Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review.

No randomized controlled trials were found, so the review cannot show that surgery works better than non-surgical care. Most evidence came from case series and other low-level studies with mixed participants and procedures. Many patients had several surgeries at once, so the contribution of any single operation could not be separated. Outcome measures differed across studies, and comparison was difficult. Complications were often not reported, although recurrence, weakness, overlengthening, and wound problems appeared in some studies. Post-surgical rehabilitation timing and protocols were not standardized. The search was limited to English, French, and Farsi. There is no standard method across centers for assessing and selecting patients for surgery. Although framed for adults, several included studies also enrolled children.

The authors declared no commercial or financial relationships that could be a conflict of interest.

Do not read this as proof that upper-limb spasticity surgery is effective. No randomized controlled trials were found, most studies were low level, and many patients received several procedures at once, so reported improvements cannot be attributed to one operation.