title: Adductor tenotomy and selective obturator neurectomy for the treatment of spasticity in a man with paraplegia.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  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.
authors: Department of Physical Medicine and Rehabilitation, King Fahad Medical City Riyadh, Kingdom of Saudi Arabia, Riyadh, KSA. qureshipmr@gmail.com
authors: Ahmad Zaheer
authors: AZ
authors: Qureshi
authors: Subramanya
authors: S
authors: Adiga
mesh_terms: D019771:Axotomy; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000209:etiology / Q000601:surgery; D018482:Muscle, Skeletal / Q000601:surgery; D009776:Obturator Nerve / Q000601:surgery; D010243:Paralysis / Q000209:etiology* / Q000601:surgery*; D010264:Paraplegia / Q000150:complications* / Q000601:surgery*; D058971:Tenotomy; D055815:Young Adult