PERIPHERAL SELECTIVE NEUROTOMY OF THE BRACHIAL-PLEXUS COLLATERAL BRANCHES FOR TREATMENT OF THE SPASTIC SHOULDER - ANATOMICAL STUDY AND CLINICAL-RESULTS IN 5 PATIENTS

A new type of peripheral selective neurotomy involving the collateral branches of the brachial plexus has been perfected for treatment of th e spastic shoulder. Anatomical study of six cadaveric shoulders led to the specification of a surgical approach to the pectoralis major and teres major nerves, which innervate the main muscles implicated in sho ulder spasticity. Between August 1994 and September 1995, five patient s (four men and one woman) underwent two to four associated neurotomie s of the upper limb, which included neurotomies of the pectoralis majo r (all five patients) and the teres major (two patients). The average follow-up period was 11 months, during which there were no local or ge neral complications. The spasticity of the treated muscles resolved in all five patients (Held score range 3-0). The neurotomies led to stat istically significant average amplitude increases in shoulder mobility , especially in abduction (+30 degrees), antepulsion (+50 degrees), re tropulsion (+20 degrees), and external rotation (+20 degrees). The fun ctionally useful active amplitude scores increased from 2.66 to 5.16/6 . This functional improvement mainly involved the standing position an d walking stability, as well as improvement in the range of motion of the lower limb. These results encourage the increasing use of this new type of neurotomy in treatment of the spastic upper limb.