Braun's flexor tendons transfer in disabled hands by central nervous system lesions

Facca, S.; Louis, Pascal; Isner, Marie-Eve; Gault, D.; Allieu, Y.; Liverneaux, Philippe

doi:10.1016/j.otsr.2010.03.023

Cited by 18 publications

(9 citation statements)

References 10 publications

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“…Many articles suggest tendon transfer to enhance function or to ease the care in spastic hands. Transfer of the FDS tendon to the FDP is one of the most common techniques (38)(39)(40)(41). Keenan et al (38) reported full accomplishment of goals after the procedure in 34 clenched-fist which were hand open position with the resolution of hygienic problems of palmar skin.…”

Section: Wrist and Fingermentioning

confidence: 99%

Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review

Hashemi

Sturbois-Nachef

Keenan

et al. 2021

Front. Rehabilit. Sci.

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Introduction: Spasticity is the main complication of many upper motor neuron disorders. Many studies describe neuro-orthopedic surgeries for the correction of joint and limb deformities due to spasticity, though less in the upper extremity. The bulk of care provided to patients with spasticity is provided by rehabilitation clinicians, however, few of the surgical outcomes have been summarized or appraised in the rehabilitation literature.Objective: To review the literature for neuro-orthopedic surgical techniques in the upper limb and evaluate the level of evidence for their efficacy in adult patients with spasticity.Method: Electronic databases of MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were searched for English, French as well as Farsi languages human studies from 1980 to July 2, 2020. After removing duplicated articles, 2,855 studies were screened and 80 were found to be included based on the criteria. The studies were then divided into two groups, with 40 in each trial and non-trial. The results of the 40 trial articles were summarized in three groups: shoulder, elbow and forearm, and wrist and finger, and each group was subdivided based on the types of intervention.Results: The level of evidence was evaluated by Sackett's approach. There were no randomized control trial studies found. About, 4 studies for shoulder, 8 studies for elbow and forearm, 26 studies for wrist and finger (including 4 for the thumb in palm deformity), and 2 systematic reviews were found. Around, two out of 40 trial articles were published in the rehabilitation journals, one systematic review in Cochrane, and the remaining 38 were published in the surgical journals.Conclusion: Most surgical procedures are complex, consisting of several techniques based on the problems and goals of the patient. This complexity interferes with the evaluation of every single procedure. Heterogenicity of the participants and the absence of clinical trial studies are other factors of not having a single conclusion. This review reveals that almost all the studies suggested good results after the surgery in carefully selected cases with goals of reducing spasticity and improvement in function, pain, hygiene, and appearance. A more unified approach and criteria are needed to facilitate a collaborative, evidence-based, patient referral, and surgical selection pathway.

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Section: Wrist and Fingermentioning

confidence: 99%

Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review

Hashemi

Sturbois-Nachef

Keenan

et al. 2021

Front. Rehabilit. Sci.

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“…Surgical procedures for the non-functional spastic upper limb have been shown to be effective in the longer term (Heijnen et al., 2008; Keenan et al., 1987; Pomerance and Keenan, 1996). Past publications have reviewed improvement in function and hygiene, or measured opening of the fingers (Facca et al., 2010; House et al., 1981; Keenan et al., 1987; Thevenin-Lemoine et al., 2013).…”

Section: Introductionmentioning

confidence: 99%

Upper limb surgery for severe spasticity after acquired brain injury improves ease of care

Gschwind

Yeomans

Smith

2019

J Hand Surg Eur Vol

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For individuals with acquired brain injury and severe upper limb spasticity, personal care is often difficult, time-consuming and painful. Previous studies on outcomes after surgery for upper limb spasticity have focused on functional gain, pain, hygiene and appearance. We operated on 38 non-communicative patients (45 limbs, 535 procedures) with severe spasticity and a non-functional upper limb(s). The surgical goals were to provide opening of the fingers and thumb, wrist stability and, if required, to release muscles around the elbow and shoulder. We used the Carer Burden Score as a relevant outcome measure. Preoperatively and 3 months postoperatively, the carer rated the degree of difficulty in cleaning the palm, cutting the fingernails, cleaning the axilla and dressing the upper body on a 5-point Likert scale. Surgery significantly improved the ease of care, which has implications not only for the patient but also for carers and associated health costs. Level of evidence: IV

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“…STP transfer must frequently be combined with wrist flexor elongation and arthrodesis [17,27] or peripheral neurectomies [25,27] to improve deformity correction.…”

Section: Discussionmentioning

confidence: 99%

“…Among the 22 reviewed studies, 19 (86.36%) provided level III evidence, and 21 (95.45%) obtained a low or very low score on the GRADE scale (Table 3) [39,40] (Figure 2). Sixteen studies were retrospective case series [12,17,18,[21][22][23][24][26][27][28][29][30][31][32][33]37], two were single-center [25] or multi-center [38] retrospective cohort studies, three were prospective case series [34][35][36], and one was a randomized controlled trial [16]. Only three studies included a comparative group, formed by patients who were treated with rehabilitation in two [16,38] and those undergoing a different surgical technique in the third [25].…”

Section: Quality Of Evidencementioning

confidence: 99%

“…However, four studies [12,24,26,28] describe postoperative wound infections in between 2.63 [12] and 9.09% [28] of patients. The most frequently reported complications are incomplete correction [27] or deformity recurrence (12.50-27.27% of operated hands) [21,30,31], spasticity relapse (6.66-14.28%) [32,35], unmasking of intrinsic hand muscle spasticity with the emergence of new deformities such as swan neck fingers (9.09-38.46%) [27,30,31,33,42], and finally, prehension weakness due to excessive tendon elongation, observed in 9-20% of patients undergoing tendon lengthening and muscle release [35,42]. Wrist arthrodesis nonunion has been described in between 0% [24,25,27] and 18.18% [31] of cases.…”

Section: Effectiveness/efficacy and Safetymentioning

confidence: 99%

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Surgical Treatment in Post-Stroke Spastic Hands: A Systematic Review

Hurtado-Olmo,

González-Santos,

Pérez de Rojas

et al. 2024

JCM

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Background: For more than two decades, the surgical treatment of post-stroke spastic hands has been displaced by botulinum toxin therapy and is currently underutilized. Objectives: This article aimed to assess the potential of surgery for treating a post-stroke spastic upper extremity through a systematic review of the literature on surgical approaches that are adopted in different profiles of patients and on their outcomes and complications. Methods: Medline PubMed, Web of Science, SCOPUS, and Cochrane Library databases were searched for observational and experimental studies published in English up to November 2022. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluations (GRADE) system. Results: The search retrieved 501 abstracts, and 22 articles were finally selected. The GRADE-assessed quality of evidence was low or very low. The results of the reviewed studies suggest that surgery is a useful, safe, and enduring treatment for post-stroke spastic upper extremities, although most studied patients were candidates for hygienic improvements alone. Patients usually require an individualized combination of techniques. Over the past ten years, interest has grown in procedures that act on the peripheral nerve. Conclusions: Despite the lack of comparative studies on the effectiveness, safety, and cost of the treatments, botulinum toxin has displaced surgery for these patients. Studies to date have found surgery to be an effective and safe approach, but their weak design yields only poor-quality evidence, and clinical trials are warranted to compare these treatment options.

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Braun's flexor tendons transfer in disabled hands by central nervous system lesions

Cited by 18 publications

References 10 publications

Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review

Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review

Upper limb surgery for severe spasticity after acquired brain injury improves ease of care

Surgical Treatment in Post-Stroke Spastic Hands: A Systematic Review

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