Expert warning: Procedure offers hope for patients living with physical changes after stroke and other diseases

World Brain Day is on July 22

ROCHESTER, Minnesota — Worldwide, 15 million people suffer a stroke each year, leaving 5 million permanently disabled. An estimated 69 million people worldwide suffer traumatic brain injuries each year. Spastic cerebral palsy, the most common form of cerebral palsy, accounts for 70 to 80 percent of all people diagnosed.

Patients living with physical changes resulting from stroke, traumatic brain injury, cerebral palsy or other conditions may be able to regain some function in their hands and arms, improving their quality of life, thanks to advances in surgical options for treating upper motor neuron syndrome, says Peter C. Rhee, DO, an orthopedic hand surgeon at the Mayo Clinic in Rochester.

Upper motor neuron syndrome is a dysfunction or deformity in the shoulder, elbow, wrist, and hand due to stroke, traumatic brain injury, anoxic or hypoxic brain injury, cerebral palsy, or spinal cord injury. People with this condition may have muscle weakness, reduced muscle control, altered muscle tone, and spasticity.

Depending on the level of the patient’s disability, surgeons may perform a combination of joint fusions, tendon lengthenings, and tendon and nerve transfers. People with complete paralysis of the arms may still benefit from surgery by improving the position of their hands, wrists, and elbows for hygiene reasons or to regain basic functions they’ve lost, says Dr. Rhee.

“The surgery aims to correct the deformity by treating individual muscles according to the underlying problems,” says Dr. Rhee, who has been performing this surgery for 10 years. “We work on nerves, muscles and joints. It’s different for each patient, but the overall goal is to improve hygiene, function and quality of life.”

Because patients can regain some function in the months following a stroke, surgeons wait 12 to 18 months to perform the procedure. First, Dr. Rhee conducts a virtual visit to determine if the patient is a potential candidate for surgery. If so, the patient returns for specialized nerve testing and a formal in-person exam to fully determine if they would benefit from surgery.

“Regular exams give the surgeon a lot of information. The joint may be in a certain position due to spasticity or contraction,” says Dr. Rhee. “Combined with the nerve testing, you get a comprehensive snapshot of what the muscles and nerves are doing to cause the dysfunction and/or deformity.”

Dr. Rhee uses the patient’s test results to develop a customized surgical plan.

If the entire arm is affected, Dr. Rhee performs two surgeries, both outpatient, with a three-month wait between procedures. The first step usually involves the shoulder, elbow, and forearm; the second the wrist, fingers, and thumb. Between surgeries, patients do stretching exercises at home as part of their treatment plan. The entire process takes about six months.

“We have assembled a great team to bring hope to patients with strokes, spinal cord or brain injuries, or adults with cerebral palsy,” says Dr. Rhee.

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Media contact:

Rhoda Madson, Mayo Clinic Communications, [email protected]

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