Identification of spastic muscles involved in abnormal joint posture in patients with upper motor neuron syndrome: a narrative review.
Francois Genêt, Vincent Carpentier, Guillaume Chambinaud and 2 others
Only 1 of 8 published studies offered a definitive method for identifying which specific muscles cause a spastic deformity.
The authors propose a clinical reasoning framework based on functional anatomy, closed-chain examination, and biomechanical principles.
Key findings
1Of the 8 studies retained after a PubMed search (2000–2025), 6 described broad spastic patterns without a strategy to verify which individual muscles were involved, and only 1 established a definitive method for determining the specific muscles responsible for a given clinical deformity.
2The authors identify three recurring sources of error in spastic muscle identification: over-attributing a deformity to the most superficial, easily palpated muscle; intergenerational transmission of unvalidated techniques through mentorship; and regional regulatory approval shaping which muscles get targeted rather than clinical need.
3Abnormal joint posture should be assessed during movement and under load (closed chain) rather than exclusively in a supine, non-weightbearing position, because specific spastic upper-limb patterns shift significantly between a seated position and gait or targeted physical effort.
Still to come
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What it does not show
Narrative review with no formal quality assessment of the 8 included studies and no PRISMA or equivalent reporting. Search limited to a single database (PubMed), so relevant work in other indexes may have been missed. The proposed diagnostic pathway is the authors' own clinical reasoning framework; it has not been tested in a trial or validated against a comparator. The 8 included studies were not appraised for risk of bias, sample size, or methodological rigour. The review draws heavily on the authors' clinical experience and biomechanical reasoning, which may reflect their own practice context and training.
Declared interests
The authors declare no conflicts of interest and state that the research did not receive any specific grant from public, commercial, or not-for-profit funding agencies.
The easy way to misread this
Do not read this as evidence that a specific injection strategy or assessment protocol has been shown to improve patient outcomes. The paper is a narrative review proposing a clinical reasoning framework. The 8 included studies were not assessed for quality, the search covered one database, and the proposed diagnostic pathway has not been tested in a trial. The framework is the authors' expert reasoning, not a validated intervention.
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