Specific problems
The function of the spastic upper limb is extremely variable. Some patients use it almost normally, others do not use it at all (even if it has the capacity of moving). Many stroke patients have very little movement and a lack of sensation in the impaired limb, and they tend to “neglect” it. In these “non functioning” arms and hands, surgery has little to offer in terms of function. But it can be useful for improving severe deformities, such as elbow flexion, wrist flexion, finger flexion, and/ or thumb in palm. These deformities, which may due to spasticity alone, or associated with muscle or joint contractures, often affect adversely nursing, hygiene and cosmesis. They can most often be improved by surgery, with a real positive impact on the patient’s comfort, and family assistance .
Timing of surgery
Surgery can usually be programmed when there is no more progress in the motor / sensory recovery of the limb. In spasticity resulting from head injury (cerebrolesion), some severe deformities can develop very early on and keep worsening despite appropriate rehabilitative treatment. Such circumstances may require early surgical release.
