Myotendinous lengthening of the elbow flexor muscles to improve active motion in patients with elbow spasticity following brain injury

Background: The objective of this study was to evaluate the outcomes of a novel technique of fractional myotendinous lengthening of the elbow flexors in patients with volitional motor control and spastic elbow flexion deformities after brain injury. Methods: A retrospective review of 42 consecutive patients with spastic elbow flexion deformities and upper motor neuron (UMN) syndrome was performed. Each patient had volitional motor control but limited elbow extension and underwent myotendinous lengthening of the elbow flexor muscles. Outcome measures included pre and post-operative active and passive arc of motion, Modified Ashworth Scale (MAS) of spasticity, and complications. Results: There were 26 men and 16 women. The etiologies of UMN syndrome were stroke (30 patients), traumatic brain injury (11 patients), and cerebral palsy (1 patient). Average duration between injury and surgery was 6.6 years. At an average follow-up of 14 months, improvements were noted in active extension (42 degrees to 20 degrees; P < .001). In addition, active arc of motion increased from 77 degrees (range of motion [ROM]: 42 degrees to 119 degrees) to 113 degrees (ROM: 20 degrees to 133 degrees) (P < .001) and passive arc of motion increased from 103 degrees (ROM: 24 degrees-127 degrees ) to 131 degrees (ROM: 8 degrees-139 degrees) (P < .001). Significant improvement in MAS was also noted after surgery (2.7 to 1.9; P < .001). Superficial wound dehiscence occurred in 2 patients and was successfully treated nonoperatively. Conclusion: In patients with spastic elbow flexion deformities and active motor control, fractional myotendinous lengthening of the elbow flexors safely improves active extension and the overall arc of motion while affording immediate postoperative elbow motion. Level of evidence: Level IV, Case Series, Treatment Study. (C) 2013 Journal of Shoulder and Elbow Surgery Board of Trustees.