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Year : 1980  |  Volume : 14  |  Issue : 1  |  Page : 1-12

Surgical Management And Rehabilitation In Spastic Paralysis



Correspondence Address:
R. L Mittal


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Spastic paralysis is one of the frequently seen conditions in orthopaedic outpatient departments. It results due to a variety of causes like cerebral palsy, encephalitis, cerebral thrombosis, multiple sclerosis, transverse myelitis, injuries of brain or spinal cord, various causes of compression of cervical or dorsal spine, e.g., tuberculosis, fluorosis etc. Orthopaedic surgeons are called upon to treat these cases because of the deformities and disabilities produced in the limbs. Management of these cases has been largely neglected in the past due to the complex pathophysiology of muscle imbalance and spasticity in these cases. As a lot perseverance is required in the management of these cases and hence they are generally left to their fate. This wave of pessimism does not seem to be justified because with their fate. This wave of pessimism does not seem to be justified because with proper care in treatment and rehabilitation, majority of these cases can be made serviceable to themselves and to the society. It is with this aim in view that this study was undertaken. The literature is full of reports on surgical management of spastic paralysis with new methods coming up every day claiming superiority over the old ones. The old procedures like resection of posterior nerve roots, radicotomy, local alcohol injections, and selective nerve resection (Heyman 1939) have been largely abandoned. The surgical trend in recent years has been on procedures like tenotomy, tendon lengthening, tendon transfer, arthrodesis etc. Eggers (1952) described hamstring transplant into femoral condyles to improve flexion deformity at the hip was well as the knee. Pollock (1953) described gastrocnemius tendon lengthening to correct the equines deformity when the deformity was in this component. Bleck and Holstein (1964) perfumed iliopsoas tenotomy for correcting flexion deformity of hip. In the upper limb, surgery has been recommended for pronation deformity of forearm and flexion of wrist. Mccarroll and Schwartzmann (1943) advocated correction of the adduction contracture of the thumb by adductor release.


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