Abstract
Hyperselective neurectomy (HSN) may improve upper extremity function among stroke survivors with poststroke spasticity when traditional treatments fail. Two cases show HSN benefits, including range of motion, grip strength, and use in daily activities.
Primary Author and Speaker: Genevieve Lagonera
Additional Authors and Speakers: Alanna Herman
According to the CDC, more than 795,000 people in the U.S. have a stroke, a leading cause of long-term disability (CDC, 2024). Post-stroke spasticity (PSS) in the upper extremity affects up to 80% of stroke survivors (Kuo & Hu, 2018) and significantly hinders daily activities. Spasticity is an upper motor neuron disorder characterized by increased muscle tone, causing weakness, pain, spasms, and joint contractures (Monroe et al., 2023). Traditional treatments for PSS include stretching, splinting, neuromuscular electrical stimulation, tendon lengthening, and pharmacological options (Kuo & Hu, 2018). Once these are exhausted, options become limited, leaving patients frustrated with poor functional outcomes. Hyperselective neurectomy (HSN) is a surgical intervention typically reserved for non-functional upper extremities due to spasticity (Gras & Leclercq, 2017). HSN has been used since 1912 and is considered a reliable treatment for spasticity (Gras & Leclercq, 2017). This presentation discusses two cases where patients, after limited success with traditional treatments, opted for HSN to improve function. Following surgery, post-surgical recovery focused on edema and scar management, followed by neuro re-education using functional electrical stimulation, task-specific training, targeted resistance training, and motor learning. Outcome measures included ADL/IADL, Patient-Specific Functional Scale (PSFS), A/PROM, dynamometry for grip strength, Modified Ashworth Scale, and Box and Blocks. Results showed improvements in grip strength, coordination, AROM, Modified Ashworth, and increased use of the affected arm in daily activities, as indicated by the PSFS. HSN may offer significant benefits for patients with PSS when traditional interventions have failed, and should be considered as a viable option for improving upper extremity function in stroke survivors.
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