Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review
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 pr...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2021-08-01
|
| Series: | Frontiers in Rehabilitation Sciences |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fresc.2021.709969/full |
| _version_ | 1797971957810987008 |
|---|---|
| author | Mahdis Hashemi Mahdis Hashemi Nadine Sturbois-Nachef Nadine Sturbois-Nachef Marry Ann Keenan Marry Ann Keenan Marry Ann Keenan Paul Winston Paul Winston Paul Winston |
| author_facet | Mahdis Hashemi Mahdis Hashemi Nadine Sturbois-Nachef Nadine Sturbois-Nachef Marry Ann Keenan Marry Ann Keenan Marry Ann Keenan Paul Winston Paul Winston Paul Winston |
| author_sort | Mahdis Hashemi |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-11T03:40:50Z |
| format | Article |
| id | doaj.art-3f23af3848634b89b8ee1f1fe4fe4e3c |
| institution | Directory Open Access Journal |
| issn | 2673-6861 |
| language | English |
| last_indexed | 2024-04-11T03:40:50Z |
| publishDate | 2021-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Rehabilitation Sciences |
| spelling | doaj.art-3f23af3848634b89b8ee1f1fe4fe4e3c2023-01-02T03:51:24ZengFrontiers Media S.A.Frontiers in Rehabilitation Sciences2673-68612021-08-01210.3389/fresc.2021.709969709969Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature ReviewMahdis Hashemi0Mahdis Hashemi1Nadine Sturbois-Nachef2Nadine Sturbois-Nachef3Marry Ann Keenan4Marry Ann Keenan5Marry Ann Keenan6Paul Winston7Paul Winston8Paul Winston9Canadian Advances in Neuro-Orthopedics for Spasticity Congress, Victoria, BC, CanadaVancouver Island Health Authority, Victoria, BC, CanadaCanadian Advances in Neuro-Orthopedics for Spasticity Congress, Victoria, BC, CanadaOrthopédic and Traumatologic Département, University Hospital of Lille, Lille, FranceCanadian Advances in Neuro-Orthopedics for Spasticity Congress, Victoria, BC, CanadaNeuro-Orthopaedics, MossRehab Hospital, Elkins Park, PA, United StatesOrthopaedic Surgery (Ret), University of Pennsylvania, Philadelphia, PA, United StatesCanadian Advances in Neuro-Orthopedics for Spasticity Congress, Victoria, BC, CanadaVancouver Island Health Authority, Victoria, BC, CanadaDepartment of Physical Medicine and Rehabilitation, University of British Colombia, Vancouver, BC, CanadaIntroduction: 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.https://www.frontiersin.org/articles/10.3389/fresc.2021.709969/fullspasticityupper limborthopedic surgical procedurecerebral palsystroketraumatic brain injury |
| spellingShingle | Mahdis Hashemi Mahdis Hashemi Nadine Sturbois-Nachef Nadine Sturbois-Nachef Marry Ann Keenan Marry Ann Keenan Marry Ann Keenan Paul Winston Paul Winston Paul Winston Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review Frontiers in Rehabilitation Sciences spasticity upper limb orthopedic surgical procedure cerebral palsy stroke traumatic brain injury |
| title | Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review |
| title_full | Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review |
| title_fullStr | Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review |
| title_full_unstemmed | Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review |
| title_short | Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review |
| title_sort | surgical approaches to upper limb spasticity in adult patients a literature review |
| topic | spasticity upper limb orthopedic surgical procedure cerebral palsy stroke traumatic brain injury |
| url | https://www.frontiersin.org/articles/10.3389/fresc.2021.709969/full |
| work_keys_str_mv | AT mahdishashemi surgicalapproachestoupperlimbspasticityinadultpatientsaliteraturereview AT mahdishashemi surgicalapproachestoupperlimbspasticityinadultpatientsaliteraturereview AT nadinesturboisnachef surgicalapproachestoupperlimbspasticityinadultpatientsaliteraturereview AT nadinesturboisnachef surgicalapproachestoupperlimbspasticityinadultpatientsaliteraturereview AT marryannkeenan surgicalapproachestoupperlimbspasticityinadultpatientsaliteraturereview AT marryannkeenan surgicalapproachestoupperlimbspasticityinadultpatientsaliteraturereview AT marryannkeenan surgicalapproachestoupperlimbspasticityinadultpatientsaliteraturereview AT paulwinston surgicalapproachestoupperlimbspasticityinadultpatientsaliteraturereview AT paulwinston surgicalapproachestoupperlimbspasticityinadultpatientsaliteraturereview AT paulwinston surgicalapproachestoupperlimbspasticityinadultpatientsaliteraturereview |