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Spasticity affecting the upper limb
We see adults and children who have had brain injuries that have affected the function of their arms and hands. These injuries can result from stroke, birthing difficulty, infection, tumour, or trauma. The limbs can be weak or can be tense due to increased muscle tone and are difficult to control or relax. Sometimes the arm has no movement at all and this can make washing and dressing difficult. The muscles and tendons can become shortened and weak and the joints stiff and sometimes surgery can correct this and improve arm function.
Spinal cord injury affecting arm and hand movement
A high spinal cord injury can affect arm and hand movement.
Patients with this type of injury often have weak elbow straightening which makes it difficult for them to transfer themselves from bed to chair and vice versa. They may not have the strength to propel a wheel chair by themselves and it is difficult to position their hands in space. Patients may also have weakness of their hand grip.
For some patients it is possible to improve elbow straightening with surgery to allow more independent transferring and wheel chair use.
In some patients there are also opportunities to improve hand grasp and / or thumb pinch.
Treatment
After assessment some patients will need further therapy input which may include their arm being splinted or casted and stretched or strengthened. Sometimes this is all that is required. Some patients undergo this therapy first to optimize the condition of their arm in preparation for surgery.
Some patients will require botulinum toxin followed by stretching and splinting. This is also sometimes done in preparation before surgery and can improve the surgical outcome.
Some patients will be suitable for surgery such as tendon lengthening, tendon transfers or tone reducing surgery.
Some patients may benefit from psychological support to help them cope with their arm disability and we can refer them to our Clinical and health psychology department for this.