Effects of Diagnostic Tibial Nerve Block and Selective Tibial Nerve Neurotomy on Spasticity and Spastic co-contractions: A Retrospective Observational Study.
Jean-Philippe Lamora, Thierry Deltombe, Thierry Gustin
PMID 37309226WHAT IT FOUND
Selective tibial nerve neurotomy significantly improved active ankle dorsiflexion and reduced spastic co-contractions in patients with spastic equinovarus foot.
These benefits persisted beyond six months for the soleus muscle but declined over time for the soleus-gastrocnemius complex. Diagnostic nerve blocks predicted spasticity outcomes but not functional gains.
Key findings
01The paresis angle Z, which measures spastic co-contractions, was significantly reduced after selective tibial nerve neurotomy at both short-term and long-term follow-ups.
02Improvements in active ankle dorsiflexion were not correlated with increased dorsiflexor strength, but were associated with a reduction in the paresis Z angle.
03While reflex spasticity was permanently reduced, the effect of surgery on the soleus-gastrocnemius complex tended to decline over time, unlike the sustained effect on the soleus.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study was retrospective, leading to missing data for some secondary outcomes. The sample size for long-term follow-up was small (24 patients). Co-contractions were inferred from angle measurements rather than measured directly via electromyography. Reliability of the paresis Z angle has not been previously documented. Surgical techniques evolved over the 22-year study period, potentially affecting consistency.
Declared interests
The authors have no conflicts of interest to declare.
The easy way to misread this
Do not assume that a positive response to a diagnostic nerve block predicts long-term functional improvement in active dorsiflexion. The study found that while nerve blocks accurately predicted spasticity reduction, their predictivity for surgery's effect on co-contractions and active function was much lower, especially in the long term.