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Surgical Management of the Spastic Forearm, Wrist, and Hand: Evidence-Based Treatment Recommendations

A Critical Analysis Review

Rhee, Peter Charles DO, MS1

doi: 10.2106/JBJS.RVW.18.00172
Review Articles with Critical Analysis Component
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Disclosures

  • » The surgical approach for the patient with a spastic upper limb must be individualized and goal-focused.
  • » An injury to the central nervous system can lead to spinal reflex hyperexcitability with exaggerated muscle activation in response to quick stretch stimuli (i.e., spasticity).
  • » Surgical treatment options are dependent on the potential for function in the spastic upper limb.
  • » If volitional motor control is present, spastic motor units can be lengthened or released while preserving function.
  • » In the absence of volitional motor control, spastic muscles can be divided, released, or denervated with selective neurectomies.

1Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

E-mail address: rhee.peter@mayo.edu

Investigation performed at the Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

Disclosure: The author indicated that no external funding was received for any aspect of this work. The Disclosure of Potential Conflicts of Interest form is provided with the online version of the article (http://links.lww.com/JBJSREV/A458).

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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