Selective Neurectomy for the Spastic Upper Extremity.

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.