gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Spasticity-reducing hand surgery for patients with upper motor neuron injuries: a prospective study of 30 patients with a one-year follow-up

Meeting Abstract

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  • presenting/speaker Joakim Stromberg - Department of Hand Surgery, Sahlgrenska University Hospital, Department of Orthopedics, Alingsås lasarett, Gothenburg, Sweden
  • Ulla Bergfeldt - C.A.R.E., Sahlgrenska University Hospital, Gothenburg, Sweden
  • Therese Ramström - C.A.R.E., Sahlgrenska University Hospital, Gothenburg, Sweden
  • Katarzyna Kulbacka Ortiz - C.A.R.E., Sahlgrenska University Hospital, Gothenburg, Sweden
  • Carina Reinholdt - C.A.R.E., Sahlgrenska University Hospital, Gothenburg, Sweden

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-288

doi: 10.3205/19ifssh0901, urn:nbn:de:0183-19ifssh09017

Veröffentlicht: 6. Februar 2020

© 2020 Stromberg et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Objectives/Interrogation: Spasticity is common in patients with upper motor neuron injuries, with a prevalence reported between 30 to 90% in patients with stroke, traumatic brain injury, incomplete spinal cord injury and cerebral palsy. While pharmacological spasticity therapy has been applied for decades, surgical procedures remain fairly uncommon in adults with spasticity. The objective of this prospective cohort study was to evaluate the outcome of spasticity-reducing surgery in the upper extremity.

Methods: Thirty patients suffering from spasticity in the upper extremity with transient or little effect of BoNT-treatment were included in the study. Between March 2015 and January 2017, all patients had spasticity reducing surgery, which included a tailored set of procedures including lengthening of tendons, tenotomies and correction of deformities according to the specific spasticity pattern in each patient. Active motion exercises were initiated the first day postoperatively with splints used between exercises for three weeks, and patients were also taught a home-training program. All 30 patients were assessed after three weeks, three and six months and after a year.

Results and Conclusions: At one-year follow-up all outcome measures had improved significantly compared to baseline. Spasticity as measured by the modified Ashworth scale (0-5) had decreased by a mean 1.4 (p<0.001), and all but two patients were found to have reduction in spasticity by at least one scale unit. Pain and general hand function (as measured by VAS-scale) had decreased by 1.3 (p<0.05) and 2.1 (p<0.001) respectively. The patients prioritized activity as measured by Canadian Occupational Performance Measure (COPM) had also increased significantly (performance by 3.4 and satisfaction by 3.6 (p<0.01). Passive range-of-motion had increased significantly.

Spasticity-reducing surgery combined with immediate postoperative functional rehabilitation can reduce spasticity, reduce pain and improve hand function in patients with upper motor neuron injuries. The beneficial effects of these surgical procedures are consistent one year postoperatively, and surgery should be considered a treatment option for this large group of patients.