title: Outcomes of tendon fractional lengthenings to improve shoulder function in patients with spastic hemiparesis.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors: Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors: Surena
authors: S
authors: Namdari
authors: Hassan
authors: H
authors: Alosh
authors: Keith
authors: K
authors: Baldwin
authors: Samir
authors: S
authors: Mehta
authors: Mary Ann
authors: MA
authors: Keenan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D020516:Brachial Plexus Neuropathies / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000503:physiopathology / Q000601:surgery; D010291:Paresis / Q000503:physiopathology / Q000601:surgery; D010369:Pectoralis Muscles / Q000294:innervation / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D013709:Tendon Transfer; D058971:Tenotomy / Q000379:methods*; D055815:Young Adult