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

Wrist arthrodesis is exceptionally performed in children. The main indication is severe wrist flexion contracture resulting from Volkmann's ischaemia or spasticity. In such cases, a proximal row carpectomy is usually necessary to allow the wrist to be positioned in neutral position. In young children, it is essential to preserve the distal radius growth plate, to prevent physeal closure. In these very particular indications, with high stresses along the stretched palmar soft-tissues, Kirschner wire fixation provides poor stability, and plate fixation is contra-indicated. Radio-metacarpal external fixation is an excellent alternative, preserving the distal radius growth plate and offering sufficient stability. This technique was used in a seven-year-old girl suffering from Volkmann's ischaemic contracture, treated by first carpal bone resection and subsequent arthrodesis with radio-metacarpal external fixation. Bone healing was achieved in three months, with a five years follow-up preservation of the distal radius growth plate.
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PMID:Wrist arthrodesis in children - a new technique: case presentation. 2487 19

Flatfoot in a child may be normal before development of the arch, but the prevalence decreases with age. Treatment is indicated only in the presence of pain and should begin with nonsurgical management options such as stretching of the Achilles tendon and the use of soft shoe orthotics. If pain persists, a modified Evans procedure, together with additional procedures to address forefoot supination, can be successful in correcting deformity and addressing pain. A thorough understanding of the pathology and correction desired will help minimize complications and recurrence. If neuromuscular pathology is present, treatment principles are altered and greatly depend on the severity of the deformity, the association of tibialis posterior spasticity, and ambulatory status. In mild to moderate pathology in walking patients with cerebral palsy, osteotomies can be successful. Various forms of arthrodesis can decrease recurrence when the deformity is severe in a nonambulatory patient with cerebral palsy and a symptomatic valgus foot deformity. In cases of collagen disorders, where soft-tissue laxity complicates management, deformity correction may be of higher importance. Overall alignment always should be evaluated and corrected when necessary to optimize the outcome in patients with valgus foot deformities. The successful treatment of flexible or rigid flatfoot deformity must take into account underlying pathology to optimize outcomes.
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PMID:Management of idiopathic and nonidiopathic flatfoot. 2574 26

The wrist and hand are essential in the placement of the upper extremity in a functional position for grasp, pinch, and release activities. This depends on the delicate balance between the extrinsic and intrinsic muscles of the wrist and hand. Spasticity alters this equilibrium, limiting the interaction of the upper limb with the environment. Classically, pediatric patients with upper limb spasticity present with a flexed wrist, thumb-in-palm, and flexed finger posture. These contractures are typically secondary to spasticity of the extrinsic flexor muscles of the wrist and hand and intrinsic muscles of the thumb and digits. Tendon release, lengthening, or transfer procedures may help correct the resultant abnormal postures. A total wrist arthrodesis with or without proximal row carpectomy may help address the severely flexed wrist deformity. With proper diagnosis, a well-executed surgical plan, and a consistent hand rehabilitation regimen, successful surgical outcomes can be achieved.
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PMID:Surgical Treatment of Pediatric Upper Limb Spasticity: The Wrist and Hand. 2686 61

Mechanism of hypertonia in cerebral palsy children is dual: a neural component due to spasticity (velocity dependent) and a biomechanical component linked to soft tissue changes. Their differentiation-which might be clinically difficult-is however crucial, as only the first component will respond to anti-spastic treatments, the second to physiotherapy. Furthermore, spasticity is frequently associated with dystonia, which is a sustained hypertonic state induced by attempts at voluntary motion. Spasticity and dystonia have to be carefully distinguished as dorsal rhizotomy will not significantly influence the dystonic component. Spasticity, which by definition opposes to muscle stretching and lengthening, has two important consequences. First, the muscles tend to remain in a shortened position, which in turn results in soft tissue changes and contracture. The second is that movements are restricted. Thus, both hypertonia and lack of mobilization create a vicious circle leading to severe locomotor disability linked to irreducible musculotendinous retraction and joint ankylosis/bone deformities. These evolving consequences should be highly considered during the child's assessment for decision-making. The hypotonic effects of lumbosacral dorsal rhizotomy, which are not only segmental on the lower limbs but also supra-segmental through the reticular formation, are finally discussed.
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PMID:Neurophysiological mechanisms of hypertonia and hypotonia in children with spastic cerebral palsy: surgical implications. 3254 70

Wilson's disease (WD), an autosomal recessive disorder of copper metabolism, may develop complex foot and ankle deformity associated with gastrosoleus muscle complex spasticity. In this case report, we present a female WD patient with bilateral equinocavovarus foot deformity in which the right foot deformity was progressed with severe contracture of posteromedial hindfoot structures and manifested as a rigid deformed foot. One-stage correction surgery including modified Lambrinudi arthrodesis, posterior tibialis tendon transfer to the lateral column of the foot, plantar fascia release (Steindler release), and Achilles tendon lengthening procedures was performed. Shortening the treatment period and decreasing possible complications due to multiple procedures are the main benefits of this technique. Although the limitation is that only a single patient was enrolled, this study provides a practical and reasonable surgical procedure with a satisfactory outcome.
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PMID:Unusual neuromuscular presentation of a Wilson's disease patient with one-stage surgical correction treatment: A case report. 3305 47


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