SELECTIVE MUSCULOCUTANEOUS FASCICULOTOMY FOR SPASTIC ELBOW IN CEREBRAL-PALSY - A PRELIMINARY-STUDY

Three hundred and ten people with cerebral palsy who had spasticity in one or more limbs underwent selective motor fasciculotomy (SMF) of th e nerves supplying the harmful spastic muscles with the aim of achievi ng useful tone and to improve voluntary movements. Among them, 52 peop le (average age 9.5 years) had 75 spastic elbows who were considered f it cases to undergo SMF of the musulocutaneous nerve (MCN). The nerve was dissected in the upper 1/3rd of the arm. Bipolar current was used to stimulate the component fascicles and to detect those carrying exce ssive impulses. Some of the hyperactive fascicles were ablated accordi ng to preoperative grading of the spasticity, etc. Total relief in spa sticity was achieved in 47 (62.66%) elbows. Whereas, in the remaining 28 (37.33%) elbows some degree of spasticity persisted. There were ove rall beneficial effects of SMF on the motor functions and the flexed e lbow posture. There were no side effects and recurrence of spasticity. The results were observed for an average period of 17 months. It must be noted that, 5 people who had involuntary elbow flexion on activity , like walking, also developed normal posture and the to & fro swingin g movements following surgery. In conclusion, SMF of MCN is an effecti ve and safe procedure for achieving longlasting useful tone and volunt ary movements in the harmful spastic elbow of people with cerebral pal sy. The present report is an account of the largest number of cerebral palsy people in the world literature to date.