Microsurgical Applications in Upper Extremity Spasticity

To highlight and summarize the growing evidence that supports microsurgical techniques, namely hyperselective neurectomies, in conjunction with traditional tendon procedures to establish a general treatment framework for upper extremity spasticity. Publications show that with advances in anatomical knowledge of distal nerve branching patterns, microsurgical techniques, and careful preoperative decision making based on a careful physical exam supplemental by anesthetic blocks and botulinum toxin, there are remarkably reduced recurrence rates and significant spasticity reduction. The main takeaway of this research is that hyperselective neurectomies do not weaken the muscle beyond the transient post-operative period while providing long-lasting and durable spasticity reduction. This review should provide the surgeon and practitioner a guide to synthesizing and executing these difficult surgeries in a reproducible and reliable way.