Neurectomie Hyperselective: un traitement de la spasticité au membre supéreur

Conférence d'enseignement

Congrès de la Société Française de Chirurgie de la Main, Paris, 15 Décembre 2016

Spasticity is a complex pathology, as well for the evaluation, than for the treatment. This article focuses on the examination (analytic, capacity, performance and function), which is the key for the choice of the treatment and can be helped by botulinium toxin injection. The treatment involves physiotherapy, occupational therapy, medications, and surgery. Neurectomy had been proposed at the upper limb since 1912 and is one of the therapeutic options against spasticity itself.

This treatment was usually reserved to non-functional hand. Cadaver studies helped to better understand the nerves anatomy and to improve the technique by HyperSelective Neurectomy (HSN). This article described neurectomy history, application of the anatomic dissections to surgery, the HSN technique according to the musculo-cutaneous nerve, median nerve and ulnar nerve, and the results of the preliminary prospective studies. Spasticity, mobility, performance and function had been evaluated after HSN at an early time and at the last follow up in order to evaluate the perenity of the results in children and adults spastic patients. Whatever the nerve and the function targeted (elbow extension, wrist extension, or supination), spasticity reduced with improvement of the functional House score, and seemed stable at the last follow up. HSN seems to be a good and reliable therapeutic option for spasticity, including in functioning hands.