, Victoria, BC, Canada
- Vancouver Island Health Authority, Victoria, BC, Canada
| | - Nadine Sturbois-Nachef
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress, Victoria, BC, Canada
- Orthopédic and Traumatologic Département, University Hospital of Lille, Lille, France
| | - Marry Ann Keenan
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress, Victoria, BC, Canada
- Neuro-Orthopaedics, MossRehab Hospital, Elkins Park, PA, United States
- Orthopaedic Surgery (Ret), University of Pennsylvania, Philadelphia, PA, United States
| | - Paul Winston
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress, Victoria, BC, Canada
- Vancouver Island Health Authority, Victoria, BC, Canada
- Department of Physical Medicine and Rehabilitation, University of British Colombia, Vancouver, BC, Canada
- *Correspondence: Paul Winston orcid.org/0000-0002-8403-6988
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Functional and/or hygienic surgery of the hypertonic upper limb. HAND SURGERY & REHABILITATION 2021; 41S:S153-S158. [PMID: 34216811 DOI: 10.1016/j.hansur.2019.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 11/07/2018] [Accepted: 03/04/2019] [Indexed: 11/20/2022]
Abstract
Neuro-orthopedic complications of the upper limb affect all of its joints and lead to a multitude of clinical pictures. The clinical assessment, which should be multidisciplinary, will have to answer basic questions to define the goal(s) and the appropriate surgical strategy. What is the patient's and family's complaint? What is the possible utility of the deformities? What is the type of deformity? Is it reducible or not? What is the contribution of the upper limb deformities versus that of any associated injuries to the discomfort? Several difficulties exist in the clinical assessment: evaluation of the antagonists especially the wrist extensor muscles; the intrinsic deformity component, which can be masked by the extrinsic component when retracted, the muscles responsible for a wrist flexion contracture and the complex shoulder deformities. Many patients have multiple deformities, which creates a problem for the hierarchy of corrections depending on the objectives. The answer to these questions helps to define a clear objective that will be formalized in a contract with the patient and subsequently to define the surgical strategy. Surgery is based on a simple principle: relax the muscles on the side of the deformity, either by selective neurotomy if there is a simple hypertonia, or by a tendon procedure if the muscle is retracted; compensate for the antagonists if they are deficient, and potentially stabilize the joint. Conservative procedures are preferred to preserve the possibility of functional recovery in the future. The wide range of medical and surgical solutions allows the patient's care to be personalized. In the upper limb, the results are better for hygienic, positioning, and analgesic objectives. They remain more difficult to obtain for functional objectives, due to the biomechanical complexity of gripping.
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Patel R, Rhee PC. Team Approach: Multidisciplinary Perioperative Care in Upper-Extremity Reconstruction for Adults with Spasticity and Contractures. JBJS Rev 2020; 8:e0164. [DOI: 10.2106/jbjs.rvw.19.00164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Tranchida GV, Van Heest A. Preferred options and evidence for upper limb surgery for spasticity in cerebral palsy, stroke, and brain injury. J Hand Surg Eur Vol 2020; 45:34-42. [PMID: 31594425 DOI: 10.1177/1753193419878973] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Surgical interventions for the spastic upper extremity secondary to stroke, traumatic brain injury, and cerebral palsy aim to correct the common deformities of elbow flexion, forearm pronation, wrist and finger flexion, ulnar deviation, and thumb-in-palm deformity. After appropriate evaluation, as well as determining the goals of surgery, deformity correction can be achieved through single-event, multi-level surgery. Surgery includes a combination of soft tissue lengthening, tendon transfer, and joint stabilization procedures. Surgical treatment for shoulder adduction/internal rotation, elbow flexion, forearm pronation, wrist flexion, thumb-in-palm, and clenched fist deformities due to spasticity are discussed, and treatment outcomes are reviewed.
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Affiliation(s)
- Geneva V Tranchida
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Ann Van Heest
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
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Genêt F, Denormandie P, Keenan MA. Orthopaedic surgery for patients with central nervous system lesions: Concepts and techniques. Ann Phys Rehabil Med 2018; 62:225-233. [PMID: 30290282 DOI: 10.1016/j.rehab.2018.09.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 09/09/2018] [Accepted: 09/09/2018] [Indexed: 12/26/2022]
Abstract
Since ancient times, the aim of orthopedic surgery has been to correct limb and joint deformities, including those resulting from central nervous system lesions. Recent developments in the treatment of spasticity have led to changes in concepts and management strategies. The increase in life expectancy has increased the functional needs of patients. Orthopedic surgery, along with treatments for spasticity, improves the functional capacity of patients with neuro-orthopaedic disorders, improving their autonomy. In this paper, we describe key moments in the history of orthopedic surgery regarding the treatment of patients with central nervous system lesions, from poliomyelitis to stroke-related hemiplegia, from the limbs to the spine, and from contractures to heterotopic ossification. A synthesis of the current surgical techniques is then provided, and the importance of multidisciplinary evaluation and management is highlighted, along with indications for medical, rehabilitation and surgical treatments and their combinations. We explain why it is essential to consider patients' expectations and to set achievable goals, particularly before surgery, which is by nature irreversible. More recently, specialized surgical teams have begun to favor the use of soft-tissue techniques over bony and joint procedures, except for spinal disorders. We highlight that orthopedic surgery is no longer the end-point of treatment. For example, lengthening a contractured muscle improves the balance around a joint, improving mobility and stability but may be only part of the problem. Further medical treatment and rehabilitation, or additional surgery, are often necessary to continue to improve the function of the limb. Despite the recognized effectiveness of orthopedic surgery for neuro-orthopedic disorders, few studies have formally evaluated them. Hence, there is a need for research to provide evidence to support orthopedic surgery for treating neuro-orthopedic disorders.
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Affiliation(s)
- F Genêt
- Service de médecine physique et de réadaptation, hôpital Raymond Poincaré, Assistance publique-Hôpitaux de Paris, CIC-IT 1429, 92380 Garches, France; End:icap" U1179 Inserm, service de université Versailles Saint Quentin en Yvelines, UFR des Sciences de la Santé-Simone Veil, 2, avenue de la source de bièvres, 78170 Montigny le Bretonneux, France.
| | - P Denormandie
- End:icap" U1179 Inserm, service de université Versailles Saint Quentin en Yvelines, UFR des Sciences de la Santé-Simone Veil, 2, avenue de la source de bièvres, 78170 Montigny le Bretonneux, France; Chirurgie orthopédique et traumatologique, hôpital Raymond Poincaré, Assistance publique-Hôpitaux de Paris, CIC-IT 1429, 92380 Garches, France
| | - M A Keenan
- Penn Neuro-Orthopaedics Service, University of Pennsylvania, Philadelphia, PA, USA
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