Surgery for the Wrist in Upper Limb Spasticity

Surgery for the Wrist in Upper Limb Spasticity: Results In Leeds UK Leeds Teaching Hospitals NHS Trust, Leeds, UK Mr Jonathan Wiper (Senior SHO) Mr Koo Chan (Registrar) Mr Waseem Saeed (Consultant Hand Surgeon) Joanna Burdon (Senior Occupational Therapist) Michelle Dolan (Senior Physiotherapist)

Methods • Prospective review of all patients operated on for upper limb spasticity. • One consultant team • All procedures carried out by senior author • 6 year period • Formal pre-op and post-op assessment using validated tools

Indications

Demographics

Inclusion Criteria • Voluntary motion of joint • Flexion deformity causing problem • Motivated (adults) and well supported (children) • Safe for anaesthetic • Compliant

Surgical Procedure Number FCR – ECRB 16 FCU – ECRB 18 FDS - ECRB 5 33 / 39 full data sets obtained

Range of Motion (median) Range:

Arc of motion • Pre-op • 56° flexed 3° flexed • Post-op • 37° flexed 27° extension • Arc based around more neutral pivot post operatively (more useful arc)

Resting Position (median) Degrees of flexion Neutral Degrees of extension Pre op Range: Post op

Voluntary Motor Capacity

Clinical Assessment

Conclusions • Improvement • Surgery is worthwhile • FCU ECRB most successful transfer for this group • Believe that FCR ERCB result in ulnar deviation and loss of correction • Wide inclusion criteria – Offer surgery to more people

Future? • Ongoing process • All patients have video assessment with record of functional tasks – Eg Lifting a receiver of a telephone