Treatment

Spastic hand therapy obviously depends on the therapeutic scheme established with the patient.

The overall treatment is usually overseen by a rehabilitation physician or a neurologist. It includes oral medication, and routine rehabilitation sometimes associated with posture braces.

Botulinum toxin injections make it possible to act against muscle spasticity selectively by targetting specific muscles only. Botulinum injections only have a transitory effect so they are often used as a pre-surgery therapeutic test.

 

Spastic hand surgery

The difficulty posed by the spastic hand is primarily the diagnosis.More than in any other surgery, the difficulty here resides not in procedure performance, but in performing the most appropriate procedure for the patient's situation.

Because the origin of the lesion is central, direct nerve surgery is not possible and only palliative surgery aimed at correcting the various function deficits can be considered:

  • paresis can be compensated by musculotendinous transfers and/or arthrodesis (joint fusion)
  • spasticity can be amended by hyponeurotisation surgery (selective denervation), complete or partial severance of nerve branches
  • muscle shrinkage can be corrected by tendon and/or muscle lengthening procedures
  • bone and joint deformity can be corrected by corrective osteotomy

 

These thoroughly planned procedures are carried out on an inpatient basis under loco-regional or general anaesthesia.

They require initial immobilization followed by specialized rehabilitation over a period of several months.