Fifteen million people worldwide experience a stroke each year, with 5 million left permanently disabled. Additionally, an estimated 69 million people globally suffer traumatic brain injuries annually. Spastic cerebral palsy, the most common form of cerebral palsy, accounts for 70% to 80% of all diagnoses.
Patients living with physical changes from stroke, traumatic brain injury, cerebral palsy, and other conditions may regain some function in their hands and arms due to advances in surgical options for upper motor neuron syndrome. This information was provided by Peter C. Rhee, D.O., an orthopedic hand surgeon at Mayo Clinic in Rochester.
Upper motor neuron syndrome involves dysfunction or deformity in the shoulder, elbow, wrist, and hand due to various conditions such as stroke or spinal cord injury. Symptoms include muscle weakness, decreased muscle control, altered muscle tone, and spasticity.
Surgeons can perform joint fusions, tendon lengthenings, and tendon and nerve transfers depending on the extent of the patient's disability. Dr. Rhee explains that even patients with complete paralysis in their arms can benefit from surgery by improving the position of their hands, wrists, and elbows for hygiene or basic functions they have lost.
"The surgery aims to correct the deformity by treating individual muscles based on the underlying problems," says Dr. Rhee. "We work on the nerves, muscles and joints. It's different for each patient, but the overall goal is to improve hygiene, improve function and improve quality of life."
Surgeons typically wait 12 to 18 months after a stroke before performing this procedure to allow for potential natural recovery. Initially, Dr. Rhee conducts a virtual visit to assess if the patient is a candidate for surgery. If so, specialized nerve tests and an in-person evaluation follow.
"Regular exams give the surgeon a lot of information," says Dr. Rhee. "Combining that with the nerve tests provides a comprehensive snapshot of what the muscles and nerves are doing to create the dysfunction and/or deformity."
Dr. Rhee uses these test results to develop a tailored surgical plan. For patients whose entire arm is involved, he performs two outpatient surgeries three months apart: one focusing on the shoulder, elbow and forearm; the other on the wrist, fingers and thumb. Patients engage in stretching exercises at home between surgeries as part of their treatment plan.
"We have built an amazing team to give hope to patients who have had strokes, spinal cord or brain injuries or adults with cerebral palsy," Dr. Rhee says.
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research while providing compassion and expertise to those seeking healing.
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