Thursday, April 15, 2010

Addition of a new surgical procedure for spasticity in tetraplegia by Dr. Carina Reinholdt

Patients with incomplete tetraplegia often suffer from spasticity in the upper extremities. The spasticity can be focal or general. When conservative treatment with medication and injections with botulinum toxin fail, surgical treatment of the spasticity may be an option. Since several years, tendon lengthenings and muscles releases have been used. However no attention has been paid to the intrinsic muscles that extend the finger joints and flex the knuckles. Intrinsic spasticity or tightness causes inability to grip especially around small tools and decreased grip-control. The surgical treatment is a release of the intrinsic muscle. The method is described by Littler long ago, but has not been used on patients with tetraplegia. The method is now modified, distal ulnar intrinsic release, to better suit patients with tetraplegia and spasticity. The method is technically simple to perform and the release can be evaluated instantly. It can be used as a single procedure or added to tendon lengthenings. A study on 17 patients with intrinsic tightness/spasticity has been made in our unit. 7 patients had focal spasticity and 11 had a clenched fist needing additional surgery such as tendon lengthenings. Both groups showed improved motion of about 40% of the finger joints with better function and a high level of satisfaction.