Adductor tenotomy and selective obturator neurectomy for the treatment of spasticity in a man with paraplegia.
ABSTRACT Excessive hip adductor spasticity in patients with spinal cord injury (SCI) can produce scissoring effect of the thighs which can interfere with various activities of daily living. If noninvasive measures do not produce desired results, surgical treatment may be considered. One surgical option for the management of adductor spasticity includes adductor tenotomy and selective obturator neurectomy. This procedure was performed in an individual with T11 paraplegia having severe adductor spasticity in both thighs.
Adductor spasticity at hips was identified as the main barrier in functional activities and rehabilitation of our patient. After a trial of noninvasive treatment, a selective obturator neurectomy and adductor tenotomy were carried out, which completely relieved his adductor spasticity at both thighs without any complications. With comprehensive rehabilitation, the patient showed enhanced functional independence in various activities of daily living. This helped the patient to achieve functional indoor ambulation using orthosis in spite of complete paraplegia. Conclusion/clinical reference: Severe adductor spasticity can have debilitating effects and could be a major barrier in rehabilitation of patients with SCI. Surgical treatment for adductor spasticity can be considered when patients are unresponsive to noninvasive treatment. Relief from adductor spasticity can improve functional outcomes and decrease dependency. Although this procedure is commonly performed in patients with cerebral palsy, it remains a viable surgical alternative in carefully selected patients with SCI when other modes of treatment are contraindicated, failed, or not available.
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ABSTRACT: We undertook this investigation to determine the interrater reliability of manual tests of elbow flexor muscle spasticity graded on a modified Ashworth scale. We each independently graded the elbow flexor muscle spasticity of 30 patients with intracranial lesions. We agreed on 86.7% of our ratings. The Kendall's tau correlation between our grades was .847 (p less than .001). Thus, the relationship between the raters' judgments was significant and the reliability was good. Although the results were limited to the elbow flexor muscle group, we believe them to be positive enough to encourage further trials of the modified Ashworth scale for grading spasticity.Physical Therapy 03/1987; 67(2):206-7. · 3.25 Impact Factor
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ABSTRACT: Obturator neurectomy was performed in 35 patients with severe spasticity of the lower limbs. Immediate release of excessive spasticity in the adductor group of muscles was observed and confirmed by E.M.G. In most cases, a beneficial reduction of spasticity in other groups of muscles in the lower limbs was also observed. As a result, rehabilitation of the patients was improved.Paraplegia 11/1987; 25(5):394-6. DOI:10.1038/sc.1987.69
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ABSTRACT: The management of childhood spasticity requires a multidisciplinary effort. With input from pediatricians, physical and occupational therapists, neurologists, orthotists, orthopedic surgeons, neurological surgeons, and other healthcare personnel, effective treatment for spasticity can be initiated and maintained that can lead to meaningful improvements in quality of life for vast numbers of children. Neurosurgical treatment of spasticity will continue to evolve and be refined as procedures and techniques are appropriately evaluated with reliable and validated outcome measures.Pediatric Annals 06/2006; 35(5):354-62. DOI:10.3928/0090-4481-20060501-07 · 0.29 Impact Factor