Ultrasound-Guided Percutaneous Distal Biceps Tenotomy for Fixed Spastic Elbow Contracture in Cerebral Palsy: Case Report and Technical Note.

This is a single case report without a comparator, so it cannot show that the procedure works better than no procedure, landmark-based tenotomy, or open surgery. The incremental value of ultrasound guidance over landmark-based technique cannot be determined. The elbow was the only joint systematically reported. Distal joint motion and other outcomes beyond the elbow were not quantified. Postprocedural care was pragmatic, with no structured rehabilitation protocol beyond caregiver-instructed stretching and hygiene measures. Follow-up was 12 weeks and 6 months, so durability, recurrence, and delayed adverse events remain unknown. The patient had severe spastic cerebral palsy, a nonfunctional left upper limb, and full assistance for daily living, so the result may not apply to patients with functional upper limbs. A hematoma occurred at 7 days, and a cast was avoided because of preexisting macerated skin, which may affect generalizability to other postprocedural plans. The table reports elbow extension deficit as −30° at 12 weeks and 6 months, while the text describes near-complete extension immediately and at 7 days. The immediate angle is not specified. The authors state that the Modified Ashworth Scale reduction should not be interpreted as a neurophysiologic reduction in spasticity.

I.G.d.S.D., A.M.L., P.I.T.E., D.H.d.M.P., and A.R.P. report honoraria from Merz, AbbVie, Ipsen, Surgimedic, or PRIM. A.R.P. also reports expert testimony fees from Surgimedic and travel support from PRIM. These relationships are outside the submitted work. The other authors have nothing to disclose.

Do not read this as evidence that ultrasound-guided percutaneous distal biceps tenotomy works for fixed spastic elbow contracture. It is a single case without a comparator, and the authors describe the result as hypothesis-generating.