Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review

Spasticity, a common issue in upper motor neuron disorders, can cause stiffness and limit movement, affecting daily activities. While rehabilitation specialists primarily manage spasticity, surgical options are often overlooked in rehabilitation guidelines. This review aims to evaluate the evidence for neuro-orthopedic surgical techniques in the upper limb for adult patients with spasticity. The review examines various surgical techniques, including muscle releases, tendon lengthening, neurectomies, and arthrodesis, for addressing spasticity in the shoulder, elbow, forearm, wrist, and fingers. The surgeries aim to improve muscle balance, stabilize joints, correct deformities, and ultimately enhance function, reduce pain, and improve hygiene and appearance. The study emphasizes that surgical procedures are complex and tailored to individual patient needs, making it difficult to evaluate each procedure in isolation. Despite the heterogeneity of studies and lack of clinical trials, the review suggests that surgery can be beneficial in carefully selected cases when combined with other rehabilitation treatments.

• 1
  Most surgical procedures for upper limb spasticity are complex, consisting of several techniques based on the patient's problems and goals, which interferes with evaluating each procedure individually.
• 2
  The review found a lack of randomized controlled trials (RCTs), with most studies being case series or retrospective reviews, limiting the level of evidence for the efficacy of different surgical techniques.
• 3
  Almost all studies suggested good results after surgery in carefully selected cases, with goals of reducing spasticity and improving function, pain, hygiene, and appearance.