Outcomes of tendon fractional lengthenings to improve shoulder function in patients with spastic hemiparesis

• Published in: Journal of shoulder and elbow surgery Vol. 21; no. 5; pp. 691 - 698
• Main Authors: Namdari, Surena, MD, MSc, Alosh, Hassan, MD, Baldwin, Keith, MD, MPH, MSPT, Mehta, Samir, MD, Keenan, Mary Ann, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.05.2012; Elsevier
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Brachial Plexus Neuropathies - physiopathology; Brachial Plexus Neuropathies - surgery; Diseases of the osteoarticular system; Female; Follow-Up Studies; hemiparesis; Humans; Male; Medical sciences; Middle Aged; Muscle Spasticity - physiopathology; Muscle Spasticity - surgery; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Orthopedics; Paresis - physiopathology; Paresis - surgery; Pectoralis Muscles - innervation; Pectoralis Muscles - surgery; Range of Motion, Articular - physiology; Retrospective Studies; Shoulder Joint - physiopathology; Shoulder Joint - surgery; spasticity; Tendon lengthening; Tendon Transfer; Tenotomy - methods; Young Adult; Level IV; spasticity; Treatment; Tendon lengthening; Case Series; hemiparesis; Human; Hemiparesis; Nervous system diseases; Prognosis; Motor system disorder; Shoulder; Rheumatology; Neurological disorder; Tendon
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2011.03.026

Background Patients with spastic hemiparesis after upper motor neuron (UMN) injury often exhibit limited shoulder movement. We evaluated the outcomes of shoulder tendon fractional lengthenings in patients with spasticity and preserved volitional control. Methods A consecutive series of 34 adults with spastic hemiparesis from UMN injury (23 post-stroke, 11 post-traumatic brain injury) and limited shoulder movement with preserved volitional motor control who underwent shoulder tendon fractional lengthenings (pectoralis major, latissimus dorsi, teres major) were evaluated. Active and passive shoulder motion, spasticity, pain, and satisfaction were considered pre- and postoperatively. Results There were 15 males and 19 females with a mean age of 44.1 years. Mean follow-up was 12.2 months. Mean Modified Ashworth spasticity score was 2.4 preoperatively compared to 1.9 postoperatively ( P = .001). Active flexion, abduction, and external rotation improved compared to the normal contralateral side ( P < .001) with most dramatic gains in external rotation. Similarly, passive extension, flexion, abduction, and external rotation improved compared to the normal contralateral side ( P < .01). Ninety-four percent (15/16) with preoperative pain had improved pain relief postoperatively with 14 (88%) being pain-free. Thirty-one (92%) were satisfied with the outcome. Conclusion Shoulder tendon lengthenings can be an effective means of pain-relief, improved motion, enhanced active motor function, and decreased spasticity in patients with spastic hemiparesis from UMN injury.