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Query: UMLS:C0026838 (spasticity)
 6,471 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ankle arthrodesis treated by external fixation frequently results in complications from pin tract infections, loss of position, nonunion, and malunion. A method of ankle arthrodesis using 6.5-mm cancellous screws as the primary fixation hardware was developed. The most important screw is placed from the posterior malleolus into the neck and head of the talus, and medial and lateral malleolar screws are added to secure fixation. Near-normal anatomy is maintained with this technique because little or no bone, only cartilage, is removed. Earlier cases were all done through an anterior approach. Later, special techniques were developed for placing screws and strain-relieving bone grafting was added to promote union. Twenty-three cases that were treated by the earlier technique are reviewed. The overall fusion rate was 74%. Three conditions (avascular talus, pyarthrosis, and spasticity) were identified that placed patients at high risk for failure of fusion. Of the patients who were not in a high-risk group, only one had a delayed union. When the high-risk patients were not included in the statistics, the fusion rate was 93%. The evolved technique shows great promise for accurate and trouble-free ankle arthrodesis.
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PMID:Ankle arthrodesis using internal screw fixation. 206 Feb 10

The results of the Grice extra-articular subtalar arthrodesis were evaluated in 102 feet of 60 ambulatory patients with spasticity at an average of five years postoperatively. Results were satisfactory in 96 feet (94 per cent). Unsatisfactory results were attributed to recurrent deformity in four feet and over-correction in two. No other significant complications were identified. The Grice arthrodesis is recommended for hindfoot valgus deformity secondary to spasticity which is refractory to non-operative management.
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PMID:The Grice extra-articular subtalar arthrodesis in the treatment of spastic hindfoot valgus deformity. 280 46

The records of 496 adult patients who sustained severe injuries to the head were reviewed retrospectively in order to reveal the incidence and location of heterotopic ossification. All traumatized joints were excluded from the study. Clinically significant heterotopic bone causing pain and a decrease in the range of motion of the adjacent joint was identified in 100 joints in fifty-seven patients (11 per cent). All fifty-seven patients had some residual spasticity, although the spasticity was not always present about the involved joint. Twenty-seven patients had monoarticular involvement while thirty patients had involvement of more than one joint. Forty-four hips, twenty-seven shoulders, twenty-six elbows, and three knees had heterotopic ossification. Complete ankylosis (16 per cent of all joints) developed in eight elbows, six hips, and two shoulders.
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PMID:Periarticular heterotopic ossification in head-injured adults. Incidence and location. 677 26

Twenty-eight joints with heterotopic ossification in 16 head-injured adults were forcefully manipulated 39 times under general anesthesia. The etiology of the heterotopic bone was trauma in seven joints and idiopathic (neurogenic) in 21. Indications for manipulation were inability to participate in therapy due to a lowered pain threshold, uncontrolled spasticity, voluntary muscle guarding or early bony ankylosis. An increase in motion was achieved under anesthesia in 23 joints (82%). Eighteen joints (64%) maintained or gained further motion with rehabilitation. Repeated manipulations were indicated if the patient evidenced neurological improvement. Five of 11 hips were manipulated once, five twice, and one hip three times. Seven hips (63%) gained an average of 52 degrees. Seven of 13 elbows were manipulated once and six twice. Eight elbows (62%) gained an average of 47 degrees. Four shoulders were manipulated, and three of the four increased in degree of external rotation. No exacerbation of the heterotopic process was detected. No fractures of long bones occurred.
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PMID:Forceful joint manipulation in head-injured adults with heterotopic ossification. 680 90

Seven patients with thumb-in-palm deformity due to spasticity of the flexor pollicis longus (FPL) were treated by transferring the tendon of the FPL to the radical side of the proximal phalanx of the thumb and stabilizing the interphalangeal (IP) joint in 15 degrees of flexion by tenodesis or arthrodesis. Surgery was not performed unless: (1) the affected limb was used spontaneously for bimanual activities, (2) there was functional disability due to the thumb-in-palm deformity, (3) the thumb could be passively extended and abducted with the wrist palmar flexed, or (4) the thumb could be actively adducted and the metacarpophalangeal joint flexed with the wrist palmar flexed. Neither low intelligence nor sensory deficit was considered an absolute contraindication to treatment. After the operation, there was improved appearance in the hands of all seven patients. The thumb was no longer held clenched in the palm. Each patient was able to use the operated hand for assistive grasp; however, ability to use the hand for manipulation of small objects and for pinch was not improved. In fact, one patient had decreased small object manipulative ability postoperatively and required subsequent tendon transfer to restore thumb adduction. Release of the FPL from its insertion, stabilization of the IP joint of the thumb, and transfer of the FPL to the radical side of the thumb can achieve improved thumb balance and function in patients with spastic FPL thumb-in-palm deformity who have functioning adductor pollicis and thumb extensors. The operation lessens thumb flexion and adduction and improves thumb extension and abduction.
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PMID:Flexor pollicis longus abductor-plasty for spastic thumb-in-palm deformity. 711 91

Hallux valgus and hallux flexus associated with cerebral palsy foot deformity may be due to equinovalgus and/or metatarsus primus adductus or combinations of these. Occasionally the condition occurs in equinovarus feet. Hallux flexus or "dorsal bunion" is usually due to a weak extensor hallucis longus, overpull of the anterior tibial muscle on the first metatarsal and spasticity or contracture of the flexor hallucis longus or brevis. A weak peroneus longus muscle has not caused this deformity. The condition is usually predictable in the growing child if all factors related to gait, collagen stability and foot alignment are observed. Treatment includes soft-tissue and bone realignment. Release of the adductor hallucis, lateral collateral ligaments of the metatarsophalangeal joint, plication of the medial capsule and of the abductor hallucis and centralization of the extensor hallucis longus will realign the first ray. The flexor hallucis longus is transferred to athe extensor hallucis longus proximal to the metatarsophalangeal joint and the anterior tibial tendon is transferred to the second metatarsal. An osteotomy at the base of the first metatarsal and at the base of the proximal phalanx will realign the skeleton. Twenty-six great toes in 16 patients have been observed for two to 20 years. The correction has been maintained without arthrodesis of the metatarsophalangeal joint except where chondromalacia occurred. Once the pattern of deformity is evident, progression is unrelenting and treatment is indicated in order to prevent chondromalacia of the articular cartilage.
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PMID:Hallux valgus and hallux flexus associated with cerebral palsy: analysis and treatment. 724 69

CVA is a very common problem that can lead to lower extremity complications. Impairment in gait pattern occurs often due to spasticity and less frequently due to prolonged flaccidity. This problem is manifested by equinus, varus, equinovarus, and toe flexion deformities. Therefore, prevention or elimination of spasticity must be achieved. Various modalities have been used, both conservative and surgical. Nonsurgical interventions include range of motion and strengthening exercises, pharmacologic agents, local anesthetic and phenol motor point blocks, and the use of orthoses. Surgical intervention should be considered after conservative treatment has failed. The goal of treatment is to reduce the deforming force as a result of spasticity and to allow for almost normal function to be achieved. This includes tendon transfers, tendon lengthenings, tenotomies, and arthrodeses of small toe joints. Preoperatively, the extent and progression of spasticity must be determined because this may affect the rate of recurrence of the deformity following surgical correction. The combination of arthrodeses of the interphalangeal joints and flexor tendon release is the best option in the presence of a spastic deformity. Arthrodesis provides for stability at the joint, whereas a flexor release eliminates the deforming force. Failure to address the plantar-flexor force of the long flexors can lead to instability at the fusion site. This may in turn lead to nonunion and recurrence of flexion contracture as shown in the case report in this article.
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PMID:Stroke and its manifestations in the foot. A case report. 781 9

The authors report the results of surgical treatment of the equinus deformity of the foot in adult hemiplegia performed on 23 patients with a long term follow-up for 20 of them. Surgical treatment required two phases. Firstly, a spasticity correction by scopiform neurotomy of the posterior tibial nerve: this operation had to be done 14 times because of the importance of the spasticity. Secondly, a phase of truly orthopaedic surgery which involved successively, a treatment of the equinus deformity by lengthening of the Achilles tendon, a restoration of the dorsal flexion by anterior muscle transfer and some complementary operations on the forefoot. An astragalo-scaphoid arthrodesis was associated in the 13 most recent cases. Results were subjectively judged very good or good for 17 patients. Objectively, walking appliances have been reduced, gait was more secure and a greater autonomy has been reached. However, the goals of this surgery are limited as it has no incidence on central interferent lesions and neuropsychological troubles resulting from brain damage. The quality of the result is, in other respects, conditional upon the gait pattern of the whole limb, particularly upon the importance of the flexion of the knee during the step cycle.
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PMID:[Surgery of the foot in equinus deformity in hemiplegic adults]. 828 67

The superficialis to profundus transfer has been a time-honored treatment of spasticity in nonfunctional hands, but it does not address the many associated problems. Fourteen patients were treated with 15 procedures (1 bilateral) designed to relieve severe flexion contractures of the hand and wrist over a 3-year period with a single-stage comprehensive surgical correction consisting of superficialis to profundus transfer, wrist flexor release, flexor pollicis longus lengthening, wrist arthrodesis, carpal tunnel release, and ulnar motor branch neurectomy or intrinsic release. For all, nonoperative treatment had failed or there were chronic skin problems. The follow-up period averaged 1 year. In 13 of 15 patients, there was wrist fusion after the index procedure, with 1 patient requiring replating and another uniting after prolonged casting. Two patients had a residual claw hand with only partial correction of a thumb-in-palm deformity. All preoperative hygiene problems and infections resolved. The comprehensive protocol allowed correction of severe contractures of the hand and wrist by a single operation with improved care and appearance of the hand.
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PMID:Correction of severe spastic flexion contractures in the nonfunctional hand. 889 81

The clinical and radiographic results of 9 patients (11 wrists) who had wrist arthrodeses for severe spastic flexion contracture were evaluated. The spasticity was due to cerebral palsy, traumatic head injury, and cerebrovascular accident. All wrist deformities were aesthetically unappealing and the patients or their caretakers had difficulty with hygiene or function. The subjective evaluation included overall satisfaction, hand hygiene, wrist deformity, functional improvement, and willingness to have surgery again given the same preoperative circumstances. A standardized hand function questionnaire was used to determine functional improvement following surgery. The objective evaluation included clinical evidence of fusion, skin condition, wrist position, and radiographic assessment. The average age of the patients was 22 years at the time of surgery and the average follow-up period was 32 months. All patients were satisfied with the results of the surgery and hygiene improved in all cases. None had palmar skin maceration or breakdown. All patients or their caretakers rated the overall appearance or wrist and hand deformity as improved and all but one patient would agree to have the surgery over again given the same preoperative circumstances. According to a 17-task hand function questionnaire, 8 of 9 patients (10 wrists) reported improved function after surgery. Face washing, propelling a wheelchair, and picking up both large and small objects were among the most frequently improved functions. Radiographic fusion was present in all cases. The average position of wrist fusion was 15 degrees flexion and the average amount of wrist correction was 85 degrees. Improved appearance, hygiene, and a certain degree of upper extremity function, regardless of cognitive abilities, can be expected following arthrodesis for severe spastic wrist deformity.
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PMID:Arthrodesis of the spastic wrist. 1050 72


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