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Hand Clinics

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https://www.readbyqxmd.com/read/30286974/upper-extremity-spasticity
#1
EDITORIAL
Joshua M Adkinson
No abstract text is available yet for this article.
November 2018: Hand Clinics
https://www.readbyqxmd.com/read/30286973/the-future-of-upper-extremity-spasticity-management
#2
REVIEW
Mitchel Seruya
Surgical management of upper limb spasticity has traditionally tackled the downstream effects at the muscle, tendon, and joint levels. Because this approach does not address the underlying pathologic condition within the nerve, surgical outcomes have been marked by unsatisfactory relapse over time. Future management may focus on reestablishing a normal neuronal impulse pathway to the dysfunctional musculotendinous unit. By severing the faulty γ-neuronal circuit at the C7 level, spasticity may be reduced. Transfer of the contralateral C7 nerve root to the injured C7 nerve root may open the potential for simultaneously restoring extension and improving reach and grasp functions...
November 2018: Hand Clinics
https://www.readbyqxmd.com/read/30286972/outcomes-after-surgical-treatment-of-spastic-upper-extremity-conditions
#3
REVIEW
Geneva V Tranchida, Ann E Van Heest
Surgical interventions for the spastic upper extremity aim to correct the common deformities of elbow flexion, forearm pronation, wrist flexion and ulnar deviation, and thumb-in-palm deformity. One goal is achieving optimal function and improved limb positioning. Aesthetics of the limb have a profound impact on self-esteem and satisfaction. Surgical deformity correction has not reliably been shown to improve sensory function such as stereognosis. Validated outcome measures are used to present outcomes after surgical treatment of the spastic upper extremity as it relates to motor function and limb positioning, sensory function, and self-esteem...
November 2018: Hand Clinics
https://www.readbyqxmd.com/read/30286971/rehabilitation-strategies-following-surgical-treatment-of-upper-extremity-spasticity
#4
REVIEW
Janese Petuchowksi, Kaitlin Kieras, Kristina Stein
Upper motor neuron injuries that occur in cases such as cerebral palsy, cerebrovascular accidents, and traumatic brain injury often have resulting upper extremity deformity and dysfunction. Multiple surgical options are available to improve upper extremity positioning, and, in some cases, motor control. Postoperative therapeutic management is imperative to assist the patient/caregiver in maximizing potential functional gains. This article provides an overview of postoperative guidelines for commonly performed surgeries to manage upper extremity dysfunction caused by spasticity and discusses acute management as well as therapeutic techniques for functional training and improved motor control...
November 2018: Hand Clinics
https://www.readbyqxmd.com/read/30286970/management-of-spinal-cord-injury-induced-upper-extremity-spasticity
#5
REVIEW
Andreas Gohritz, Jan Fridén
Spasticity affects more than 80% of patients with spinal cord injury. Neural mechanisms and musculotendinous alterations lead to typical upper extremity features including shoulder adduction/internal rotation, forearm pronation, and elbow, wrist, and finger flexion. Long-standing spasticity may lead to soft tissue and joint contractures and further impairment of upper extremity function. Surgical management involves tendon lengthening, release, and transfer, as well as selective neurotomy, in an effort to reduce spastic muscle hypertonicity, restore balance, prevent further contracture, and improve posture and function...
November 2018: Hand Clinics
https://www.readbyqxmd.com/read/30286969/neurosurgical-management-of-spastic-conditions-of-the-upper-extremity
#6
REVIEW
Karl Balsara, Andrew Jea, Jeffrey S Raskin
Spasticity is a hypertonic segmental reflex pathway caused by a central nervous system injury. Spasticity of the upper extremity causes loss of function, joint contracture, pain, and poor cosmesis. Treatment aims to reduce or change the pathophysiology underlying the hyperactive reflex from dorsal sensory rootlets through the intrinsic machinery of the spinal cord to the neuromuscular junction. There are many treatments for upper extremity spasticity including oral medication, physiotherapy, intrathecal baclofen, and lesional or neuromodulatory surgical approaches...
November 2018: Hand Clinics
https://www.readbyqxmd.com/read/30286968/selective-neurectomy-for-the-spastic-upper-extremity
#7
REVIEW
Caroline Leclercq
Surgery is one element of the rehabilitative care of the spastic upper limb. Different surgical techniques have been advocated to address each of the common deformities and underlying causes, including muscle spasticity, joint contracture, and paralysis. Partial neurectomy of motor nerves has been shown to reduce spasticity in the target muscles. It is effective only for the spastic component of the deformity, which underscores the importance of a preliminary thorough clinical examination. Hyperselective neurectomy, which involves performing a partial division of each motor ramus at its entry point into the target muscle, results in improved selectivity, reliable partial muscle denervation, and durable results...
November 2018: Hand Clinics
https://www.readbyqxmd.com/read/30286967/technical-pearls-of-tendon-transfers-for-upper-extremity-spasticity
#8
REVIEW
Samir K Trehan, Kevin J Little
Tendon transfers are an important surgical option when treating patients with muscular imbalance due to upper extremity spasticity. A successful surgical outcome requires a thorough preoperative clinical evaluation, an understanding of tendon transfer biomechanics, appropriate donor and recipient muscle selection, technical execution, and postoperative rehabilitation. This article reviews the principles, biomechanics, and techniques for commonly performed tendon transfers in patients with upper extremity spasticity...
November 2018: Hand Clinics
https://www.readbyqxmd.com/read/30286966/management-of-joint-contractures-in-the-spastic-upper-extremity
#9
REVIEW
Kristi S Wood, Aaron Daluiski
Upper extremity contractures in the spastic patient may result from muscle spasticity, secondary muscle contracture, or joint contracture. Knowledge of the underlying cause is critical in planning successful treatment. Initial management consists of physical therapy and splinting. Botulinum toxin can be helpful, as a therapeutic treatment in relieving spasticity and as a diagnostic tool in determining the underlying cause of the contracture. Surgical management options include release or lengthening of the causative muscle/tendon unit and joint capsular release, as required...
November 2018: Hand Clinics
https://www.readbyqxmd.com/read/30286965/surgical-management-of-spasticity-of-the-shoulder
#10
REVIEW
Dan A Zlotolow
Although spastic conditions often involve the shoulder, it is rare for surgical intervention to be required. In cases in which chemodenervation and therapy are insufficient to optimize the patient's function or minimize their care requirements, surgical options, such as tendon and joint releases, can be considered. Tendon transfers are rarely indicated. Nerve transfers, particularly contralateral C7, may play a larger role in the future as we gain further understanding into the risks, indications, and contraindications of this exciting technique...
November 2018: Hand Clinics
https://www.readbyqxmd.com/read/30286964/surgical-management-of-spasticity-of-the-elbow
#11
REVIEW
Aaron Berger, Saoussen Salhi, Monica Payares-Lizano
A spastic limb refers to one with increased tone. This commonly results from an upper motor neuron injury, which, in turn, leads to disinhibition of reflex arcs. At the level of the elbow, affected individuals typically exhibit a flexion posture secondary to spastic contracture of the biceps, brachialis, and brachioradialis muscles. Surgical treatment aims to improve access for hygiene, function, and cosmetic appearance of the affected limb. The specific surgical intervention performed depends on the degree of elbow flexion contracture and whether there is an associated joint contracture or soft tissue deficit...
November 2018: Hand Clinics
https://www.readbyqxmd.com/read/30286963/surgical-management-of-spasticity-of-the-forearm-and-wrist
#12
REVIEW
Stephen P Duquette, Joshua M Adkinson
Upper extremity spasticity may result from a variety of types of brain injury, including cerebral palsy, stroke, or traumatic brain injury. These conditions lead to a predictable pattern of forearm and wrist deformities caused by opposing spasticity and flaccid paralysis. Upper extremity spasticity affects all ages and sociodemographics and is a complex clinical problem with a variety of treatment options depending on the patient, the underlying disease process, and postoperative expectations. This article discusses the cause, diagnosis, operative planning, operative techniques, postoperative outcomes, and rehabilitation protocols for the spastic wrist and forearm...
November 2018: Hand Clinics
https://www.readbyqxmd.com/read/30286962/surgical-management-of-spasticity-of-the-thumb-and-fingers
#13
REVIEW
Jennifer F Waljee, Kevin C Chung
Spasticity of the hand profoundly limits an individual's independent ability to accomplish self-care and activities of daily living. Surgical procedures should be tailored to patients' needs and functional ability, and even patients with severe cognitive injuries and poor upper extremity function may benefit from surgery to improve appearance and hygiene. Careful preoperative examination and planning are needed, and consideration is given to the potential unintended detrimental effect of a surgical procedure on hand function...
November 2018: Hand Clinics
https://www.readbyqxmd.com/read/30286961/considerations-in-the-management-of-upper-extremity-spasticity
#14
REVIEW
Michael S Gart, Joshua M Adkinson
Spasticity is a movement disorder characterized by a velocity-dependent increase in muscle tone and a hyperexcitable stretch reflex. Common causes of spasticity include cerebral palsy, spinal cord injury, and stroke. Surgical treatment plans for spasticity must be highly individualized and based on the characteristics of patients and the spasticity in order to maximize functional gains. Candidates for surgery must be carefully selected. In this article, the authors review the pathophysiology of spasticity and discuss general considerations for surgical management with an emphasis on patient factors and spasticity characteristics...
November 2018: Hand Clinics
https://www.readbyqxmd.com/read/30286960/nonsurgical-treatment-options-for-upper-limb-spasticity
#15
REVIEW
Laura Black, Deborah Gaebler-Spira
There are many nonsurgical treatment options for patients with upper limb spasticity. This article presents an algorithmic approach to management, encompassing evidence-based rehabilitation therapies, medications, and promising new orthotic and robotic innovations.
November 2018: Hand Clinics
https://www.readbyqxmd.com/read/30286959/assessment-of-the-spastic-upper-limb-with-computational-motion-analysis
#16
REVIEW
Tasos Karakostas, Kelsey Watters, Erik C King
This article presents the current status of integrating 3-dimensional motion analysis and electromyography to assess upper extremity function clinically. The authors used their approach to establish a normative database for 5 Shriners Hospital Upper Extremity Evaluation tasks, which provides ranges of motion at the point of task achievement. Also, the inter-joint correlations are provided to understand the movement coordination required for each task. Distal upper extremity motion is strongly related to proximal function, supporting the idea that treatment of the proximal upper extremity deficits may be best preceded by treatment of the more distal upper extremity segments...
November 2018: Hand Clinics
https://www.readbyqxmd.com/read/30286958/common-etiologies-of-upper-extremity-spasticity
#17
REVIEW
Francisco J Angulo-Parker, Joshua M Adkinson
Spasticity is a motor disorder that manifests as a component of the upper motor neuron syndrome. It is associated with paralysis and can cause significant disability. The most common causes leading to spasticity include stroke, traumatic brain injury, multiple sclerosis, spinal cord injury, and cerebral palsy. This article discusses the pathophysiology and clinical findings associated with each of the most common etiologies of upper extremity spasticity.
November 2018: Hand Clinics
https://www.readbyqxmd.com/read/30012304/errata
#18
(no author information available yet)
No abstract text is available yet for this article.
August 2018: Hand Clinics
https://www.readbyqxmd.com/read/30012303/dupuytren-disease
#19
EDITORIAL
Steven C Haase, Kevin C Chung
No abstract text is available yet for this article.
August 2018: Hand Clinics
https://www.readbyqxmd.com/read/30012302/bringing-it-all-together-a-practical-approach-to-the-treatment-of-dupuytren-disease
#20
REVIEW
Steven C Haase, Kevin C Chung
As minimally invasive options for treatment of Dupuytren contractures become increasingly widespread, it is important that the evidence is carefully evaluated and patients are informed of the risks and benefits of the options available. The authors advocate a shared decision-making process, using evidence-based medicine, to guide patients in their treatment choices. In this article, the authors present their thoughtful approach to selecting the appropriate Dupuytren treatment of patients, along with detailed, practical technical tips to avoid complications during the execution of these interventions; both collagenase injection and limited fasciectomy techniques are described in detail...
August 2018: Hand Clinics
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